HEALTH OF WOMAN. 2016.10(116):87–90; doi 10.15574/HW.2016.116.87 
 

Temporary intra-abdominal extravasal transparietal compression of terminal abdominal aorta – the key to reducing the duration of obstetric bleeding and amount of blood loss

Аntonyuk-Kysil V. M., Yenikieieva V. M., Lichner S. І., Lypnyi V. M., Drozd V. V.

PI «Regional perinatal center» of Rivne regional Council

The objective: supplement of the progress of hemostasis of the surgical stage a, temporary intra-abdominal transparietal extravasal compression of terminal abdominal aorta (ТIIETCTAA), which is aimed at reducing the duration of postpartum haemorrhage (PH) and volume of blood loss, rapid stabilization of the patient with the prevention of a possible hysterectomy.

Patients and methods. On the basis of KU "Kharkiv perinatal center" of Rivne regional Council for the period from 2012 to IV quarter of 2016 with the aim of reducing the length of AK and blood loss volume were used ТIIETCTAA as the application, as the stage of surgical hemostasis.

In the operated group were included pregnant women aged from 22 years to 38 years. Among the operated method is using ТIIETCTAA were 2 (20%) nulliparous pregnant and 8 (80%) pregnant women with repeated childbirth. Delivery in all cases in this group of pregnant women was performed by caesarean section.

Indications for carrying out this stage of the surgical intervention was in 3 (30%) cases, the suspected abnormal placentation, 4 (40%) of pregnant – abnormal placentation, 1 (10%) case – frozen intra-abdominal 6-month pregnancy and 2 (20%) cases, premature detachment of the placenta. In 6 (60%) cases surgery was performed in urgent procedure. Only in 4 (40%) cases by the plan.

Results. The duration of the stage of surgical hemostasis with the use of our technique was 25±15 min. For the period of contraction of aorta in all operated patients direct anticoagulants use. All 10 (100%) of the operated patients in the postoperative period neurological, arterial, venous deficits in the lower extremities is not revealed. Additional treatment is not needed. The size of the actually operative blood loss during surgical intervention following this technique in conjunction with preoperative blood loss decreased significantly. All the operated pregnant discharged from the facility in a satisfactory condition. In 5 (50%) patients managed to avoid hysterectomy.

Conclusion. Our proposed phase of the operation – ТIIETCTAA to the vertebral bodies of the lumbar spine requires a significant time to run (5-10 s) after removal of the fetus from the uterus. For the performance this procedure of additional access to the terminal aorta, corresponding to vascular instrumentation, specific knowledge are not necessary. This gives the obstetrician-gynecologist to make decisions without the nervousness that occurs when bleeding from the incision of the uterus, and the anaesthetist to stabilize the patient's condition in a short period of time.

Our recommended stage of surgical intervention can be performed if necessary, the obstetrician-gynecologist of the members of the operating team in any obstetric institution in urgent and planned manner. The principle of this surgical modification of hemostasis can be used if necessary and other surgical interventions on the pelvic organs in case of threat or occurrence of bleeding.

Key words: cesarean section, pathological placentation, temporary intra-abdominal transparietal extravasal compression of terminal abdominal aorta (ТIIETCTAA), surgical hemostasis.

REFERENCES

1. Baranov II. 1999. Sovremennyie printsipy lecheniya akusherskih krovotecheniy. Vestnik Ros. assots. akush.-ginek. 2:17–21.

2. Golyanovskiy OV. 2010. Efektivnist vprovadzhennya kompleksu zahodiv shchodo prognozuvannya, profilaktiki ta terapiyi akusherskih krovotech. Zdorove zhenshchiny 1:114–118.

3. Dikiy OM, Shkodenko GI, Kapustyan SV, Skoromets IM. 2010. Masivni krovotechi v akushersko-ginekologichniy praktitsi. Dosvid likuvannya. Meditsina nevidkladnih staniv 5(30).

4. Egorova NA, Dobrotina AF, Guseva OI, Zagryadskaya PP, Strukova VI. 2006. Krovotecheniya pri beremennosti, v rodah i rannem poslerodovom periode. NN NGMA:79.

5. Kaminskiy VV, Golyanovskiy OV. 2009. Kompleksniy pidhid do hirurgichnogo gemostazu masivnoyi pislyapologovoyi krovotechi. Zbirnik naukovih prats Asotsiatsiyi akush.ginekologiv Ukraini. K, Intermed:293–298.

6. MOZ Ukrayinу. Klinichniy protokol «Akusherski krovotechi». Nakaz vid 24 bereznya 2014 roku za № 205.

7. Morozova NA. 2008. Krovotecheniya vo vtoroy polovine beremenonosti (dorodovyie). Novosti meditsinyi i farmatsii 253:70–74.

8. O.Leary JA. 1995. Uterine artery ligacion in the control of poetcesarean hemorrhage. J. Reprod. Med. 40:189–193. PMid:7776302