inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2500-0268-2019-16-4-6-11inovmed-222Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОпыт применения экстракорпоральной мембранной оксигенации в акушерстве и гинекологииExperience of extracorporeal membrane oxygenation in obstetrics and gynecologyhttps://orcid.org/0000-0002-7211-1071СкопецА. А.SkopetsA. A.

Скопец Александр Алексеевич – к. м. н., заведующий отделением анестезиологии и реанимации № 2; доцент кафедры анестезиологии, реаниматологии и трансфузиологии ФПК и ППС

350086, Краснодар, ул. 1 Мая, 167

Skopets Alexander A. – Cand. of Sci. (Med.), Head of Аnaesthesiology and Resuscitation Department no. 2; Assoсiate Professor of the Department for Аnaesthesiology, Reanimation and Transfusion with advanced training

350086, Krasnodar, 1st May str., 167

alskop1961@mail.ruНаучно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского Министерства здравоохранения Краснодарского края; Кубанский государственный медицинский университет Министерства здравоохранения РФРоссияScientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1; Kuban State Medical UniversityRussian Federation20193012201904611Copyright © Скопец А.А., 20192019Скопец А.А.Skopets A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/222Цели

Цели. Все чаще экстракорпоральная мембранная оксигенация (ЭКМО) используется при тяжелой сердечной и легочной недостаточности у гинекологических больных, беременных женщин и пациенток в послеродовом периоде. Важно отметить, что клинические результаты применения методики и особенности ведения такой категории больных оценены недостаточно глубоко. Это исследование представляет опыт применения технологии ЭКМО у пациенток гинекологического и акушерского профиля в перипартальном периоде.

Методы

Методы. В исследование были включены гинекологические больные, беременные женщины и пациентки в послеродовом периоде, получавшие поддержку с помощью ЭКМО в отделении анестезиологии и реанимации c 1 ноября 2009 г. по 1 сентября 2019 г. Данные проанализированы ретроспективно. Предварительная задача состояла в том, чтобы охарактеризовать обстоятельства и клинические характеристики пациентов, получавших ЭКМО; описать их ведение во время беременности, при родах и в послеродовом периоде; оценить результаты лечения матерей и плодов и сообщить о кровотечениях и тромботических осложнениях.

Результаты

Результаты. За период исследования с помощью ЭКМО было пролечено 7 пациенток акушерско-гинекологического профиля. Среди них – 2 беременные, 4 – послеродовые и 1 – гинекологическая. Средний возраст составил 27,0 лет, средний гестационный срок беременности – 27,5 недель. Пять пациенток (71,4%) были выписаны из лечебного учреждения с полным выздоровлением. Фетальная выживаемость в группе беременных и послеродовых женщин составила 5 (80,8%). Одна пациентка успешно родила с использованием ЭКМО. Геморрагические осложнения развились у 3 человек (42,8%) и были вызваны диссеминированным внутрисосудистым свертыванием. Никаких осложнений у плода, связанных с ЭКМО, не было.

Выводы

Выводы. При работе мультидисциплинарной команды опытных специалистов технология ЭКМО может быть использована в гинекологии, у беременных и женщин в послеродовом периоде, перевешивая риски кровотечений или тромбозов, с благоприятными результатами для матери и плода. 

Objectives

Objectives. In severe cardiac and pulmonary insufficiency extracorporeal membrane oxygenation (ECMO) is increasingly used in gynecological, pregnant and postpartum patients, although the management of such patients and clinical results remain underestimated. This study presents the experience of ECMO in gynecological and obstetric patients in the peripartal period.

Methods

Methods. This study included all obstetric, pregnant or postpartum patients who received ECMO support in the Department of anesthesiology and intensive care unit between 1 November 2009 and 1 September 2019. The data were analyzed retrospectively. The preliminary task was to describe the circumstances and clinical characteristics of patients receiving ECMO, describe the management of such patients during pregnancy, childbirth and the postpartum period, evaluate the results of treatment of mothers and fetuses and report bleeding and thrombotic complications.

Results

Results. During the study period, seven obstetric and gynecological patients were treated with ECMO. Including two pregnant, 4 postpartum and 1 gynecological. The mean age was 27.0 years and the average gestational age of pregnant women was 27.5 weeks. Five patients (71.4%) were discharged from the hospital with full recovery. The fetal survival rate in the group of pregnant and postpartum 85 was 5 (80.8%). One patient was successfully delivered to ECMO. Hemorrhagic complications developed in 3 patients (42.8%) and were associated with disseminated intravascular coagulation. There were no complications in the fetus associated with ECMO.

Summary

Summary. In the work of a multidisciplinary team of experienced specialists ECMO can be used in gynecology, in pregnant women and in the postpartum period, outweighing the risks of bleeding or thrombosis, with favorable results for the mother and fetus. 

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The authors declare that there are no conflicts of interest present.