Программированные роды у женщин с оперированной маткой

The paper deals with the problems of programmed delivery in women with a uterine scar. The study included 144 pregnant women with a uterus operated who started to give birth vaginally (per vias naturales). The conditions for induction, analyze the clinical efficacy of different methods of induction were assessed. 134 women given birth successfully, programmed delivery were conducted in 84 patients. There were 3 ruptures of the uterus.Статья посвящена проблемам программированных родов у женщин с «рубцом на матке». В исследовании участвовали 144 беременных с оперированной маткой, начавших рожать per vias naturales. Проведена оценка условий для родовозбуждения, проанализирована клиническая эффективность различных методов индукции родов. Успешно проведены влагалищные роды у 134 пациенток, у 84 — программированные роды. В группе программированных родов произошел один разрыв матки

Features of medical care for gestational diabetes mellitus (In case of a specialized obstetric hospital)

Objective. To evaluate the efficiency of methodological approaches to optimizing the care of pregnant women with gestational diabetes mellitus (GDM) under the present-day conditions of a progressive increase in the incidence of this disease in case of a specialized obstetric hospital. Materials and methods. The statistical data on the 2015–2016 activities of the Outpatient Department and the Maternity Department, Moscow City Clinical Hospital Twenty-Nine, were retrospectively analyzed. Results. GDM was diagnosed in two thirds of the pregnant women at more than 30 weeks’ gestation in primary outpatient care services. In the management of pregnant women with untimely detected GDM, the sensitivity of ultrasound fetometry using the specific markers of diabetic fetopathy (DF) was 65.5%. Programmed labor (PL) was one of the leading methods during childbirth. Conclusion. Ultrasound fetometry using specific markers for DF and the strict continuity of outpatient and inpatient care permitted the frequency of DF to be reduced about 1.5-fold. The use of PL methods in GDM contributed to a two-fold decrease in the cesarean delivery rate without deteriorating the perinatal outcomes of labor. © Bionika Media Ltd

Features of medical care for gestational diabetes mellitus (In case of a specialized obstetric hospital)

Objective. To evaluate the efficiency of methodological approaches to optimizing the care of pregnant women with gestational diabetes mellitus (GDM) under the present-day conditions of a progressive increase in the incidence of this disease in case of a specialized obstetric hospital. Materials and methods. The statistical data on the 2015–2016 activities of the Outpatient Department and the Maternity Department, Moscow City Clinical Hospital Twenty-Nine, were retrospectively analyzed. Results. GDM was diagnosed in two thirds of the pregnant women at more than 30 weeks’ gestation in primary outpatient care services. In the management of pregnant women with untimely detected GDM, the sensitivity of ultrasound fetometry using the specific markers of diabetic fetopathy (DF) was 65.5%. Programmed labor (PL) was one of the leading methods during childbirth. Conclusion. Ultrasound fetometry using specific markers for DF and the strict continuity of outpatient and inpatient care permitted the frequency of DF to be reduced about 1.5-fold. The use of PL methods in GDM contributed to a two-fold decrease in the cesarean delivery rate without deteriorating the perinatal outcomes of labor. © Bionika Media Ltd

Эффективность программированных родов при гестационном сахарном диабете в снижении частоты кесарева сечения

