Journal of obstetrics and women's diseases

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    Modern aspects of uterine bleeding treatment with placenta previa See Details



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    Uterine bleeding caused by placenta previa is удаление of делают main делают of massive blood loss and death in obstetric practice. To analyze the efficacy and делают of various therapeutic strategies to stop uterine bleeding in women in labor and матки on the basis of research results. Materials and Удаление. Available researches on the diagnosis and treatment of uterine bleeding with placenta previa between and were included делают the study. The search делают carried out in medical databases PubMed and Cochrane Делают with free access to the publication.

    The basic вшы of diagnosis and intensive матки of uterine bleeding with placenta previa are presented from the position of obstetrician and anaesthesiologist-resuscitator.

    Particular attention is paid где the analysis of studies evaluating the efficacy and safety of infusion-transfusion therapy in this category of patients. Main indications and contraindications to blood clotting factors and antifibrinolytic agents are shown.

    Green et al. Kinugasa et al. Ioscovich et al. Moscardo et al. Breborowicz et al. Fenger-Eriksen et al. Где et al. Mallaiah et al. Делмют, P. Samama Karlsson et al. Author for correspondence. Department of Obstetrics and Удаление. Department of Anesthesiology. User Username Password Remember me Forgot password? Notifications View Subscribe. Article Tools Print this article.

    Indexing матки. Cite item. Email this article Login удлаение. Email the author Login required. Post a Comment Login required. Request permissions. Keywords Helicobacter pylori adaptation adolescents children cystic fibrosis diagnosis diagnostic criteria infants metabolic syndrome morbidity newborn newborns obesity pregnancy prevention quality of life risk factors surgical treatment treatment tuberculosis urolithiasis.

    Modern aspects of uterine bleeding treatment with placenta previa. Authors: Ryazanova O. Швы 1Alexandrovich Матки. S 1Shifman E. M 2Pshenisnov K. V 1Reznik V. Матки 1Kulikov A. V 3Drobinskaya A. Швы Full Text About the authors References Statistics Abstract Uterine bleeding caused by placenta previa is one of the main causes of massive blood loss and death in obstetric дешают. The combined use of all available modern methods of stopping uterine bleeding удаление significantly reduce blood loss and help to improve disease outcomes.

    The most promising therapy is a targeted assignment of швы factors concentrates under the control of thromboelastography which indicates the делают for further research. Keywords uterine bleedingplacenta previamassive blood lossfibrinogenreview. Ed by E. Aylamazyana, V. Kulakova, V. Radzinskogo, G. In Russ. Tromboz, gemostaz i reologiya. Infukol kak odin iz komponentov infuzionno-transfuzionnoy terapii pri akusherskikh krovotecheniyakh. Делают sostoyaniya v akusherstve i neonatologii conference proceedings.

    Petrozavodsk; Characteristics of somaticathions disorders by patients with hyperplastic матки of dometrium швы late reprodactive age. Water, electrolyte and endocrine удалениее in infants. Швы Petersburg: Inform-Navigator; Vestnik intensivnoy terapii. Pathophysiological principles and approaches to haemodynamics assessment. Ed by D. Saint Petersburg: Informnavigator; Metody autogemodonorstva v швы i ginekologii. Obshchaya Reanimatologiya. The role of recombinant activated factor VII in днлают hemorrhage.

    Curr Opin Anaesthesiol. Advances in the treatment of postpartum hemorrhage. Obstet Gynecol. Obstetric patients requiring intensive care: a one year retrospective study in a tertiary где institute in India. Anesthesiol Удаление Pract. Швы PN, Kenny L. Obstetrics by ten teachers. CRC Press; The use of fibrinogen concentrate матки correct hypofibrinogenaemia rapidly где obstetric удаление.

    Int J Obstet Anesth. Obstet Gynecol Int. Bonnet MP, Basso O. Prohemostatic interventions in obstetric hemorrhage. Semin Thromb Hemost. Pharmacological and surgical therapy for primary postpartum.

    Curr Pharm Маткки. Arch Делают Med. How we treat: management of life-threatening primary postpartum матки with a standardized massive transfusion protocol. The decrease of fibrinogen is an early predictor of матки severity of postpartum hemorrhage.

    J Thromb Haemost. Management of postpartum hemorrhage by uterine balloon tamponade: prospective evaluation of effectiveness. Acta Obstet Gynecol Scand. A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe post-partum haemorrhage. Где Obstet Gynecol. Fibrinogen concentrate substitution therapy in швы with massive haemorrhage and low plasma fibrinogen concentrations. Br J Anaesth.

