METHOD FOR TWO-LEVEL HEMOSTASIS DURING ORGANO-PRESERVING OPERATIVE DELIVERY IN PATIENTS WITH PLACENTA INGROWTH Russian patent published in 2017 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: after standard mid-lower-middle laparotomy, bottom Cesarean section is performed. The fetus is removed from the uterine cavity, the umbilical cord is crossed, then the uterine cavity is sutured, without extraction of the placenta. Further, free loops of the intestine are removed in the head direction and the uterus is removed into the wound. Aortic bifurcation and common iliac arteries are visualized subperitoneally. An arcuate abdominal incision is then performed at the site of the common iliac artery with using a dissector and a bipolar coagulator. The front and side walls of the common iliac arteries are exposed, the peritoneum of the vesicle-uterine fold is then dissected, the bladder is reduced with targeted vascular coagulation. The front surface of the cervix is exposed. The uterine cervix is stitched with a Vicrystal filament by a full-width 1/0 U-shaped suture in the anterior-posterior direction, to mark the healthy tissues boundaries, the filaments ends are fixed with a clamp. Further, in the wide ligament of the uterus, on the left and right, at the isthmus level, "windows" are formed, through which turnstile tourniquets from elastic rubber tubes are placed along the rib of the uterus, on the left and right, which are tightened and fixed by two clamps, with the ovaries withdrawn proximally to the turnstiles. Then the third turnstile is deirected through the same windows around the cervix, tightened at the cervix level and fixed with a clamp. After a preliminary intravenous injection of 2500 units of heparin into the common iliac arteries, direct vascular clamps are superimposed as closely as possible to the site of their departure from the aortic bifurcation. The uterine wall is excised in placenta ingrowth area, followed by placenta extraction from the uterine cavity. The uterine wall is sutured with separate U-shaped sutured followed by peritonization. After uterine walls suturing, the clamps are remobed from the common iliac arteries. Turnstile tourniquets are removed, broad ligament defects are sutured, if necessary, additional hemostasis is performed. Peritoneum is sutured above the vessels with a continuous suture. lower limb tissues oxygenation is monitored throughout the operation with a pulse oximeter located on the big toe. After clamps removal, pulsation is determined on the posterior tibial and anterior artery of the foot.

EFFECT: method allows to minimize the anatomical and functional damage of the operation, provide a lower volume of blood loss, perform organ-preserving delivery in pregnant women with placenta ingrowth with a possibility of reproductive function in the future.

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