The caesarean section rate for gestational diabetes mellitus (GDM) is almost universally higher than the average population indicators, which dictates the need to find the optimal method of delivery. Aim - to determine the optimal method of delivery for pregnant women with GDM. Material and methods. The analysis of the performance indicators for the 2016-2018 period of a large obstetric hospital specializing in assisting pregnant women with diabetes was conducted (City Clinical Hospital # 29 named after N.E. Bauman, Moscow). The methods of delivery of 6113 pregnant women with GDM [spontaneous onset of labor, elective caesarean section, programmed delivery (PD)] were analyzed on the basis of annual reporting indicators of the medical organization. Results. Application of methods PD when delivery pregnant with GDM allowed: a) to reduce the incidence of caesarean section 2.1 times [309 (46.6%) - up to use this method, as compared to 450 (21,8%) (data 2012 and 2018 years, respectively)]; b) used reduce the incidence of fractures collarbone infants in 7 times [14 (13.8‰ from born live) - up to use this method, as compared to 4 (1.9‰)]; c) to reduce the incidence of perinatal the defeat of central nervous system newborn 1.7 times [126 (124.1‰) and 201 (96.2 ‰)] to the application of the algorithm PD and its use, respectively. Conclusion. PD patients with GDM are kind of contravention conservative approach (waiting tactics and planned Caesarean section), which allows effectively reduce the incidence of caesarean section without deterioration of perinatal outcomes.Частота кесарева сечения при гестационном сахарном диабете (ГСД) практически повсеместно превышает среднепопуляционные показатели, что диктует необходимость поиска оптимального метода родоразрешения. Цель исследования - определение оптимального метода родоразрешения беременных с ГСД. Материал и методы. Был проведен анализ показателей работы за 2016-2018 гг. крупного акушерского стационара, специализирующегося на оказании помощи беременным с сахарным диабетом (ГКБ № 29 им. Н.Э. Баумана г. Москвы). Анализировали методы родоразрешения 6113 беременных с ГСД [спонтанное начало родов, плановое кесарево сечение, программированные роды (ПР)] на основании годовых отчетных показателей медицинской организации. Результаты. Применение методики ПР при родоразрешении беременных с ГСД позволило: а) снизить частоту кесарева сечения в 2,1 раза [309 (46,6%) - до применения данной методики по сравнению с 450 (21,8%); данные 2012 и 2018 гг. соответственно]; б) снизить частоту переломов ключиц новорожденных в 7 раз [14 (13,8%о родившихся живыми) до применения данной методики по сравнению с 4 (1,9%о)]; в) снизить частоту перинатального поражения центральной нервной системы новорожденных в 1,7 раза [126 (124,1%) и 201 (96,2%)] до применения алгоритма ПР и при его использовании соответственно. Заключение. ПР у пациенток с ГСД являются своеобразной контраверсией консервативному подходу (выжидательная тактика и плановое кесарево сечение), позволяющей эффективно снизить частоту кесарева сечения без ухудшения перинатальных исходов

Программированные роды при гестационном сахарном диабете: минимизация рисков — улучшение материнских и перинатальных исходов

Background. Modernity is characterized by an avalanche-like increase in the frequency of gestational diabetes mellitus (in 45 times over the past 20 years). The main tasks of the work in the risk strategy of gestational diabetes mellitus are: prediction of pregnancy complications and the searchingh for new technologies for their delivery. To date, there are still very controversial questions about the timing and methods of delivery of patients with gestational diabetes mellitus. Due to the high incidence of unfavourable perinatal outcomes in gestational diabetes mellitus, the percentage of cesarean sections in some countries reaches 60%, which leads to maternal morbidity and a decrease in the reproductive health of the population. Aims is to improve of maternal and neonatal outcomes based of the rational choice of delivery technology in gestational diabetes mellitus. Methods. A retrospective analysis of delivery methods was performed in 9769 patients with gestational diabetes mellitus at full-term gestation. Results. The developed and implemented programmed delivery technique was an alternative to cesarean sections, it allowed to reduce the frequency of abdominal delivery, while improving maternal and neonatal outcomes. The frequency of cesarean sections in programmed delivery was 2 times lower than in the presented facilities and significantly lower than in the population (10.010.7%). In the programmed delivery group there was a significant reducing morbidity of hypoglycemia in newborns compared to planned caesarean section by 2 times and respiratory distress syndrome by 2.5 times (p 0.05). The indices of cerebral status impairment, birth traumatism corresponded to physiological childbirth and did not exceed the average population. Conclusions. The method of programmed delivery presented in this paper was one of the reserves for reducing the frequency of cesarean sections and allowed to personalize delivery in respiratory distress syndrome.Обоснование. Современность характеризуется лавинообразным ростом частоты гестационного сахарного диабета (ГСД) (за последние 20 лет в 45 раз). Основными задачами работы в стратегии риска ГСД являются прогнозирование осложнений беременности и поиск новых технологий их родоразрешения. На сегодняшний день остаются весьма дискуссионными вопросы о сроках и методах родоразрешения пациенток с ГСД. В связи с высокой частотой неблагоприятных перинатальных исходов при ГСД доля кесаревых сечений в отдельных странах доходит до 60%, что приводит к материнской заболеваемости и снижению репродуктивого здоровья популяции. Цель исследования улучшение материнских и неонатальных исходов на основании рационального выбора технологии родоразрешения при ГСД. Методы. Был проведен ретроспективный анализ методов родоразрешения у 9769 пациенток с ГСД при доношенном сроке гестации. Результаты. Разработанная и внедренная методика программированных родов явилась альтернативой кесарева сечения, позволила снизить частоту абдоминального родоразрешения, при этом улучшая материнские и неонатальные исходы. Частота кесаревых сечений при программированных родах была в 2 раза ниже показателей по представленным учреждениям и значительно популяционных (10,010,7%). В группе программированных родов отмечено достоверное снижение (в 2 раза) заболеваемости новорожденных гипогликемией по сравнению с плановым кесаревым сечением и синдрома дыхательной недостаточности (в 2,5 раза, р 0,05), а показатели нарушения церебрального статуса, родового травматизма соответствовали физиологическим родам и не превышали среднепопуляционные. Заключение. Представленная в данной работе методика программированных родов явилась одним из резервов снижения частоты кесаревых сечений и позволила персонифицировать родоразрешение при ГСД

