Ulyanovsk Medico-biological Journal

Клиническая медицина

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DOI 10.23648/UMBJ.2018.31.17211

УДК 618.5-089.888.61

 

ПРОБЛЕМЫ РОДОРАЗРЕШЕНИЯ ЖЕНЩИН ПОСЛЕ ПРЕДШЕСТВУЮЩЕГО КЕСАРЕВА СЕЧЕНИЯ

 

Р.Н. Степанова

ФГБОУ ВО «Орловский государственный университет им. И.С. Тургенева», г. Орел, Россия

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Последняя треть двадцатого столетия ознаменовалась созданием инновационных технологий оценки состояния плода (кардиотокография, УЗИ, допплерометрия), благодаря чему стала возможной ложноположительная гипердиагностика интранатального страдания плода; достижения в акушерстве и перинатологии спровоцировали драматическое увеличение числа кесаревых сечений (КС). Решением объединенного Пленума правлений Всесоюзного и Всероссийского научных медицинских обществ акушеров-гинекологов в 1986 г. пересмотрены вопросы, касающиеся определения места операции КС в современном акушерстве, оптимальной ее частоты и техники, определены и существенно расширены показания к абдоминальному родоразрешению.

Посредством КС в России на свет появляется каждый пятый ребенок, или 300 тыс. из 1,5 млн новорожденных. Благодаря либерализации показаний к КС его частота стремительно возрастает. Однако после КС матери умирают в 3 раза чаще, чем при вагинальных родах; перитонит и сепсис развиваются в 5–6 раз чаще, чем после родов через естественные родовые пути. Абдоминальное КС стало самым распространенным видом родоразрешающей операции, вследствие чего за последние 35 лет прогрессивно увеличилось число женщин репродуктивного возраста, зачинающих беременность, имея рубец на матке. Вместе с тем около 80 % женщин с КС в анамнезе являются кандидатами для самостоятельных вагинальных родов в следующую беременность. Примерно 40 % из 1,3 млн КС в США являются повторными операциями. В связи с этим ведение последующей беременности и особенно родоразрешение этих женщин представляют серьезнейшую медицинскую и социальную проблему.

В статье рассматриваются вопросы материнской и перинатальной заболеваемости и смертности при абдоминальном родоразрешении, факторы, благоприятствующие вагинальным родам, возможность прогнозирования благополучного исхода вагинальных родов у женщин с рубцом на матке после КС.

Ключевые слова: кесарево сечение, частота, показания, вагинальные роды после кесарева сечения.

Литература

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  41. Grobman W.A., Gilbert S., Landon M.B., Spong C.Y. Outcomes of induction of labor after one prior cesarean. Obstet. Gynecol. 2007; 109 (2): 262–269.

  42. Fagerberg M.C., Marsal K., Kallen K. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015; 188: 88–94.

  43. Tessmer-Tuck J.A., El-Nashar S.A., Racek A.R., Lohse C.M. Predicting vaginal birth after cesarean section: a cohort study. Gynecol. Obstet. Invest. 2014; 77 (2): 121–126.

  44. Kehl S., Weiss C., Rath W. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review. Europ. J. Obstet. Gynecol. Reprod. Biol. 2016; 204: 44–50.

  45. Hehir M.P., Rouse D.J., Miller R., Ananth C.V. Second-stage duration and outcomes among women who labored after a prior cesarean delivery. Obstet. Gynecol. 2018; 131: 514–522.

  46. Schmidl M., Berner P., Reingrabner M. Elective cesarean section vs. spontaneous delivery. Acta Obstet. Gynecol. Scand. 2003; 82 (9): 834–840.

 

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DOI 10.23648/UMBJ.2018.31.17211

PROBLEMS OF DELIVERY AFTER CESAREAN SECTION

 

R.N. Stepanova

Orel State University named after I.S. Turgenev, Orel, Russia

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

The end of the 20th century was marked by innovative technologies for assessing the fetal condition (cardiotocography, ultrasound, Doppler ultrasonography). These technologies led to a false-positive overdiagnosis of fetal intrapartum suffering. Thus, achievements in obstetrics and perinatology provoked a profound increase in the number of cesarean sections (CS). In 1986 the joint Plenary meeting of the All-Union and All-Russian Scientific Medical Societies of Obstetricians and Gynecologists examined the problems connected with the CS in modern obstetrics, its optimal frequency and technique. Indications for abdominal delivery were determined and sufficiently revised. Every fifth child in Russia is born by CS, in other words 300,000 out of 1.5 million newborns. Due to liberal attitude of doctors to CS, its frequency is increasing very quickly. However, after CS, mothers die 3 times more often than in case of vaginal delivery; peritonitis and sepsis develop 5–6 times more often than after natural birth. Abdominal CS has become the most common type of delivery operation. As a result, over the past 35 years, there increased the number of women of reproductive age, beginning pregnancy with a uterine scar. However, about 80 % of women with CS in history are candidates for independent vaginal delivery in the next pregnancy. Approximately 40 % of the 1.3 million CSs in the US are reoperations. In this regard, the management of subsequent pregnancy and especially the delivery of women with CS is a serious medical and social problem. The article deals with the issues of maternal and perinatal morbidity and mortality in case of abdominal delivery; factors favoring vaginal birth; the possibility of predicting the safe outcome of vaginal birth in SC women with uterine scars.

Keywords: cesarean section, frequency, indications, vaginal delivery after cesarean section.

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  30. Scott J.R. Vaginal birth after cesarean delivery. Obstet. Gynecol. 2011; 118 (2, part 1): 342–350.

  31. Sabol B.1, Denman M.A., Guise J.M. Vaginal birth after cesarean: an effective method to reduce cesarean. Clin. Obstet. Gynecol. 2015; 58 (2): 309–319.

  32. Guise J.M., Eden K., Emeis C. Vaginal birth after cesarean: new insights. Evid. Report. Technol. Assess. Portland: Evidence-based practice center; 2010. 397.

  33. Guise J.M., Denmann M.A., Emeis C. Vaginal births after cesarean: on maternal and neonatal outcomes. Obstet. Gynecol. 2010; 115 (6): 1267–1278.

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  43. Tessmer-Tuck J.A., El-Nashar S.A., Racek A.R., Lohse C.M. Predicting vaginal birth after cesarean section: a cohort study. Gynecol. Obstet. Invest. 2014; 77 (2): 121–126.

  44. Kehl S., Weiss C., Rath W. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review. Europ. J. Obstet. Gynecol. Reprod. Biol. 2016; 204: 44–50.

  45. Hehir M.P., Rouse D.J., Miller R., Ananth C.V. Second-stage duration and outcomes among women who labored after a prior cesarean delivery. Obstet. Gynecol. 2018; 131: 514–522.

  46. Schmidl M., Berner P., Reingrabner M. Elective cesarean section vs. spontaneous delivery. Acta Obstet. Gynecol. Scand. 2003; 82 (9): 834–840.