SEARCHING FOR RESERVES TO REDUCE THE FREQUENCY OF CESAREAN SECTION IN WOMEN WITH AN OPERATION ON THE UTERUS

Аннотация

This article describes the search for resources to reduce the frequency of cesarean sections in women who have undergone uterine surgery. Keywords: cesarean section, pregnant women, uterus, birth canal. ПОИСК РЕЗЕРВОВ ДЛЯ СНИЖЕНИЯ ЧАСТОТЫ КЕСАРЕВА СЕЧЕНИЯ У ЖЕНЩИН С ОПЕРАЦИЕЙ НА МАТКЕ Аннотация. В статье описывается поиск ресурсов для снижения частоты кесарева сечения у женщин, перенесших операцию на матке. Ключевые слова: кесарево сечение, беременные женщины, матка, родовые пути. Relevance: According to literary sources, the frequency of cesarean section operations worldwide is steadily increasing, reaching 21-29% of all deliveries and does not tend to decrease. WHO suggests the optimal frequency of cesarean section operations and this figure should not exceed 15%. The increase in the frequency of abdominal deliveries is associated with multiple factors, primarily with an increase in the priority of relative indications for cesarean section. According to Shalashova Yu.V., recently obstetricians and gynecologists have very often encountered psychological reasons, one of them is the lack of readiness of a pregnant woman to cooperate with obstetricians and gynecologists; pregnant women most often have an unfavorable attitude towards the labor process, there is fear, misconceptions about the labor process. These moments lead to overdiagnosis of complications of childbirth, including anomalies of labor. Purpose of the study: Study of the psycho-emotional state of pregnant women with an operated uterus. Materials and methods of the study: the study was conducted in 2 stages. At the 1st stage, we conducted a retrospective analysis of the birth history of 168 women with an operated uterus, who were divided into 2 groups. Group 1 included 125 women with a scar on the uterus who gave birth by cesarean section, while group 2 was formed from 43 women with a scar on the uterus who gave birth through the natural birth canal. After determining the key points of the retrospective analysis, a prospective study of 104 women was conducted, which were divided into 2 groups. 1876 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 4 The 1st main group was formed from 74 pregnant women with an operated uterus, who were divided into 2 subgroups depending on the method of delivery: Group 1 - 44 pregnant women with an operated uterus who gave birth by cesarean section and group 2 - 30 pregnant women with a scar on the uterus who gave birth by vaginal delivery. To conduct a comparative analysis, a control group of 30 pregnant women with a physiological course of pregnancy and childbirth was formed. The research methods were general clinical, clinical-anamnestic, laboratory, instrumental studies and a test to determine the degree of anxiety. Results and discussion: Retrospective analysis showed that the average age of the subjects fluctuated within 28.4±2.4 years in Group 1 and 29.7±2.4 years in Group 2. During the retrospective analysis, we identified key indicators that could play an important role in planning the method of delivery. Thus, the analysis revealed that the main indications for abdominal delivery were a scar on the uterus in combination with the rupture of amniotic fluid (22.2%), the 1st stage of labor (19.4%), the woman's refusal of natural childbirth (11.1%), somatic diseases such as myopia (5.5%), and heart disease (8.3%). Analysis of the degree of maturity of the cervix according to the Bishop scale revealed that in Group 1, in 76% of cases, an immature cervix according to the Bishop scale was detected, while in Group 2 this indicator was 10%. The degree of maturity of the cervix above 5 points was present in 23% of women with an operated uterus, who subsequently gave birth surgically, and in 90% of cases in women with a scar on the uterus, who gave birth through the natural birth canal. In addition, when analyzing the anamnestic data, 63% of women in the 2nd group had a history of vaginal birth before the previous cesarean section. After determining the key points of the retrospective analysis, we conducted a prospective study. Analysis of the age aspect of women in the prospective study showed that in all groups, women aged 25 - 29 years predominated, which has no reliable differences between the studied groups. Analysis of the structure of indications for previous operative deliveries in women of the main group showed that in the 1st group the dominant positions are occupied by hypertensive disorders, in particular severe preeclampsia - 25%, then placental abruption - 17.5%, cephalopelvic disproportion 10%. The 2nd group in the structure of indications for operative delivery had certain differences compared to the first group, so the main indications were breech presentation of the fetus 23.3%, inconclusive condition of the fetus 16.7%, severe preeclampsia, PONRP in 13.3% of cases, cephalopelvic disproportion 6.7%. Analysis of the history of vaginal births showed that there is a reliable statistical differe