[OBESITY AS A RISK FACTOR FOR MASSIVE POSTPARTUM HEMORRHAGE.]

INTRODUCTION: No mat analysis devoted to the study of obstetric hemorrhage due to obesity has not yet been carried out. Publications of the results of major studies on the subject have appeared recently. Only the multivariate analysis will make a reasonable conclusion about the causes that affect the outcome and assess the extent of the simultaneous influence on him of often interrelated reasons. THE AIM: To estimate the signficance of obesity as an independent risk factor for serious obstetric haemorrhage. MATERIALS AND METHODS: A retrospective cohort study ofpregnancy and childbirth outcomes of 24634 women in childbirth. Depending on the initial body mass index (BM) of the patients were allocated two groups: basic - 2140 obese women with control - 17937 patients with an initial BW of 18.5 to 24.9 kg / m2. In order to determine the significance of obesity as a riskfactor of massive blood loss midwife performed multivariate statistical analysis, including cluster analysis, multiple correlation, linear and non-linear regression, statistical quality control using control charts. RESULTS: Hypotension uterus has been a major factor in the development of massive blood loss. For the implementation of hypotonic uterine bleeding was necessary set of conditions, interacting with other causal factors affecting the outcome. The minimum combination of these factors is the combination of "obesity" + "somatic pathology" + "induction of labor," in which the OR of postpartum hemorrhage was 8,57 [CI 95% 6,13-36,28], p < 0.001. It is also significant risk factors were fetal macrosomia, multiple pregnancy, abdominal method of delivery, the degree of obesity, the method of anesthesia and duration of the operation. OR to define obesity as an isolated risk factor for the implementation of massive blood loss was 1.18 [95% CI: 0,78-1,27], p > 0.05. DISCUSSION: The impact of obesity as an isolated causes massive obstetric hemorrhage was minimal, but is powerful potentiating factor in the outcome. CONCLUSION: Analysis of the causes of complications in childbirth did not confirm the possibility of considering obesity as an independent risk factor for massive blood loss.

[CONTROVERSIAL ISSUES OF THE ANESTHESIOLOGICAL MAINTENANCE OF DELIVERY IN OBESE PATIENTS].

The review represents debatable issues of the anesthesia management of the surgical delivery and postoperative period in patients with obese: the choice of anesthesia methods, anesthesia as a risk factor of maternal and perinatal morbidity and mortality and methods of intraoperative pain management. Authors made an attempt to reveal preventable risk factors of complications in obese patients: professional skills, technical equipment, standards compliance, period of time from the decision till delivery itself selection of an adequate dose of local anesthetic during spinal anesthesia, necessity of monitoring and correction of intra-abdominal hypertension. The article discusses the variety of problems, and in case offurther researches they will help to decrease frequency of the anesthetic complications, that determine obstetric and perinatal outcomes in obese patients.

[Correction of local anesthetic dosage in spinal anesthesia in pregnant women with obesity].

INTRODUCTION: Intra-abdomninal pressure (IAP) is one of the reasons for reducing the volume of the subarachnoid space, the cerebrospinal fluid of pregnant iwomnen with obesity and as a result, a high spinal block in spinal anesthesia (SA), clinical manifestation of which is marked arterial hypotension. OBJECTIVE: To decrease the frequency and severity of arterial hypotension related to the conduct of SA due to the correction dose of local anesthetic with the level of intra-abdomninal pressure and timing of operative delivery MATERIAL AND METHODS: The study involved 252 women. To determine the physiological level of IAP at different stages of gestation used to study the level of IAP in 118 pregnant women with normal body weight. To explore the relationship of frequency of hypotension in the SA and the development of methodology for calculating the dose of local anesthetic in pregnant women examined 92 patients, 62 of whom were obese. To assess the adequacy of the developed technique further examined 42 obese women. RESULTS: it was determined that the gestation 38-40 weeks, the mean physiological IAP corresponds to 20 mm Hg, at the term of 35-37 weeks - 18 mm Hg at 32-34 weeks of pregnancy - 16 mnm Hg. Studies have shown that an adequate dose of local anesthetic for spinal anesthesia for operative delivery in pregnant women with obesity depends on the level of IAP The required dosage is determined by the percentage reduction for the difference between the actual level of IAP and the predicted IAP The required dosage 5.5% per mm Hg IAP is higher than the physiological norm. CONCLUSION: The developed method of calculating the dose of local anesthetic with the levels of IAP and gestational age prevents development of arterial hypertension, the optimum level of sensory block during SA for operative delivery obese women.