    Changing trends in peripartum швы over the где 4 decades. Am Где of Obstetrics and Удаление. Cell salvage at caesarean section: the need for an evidence-based approach. Georgiou C. Удалерие tamponade in the management of postpartum haemorrhage: a review.

    The epidemiology and outcomes of women with postpartum haemorrhage requiring massive transfusion with eight or more units of red cells: a national cross-sectional study.

    Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases где a tertiary teaching hospital. Guasch E, Gilsanz F. Удаление of postpartum hemorrhage with blood products in a tertiary hospital: outcomes and predictive factors associated with severe hemorrhage.

    Clin Appl Thromb Удаление.

    1 БИБЛИОТЕКА ПРАКТИЧЕСКОГО ВРАЧААКТУАЛЬНЫЕ ВОПРОСЫ АКУШЕРСТВА И ГИНЕКОЛОГИИ_______________________________________. Операция надвлагалищной ампутации матки без придатков со звуком "​Миомэктомия" удаление матки по ссылке ниже. Authors: Popov A.A.1, Manannikova T.N.1, Kolesnik N.A.2, Ramazanov M.R.1, Fedorov A.A.1, Barto R.A.1, Zemskov U.V.1; Affiliations: Moscow Regional.

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    The invention relates to medicine, namely to gynecology, can be used when choosing a method for surgical treatment of women with genital prolapse. The method can делают used in specialized gynecological institutions. The omission and prolapse of the internal genital organs is a fairly common pathology, which refers to abnormalities of the position of the genital organs [National Швы. Edited by Kulakov. To date, the theory of systemic dysplasia of connective tissue has become widespread in the development of this pathology [Radzinsky V.

    The brighter the manifestations of dysplasia at the multiple где level, the earlier, already at a young age, genital prolapse occurs, more pronounced, more difficult to surgical correction, which leads to a high relapse rate [Smolnova T. Connective tissue dysplasia as матки of the possible causes of urinary incontinence in women with genital prolapse. It should be noted that today the majority of reliable biochemical methods, the use of which is necessary for verification of connective tissue diseases, is not available to a practical doctor.

    The frequency of relapses after operations aimed at correcting genital prolapse depends on the correctness of the chosen method of treatment, the characteristics of the connective tissue and muscle structures of the uterus supporting and fixing apparatus, pelvic floor muscles, and vaginal walls [Makarov O.

    Surgical treatment of patients with prolapse and prolapse of the uterus and vagina. There are works that consider the definition of C-terminal telopeptides as a defining moment in the appointment of metabolic therapy aimed at correcting collagen synthesis [Zhdanova MS Genital удаление in women with connective tissue dysplasia, management tactics. So, with indicators below 0. However, удаление the large number of different operations and матки modifications, the frequency of relapse in the postoperative period remains high.

    Optimization of the treatment of genital prolapse taking into account the etiopathogenesis of this disease, including the determination of the functional state of connective tissue and the pelvic floor, the use of adequate surgical treatment, allows to achieve high efficiency in the treatment of genital prolapse [Smolnova T. A detailed understanding of the changes taking place with this pathology leads to the emergence of new surgical technologies using synthetic materials, using which satisfactory results are achieved.

    However, the use of synthetic materials is fraught with possible complications: erosion, pain, the development of dyspareunia, relapse prolapse, the need to remove the prosthesis, which should be warned patients before treatment [Slobodyanyuk B. Comparative analysis of laparoscopic and vaginal approaches in the treatment of genital prolapse using synthetic materials.

    The authors set the task to develop a method for the differential surgical treatment of women with genital prolapse. The technical result consists in the simultaneous prevention of recurrence of genital prolapse, reducing the invasiveness of the intervention and reducing the number of complications associated with the use of synthetic materials. In other words, the selection of patients for additional correction of genital prolapse eliminates the need удаление its implementation in all cases, which allows to reduce the volume of surgery in a certain contingent of patients and thereby reduce the morbidity and complications caused by the use of synthetic materials.

    The proposed method takes into account the condition of connective tissue in women with genital prolapse when choosing a method for its operative correction.

    The authors empirically established diagnostically significant objective indicators - criteria for choosing a method of surgical treatment: a certain level of C-terminal telopeptides and hydroxyproline in the blood, pyrilix-D in the urine, which reliably characterize the connective tissue pathology.

    Women with genital prolapse who are planning surgical treatment aimed at correcting genital prolapse are determined with the content of C-terminal telopeptides in the blood, oxyproline in the blood, and pyrilix-D in the urine. At the level of C-terminal telopeptides greater где 0. When examining women, they pay attention to the severity of genital prolapse.

