METHOD OF PREVENTION OF POSTPARTUM HEMORRHAGE DURING CAESAREAN SECTION IN HIGH-RISK PATIENTS (PLACENTA PREVIA, FAILURE OF THE UTERINE SCAR) Russian patent published in 2023 - IPC A61B17/42 A61M25/10 A61M3/00 A61K38/95 A61P15/00 

FIELD: medicine, obstetrics and operative gynecology.

SUBSTANCE: preoperative installation of an intravaginally vaginal module is performed, during a caesarean section, the placenta is removed by pulling on the umbilical cord, a manual revision of the walls of the uterus is performed, a retrograde insertion through a hysterotomy incision into the cervical canal of the plug guide and the open end of the uterine catheter is attached with the guide being advanced along with the catheter through the cervical canal into vagina before placing the balloon in the uterine cavity and its contact with the fundus of the uterus. The vaginal catheter is filled with an isotonic NaCl solution, carbetocin is administered intravenously at a dose of 100 μg, a purse-string suture is applied using absorbable braided threads with a diameter of 0.1–1 with a curved piercing-cutting needle 45 to 48 mm long from both sides along the outer surface of the uterus in the lower segment uterus parallel to the hysterotomy incision through 2/3 of the myometrium — figuratively, without capturing the endometrium, without penetration into the uterine cavity with simultaneous tightening of the ligatures to avoid asymmetry. The hysterotomy incision is sutured with a two-row continuous suture with synthetic absorbable suture material. The conductor is disconnected from the catheter. The axial tube of the vaginal catheter is passed through the cervix into the vagina to connect the tubes of the uterine and vaginal balloon catheters. Fill the uterine balloon catheter with warm saline NaCl.

EFFECT: method allows to perform local formation of compression hemostasis in the region of the lower uterine segment with low placentation, placenta previa, reduces the risk of intraoperative blood loss, minimizes the risks of ligature eruption on thinned tissues of the lower segment, avoids deformation of the lower segment, since it is superimposed symmetrically, without the risk of ischemic damage to the myometrium, does not affects the blood flow in large vessels supplying the myometrium, does not require special surgical skills, and is easily reproducible.

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