In modern obstetrics, the issue of postpartum hemorrhage prevention is extremely relevant, especially among patients with repeated cesarean section, who are at high risk of complications. The objective: analysis of the use of various preventive approaches to the prevention of postpartum hemorrhage in patients with repeated cesarean section. Materials and methods. The study involved 60 patients with at least one previous surgical delivery in history. The study participants were divided into two groups of 30 women each. The gestational age of pregnant women was 37–40 weeks. We considered medical approaches (uterotonics), surgical (compression sutures, balloon tamponade, etc.), and, interestingly, we looked separately at RENIS as a risk assessment tool even before the onset of labor. Results. During the study, it was found that personalized tactics (especially using RENIS) demonstrated better indicators: less blood loss, fewer transfusions, and generally a calmer postoperative period. In our opinion, this approach is worth including in clinical practice. Postpartum hemorrhage is one of those complications that, it seems, have been known to us for a long time, but they still turn out to be unpredictable in clinical practice. This is especially true for repeated cesarean sections. Here the situation takes on a different scale: we are dealing not only with surgical intervention, but with a patient who already has a surgical history, often with changes in the structure of the myometrium and the risk of complicated placental attachment. For its part, this requires a different approach. Not just «according to the protocol», but taking into account every nuance: how much time has passed since the previous birth, what the scar looks like, what complications have been in the past. That is, we are talking about clinical thinking that begins not in the operating room, but long before it. And, importantly, often it is prevention that becomes the key to avoiding critical situations. Conclusions. The results of the study indicate the importance of an individualized approach to the prevention of postpartum hemorrhage, where the choice of method should be based on a comprehensive assessment of risk factors and the general condition of the patient. The proposed algorithms of preventive actions demonstrate a positive effect on reducing the frequency of hemorrhagic complications and improving overall treatment outcomes. The study has practical significance for optimizing the tactics of repeated cesarean section and increasing the safety of motherhood.
Serhii I. Akhrameev (Mon,) studied this question.