[OBESITY AS A RISK FACTOR FOR MASSIVE POSTPARTUM HEMORRHAGE.]

INTRODUCTION: No mat analysis devoted to the study of obstetric hemorrhage due to obesity has not yet been carried out. Publications of the results of major studies on the subject have appeared recently. Only the multivariate analysis will make a reasonable conclusion about the causes that affect the outcome and assess the extent of the simultaneous influence on him of often interrelated reasons. THE AIM: To estimate the signficance of obesity as an independent risk factor for serious obstetric haemorrhage. MATERIALS AND METHODS: A retrospective cohort study ofpregnancy and childbirth outcomes of 24634 women in childbirth. Depending on the initial body mass index (BM) of the patients were allocated two groups: basic - 2140 obese women with control - 17937 patients with an initial BW of 18.5 to 24.9 kg / m2. In order to determine the significance of obesity as a riskfactor of massive blood loss midwife performed multivariate statistical analysis, including cluster analysis, multiple correlation, linear and non-linear regression, statistical quality control using control charts. RESULTS: Hypotension uterus has been a major factor in the development of massive blood loss. For the implementation of hypotonic uterine bleeding was necessary set of conditions, interacting with other causal factors affecting the outcome. The minimum combination of these factors is the combination of "obesity" + "somatic pathology" + "induction of labor," in which the OR of postpartum hemorrhage was 8,57 [CI 95% 6,13-36,28], p < 0.001. It is also significant risk factors were fetal macrosomia, multiple pregnancy, abdominal method of delivery, the degree of obesity, the method of anesthesia and duration of the operation. OR to define obesity as an isolated risk factor for the implementation of massive blood loss was 1.18 [95% CI: 0,78-1,27], p > 0.05. DISCUSSION: The impact of obesity as an isolated causes massive obstetric hemorrhage was minimal, but is powerful potentiating factor in the outcome. CONCLUSION: Analysis of the causes of complications in childbirth did not confirm the possibility of considering obesity as an independent risk factor for massive blood loss.

[Amniotic fluid embolism as a cause of maternal death].

This article reports the case of death of a puerperal woman resulting from amniotic fluid embolism. The diagnosis was established based on the results of the pathohistological study that revealed the presence of mucoproteides and epithelial scales in pulmonary blood vessels and capillaries.