MIFEPRISTON IN OBSTETRICS - WHY NOT?

Cervical ripening is a critical component of normal parturition. There are substantial variations in labour induction (IOL) techniques around the world. Mifepristone causes the termination of unwanted pregnancies, but there is a lack of consensus on its use for labour induction. The purpose of our study was to compare the combination of Mifepristone and Misoprostol with the combination of a Foley balloon and Misoprostol for labour induction. The study included 175 pregnant women, with gestational age 37-42 weeks. In the study group - 88 pregnant aged 21-35 (28.56±3.23), a combination of Mifepristone-Misoprostol was used. A combination of Foley catheter and Misoprostol was used in the control group - 87 pregnant aged 21-35 (29.48±3.03). The outcomes were assessed. In the study group the rate of vaginal delivery was higher and the frequency of cesarean section was lower compared to the control group (75 vs. 72, and 13 vs. 15, respectively); The total duration of labour was shorter in the study group (p<0,05); There was no difference between groups in the incidences of neonatal morbidity on the first and the fifth minute of life (p>0,05); The pain level was significantly low in the study group compared to the control group (5±0,75 vs. 8±0,96) and no cervical laceration was revealed in the study group. The Mifepristone - Misoprostol combination has advantages over the Foley balloon - Misoprostol combination for induction of labour regarding reduction in pain intensity, duration of labour, and cervical laceration.

PATHOLOGICAL ADHERENCE OF PLACENTA - CASE REPORTS.

Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hemorrhage in pregnant women may result from abnormal adherence of placenta. Three grades of abnormal placental attachment are defined according to the depth of invasion: placenta accreta, placenta increta, and placenta percreta. An important risk factor for placenta abnormal adherence of placenta is placenta previa in the presence of a uterine scar. The increased prevalence of cesarean section, uterine surgery, and increasing parturient age and parity have led to an increased incidence of abnormal placentation, from one in 2,500 a quarter century ago, to one in 533 deliveries currently. Placenta percreta significantly increases risk for both maternal and fetal morbidity and mortality. Placental invasion of the bladder carries a maternal morbidity of 9.5% and perinatal mortality of 24%. Prevention of the maternal death in the condition when the patients have uterine scarring or a history of other invasive procedures may be improved by the adequate preoperative diagnostics of these conditions. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics-gynecology is the key to successful management.

[Benchmarking study of effectiveness of simultaneous and isolated surgeries].

Benchmarking study was conducted on effectiveness of simultaneous and isolated surgeries in practice of obstetrics and gynecology. In terms of the work, data were analyzed on the isolated and simultaneous surgeries with the patients with combined gynecological and surgical pathologies, requiring operative treatment. Man group included 254 patients with combined abnormalities, who underwent simultaneous surgeries; control group included 122 patients who underwent surgical treatment for combined diseases consecutively in two stages, in different times. Periodicity of complications in early and late post-surgical periods was evaluated, as well as risk ratio (RR) and attributable risk (AR). Simultaneous surgery is safe method of treatment of combined gynecological and surgical abnormalities. Notwithstanding extension of duration of pre-surgical examinations and post- surgical hospital stay, simultaneous operations are considered to be opportunity for being cured from several combined abnormalities within one hospitalization and anesthesia, creating positive moral and psychological background for the patients and making additional argument in favor of their conducting.