[Concept, definition and classification of intra-abdominal hypertension in pregnancy].

The article stresses methodological aspects of intaabdominal hypertension at pregnancy. Formal-logical analysis of conceptual framework and available classifications of intaabdominal hypertension was carried out. The article presents new definition and classification of intaabdominal hypertension.

[Anesthetic aspects of the problem of morbid obesity in pregnancy].

The prevalence of morbid obesity has been grown at a very heart rate in developed countries during the last decades. Over-weight pregnant women make up a group of risk of such serious complications as gestational hypertension, preeclampsia, gestational diabetes, increased frequency of Cesarean sections, and uterine inertia. Morbid obesity creates problems in anesthetic support. Obesity is associated with many physiological changes that compromise the adaptive ability in pregnant and delivering women. This review describes clinical and functional peculiarities of pregnancy, labor, and perioperative period in women with morbid obesity. Main physiological changes in these patients are described. Clinical aspects of the problem of practical significance for obstetricians/anesthetists are discussed.

[Role of intra-abdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome].

OBJECTIVE: To evaluate the role of intraabdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome. MATERIAL AND METHODS: 60 patients with varying degrees of ovarian hyperstimulation syndrome (OHSS) due to ongoing pregnancy were involved in the study. Intraabdominal pressure (IAP) was measured in the bladder. Performance of abdominal perfusion pressure, filtration gradient, extensibility and compliance of the anterior abdominal wall were evaluated. A size of the ovaries, chorionic condition and ascites were determined by ultrasonic method. Relation of pregnancy outcome and IAP was analyzed. RESULTS: The mean value of IAP in patients with light form of ovarian hyperstimulation syndrome was 7.05 +/- 1.76 mm Hg, 13.65 +/- 1.92 mm Hg in patients with moderate form, and 20.60 +/- 2.52 mm Hg in patients with severe form of OHSS. The leading factors in the development and progression of intraabdominal hypertension (IAH) are the volume of the ovaries, ascites, and extensibility of the abdominal wall. The comparison of pregnancy outcome and severity of IAP revealed a strong positive correlation--r = 0.726, p < 0.001. CONCLUSION: Evaluation of the severity of intra-abdominal hypertension in patients with ovarian hyperstimulation syndrome with considering the clinical data and results of laboratory and instrumental studies allow clarifying the severity of condition and predict the potential complications and pregnancy outcomes.

[Relationship between uteroplacental blood flow and of intra-abdominal hypertension in pregnant women].

UNLABELLED: RESEARCH AND OBJECTIVE: Identification of relationship between intra-abdominal pressure and uteroplacental blood flow MATERIALS AND METHODS: 90 second trimester women (20-24 weeks) were examined. An assessment of intra-abdominal pressure (IAP) was carried out by "Unometerabdopressure" system through a bladder. Doppler imaging with resistance index in uterine arteries (RIUA) and umbilical cord arteries (UCA) assessment was carried out to evaluate uteroplacental blood flow. We calculated indicator (1) that characterize extent uteroplacental blood flow compensation degree. Pregnancy course and birth results were studied. RESULTS: It is established that uteroplacental blood flow disturbances during 2nd trimester of pregnancy are closely connected with IAP level. RIUA and I data are assessment criteria of chronic intra-abdominal hypertension compensation degree in pregnant women. Obstetric and perinatal complications frequency is closely connected with IAP value. IAP and uteroplacental blood flow data are important parameters which can be received with use of noninvasive techniques.

[Anaesthesia peculiarities during delivery in morbid obese women].

This review presents principals of complications prevention, anaesthesia methods choose, preoperative preparation, anaesthesia management and postoperative care in morbid obese patients.

[Prognosis and intensive care for massive obstetric blood loss].

The study covered 235 obstetric patients having varying blood loss (1.8 to 55.7%) at labor. Their constitutional, history, clinical, functional, and biochemical data were studied, which allowed the authors to develop a strategic and tactic line of prediction of the development of massive blood loss at labor. The algorithm of preventive intensive care, developed on the basis of predictive criteria, was found to significantly improve the results of treatment and to reduce the frequency and severity of obstetric hemorrhagic complications.