Introduction:The aim of study was to analyze two pregnancies, deliveries and puerperal periods in a woman who had experienced bilateral lower limb amputation, pelvic bone fracture and severe injury of the urinary tract and reproductive organs. Case report: At the age of 4 she was the victim of a traffic accident, getting squashed by a trolley car, which caused crush wounds to both lower limbs and extensive perineal injury. Surgical intervention consisted of bilateral lower limb amputation at the level of the coxofemoral joint, and suturing of the torn vagina and rectum, with a temporary artificial anus formed from the sigmoid colon. Subsequent reconstructive surgery made spontaneous and well-controlled urination and defecation possible. The severe bodily injury experienced in the early life of the patient caused irreversible physical disability, accompanied, obviously, by psychological trauma. Despite this, at the age of 42, the patient decided to procreate. The first pregnancy was complicated by hyperthyroidism. Delivery by caesarean section was performed in the 31st week of gestation because of the premature rupture of membranes. Before delivery the patient was given a standard course of corticosteroids to accelerate foetal maturation. The second pregnancy was complicated not only by hyperthyroidism, but also by recurrent tachycardia and gestational diabetes mellitus. The patient received a standard dose of corticosteroids in the 32nd week of gestation. Caesarean section was performed in the 36th week of gestation because of spontaneous labour onset. During both pregnancies no neurologic abnormalities were found in the patient. She was able to asses foetal movements and uterine activity adequately, which made ambulatory perinatal care possible. The reconstructive surgery of the urinary and digestive tract that the patient underwent in her childhood was not only a strong risk factor for operative delivery complications, but also because changes in anatomy and the potential presence of adhesions could have affected the pregnancy course itself. Keywords: delivery; lower limbs amputation; pregnancy; traffic accident. ABSTRAKT Wstęp:Celem pracy było przedstawienie przebiegu ciąż, porodów i połogu u 42-letniej pacjentki, która w dzieciństwie przebyła obustronną wysoką amputację kończyn dolnych, złamanie kości miednicy oraz uszkodzenie układu moczowo-płciowego. Opis przypadku: Pacjentka w 4. r.ż. uległa wypadkowi tramwajowemu, doznając zmiażdżenia obu kończyn dolnych oraz rozległego urazu krocza. Dokonano wówczas obustronnej amputacji ud w stawach biodrowych. Rozerwaną pochwę i odbytnicę zaopatrzono chirurgiczne, wytworzono sztuczny odbyt na okrężnicy esowatej. Po licznych operacjach rekonstrukcyjnych pacjentka mogła samoistnie oddawać mocz i stolec, kontrolując potrzeby fizjologiczne. Pierwsza ciąża powikłana była nadczynnością tarczycy. Ciążę ukończono drogą cięcia cesarskiego w 31. tyg. z powodu przedwczesnego pęknięcia błon płodowych po przeprowadzeniu sterydoterapii. Kolejna ciąża pacjentki powikłana by...

Objectives: The aim of this study was to compare the costs of using carbetocin in the prevention of uterine atony following delivery of the infant by Caesarean section (C-section) under epidural or spinal anesthesia with standard methods of prevention (SMP). Material and methods:This retrospective multicenter study was based on data from three medical centers. A questionnaire was developed to gather patient records on consumption and costs of resources related to C-section, prevention of uterine atony and postpartum hemorrhage (PPH) treatment. Six subpopulations were considered, depending on patient characteristics. The analysis covered two perspectives: that of the hospital and of the public payer.Results: The subpopulations were homogenous, which was a premise for pooling the data. The use of carbetocin in the prevention of uterine atony following Caesarean section generates savings for hospital in comparison with SMP (oxytocin) in 5 of 6 subpopulations. The biggest savings were observed amongst patients who experienced severe PPH and reached 2.6-6.2 thousand PLN per patient. Costs of services related to C-section borne by the hospitals were higher than the refund received from a public payer. The greatest underestimation reached 12.1 thousand PLN per patient. Nevertheless, loss generated by this underfunding was lower in carbetocin versus oxytocin group. Conclusions:The use of carbetocin instead of SMP gives hospitals an opportunity to make savings as well as to reduce losses resulting from the underfunding of the services provided by the National Health Fund.

cervicitis, bacterial vaginosis) according to the current official clinical protocols for the ambulatory gynecological care in Ukraine (Decree of the MOH No.417 dd 15.07.2011). Hormonal drugs were prescribed in 20% cases: norethisterone (Table 5 mg) -$16,5, medroxyprogesterone (susp. for injection 150 mg/ml) -$21,8, levonorgestrel releasing intrauterine system (LNG-IUS) -$87, dienogest (Table 2 mg) -$111, 7. The average cost of herbal medicines along with the recommendation of long-term monitoring was $26,7 in 30% of patients. Other patients were treated symptomatically with antibiotics, antiprotozoal medicines for an average 10 days (jozamycin, clindamicin+clotrymazol, ciprofloxacin+ornidazole, doxycycline). ConClusions: Accessibility and usability of patients'electronic databases provides a dataset for healthcare system stakeholders to make rational and evidence-based decisions about whether a particular treatment should be approved or reimbursed on the local and national level.

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