METHOD OF ORGAN-PRESERVING SURGICAL DELIVERY IN PATIENTS WITH PLACENTA INGROWTH

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to obstetrics and gynecology. After the standard middle-bottom-median laparotomy, the uterus is removed from the abdominal cavity and ultrasound is performed to determine an upper edge of the placenta. Then over the upper edge of the placenta, the peritoneum of the uterovesical fold is dissected, the urinary bladder is reduced with the targeted vascular coagulation. Front surface of the uterine cervix is exposed, in broad ligaments of the uterus; on the level of the isthmus, the "windows" are formed on the left and on the right, through them along the uterine ribs, on both sides the turnstile cords are inserted from the elastic rubber tubes, they are not tightened and fixed with two clamps. Ovaries are removed proximally to the turnstiles, and the third round turn is made around the neck via the same openings at the neck level and fixed with a clamp. Then a transverse incision is made above the upper edge of the placenta and the fetus is removed. Or, with a high-lying upper edge of the placenta, the incision is transplacentary, the placenta is not separated, the umbilical cord is transected, and the turnstiles are tightened after removing the fetus in order to reduce blood loss. That is followed by excising the uterine wall in the area of the placenta with subsequent removal of the placenta from the uterus, followed by curettage of the uterine cavity and an intrauterine balloon. Defect of the uterus wall is closed with separate U-sutures with subsequent peritonization; after the uterine wall is closed, the tourniquet bundles are slowly removed and an intravenous infusion of 10 un. of oxytocin is applied, the wide ligament defects are closed, the wound of the anterior abdominal wall is closed tightly.EFFECT: method enables reducing uterine injuries, reducing the rate of complications and blood loss, reducing length of hospital stay and, as a result, reducing economic costs.1 cl, 2 ex Изобретение относится к медицине, а именно к акушерству и гинекологии. После проведения стандартной средне-нижне-срединной лапаротомии матку извлекают из брюшной полости и выполняют ультразвуковое исследование для определения верхнего края плаценты. Затем над верхним краем плаценты рассекают брюшину пузырно-маточной складки, мочевой пузырь низводят с прицельной коагуляцией сосудов. Обнажают переднюю поверхность шейки матки, в широких связках матки, на уровне перешейка формируют «окна» слева и справа, через них вдол