{'fraction_non_alphanumeric': 0.025781501772478246, 'fraction_numerical': 0.012998173810291115, 'mean_word_length': 5.033700583279326, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Comparative analysis of neonatal complications after cesarean section to M

The urgency of the problem lies in the large proportion of premature babies in the structure of perinatal morbidity and mortality. According to the WHO, the frequency of premature birth in the world varies widely from 4.5% to 16% [1, 2, 5]. It is known that for premature infants, children with congenital malformations in the presence of obstetric indications is more careful surgical delivery [4, 5]. Therefore, the improvement of the technique of abdominal delivery in premature birth and congenital malformations of the fetus creates a certain additional reserve for improving


Background
Despite the increase in the frequency of operative delivery, the incidence and early neonatal mortality of newborns do not tend to decrease [1,2,4,5,10]. The perinatal mortality rate in Ukraine remains without positive changes and in 2018 amounted to 7.0 %%. Urgent caesarean section 2 -3 times more often than planned surgery, hypoxic conditions, respiratory disorders and intraventricular hemorrhage in newborns [3,4,6]. The frequency and severity of hypoxic -ischemic, hemorrhagic CNS injuries in premature infants born by cesarean section, in the early neonatal period is 1.5 -2 times lower than in natural childbirth [1,3,5,9].
The urgency of the problem lies in the large proportion of premature babies in the structure of perinatal morbidity and mortality. According to the WHO, the frequency of premature birth in the world varies widely -from 4.5% to 16% [1,2,5]. Therefore, the improvement of the technique of abdominal delivery in premature birth and congenital malformations of the fetus creates a certain additional reserve for improving perinatal outcomes.

Objectives
To carry out a comparative analysis of the features of the early neonatal period and the frequency of neonatal complications in premature birth and congenital malformations of the fetus after the method to M. Stark and modified method of cesarean section to improve perinatal outcomes.

Materials and methods
To solve this goal, a comparative analysis of 35 histories of premature birth, the birth of which was carried out in the abdominal way. The method of operative delivery used in the study is a modification of the classical method of cesarean section by M. Stark, using several new technical approaches [2], which are aimed at improving certain perinatal parameters.
The main difference between abdominal delivery at the stage of fetal retrieval in the presented modified method is the birth of children weighing less than 1500 g in the whole amniotic sac. In cases of birth of children in the early stages of gestation up to 30 weeks, with pelvic presentation of the fetus, infants with congenital malformations, was performed corporal incision on the uterus for more careful removal. In addition, a multidisciplinary organizational approach was used for children with congenital malformations. The modified caesarean section was performed in the hospital of the children's hospital of the III level in order to provide the newborn with the highest possible highly qualified assistance of related specialists. In the study, the condition of newborns was assessed on the Apgar scale at 1 and 5 minutes of life and the Ballard scale. In two clinical groups, the choice of analgesia was made individually, taking into account the condition of the mother and fetus, the planned operation and indications for cesarean section.
The comparative analysis of clinical-anamnestic and possible preoperative predictors testified to the representativeness of both clinical groups (Table 1). Gestational age in patients of both study groups ranged widely from 28 to 35 weeks, but the average duration of pregnancy was 32.1 ± 3.06 weeks, with no statistically significant difference between the comparison groups (p> 0.05%). calculations and the differences were considered statistically significant if the probability of the null hypothesis (pH0) was equal to or less than 0.05%.

Results and discussion
The The literature widely discusses the birth of infants in the whole fetal bladder [1,5,9].
This method of cesarean section, in which it is proposed to dissect the uterus in layers to the amniotic sac, while maintaining its integrity, was primarily developed to reduce intraoperative blood loss and the risk of damage to the fetus with a scalpel, which occurs in 0.1 -3.1% of the total cesarean section [4, 5,9]. Subsequently, this technique was used to give birth to HIVinfected women to prevent contact of the child with the mother's blood [2,9]. Krasnopolsky believe that the whole amnion when removing children with critical and low body weight serves as a natural water reservoir, which helps to minimize mechanical and barometric trauma of the newborn, improve the overall condition.
Various scales (Ballard, Silverman) are used to assess the condition of infants at birth, but the easiest way to determine the category of children in need of resuscitation, more indepth attention of neonatologists or the appointment of additional methods of examination is the Apgar scale [2,4,5]. The results of our study show that almost 90% of newborns in the main study group were removed in a condition that is oriented closer to satisfactory (table 2).
The average score for the Apgar school was 6 points. In the comparison group, about 40% of infants were born in a state of moderate severity (p = 0.022), needed oxygen support, stay in the intensive care unit and further treatment in level III institutions. The absence of newborns in satisfactory condition (Apgar score of 7 points or more per 1 minute of life) in both groups of the study is most likely due to the short gestational age.
After all, such children are born with impaired respiratory functions and are less able to adapt to changing environments. We assume that due to the use of technically advanced stages of evidenced by the results of our previous study [2]. This is especially true in an emergency situation, when the baby needs a quick removal and further assistance from a neonatologist.
In the conditions of deeply premature pregnancy, pregnancies with congenital malformations of the fetus, we consider it rational to perform a corporal incision on the uterus during a cesarean section Wide access, in addition to accelerating the removal of the affected fetus, helps to minimize trauma to the baby at birth, improves its overall condition in the early neonatal period, as evidenced by comparative data (table 2) However, the decrease in the frequency of neurological disorders and morbidity in infants did not affect the decrease in early neonatal mortality (p = 0.223). It should be noted that the case of early neonatal mortality of a newborn with VVR in the main group of the study (diaphragmatic hernia of the II fetus in monochorionic, monoamnitic twins) was inevitable.
Ultrasound revealed a lack of diaphragm by more than 50%, aplasia of the left lung.
In The decision on the method of delivery in such cases is made by the prenatal council consisting of: obstetrician-gynecologist, neonatologist, ultrasound doctor, surgeon, other related specialists to determine the optimal time and method of delivery, further management of the newborn.
Today, most obstetric hospitals in the country lack technical equipment and specialized specialists, which makes it impossible to provide quality diagnosis and emergency surgical care to newborns with congenital malformations. Therefore, in three cases it was decided to perform a modified cesarean section in the hospital of the regional children's hospital. This allows you to coordinate around the newborn with congenital malformations specialists in obstetrics and pediatrics, thereby increasing the chances of favorable consequences for the baby.
The newborn is referred to neonatologists and related specialists with a clear diagnosis, necessary examinations and a preliminary treatment plan, which is adjusted in the dynamics. In the study, all infants with congenital malformations were born in a satisfactory condition with an Apgar score of 6 and 7 points at 1 and 5 minutes of age. After a comprehensive examination and additional examination successfully operated on the firstsecond day after birth. In our opinion, in order to improve the perinatal consequences, in some selected cases it is advisable to perform a modified caesarean section in the walls of a children's hospital, with a corporal incision in the uterus and removal of premature infants in the entire fetal bladder. However, these studies require further, more extensive and in-depth analysis.

Conclusions
The proposed modified method of cesarean section, namely an improved method of entering the abdominal cavity, performing a corporal incision in the uterus, the birth of premature babies in the entire fetal bladder improves the overall condition of newborns according to the Apgar score at 1 and 5 minutes (p = 0.05 ), accompanied by a decrease in the incidence of CNS CIP (p = 0.022), reduces the need for treatment of newborns at III level (p = 0.004), which may be an additional reserve in improving perinatal outcomes in preterm birth and congenital malformations.

Conflict of interest.
The authors argue that there is no conflict of interest.