Cesarean section is the most common delivery operation in modern obstetrics, which prevents the development of severe complications for the mother and fetus. The increasing frequency of cesarean section observed in recent years is one of the problems of modern obstetrics. Raising the incidence of caesarean section higher than 15 % is not recommended by the Ministry of Health Care of Ukraine and the World Health Organisation because it does not affect the reduction of perinatal morbidity and mortality among children born by caesarean section compared to those born naturally. Abdominal delivery leads to an increase in the number of postpartum complications and impaired adaptive capacity of the newborn baby. Material and methods. After analyzing the abdominal delivery in the maternity ward of the Poltava City Clinical Maternity Hospital over the last 10 years, we found out that the incidence of caesarean sections increased from 14.6 % in 2008 to 19.9 % in 2017, reflecting global trends in obstetrics and meeting average statistics across Ukraine. It is noteworthy that the number of planned operations is growing and the number of urgent operations is reducing over recent five years. Results and discussion. Analyzing perinatal mortality for the period from 2008 to 2018, this indicator is more than tripled (from 10.7 % in 2008 to 3.5 % in 2018). Reviewing the experience of perinatal losses and considering the level of caesarean sections, we can conclude that there is a relationship between an increase in the frequency of abdominal delivery and a decrease in perinatal losses. Although there is a decrease in perinatal mortality with an increase in the incidence of Cesarean section, one should not forget the high risk of obstetric and anesthesiologic complications both during surgery and in the postoperative period. Thus, it can be argued that the most significant indications for carrying out a planned caesarean section are a scar on the uterus and breech position of the fetus, and for urgent caesarean section – fetal distress in the absence of conditions for rapid delivery through natural genital tract, anomalies of birth defects and anomalies of childbirth. Therefore, the above indications remain the potential to be influenced to reduce the frequency of caesarean section. Prevention of the first operation is essential. It is important to standardize the obstetric care in addressing the issue of cesarean section optimization, as well as the social and legal protection of the obstetrician-gynecologist. Conclusion. Analysis of cases of abdominal delivery, its structure according to indications, and assessment of the effect of cesarean section frequency on perinatal losses in the Poltava City Clinical Maternity Hospital revealed ways to reduce the frequency of caesarean section.

Keywords: pregnancy, caesarean section, perinatal mortality, obstetric complications

Full text: PDF (Ukr) 200K

1. Alieva EN, Kulbaeva SN. Kesarevo sechenie – rezervy snizheniya chastity. Vestnik KazNMU. 2015; 4: 5-6. [Russian]
2. Borshcheva AA, Pertseva GM. Kesarevo sechenie kak odin iz metodov rodorazresheniya. Valeologiya. 2015; 3: 36-41. [Russian]
3. Ventskovskii BM. Nekotorye disskusionnye voprosy kesareva secheniya. Zb nauk pracz Asociaciyi akusheriv-ginekologiv Ukrayiny. Kyiv; 2010: 40-3. [Russian]
4. Ventskіvskii BM, Vіtrenko DV. Osoblivostі perebіgu pіslyaoperatsіinogo perіodu u zhіnok zalezhno vіd metodu abdomіnal'nogo rozrodzhennya. Zdorove zhenschinyi. 2014; 2: 92-6. [Ukrainian]
5. Vdovichenko YuP, Shlapak ІM. Povtornii kesarіv roztin: dіagnostika і profіlaktika perinatalnoї patologії, vіdnovlennya reproduktivnogo zdorovya. Zdorov’e zhenschinyi, 2015. 3(99): 153-5. [Ukrainian]
6. Gazazyan MG, Adzhieva DN, Sarukhanov VM. Novye podkhody k vedeniyu perioperatsionnogo perioda pri kesarevom sechenii. Kurskii nauchno-prakticheskii vestnik «Chelovek i ego zdorov'e». 2015; 3: 5-10. [Russian]
7. Gojda NG. Stan reproduktyvnogo zdorovya naselennya Ukrayiny na mezhi tysyacholitj. Zhurn prakt likarya. 2012; 5: 2-6. [Ukrainian]
8. Gor’kovaya IA, Miklyaeva AV, Korgozha MA. Dinamika kachestva zhizni zhenshchin posle rozhdeniya rebenka v zavisimosti ot tipa rodorazresheniya. ANI: pedagogika i psikhologiya. 2016; 4(17): 324-7. [Russian]
9. El'tsov-Strelkov VI, Goldina AYa. Kesarevo sechenie v sovremennom akusherstve: Metodicheskie rekomendatsii. M; 2009. 27 s. [Russian]
10. Sarbasova AE, Sinchikhin SP, Mamiev OB, Dzhumanova ZD, Karnaukh MM. Kesarevo sechenie v sovremennom akusherstve: epidemiologiya, znachenie dlya preduprezhdeniya akusherskoi i perinatal'noi patologii, oslozhneniya. Astrakhanskii meditsinskii zhurnal. 2016; 2: 57-63. [Russian]
11. Krasnopol'skii VI, Radzinskii VE. Kesarevo sechenie. K: Zdorov`ya; 2011. 268 s. [Russian]
12. Markaryan NM, Golikova TP, Esipova LN. Kesarevo sechenie. Nereshennye voprosy. Vestnik RUDN. Seriya Meditsina. 2016; 2: 143-9. [Russian]
13. Osnovy reproduktivnoi meditsiny: Prakt Rukovodstvo. Ed by VK Chaika. Donetsk: Al'mateo; 2011. S. 275–321. [Russian]
14. Shilova SD, Zamara II, Lobachevskaya OS, Goncharevich MM. Perinatal'nye aspekty i chastota operatsii kesareva secheniya. Okhrana materinstva i detstva. 2017; 2(30): 59-61. [Russian]
15. Rudzevich AYu, Kukarskaya II, Fil'gus TA. Otsenka chastoty kesareva secheniya po klassifikatsii Robsona. Sovremennye problemy nauki i obrazovaniya. 2017; 6. Available from: http: //www.science-education.ru/ru/article/view?id=27171 [Russian]
16. Hehir MP, Ananth CV, Siddiq Z, Flood K, Friedman AM, D’Alton ME. Cesarean delivery in the United States 2005 through 2014: a population-based analysis using the Robson 10-Group Classification System. Am J Obstet Gynecol. 2018; 219(1): 105.e1–11. https://www.ncbi.nlm.nih.gov/pubmed/29655965. https://doi.org/10.1016/j.ajog.2018.04.012
17. Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol. 2013; 25(6): 456–61. https://www.ncbi.nlm.nih.gov/pubmed/22011956. https://doi.org/10.1097/GCO.0b013e32834cef0c
18. Paul RH, Miller D.A. Cesarean birth: how to reduce the rate. Am J Obstet Gynecol. 2015; 172(6): 1903–11. https://doi.org/10.1016/0002-9378(95)91430-7
19. Tanaka K, Mahomed K. The Ten-Group Robson Classification: a single centre approach identifying strategies to optimise caesarean section rates. Obstet Gynecol Int. 2017; 2017: 5648938. https://doi.org/10.1155/2017/5648938
20. WHO statement on caesarean section rates. 2015.