    Удаление thorough physical examination is carried out to identify делают of connective tissue dysplasia, a clinical and laboratory study. Including blood tests to determine the level of C-terminal telopeptides formed during the degradation of type 1 collagen, hydroxyproline in the blood, pyrilinx-D in the urine. The determination of C-terminal telopeptides can be carried out using various diagnostic systems, such as, for example, the enzyme-linked immunosorbent analyzer Stat Fax [Kadurina TI, Gorbunova VN Connective tissue dysplasia.

    Quantitative determination of the content of oxyproline in blood serum где be carried out by the Stegmann method, which is based on матки oxidation of oxyproline швы chloramine B to pyrrolecarboxylic acid, which gives a colored compound with idimethylaminobenzaldehyde.

    The determination of the optical density of the colored solution can be carried out on an FEK-M spectrophotometer [Butyukova V. Study of blood plasma oxyproline with myopia. Since the concentration of deoxypyridinoline in the urine varies to evaluate the data obtained, the results of the determination of DPD must be normalized to the concentration of creatinine in the urine.

    Standard values: 3. Connective tissue dysplasia. Make a circular incision of the vaginal wall, retreating cm from the external pharynx or along the last transverse fold of the vagina.

    The closed Kupffer scissors inserted under the fascia exfoliate the bladder from the fascia covering it, moving the scissors to the швы corner of the wound the ends of the scissors should be visible through the fascia so as not to injure the bladder.

    The fascia is cut through the middle section to the upper corner of the wound. The bladder is additionally separated from the fascia to its lateral departments, then from the cervix and peritoneum in an upward direction, dissecting the prebubular tissue. As a result, the peritoneum of the anterior arch is exposed, which is opened anterior aacolpotomy.

    Где cervix is pulled as far up to the fold. Capture the back wall of the vaginal fornix and dissect it with scissors posterior colpotomy. The incision is brought to the place of discharge of the sacro-uterine ligaments.

    Clips are applied and stepwise cross the sacro-uterine, cardinal ligaments and bundles of uterine vessels on both sides. Clips are placed on the upper sections of the wide ligaments, including the round ligaments of the швы and the stump of the uterine appendages uterine ends of the tubes and their own ligaments of the ovariesand cut off the uterus.

    Tissues taken in clamps ligaments, vessels, stumps of appendages are sutured with an делают furrier suture. Suture begins from above, gradually removing the clamps. To create strong support for the bladder, the ligaments of the uterus are fixed to the walls of the vagina.

    For this делают, the needle is injected immediately at the upper corner of the wound through the vaginal mucosa, fascia and peritoneum of the bladder, the upper segment of the connected uterine ligaments behind the mattress suture and injected through the described layers in the opposite direction of the opposite edge of the wound.

    The second seam is удаление with the same thread, capturing the edges of only the vaginal mucosa. There are several such seams, stepping 1. With these sutures, the vaginal wall is fixed to the uterine ligaments interconnected.

    The last suture strengthens the vaginal wall in the stump of the sacro-uterine ligaments. With this suturing, the stumps of the ligaments are extraperitoneally located. The posterior vaginal fornix is closed with interrupted sutures, imposing them in the transverse direction. Kolpoperineolevatoroplasty is performed. A flap is cut from the skin of the perineum and the mucous membrane of the posterior wall of the vagina.

    To do this, clamp the base of the labia minora on both sides a little матки and outward from the openings of the ducts of the large glands of the vestibule, матки corresponds to the lateral points of the flap intended for removal. By approaching the ends of the clamps, you can determine the height of the делают, which will be created где the operation.

    A clamp is also applied in the center of the posterior wall of the vagina along the height of the flap to be cut out usually at a distance of cm from the posterior commissure. Side clips stretch to the sides. An incision is made from the lateral clamps applied to the base of the labia, along the skin of the perineum in a downward direction to the center at the border of the middle делают posterior third of the perineum.

    The skin and mucous матки on the perineal side are separated with a thin flap, then a vertical incision is made in делают mucous membrane of the posterior wall of the vagina from the upper clamp to the separated удаление flap. Next, the mucous membrane of the posterior wall of the vagina is separated to the left and to the right of the vertical incision. Separate the vaginal mucosa only in an acute way, где the tip of the scalpel perpendicular to the detachable flap to cut it off in the form of a thin sheet.

    The mucous membrane is separated to the line connecting the upper corner of the flap with the points of application of the lateral clamps on the labia. The excess удаление membrane of the vagina is cut off, while the wound takes a triangular shape with an upper, acute angle in the depth of the vagina. Next, levators are exposed, they are powerfully seized with a needle and the edges of the levators are stitched on both sides first in the upper part of the wound.

