INTEGRATED COMPRESSION HEMOSTASIS IDURING ORGAN PRESERVING OPERATIVE DELIVERY IN PATIENTS WITH PLACENTAR INGROWTH

摘要

FIELD: medicine.;SUBSTANCE: after lower-medial laparotomy, Caesarean section is performed, the fetus is removed from the uterine cavity, and the umbilical cord is crossed. Then the uterine cavity is sutured without placenta extraction. At the next stage, the peritoneum of the vesicle-uterine fold is cut, the bladder is reduced with targeted coagulation of the vessels, exposing the anterior surface of the cervix. For the purpose of marking the healthy tissues boundaries, the cervix is stitched with a 1/2-wedge U-shaped suture in full width in the anteroposterior direction, the ends are fixed with a clamp. Then, "windows" are formed on the left and on the right in the broad uterine ligaments at the isthmus level, through which turnstile tourniquets from elastic rubber tubes are inserted along the rib of the uterus, tightened and fixed with two clamps. Ovaries are withdrawn lateral to the turnstiles, the 3rd turnstile is directed through the same windows around the cervix, tightened at the cervix level, fixed with a clamp. Further, the uterine wall in the area of the placenta ingrowth is excised, followed by placenta removal from the uterine cavity. Previously, a hydrostatic balloon is inserted into the uterine cavity, after which the uterine wall defect is sutured with individual U-shaped sutures followed by peritonization. Then the uterine wall is closed. The tank connected to the balloon catheter is filled, the tourniquets are removed. Broad ligament defects are sutured, if necessary, additional hemostasis is performed. The anterior abdominal wall wound is sutured tightly, an aseptic bandage is applied.;EFFECT: method allows to perform organ-preserving delivery in pregnant women with ingrown placenta with a possibility of reproductive function in future.;3 ex