Objective: to evaluate the results of treatment of patients after undergoing surgical hemostasis in obstetric hypotonic bleeding. Materials and methods: the 31 patients were examined, whose delivery was complicated by hypotonic uterine bleeding, and as a result, surgical hemostasis was performed in the amount of ligation of the ovarian and internal iliac artery. Anthropometric data were analyzed, as well as the dynamics of the results of laboratory and instrumental research methods before and after surgery. In the late postoperative period, the results of helical computed tomography (CT) under angiography conditions were evaluated in the period from 6 months to 5 years. Statistical processing was carried out using the IBM SPSS Statistics 25 program. Results: the age, anamnestic data, anatomical and physiological parameters of patients, terms of delivery and their outcome did not become predictors of developed hypotonic bleeding. Early postpartum bleeding was determined in 93,5% of cases. Extirpation of the uterus was performed in 9,7% of cases. The median blood loss was 1200,0 ml, blood loss of 45-50% of the BCC was determined in 19,4%, 35–45% of the BCC was also in 19,4%. The reduced level of erythrocytes persisted until the moment of discharge, and the reduced hemoglobin after the operation tended to increase. In the course of CT, in 100% of cases, defects in the contrasting of the internal iliac artery on both sides were determined. Collateral circulation was also developed in 100,0% of cases, despite the type of defect in the internal iliac artery. Conclusions: ligation of the ovarian and internal iliac artery is a reliable method of surgical hemostasis, which allows saving the uterus in 90,3% of cases. In the late postoperative period, all patients developed various degrees of arterial patency in the ligation zone, and collateral circulation developed on both sides.

The article presents a review of the literature on the problems of treatment of obstetric bleeding in the light of historical development and modern opportunities. Currently existing options for surgical hemostasis: ligation of pelvic vessels, ligation of internal iliac arteries, embolization of uterine arteries and compression sutures on the uterus are considered from the perspective of experimental work and clinical research. The paper reflects the opinions of domestic and foreign scientists, which were a vector for further study and experiments.

Today one of the main state tasks in the Russian Federation is to save people, which cannot be implemented without increasing the birth rate. Despite the fact that maternal mortality tends to decrease, bleeding remains one of the leading causes of death of women during pregnancy, childbirth and the postpartum period, so the fight against bleeding is one of the fundamental tasks in obstetric practice. The existing standards of step-by-step medical care for obstetric bleeding are successfully applied in practical health care, but the state of a woman’s reproductive function after the use of surgical hemostasis has not been sufficiently studied. This article presents an overview of a clinical case of reproductive function preservation in a 38-year-old woman after undergoing surgical hemostasis due to obstetric bleeding in the anamnesis.

Th e aim of the research. To evaluate the eff ectiveness of our proprietary developed compression suture on the uterus for stopping obstetric hypotonic bleeding. Material and methods. A retro- and prospective case-control study was carried out. The cohort of the examined patients (n=100) was divided into two groups: I – the patients with the original proprietary compression suturing (Patent No.2752549) (n=21); II – women with compression suturing applied according to A. Pereira et al. (n=79). Statistical data processing was performed using IBM SPSS Statistics 25 soft ware. Laboratory parameters, blood loss volume, the necessity of uterine extirpation, ligation of the ovarian and internal iliac arteries were compared. An echographic assessment of the uterus, uterine and ovarian vessels in the postoperative period was carried out. Results. The analysis has revealed the comparability of both groups in terms of the main indicators (age, height, weight, delivery time, results of clinical and laboratory examination). Th e necessity of ligation of the ovarian and internal iliac arteries was 4.8 % in group I and 11.4 % in group II. There were no cases of uterus removal in group I was while the percentage of extirpation in group II equalled 1.26 %. In group I, no blood loss amounting to 45-50 % of the CBV was found, while 6.3 % of group II patients had a blood loss equal to 45-50 % of the CBV. Echography in the postoperative period (from the 1st to the 7th day) showed adequate dynamics of uterus involution in all patients of both groups. Conclusion. Th erefore, the application of the proposed proprietary compression suture to the uterus during hypotonic bleeding is highly eff ective and is sufficient to stop bleeding in 95.2 % of the cases. There were no intraoperative or delayed complications in the postpartum period, which makes it possible to recommend the method for clinical use.