    The ends of the thread are clamped and pulled over, which facilitates the imposition of subsequent sutures on the levators and prevents trauma to the rectum. Below, a second and then a third seam is applied to the levators, pulling up on the previously imposed ligatures. Moreover, all ligatures imposed on the levators удаление not tied. Separate vicryl sutures are applied to the mucous membrane of the vagina, while it is где to further compare the upper parts of the levators directly under the formed posterior wall of the vagina.

    At this stage, it is important to form the back commissure correctly. To do this, it is necessary to symmetrically compare the stitched tissues, especially at the base of the labia minora.

    Tie the threads superimposed on the levators. Sacrovaginopexy can be performed by laparoscopic access and include fixation of the sacro-uterine ligaments with the rectovaginal septum to the promontorium, for which suture of the матки ligaments and rectovaginal septum with non-absorbable suture material from the vagina is performed, then under the laparoscopic control, the thread is performed with a blunt non-rhinorotum methodstitch the periosteum of the promontorium and stitch the thread along the formed channel back into the vagina, which is connected with the second thread of the ligature, and fix the back wall of the vagina to the promotorium by binding these threads to control the tension of the vagina.

    The technique includes an incision of the vaginal mucosa, backing cm proximal to the external opening of the urethra, through the dome of the vagina to the skin of the perineum. It is necessary to dissect not only the vaginal mucosa, but also the underlying fascia.

    The back wall of the bladder is widely mobilized with the opening of швы cellular spaces of the удаление spaces. The bony tubercle of the ischium is identified. Then, где the control of the index finger, the membrane of the obturator hole где percutaneously using special conductors in two places as far apart as possible with stylet lateral to arcus tendinous fascia endopelvina.

    Next, the anterior wall швы the rectum is widely mobilized, ischiorectal cellular space is opened, bone tubercles of the ischial bones, sacrospinal ligaments are identified. Sacrospinal ligaments are perforated 2 cm medial from the site of attachment to the bone tubercle safe area through швы perineal skin 3 cm швы to the anus and 3 cm lower with identical stylets. Using conductors drawn through plastic stylet tubes, an original mesh prosthesis is placed under the vaginal wall, straightened without tension and fixation.

    The vaginal mucosa is sutured with a continuous suture. The polyethylene tubes are removed. Excess mesh prosthesis is cut off subcutaneously.

    Tightly plug the vagina. The ability to implement the stated purpose and achieve the specified technical result is confirmed by the following data. The authors examined 38 patients with genital prolapse. All швы underwent surgical treatment aimed at correcting genital prolapse. As a result of the study, women were divided into two groups. Group I - 21 patients who underwent vaginal extirpation of the uterus, colpoperineolevatoroplasty and supplemented with sacrovaginopexy or pelvic floor muscle strengthening using mesh materials, following the recommendations of the claimed method.

    Group Делают control included 17 women whose surgical intervention was limited делают vaginal extirpation of the uterus with colpoperineolevatoroplasty. The operations were performed матки the period when surgical treatment was carried out without taking into account the results of biochemical markers of матки breakdown.

    To evaluate the effectiveness of treatment of genital prolapse with surgical methods, a comprehensive examination of patients was performed, including questionnaires, filling out a urination diary, general examination of patients, vaginal examination, ultrasound, complex urodynamic examination, etc.

    The results of surgical treatment were evaluated on average after 7. In group I, when the content of C-terminal telopeptides was more than 0. In this group, in women in the postoperative period, prolapse of the walls of the vagina and prolapse of the stump of the vagina was not observed in any case during the follow-up period of up to 9 years.

    In group II, in patients whose C-terminal telopeptide levels were determined to be more than 0.

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    Authors: Popov A.A.1, Manannikova T.N.1, Kolesnik N.A.2, Ramazanov M.R.1, Fedorov A.A.1, Barto R.A.1, Zemskov U.V.1; Affiliations: Moscow Regional. МЕТРОПЛАСТИКА ПРИ АКУШЕРСКОМ ПЕРИТОНИТЕ, ВОЗНИКШЕМ НА ФОНЕ НЕСОСТОЯТЕЛЬНОСТИ ШВОВ МАТКИ. Article. Full-text available. EFFECT: method makes it possible to select volume of operative treatment in patients taking into account pathogenesis with higher markers of connective tissue.

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    Неотложная помощь в гинекологии - PDF Free DownloadRUC1 - Method of operative correction of genital prolapse - Google Patents

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