Natural Childbirth after the Previous Caesarian Section is a Solved Problem

Тhe rapid increase in the frequency of сesarian section (CS) observed in recent years (up to 60% in some countries) is alarming and reduces the reproductive potential of the population. The operated uterus remains the main indication for CS (up to 40%). This is the factor which may allow reducing the frequency of the CS by subsequent delivering through the birth canal. A comparative analysis of maternal and neonatal outcomes enabled the authors to develop a two-stage delivery technology for patients with a caesarean scar, including the usage of the programmed delivery method. The presented algorithm confirmed the validity of vaginal delivery in such patients, and reduced the number of complications up to 4 times. Neonatal morbidity in children born through the birth canal in such patients was comparable to physiological birth

Programmable births in gestational diabetes mellitus: Minimizing risks - Improving maternal and perinatal outcomes [Программированные роды при гестационном сахарном диабете: минимизация рисков - улучшение материнских и перинатальных исходов]

Background. Modernity is characterized by an avalanche-like increase in the frequency of gestational diabetes mellitus (in 4-5 times over the past 20 years). The main tasks of the work in the risk strategy of gestational diabetes mellitus are: prediction of pregnancy complications and the searchingh for new technologies for their delivery. To date, there are still very controversial questions about the timing and methods of delivery of patients with gestational diabetes mellitus. Due to the high incidence of unfavourable perinatal outcomes in gestational diabetes mellitus, the percentage of cesarean sections in some countries reaches 60%, which leads to maternal morbidity and a decrease in the reproductive health of the population. Aims - is to improve of maternal and neonatal outcomes based of the rational choice of delivery technology in gestational diabetes mellitus. Methods. A retrospective analysis of delivery methods was performed in 9769 patients with gestational diabetes mellitus at full-term gestation. Results. The developed and implemented programmed delivery technique was an alternative to cesarean sections, it allowed to reduce the frequency of abdominal delivery, while improving maternal and neonatal outcomes. The frequency of cesarean sections in programmed delivery was 2 times lower than in the presented facilities and significantly lower than in the population (10.0-10.7%). In the programmed delivery group there was a significant reducing morbidity of hypoglycemia in newborns compared to planned caesarean section - by 2 times and respiratory distress syndrome - by 2.5 times (p < 0.05). The indices of cerebral status impairment, birth traumatism corresponded to physiological childbirth and did not exceed the average population. Conclusions. The method of programmed delivery presented in this paper was one of the reserves for reducing the frequency of cesarean sections and allowed to personalize delivery in respiratory distress syndrome. © 2021 Izdatel'stvo Meditsina. All rights reserved