INDICATIONS TO PLANNED SURGICAL TREAT-MENT OF PRIMARY SYMPTOMATIC CHRONIC DISEASE OF THE LOWER EXTREMITIES VEINS, THE EXTERNAL GENITALIA, THE PERINEUM IN PREG-NANT WOMEN

Purpose. To develop and implement strictly individualized indications for safe, both for mother and child, planned surgical treatment of pregnant women with primary symptomatic chronic vein disease (PSCVD) in a short-term stay in an obstetric hospit-al. Materials and methods of study. On the basis of the PF "Regional Perinatal Center" of Rivne Regional Council for the period from 2013-2018, 256 pregnant women with PSCVD C2s-C4s,Ep,Аs,p.Pr (CEAP, 2002) were operated. All operated pregnant women were performed duplex scans of veins with cartography of pathological zones (refluxes, varicose conglom-erates), cardiotocography (CTG), fetometry (FM), both before and after surgery. Results of the study and their discussion. The surgi-cal interventions were performed only with the consent of the pregnant women, in case of any contraindications to surgical intervention, both from the somatic and obstetric statuses in the conditions of the obstetrical in-patient department. All surgical interventions were carried out without premedication. In 100% of pregnant women during surgery, in the postoperative period violations of the somatic status, uterine tone in pregnant women, the heartbeat of the fetus (data of CTG, FM) have not been recorded. Indications for planned surgical intervention: in 246 pregnant women (69,10 %) - an increase in the phenomena of chronic venous insufficiency of the lower extremities, external genital organs, the perineum despite conservative therapy; in 84 patients (23,60 %) for the purpose of preparing maternity paths for natural childbirth with varicose veins of the external genitalia and the perineum, to reduce the risk of bleeding in the event of a possible rupture of varicose nodes and narrowing the indications to surgical delivery; in 26 patients (7,30 %), according to their wishes, the reduction of cosmetic problems caused by varicose veins of the external genital organs and / or the open parts of the lower extremities. According to the subjective evaluation of pregnant women, violations of the quantity and quality of fetal movements have not been noted. In 98% of cases the positive clinical outcome of surgical intervention was recorded. Operated in the II-nd and at the beginning of the III-rd trimesters, 85% were within 24 hours, 10% for 48 hours in the hospital, after that they were discharged under supervision of obstetrician-gynecologist at place of residence, 5% of operated women at the end of the III-rd trimester stayed in the hospital until childbirth. Concslusions. One of the main indications to planned intervention is the absence of a positive result from the con-servative therapy of the PSCVD of the lower extremities, the perineum, the external genitalia and the inguinal canal with the progression of the increase of clinical manifestations of the disease; cosmetic deficiencies of the external genitalia and on the open parts of the lower extremities; preparation of maternal passage for safe delivery by natural way. Operative intervention was carried out in a planned manner in a specialized obstetrical institution according to strictly individualized indications, taking into account the state of a pregnant woman, fetus, venous hemo-dynamics. It is 100% safe for both the mother and the fetus according to the data of objective investigation.