Efficiency and safety of terlipressin application during caesarian section in pregnant women with a high risk of bleeding: A multicenter comprehensive cohort study of terli-bleed. part i

Prevention of postpartum haemorrhage is one of the important tasks of modern obstetrics, anesthesiology and intensive care. Objective. To assess the efficacy and safety of terlipressin usage as a means of postpartum haemorrhage development prevention during caesarean section in high-risk pregnant women. Patients and methods. From February to December 2020, a multicenter comprehensive cohort study, in which 5 medical centers participated, was conducted. The study included 454 pregnant women who underwent caesarean section and who were divided into two groups: control group I (n = 351) and study group II (n = 103), with the use of terlipressin injected into myometrium. Evaluation of the preventive effect of the drug was carried out in several main directions: the volume of blood loss, the need for additional methods of surgical hemostasis, the safety of intraoperative use. Results. Considerable differences were found in the assessment of significant risk factors for the development of postpartum haemorrhage, associated pathologies and comorbidity between the groups. The study group turned out to be more threatened by the postpartum haemorrhage development. In the control group, additional measures of surgical hemostasis were more often used, including hysterectomy (2.6% versus 1.9%) and relaparotomy (1.9% versus 1%). The median blood loss was statistically lower in the study group (700 ml versus 800 ml). Nevertheless, the considerable spread of data on the volume of blood loss should be noted, with a maximum blood loss of 10,000 ml in the control group and 4,500 ml in the study group. There were no serious complications in both groups. Conclusion. The study showed that the use of terlipressin can reduce the volume of blood loss in women with high risk factors for postpartum haemorrhage, as well as reduce the number of hysterectomies and relaparotomies. It is necessary to continue the prospective part of the study with an increase in the randomized sample of patients. © 2021, Dynasty Publishing House. All rights reserved

Efficiency and safety of terlipressin application during caesarian section in pregnant women with a high risk of bleeding: A multicenter comprehensive cohort study of terli-bleed. part ii

Severe and massive bleeding remains one of the main causes of maternal mortality and morbidity. The use of terlipressin has proved to be effective in the prevention of postpartum haemorrhage in the high-risk group. Given that terlipressin is a potent vasopressor, there are concerns about its use in parturient women with hypertension. Objective. To evaluate the hemodynamic effects of terlipressin when it is injected into the myometrium during caesarean section. в Patients and methods. This publication is a continuation of the research work on the effectiveness of terlipressin in the prevention of postpartum haemorrhage in high-risk pregnant women, which was conducted between February and December 2020 with the participation of 5 medical centers. The study included 454 pregnant women who delivered by caesarean section. They were divided into two groups: control group I (n = 351) and study group II (n = 103), with local application of terlipressin injected into the thickness of the myometrium. During the study, the parameters of non-invasive hemodynamics were assessed. Results. When assessing the indicators of non-invasive blood pressure, no statistically significant difference was found between the groups. The analysis of heart rate showed slight statistical difference at the stage of operation and in the postoperative period. A significant difference in values of shock index in dynamics was found between the groups, which, nevertheless, were within acceptable limits, and the difference had no clinical significance. Conclusion. The study showed that the use of terlipressin does not significantly affect the parameters of non-invasive hemodynamics, which can complicate the operation or the labor outcome. © 2021, Dynasty Publishing House. All rights reserved

Efficiency and safety of terlipressin application during caesarian section in pregnant women with a high risk of bleeding: a multicenter comprehensive cohort study of Terli-Bleed. Part III

The search for new means of prevention and treatment of massive obstetric haemorrhage is a priority task for the world scientific community, both obstetricians and anesthesiologists. Previously, we have shown the preventive efficiency of terlipressin, which helps to reduce the volume of blood loss during caesarean section (CS), and its lack of systemic hemodynamic effects when used topically. Objective. To evaluate changes in clinical and laboratory parameters when using terlipressin topically as a means of preventing postpartum haemorrhage during CS in high-risk pregnant women. Patients and methods. This publication is a continuation of our multicenter comprehensive cohort study of Terli-Bleed. The study included 454 pregnant women at high risk for haemorrhage who delivered by CS. They were divided into two groups: a control group (n = 351) and a study group (n = 103), with topical administration of terlipressin injected into the myometrium. Complete blood count, acid-base balance, lactate and hemostasis parameters were analyzed. Results. The levels of hemoglobin, platelets, fibrinogen, lactate, and blood pH were different in the groups during the postoperative follow-up period (p < 0.05). Conclusion. The analysis of clinical and laboratory parameters indicates the preventive ability of terlipressin to reduce the volume of intra-and postoperative haemorrhage without affecting the hemostasis system. © 2021, Dynasty Publishing House. All rights reserved

Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth

Aim: To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin’s pessary with cervical cerclage in women at a high risk of pregnancy loss. Materials and methods: This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin’s pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. Results: Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p =.448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p =.011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length &lt;15 mm, and large isthmic uterine fibroids. The use of the Arabin’s pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. Conclusions: Women with a high risk of pregnancy loss treated with Arabin’s pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Empirical therapy for vulvovaginitis in reproductive-aged women in routine clinical practice

Objective. To evaluate the efficiency of empirical therapy with tergynan in reproductive-aged women in routine clinical practice. Subjects and methods. The TERRA multicenter post-registration observational study enrolled 430 reproductive-aged patients diagnosed with acute vulvovaginitis. Based on their complaints, clinical symptoms, and objective examination, the patients received empirical therapy with the combination antimicrobial drug Tergynan as a single vaginal tablet once daily for 10 days. Gynecological examination, pH-metry, and bacterioscopic and bacteriological examinations of discharge (Femoflor-16) were performed, and the time course of changes in clinical symptoms evaluated. Results. There was less vaginal discharge, a complete disappearance of unpleasant odor, and a feeling of vaginal itching and burning (74.5 and 67.1%, respectively). There were increases in the detection rate of Lactobacillus spp. by 2 times with a dissemination level of 106-107 CFU/ml, in the suppression of obligate anaerobic representatives (associations of Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp., as well as Eubacterium spp.) by 5 times, facultative anaerobic bacteria (Enterobacteriaceae and Streptococcus spp.) by 3 times, and yeast-like fungi of the genus Candida by 2 times. Conclusion. This investigation demonstrated the high clinical (96.5%) and microbiological (97.3%) efficiency of empirical therapy with tergynan in 430 reproductive-aged women with acute nonspecific vulvovaginitis. © 2020, Bionika Media Ltd. All rights reserved