Modern approaches to the therapy of urgent conditions (рlacenta praevia)

BACKGROUND: Obstetric bleeding associated with placental anomalies is a leading cause of massive bleeding and maternal mortality. Their relevance increases due to the increasing abdominal delivery frequency. Numerous proposed approaches and ways to stop such bleeding indicate the complexity and versatility of the problem, as well as its unresolved present stages.

AIM: This study aimed to evaluate the effectiveness of a new method of bleeding control in placenta previa.

MATERIALS AND METHODS: Herein presented the results of a prospective study that included 58 cases of bleeding control for placenta previa in patients who gave birth in 2017–2020 at G.G. Kuvatov Republican Clinical Hospital in Ufa. Two groups were formed depending on the method of bleeding control. The main group included 34 patients who used a new method for bleeding control. The control group included 24 patients who used traditional methods of bleeding control following the clinical protocol.

RESULTS: The proposed method of bleeding control in placenta previa using drainage silicone tubes and a circular suture is used during cesarean section surgery for placenta previa without signs of placenta accreta spectrum. When separating the placenta and bleeding from the placental site in the region of the lower uterine segment and the internal uterine pharynx, drainage tubes were used that are placed in the internal pharynx area, the uterine body, and the vagina in the necessary amount to achieve tamponade of the internal pharynx.

Further, the tubes were fixed by applying a circular suture tied in the lower uterine segment, which pressed the placental area to the tubes in a hard-to-reach place for stitching, located in the region of the lower uterine segment and internal uterine pharynx, with a mechanical vascular compression at the internal pharynx level without disturbing the outflow from the uterine cavity.

CONCLUSION: The comparative study of methods for stopping the lower segment bleeding in patients with placenta previa shows the high effectiveness of the proposed method for reducing the surgical intervention time and the postoperative period course, as well as the ergonomics and simplicity of bleeding control for the surgeon.