Prospects For The Rehabilitation Of Women Under Cesarian Section
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 3, Pages 4385-4398
AbstractOne of the popular methods of surgical birth is the cesarean section, which replaced the obstetric forceps, which were widely used in the last century. In modern obstetrics, it is most often used for delivery in complicated pregnancy and childbirth [1,3,5]. The frequency of operative delivery in our country is about 23% of all deliveries. According to reports for 2010-2018. there is an increase in the number of births (from 5100 to 5897 per year), as well as an increase in women with a scar on the uterus (from 568 to 618 cases), with women with one scar prevailing. The overwhelming majority of women with operative delivery were from rural areas. Primiparas averaged 8.7%. During pregnancy, from 68% to 77.2% of women had various extragenital diseases such as obesity, myopia, chronic pyelonephritis, chronic gastritis, anemia, hypertensive neurocirculatory dystonia, arterial hypertension, hydronephrosis, varicose veins. In more than 90% of cases, childbirth ended with a repeated cesarean section with excision of the postoperative scar, and only 7.7-8.7% of women with one full-fledged scar on the uterus gave birth through the vaginal birth canal. The main indications for a cesarean section were: a scar on the uterus, inconsistency of a postoperative scar, a combination of a scar on the uterus with obstetric pathology, and a combination of a scar on the uterus with extragenital pathology. 87.4-90.2% of operations were carried out in a planned manner and an emergency - in 9.7-12.6%. Based on the combination of the above data, the purpose of our study was to assess the viability of the postoperative scar in women who underwent cesarean section and to develop the optimal tactics for delivery, as well as rehabilitation in the postoperative period. The object of the study was 100 women from 18 to 40 years old with one scar on the uterus who had undergone a cesarean section. The patients were divided into 2 groups: the main group (35 patients) and the comparison group (65 patients). The study used general clinical studies (general blood test, general urine analysis, smear on flora), laboratory research methods (assessment of the state of hemostasis, immunohistochemical study, detection of matrix metalloproteinases (MMP 9) in the blood, biochemical blood test, determination of the level of vitamin B6 and copper in the blood, instrumental methods (ultrasound, elastography of myometrial tissues). The obtained data were subjected to automated statistical processing.
For the rehabilitation of patients, magnetotherapy and ultrasound therapy were used from the early postoperative period. The rehabilitation procedures after the course were repeated after 6 months. Based on the results of the data, an assessment was made of the viability after an operation scar, its effect on further reproductive function, and the life of women in general. And also the results of the effectiveness of early rehabilitation of women.
Keywords: postoperative scar, cesarean section, scar failure, rehabilitation of women, ultrasound therapy, magnetotherapy.
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