Vol 8, No 4 (2021)

Neonatal mortality and morbidity are substantial issues affecting the maternal healthcare sector. Extremely premature infants, notably those born before the 28-week mark, experience significant morbidity and mortality rates during neonatal care. This is a result of developmental immaturity and iatrogenic injury. Several attempts have been made to develop a womb-like environment to mimic uteroplacental physiology, but limited success has been noted over the last decade. This review aims to summarize the current literature on improved techniques implemented in creating an artificial placenta, the principles of these procedures, and their limitations. Our findings indicate that implementing techniques that closely mimic uteroplacental pathophysiology is crucial in decreasing the excessive neonatal mortality and morbidity rates seen in extremely premature infants.

The pelvic floor fascia in women has attracted the attention of obstetricians-gynecologists, proctologists and rehabilitologists due to their possible role in the development of pelvic organ prolapse and the appearance of pelvic pain. The development and improvement of new surgical techniques entails a comprehensive study of previously known approaches. For instance, regarding fascial tissues, studying the actual use of fascial flaps in plastic and reconstructive surgeries is of particular interest. This necessitates an accurate definition of and knowledge about structure of the fascia and their variations. In addition, knowledge of the fascial structure of surgical methods for treating prolapse, such as the installation of mesh prostheses in the reconstruction of the pelvic floor in the absence of alternative methods of correction. Primarily postoperative pain, a more in-depth study of the fascial anatomy of the pelvic floor can help reduce these adverse outcomes. The morphological and physiological characteristics of the perineal fascia presented in the teaching materials and teaching aids are not descriptive in nature and are far from the descriptive practice of obstetricians-gynecologists in the selection of methods for surgical correction of genital prolapse. This work is a literature review compiled from the sources of the electronic national bibliographic database of scientific citation of the Russian Science Citation Index and the English-language text database of medical and biological publications PubMed, created by the National Center for Biotechnological Information of the USA. To search for data, such key queries as “fascia”, “pelvic floor”, “pelvic floor anatomy”, “genitourinary diaphragm”, “chronic pelvic pain” were used, both individually and collectively.

BACKGROUND: Cesarean delivery is associated with prolonged hospitalization compared to spontaneous delivery and the risk of intra- and postoperative complications. The introduction of an accelerated recovery program after a planned cesarean section contributes to the rapid recovery of the patient by optimizing various elements of care.

AIM: To study the effect of the components of the accelerated recovery program on the severity of oxidative stress during abdominal delivery at different stages of the perioperative period.

MATERIALS AND METHODS: This was a comparative study assessing conformational changes in plasma proteins and erythrocytes in the blood of puerperal women using fluorescence spectroscopy. The study included 81 patients from the perinatal center of Makhachkala who underwent a planned cesarean section under spinal anesthesia. The enrolled women were grouped into the following: control group (n=38), in which perioperative period was traditionally managed, i.e. fasting for 8 h before the operation and introducing an antibiotic after clamping the umbilical cord. Within this group, blood sampling was conducted in all 38 patients at different intervals. In total, 152 samples of the material under study were obtained from control mothers. The 2nd group was the main (n=43) and included women in labor; in this group, perioperative period was managed using accelerated recovery program, by introducing the antibiotic cefazolin and with the intake of a glucose-containing drink 2 h before the operation. In total, 172 samples of the material under study were obtained from the mothers of the 2nd group. Methods for the pre-preparation of biological material and spectral methods of analysis were used in this study.

RESULTS: At all stages of preparation of delivery by cesarean section (CS) after spinal anesthesia, minor conformational changes occur in the blood plasma proteins, including umbilical cord blood. In the main group, antibiotic use an hour before delivery increased the oxidative degradation of blood plasma proteins. In the control group, a change in the structural-dynamic parameters of erythrocyte membrane proteins was observed, as indicated by the blue shift in the maximum fluorescence spectrum. This was not observed in the erythrocytes of the main group of puerperal women who received a glucose-containing drink.

CONCLUSION: According to total fluorescence data of plasma proteins and umbilical cord blood, it can be assumed that using a glucose-containing drink 2 hours before CS along with an antibiotic helps restore some parameters of the fluorescence of erythrocyte membrane proteins. The data obtained do not indicate any persistent pathological phenomena in mother’s body at all stages of preparation for CS delivery using spinal anesthesia against the background of antibiotic use.