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Рецензент: д.мед.н., проф. В.В. Сімрок
Государственное учреждение «Запорожская медицинская академия
SI “Zaporizhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine”
The different types of the pelvic presentation of the fetus in the third trimester of gestation are referred to the wrong positions of the fetus that relate the pregnant women to the group of high risk at the planned natural delivery taking into account the possible expected obstetric and perinatal complications. It is accepted to consider the delivery in the pelvic presentation of the fetus to be pathological, that’ why the tendency of operative delivery of such contingent of women is observed. The operation, which already became “routine” is conducted with the aim of reduction of the quantity of the intranatal complications.
However the new researchers indicate that the increase of the frequency of the cesarean sections doesn’t reduce the level of perinatal complications and is accompanied by the range of intraoperative complications, while directly proportional increase of the quantity of patients with seams on the uterus relates them to the group of high risk at the following pregnancies.
Nevertheless in the accessible literature there are no modern comparative data about the method of delivery of fetuses in the pelvic presentation on the part of obstetric and perinatal consequences.
The comparison of the conservative and planned operative mean of delivery of fetuses in the pelvic presentation for prospective conclusion about possible reduction of the frequency of the cesarean sections for these pregnant women.
In order to implement the aim the retrospective analysis of labour and delivery medical records of the examined contingent was conducted on the basis of the clinical maternity hospital No.3 of Zaporozhia, which comparably were divided into two basic groups; the third group made the random selection of labour and delivery medical records in the cephalic presentation for comparison of frequency of appearance of the acute distress of the fetus in the delivery at breech presentation.
In the structure of the wrong positions of the fetus of different types of the beech presentation in the third trimester of gestation take the leading position and amounts 55%. Among the indicators to the operative delivery the basic place is taken by the seam on the uterus – 30,9%, pelvic presentation – 22%, extragenital diseases – 17%.
Also it should be noted the dynamics of changes of the rate frequency of the pelvic presentation in relation to the other indicators, namely: in 2009 among all indicators to the operation the pelvic presentation amounted 13%, in 2010 – 6,5%, in 2011 – 15,5%, and in 2012 – 33%.
The analysis conduced shows that the tendency to the refusal from delivery and the increase of the frequency of cesarean section at the pelvic presentations of the fetus is observed and for the provided period of time it reached the indicator, which is for 20% higher than the average indicator of the past years.
Among the indicators for the planned operative delivery the interest area amounted 33% of the pregnant women without big fetuses, two with pelvic presentation of the first fetus and indicators on the mother’s part, entered into the group, which consciously refused the delivery through the natural delivery ways.
The age of the patients of the first group aged from 21 to 37 that sufficiently don’t differ from the age of the second group.
From 28 deliveries in the cephalic presentation, 6 (21,4%) were complicated by the acute distress of the fetus in the first period of delivery, as a result of which they were finished by means of “cesarean section”, 3 (10,7%) were complicated by the acute distress in the first period of delivery, and were finished by means of operation of overlapping of the vacuum extractor. Thus, 32,1% of the deliveries in the cephalic presentation were complicated by the fetus distress. The deliveries in the breech presentation were complicated by the acute fetus distress in 5 cases that amounted 23%. This is 9% less than in the third group.
The joint staying in postnatal ward was allowed to 34 new-born children from the first group, this is 91% and 100% of the new-born children from the comparison group.
The operative means of delivery of the fetuses in the pelvic presentation is used in bigger % of women, than the conservative one and is accompanied by the range of complications.
The conservative means of delivery of the fetuses in the pelvic presentation didn’t show the increase of the frequency of appearance of the acute distress of the fetus in comparison with the delivery in the cephalic presentation.
In the analysis conducted the contingent of women with the seam on uterus after the planned cesarean section related to the pelvic presentation was increased at 37 female patients (17,8%) from the total quantity.
In order to reduce the frequency of the cesarean section at the pelvic presentation it is necessary to study further the possibilities of prognosticating the fetus state and the search of the alternative approaches to the programme of delivery.
1. Амирова Ш.А. Выбор оптимального метода родоразрешения и исход родов при тазовом педлежании плода / Ш.А. Амирова, Т.М. Укыбасова // Денсаулык сактауды дамыту. - 2012. - № 1, ч. 1. - С. 66-72.
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