A.A. KHASANOV^1, 4, I.S. RAGINOV^2, 4, L.E. TEREGULOVA^3, 4, A.YU. TEREGULOV^3, 4, M.B. LISINA⁴, M.R. SIRAZEEVA³

 ¹Kazan State Medical University, Kazan

²Kazan Federal University, Kazan

³Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan

⁴Republic Clinical Hospital, Kazan

 Contact details:

Khasanov A.A. — MD, Professor of the Department of Obstetrics and Gynecology named after Prof. V. S. Gruzdev, Chief Specialist, Chief Researcher

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-917-239-15-00, e-mail: albirkhasanov@mail.ru

The article presents the data on subfascial hematomas observed after Pfanennstiel incisions. The frequency of hematomas increases in patients with the new coronavirus infection. The latest interim guidelines «Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19) version 15 (02.22.2022)» indicate the need for «an emergency abdominal delivery (caesarean section) taking into account all measures for the prevention of coagulopathic and hypotonic obstetric bleeding». However, no specification is given as to which technique for performing a caesarean section should be followed or with what operational access should laparotomy of the anterior abdominal wall be carried out.

Given the authors’ own experience, he authors believe that under the COVID-19 the incision of the anterior abdominal wall should be carried out according to Joel-Cohan method, as less traumatic and more rapid, with less post-operation complications. Methods for diagnosing and treating hematomas are proposed, using highly selective angiography and embolization of damaged vessels. A clinical observation is presented as an example.

Key words: pandemic of NCI, Pfannenstiel incision, subfascial hematoma, X-ray endovascular embolization, Joel — Cohen incision.

REFERENCES

1. Belokrinitskaya T.E., Shapovalov K.G. Gripp i beremennost‘ [Flu and pregnancy]. Moscow: GEOTAR-Media, 2015. 144 p.
2. Diriba K., Awulachew E., Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res., 2020yu, vol. 25 (1), p. 39. doi: 10.1186/s40001-020- 00439-w PMID: 32887660; PMCID:PMC7471638.
3. Astley Paston Cooper. Lectures on Surgery, Hernia, 182
4. Gui B., Danza F.M., Valentini A.l. Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings. Diagn Interv Radiol., 2016, vol. 22 (6), pp. 534–541.
5. Tinelli A. Post-Cesarean Section Hemorrage Treated by a Collagen Patch Coatedwith the Human Coagulation Factors. J Clinic Case Reports, 2011, vol. 1, pp. 12-14. DOI: 10.4172/2165-7920.1000e103
6. Rodgers S.K., Kirby C.L., Smith R.J., Horrow M.M. Imaging after cesarean delivery: acute and chronic complications. Radiographics, 2012, vol. 32, pp. 1693–1712. DOI: 10.1148/rg.326125516
7. Sierra A., Burrel M., Sebastia C. et al. Utility of multidetector CT in severe postpartum hemorrhage. Radiographics, 2012, vol. 32, pp. 1463–1481. DOI: 10.1148/rg.325115113
8. Parazzini F., Bortolus R., Mauri P.A., Favilli A., Gerli S., Ferrazzi E. Delivery in pregnant women infected with SARS-CoV-2: A fast review. Int J Gynaecol Obstet, 2020, vol. 150, pp. 41–60.
9. Perioperative management for cesarean section in COVID-19 patients. Bali Journal of Anesthesiology, 2020, vol. 4 (5), p. 13.
10. Brown C.E., Dunn D.H., Harrell R., Setiawan H., Cunningham F.G. Computed tomography for evaluation of puerperal infections. Surg Gynecol Obstet, 1991, vol. 172, pp. 285–289.
11. Flávio C.H., Rudolph O.K. Morphometry and Frequency of the Pyramidalis Muscle in Adult Humans: A Pyramidalis Muscle’s. Anatomical Analysis, Clinics. Sao Paulo, 2020. Rr. 23–25.
12. Lovering R.M., Anderson L.D. Architecture and fiber type of the pyramidalis muscle. Anat Sci Int, 2008, yu, vol. 83 (4), pp. 294–297.
13. Rosa F. Imaging findings of cesarean delivery complications: cesarean scar disease and much mor. Insights into Imaging, 2019, vol. 10, rr. 98–107.
14. Deep and superficial inferior epigastric artery perforator flaps, available at: https//i0.wp.com/plasticsurgerykey.com/wp
15. Kamaya A., Ro K., Benedetti N.J., Chang P.L. Imaging and diagnosis of postpartum complications: sonography and other imaging modalities. Ultrasound Q, 2009, vol. 25, rr. 151–162.
16. Lee S.M., Shin J.H., Shim J.J. et al. Post-partum haemorrhage due to genital tract injury after vaginal delivery: Safety and efficacy of transcatheter arterial embolisation. Eur Radiol., 2018, vol. 28, pp. 4800–4809.
17. Olyaeemanesh A., Bavandpour E., Mobinizadeh M. Comparison of the Joel — Cohen-based technique and the transverse Pfannenstiel for caesarean section for safety and effectiveness: A systematic review and meta-analysis, 2017, r. 45.
18. Shyama Prasad Saha. A randomized comparative study on modified Joel-Cohen incision versus Pfannenstiel incision for cesarean section. Journal of the Turkish German Gynecology Association, vol. 14 (1), pp. 28–34. DOI: 10.5152/jtgga.2013.07
19. Koreyba K.A., Ibatullin I.A. Topographic and anatomical substantiation of the introduction of trocars during endoscopic operations in abdominal surgery. KMZh, 2003, vol. 84, no. 5, pp. 360–362 (in Russ.).