EFFECTIVENESS OF THE MAGNESIUM APPLICATION IN OBSTETRICAL PRACTICE.

OBJECTIVE: The aim: Conducting an evaluation of the effectiveness and safety of the use of magnesium in pregnant women. PATIENTS AND METHODS: Materials and methods: A comprehensive examination of 60 pregnant women was conducted, of which 30 were taking a magnesium preparation in a daily dose of 2473.72 mg of magnesium citrate and 40 mg of pyridoxine hydrochloride (the main group) and 30 pregnant women who were not taking a magnesium preparation (сomparison group). The analysis of the clinical course of the first half of the pregnancy with the determination the frequency and structure of complications, blood pressure levels, indicators of ultrasound, general and biochemical blood tests, urinalysis, lipid status and carbohydrarate metabolism. RESULTS: Results: The main complications of the first half of pregnancy were: threatening miscarriage, abortion in progress, early gestosis, anemia, respiratory viral infection, exacerbation of extragenital pathology, hypertension. During the analysis of carbohydrate and lipid metabolism increased atherogenic potential. Analyzing the results of ultrasound studies reliably earlier comes down the local hypertonus. CONCLUSION: Сonclusions: The correction of chronic magnesium deficiency, performed by the drug magnesium has allowed to reduce cases of threat of abortion, the abortion that was started, the symptoms of early preeclampsia, anemia of pregnant women, symptoms of respiratory viral infection, reduces the number of bed-days in the case of hospitalization. The use of magnesium helped to normalize blood pressure, carbohydrate and lipid metabolism, reduces hypertonus of the myometrium.

PROGNOSIS AND PREVENTION OF UTERUS BLEEDINGS IN EARLY POSTPARTUM PERIOD FOR WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION.

OBJECTIVE: The aim: To establish the effectiveness of thromboelastography (TEG) and tranexamic acid (TXA) for prognosis and prevention of early postpartum period bleedings (PPB) for postpartum women with idiopathic arterial hypotension (IAH). PATIENTS AND METHODS: Materials and methods: Coagulogical research was conducted (coaugologram screening, dynamic function of platelets under the influence of adenosine diphosphate (ADP) (visual assessment), measurement of soluble fibrin-monomer complexes (FMC) and TEG of 36 in parturient women during the I chilbirth period with arterial hypotension. 14 parturient women with normal fibrinolysis were included into the first observation group; The second group includes 22 parturient women with TEG results which show signs of hyperfibrinolysis. Further, in cases when stronger fibrinolysis was detected during the late pushing phase of childbirth period, the TXA by amount of 1,0 g IV (bolus) was injected due to bleeding prevention. TEG was repeated during early postpartum period. RESULTS: Results: the inhibition of platelet aggregation activity with ADP was observed in every parturient woman with IAH in the first partum period. In 61,1% cases with TEG hyperfibrinolysis were shown, which was accompanied by significant increase in FMC levels in blood. The use of TXA as PPB prevention for parturient women with IAH and hyperfibrinolysis during TEG was fully oppressing the fibrinolytic activity and was not affecting the coagulation part of hemostasis. CONCLUSION: Conclusions: hemostasis testing during childbirth based on TEG gives the ability to prognose the hemorrhagic complications in parturient women with IAH and administer their prophylaxy using TXA.

Reverse breech extraction at cesarean section in second stage of labor.

OBJECTIVE: The aim: Taking into consideration the increase in the frequency of urgent C-sections in the second stage of labor and significant technical difficulties in the extraction of deeply impacted fetal head during this operation, the aim of our work was to analyze the current published biomedical data to identify the optimal technical strategies for conducting this type of surgical interventions. PATIENTS AND METHODS: Materials and methods: The search and analysis of current clinical data available in PubMed was performed. We analyzed 9 retrospective and randomized prospective studies with collected data from a total of 974 women (2002-2019). CONCLUSION: Conclusions: Analysis of nine prospective and retrospective studies, comparing reverse breech extraction with abdominovaginal technique, revealed a significant advantage and safety of reverse breech extraction. This procedure has been associated with the decrease of traumatic uncontrolled extension of uterine incisions in 2.3-10 times, the time of surgical intervention decreased by 6.5-33 minutes, and intraoperative blood loss was less by 149.5-444 ml as compared with abdominovaginal delivery. Moreover, less intra- and postoperative complications were observed. In conclusion, reverse breech extraction during cesarean section with impacted fetal head is a safe delivery technique that helps to significantly decrease the incidence of maternal complications.