On May 3, 2024, on Good Friday, an unusual caesarean section was performed at the Kyiv Regional Perinatal Center (hereinafter referred to as the Center) with an upper-middle laparotomy (above the navel), which was associated with obesity in the pregnant woman, severe subcutaneous edema fatty tissue of the lower abdomen, which made it impossible to perform a cesarean section in the lower uterine segment.
Pregnant L., 30, was urgently hospitalized on May 1, 2024. from one of the districts of the Kyiv region - diagnosis: pregnancy I-a 37 weeks. Transverse position of the fetus. Severe preeclampsia on the background of chronic arterial hypertension (CAH). Insufficiency of the mitral valve. Retinal angiopathy of both eyes. Metabolic syndrome, IV-degree obesity (body weight - 165 kg), generalized edema. In the intensive care unit of the Center, a clinical and laboratory examination was carried out, specialized specialists (cardiologist, therapist) consulted, and therapy for chronic obstructive pulmonary disease and combined preeclampsia was prescribed.
A conference was held in the composition of the medical director of the Center, head Department of Obstetrics and Gynecology No. 1 of Shupyk National Healthcare University of Ukraine, heads of departments, specialized consultants (M. Amosov Institute of Pediatrics, O. Lukyanova Research Institute of Pediatrics, Obstetrics and Gynecology).
According to the conclusion of the council, in connection with severe preeclampsia against the background of CABG and the transverse position of the fetus 3.05, an upper-middle laparotomy was performed (in this part of the abdomen, the thickness of the subcutaneous fatty tissue was up to 15 cm), cesarean section at the bottom of the uterus with uterine ligation vessels and drainage of the abdominal cavity and subcutaneous adipose tissue. A live full-term girl weighing 3900.0 g and d - 56 cm with an Apgar score of 7-8 points was removed. Total blood loss – 570.0 ml.
The coordinated work of the entire team of medical workers of the Perinatal Center, the intensive care unit and the correct and timely method of giving birth to such a complex patient with spinal analgesia (in this case, too, had its own difficulties, given the pronounced obesity) made it possible to prevent severe complications both from the mother's side and and a newborn.
Many thanks to all those involved in the success of this event!
The third day after cesarean section ends. Removed drains. The general condition of the mother and newborn is satisfactory. She continues to stay in the postpartum department of the Center in the joint ward.