[Management of pregnancy and labor in obese women].
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Biomedical subjects
Publications and source records attributed to E A Chernukha.
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The diagnostic system of cardiotocogram analysis in real time scale is described, and the diagnostic data of computer cardiotocography in various periods of os dilatation presented. Analysis of correlations and regressions of the parameters reflecting disorders of the fetal status has shown that the most significant parameter in the diagnosis of fetal status abnormalities is variability from beat to beat.
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The authors suggest that the coefficient, representing the ratio between the sizes of the small pelvis section and fetal head section, be used for the prediction of labor outcome for the fetus in women with a contracted pelvis. When the coefficient values K1-K4 were lower than 1.32, 1.35, 0.68, and 0.79, more than 90% of the newborns developed signs of cerebral circulation disorders, this prompting the use of cesarean section for this group of pregnant women. Timely correction of the policy of labor management with due consideration for the anatomical features of the pelvis helped reduce the perinatal mortality in multigravidae to 5/1000, mainly at the expense of carrying out planned cesarean section and monitoring in labor.
Cardiotocograms were studied in 40 women during timely labor with the use of Nedezhda MKP-01 fetal monitor with real-time automated processing of the following parameters: fetal basal heart beat rate, amplitude and length of decelerated heart beat rate, amplitude and frequency of oscillations of heart beat rate, time of delayed deceleration minimum with respect to the peak of a uterine contraction. Developing acute fetal hypoxia was detected in 3 cases, that permitted timely abdominal deliveries to preserve the fetuses. The described device was found highly informative and valuable.
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A distinct evolution of surgical delivery has been demonstrated over the past 35 years. In the past decade, the proportion of surgical deliveries has grown considerably owing to the increasing rate of cesarean sections. In most cases, the operation is performed for combined indications and, quite frequently, for the sake of the fetus. Perinatal parameters have improved while there has been no clear-cut correlation between the increasing rate of cesarean section and declining perinatal mortality. Further development of rational labor management principles is necessary.