RU174613U1 - Simulator-simulator for training in the conduct of intrauterine surgery for pathology of the posterior period - Google Patents

Abstract

The utility model relates to obstetrics and is intended to teach the intrauterine operation "manual separation of the placenta and the allocation of the placenta" with tight attachment of the placenta and subsequent bleeding. The proposed simulator simulator contains a transparent volume-retaining balloon that simulates the female uterus without converging its walls, hereinafter referred to as the “uterus model”, with a hole in it that simulates the external uterine pharynx, with a body imitating the placenta inside the model of the uterus, hereinafter referred to as the "placenta model"; the placenta model is equipped with a flexible tube simulating the umbilical cord extending from it, hereinafter referred to as the umbilical cord model; moreover, the shapes and sizes of the models of the uterus, placenta, umbilical cord, external uterine pharynx correspond to the shapes and sizes of the female uterus, placenta, umbilical cord, external uterine pharynx in the subsequent period; the detachable connection of the placenta model with the uterus model is such that it allows the placenta model to be separated from the wall of the uterus model with sawing movements of the hand entered inside the uterus model, wound beyond the edge of the placenta model, and the materials used to make the uterus and placenta models allow the aforementioned detachable connection to be made. The technical result of the claimed utility model is its property to provide the ability to demonstrate and control the intrauterine operation "manual separation of the placenta and the allocation of the placenta" with tight attachment of the placenta and subsequent bleeding.

Description

The utility model relates to obstetrics and is intended to teach the intrauterine operation "manual separation of the placenta and the allocation of the placenta" in the pathology of the posterior period, namely with tight attachment of the placenta and subsequent bleeding.

The placenta is an embryonic organ that forms during pregnancy and provides a connection between the mother and fetus. By the time of birth, the diameter of the placenta is 15-18 cm, its thickness is 2-3 cm.

In the placenta, two surfaces are distinguished: the maternal, adjacent to the uterine wall, and the opposite, the fruit

(http://medportal.ru/enc/procreation/physiology/2/).

The umbilical cord departs from the placenta - a cord-like formation in which two arteries and one vein pass, carrying blood from the fetus to the placenta and vice versa. The umbilical cord can attach to the placenta in the center (most often), on the side or on the edge. The length of the umbilical cord of a full-term fetus is on average 50-52 cm, diameter - 1.5-2 cm.

The subsequent period (3rd period of labor) begins from the moment of birth of the fetus and ends with the birth of the afterbirth; its average duration is 30 minutes. In the subsequent period, the independent separation of the placenta and membranes from the walls of the uterus and the expulsion of the exfoliated placenta by touching the woman in labor are normal (http://bono-esse.ru/blizzard/Aku/Rod/period_3.html).

One of the types of pathology that manifests itself in the subsequent period and is the cause of bleeding in women in labor can be an anomaly of the attachment of the placenta to the uterus, namely, tight attachment and rotation of the placenta. Tight attachment is the most common type of abnormality of attachment of the placenta, when the chorionic villi penetrate into the deep layers of the decidual membrane (into the basal layer).

Tight attachment of the placenta can be complete if the placenta is attached to its bed over the entire area, and partial if the placenta is attached only to any of its sites. In the first case, there is no spontaneous bleeding. In the second - with the onset of placental abruption, bleeding occurs, which can be very profuse.

Indications for the operation of manual separation of the placenta are:

- the absence of signs of separation of the placenta without bleeding 30 minutes after the birth of the baby;

- the absence of signs of separation of the placenta with the onset of bleeding, as soon as the blood loss reaches the volume of acceptable blood loss (0.5% of body weight).

Immediately after the birth of the baby, the cervix is open 10-12 cm and freely passes the wrist for the operation.

State of the art

There are a large number of models, dummies, mannequins that can be used for training in obstetrics.

1. Known simulator of a pregnant woman in full growth "NOELLE2", containing a simulator of a newborn with a placenta and umbilical cord, designed to acquire and practice full skills in the period before childbirth, during childbirth and after childbirth. The maternity simulator is equipped with a removable "cover" of the abdomen, it allows you to demonstrate placenta previa, the birth of the placenta.

When replacing the prenatal uterus with a postpartum one (included with the postpartum crotch), it is possible to simulate postpartum hemorrhage using a special device

(http://med-maneken.ru/shop.php?action=good&id=558).

In NOELLE2, a cavity that simulates a uterine cavity with a baby does not correspond to the shape and size of the uterus after the baby is born and significantly exceeds these sizes.

The solid, opaque “cover” of the abdomen of the woman in labor simulator does not allow students to demonstrate the fixation of the uterus with one hand and the surgical manipulations inside the cavity performed by the other hand of the doctor. The postpartum uterus, which is included in the NOELLE kit, is a sealed cavity without an entrance, which does not allow you to enter either the hand or the placenta with the umbilical cord into it and teach you how to manually remove the placenta and isolate the placenta.

In the description of "NOELLE2" there is no indication of the possibility of using this device or its parts for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta."

2. We offer for sale a multifunctional simulator, designed to develop delivery skills (http://czdor.ru/trenazhervi-simulyatoryi-dlya-otrabotki-navyikov/mnogofunkcionalnyij-trenazher-simulyator-dlya-otrabotki-navyikov-rodorazreshenija).

The simulator simulator consists of a pelvic cavity, a fetus (with an umbilical cord and a placenta), a model for examining the cervix (changes in the cervix before childbirth), a simulator for training and reinforcing dissection and stitching of the perineum, etc. The model allows simulation of cervical examination and delivery. Due to the presence of the umbilical cord and the placenta, one can practice the ligation of the umbilical cord and expulsion of the placenta. The model has a transparent front abdominal wall.

As indicated in the description of the device, the simulator consists of a pelvic cavity and other organs, but does not include a uterus model. The pelvic cavity does not have the shape and size of the uterus in the subsequent period. The shape of the placenta model does not imply its manual separation from the wall of the uterine model by sawing movements of the hand

In the description of this device there is no indication of the possibility of using this device or its parts for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta".

3. A known simulator for curettage of the uterine cavity (http://med-mod.ru/catalogue/show/jy-f-0022-prozrachnyy-simulyator-dlya-vy/).

The simulator has a solid, transparent body with visualization of the internal structure of the pelvis and is intended for the indicative manipulation (curettage). The simulator is characterized by a realistic structure of internal organs: uterus, fallopian tubes, ovaries, bladder, and ureters.

In connection with the appointment of this simulator, the uterus in it has dimensions typical for 6-7 weeks of pregnancy, but not for the subsequent period, it does not contain a placenta with an umbilical cord.

4. A gynecological phantom “ZOE” was developed (http://www. virtumed.ru/cat/zoe.html).

The phantom contains a life-size female torso, has a realistic external structure and internal anatomical structures and landmarks, and allows the replacement of dummies of the uterus and neck with a screw-on design. The “ZOE” phantom kit includes, in particular, those who gave birth to the uterus, a pregnant uterus for a period of 10 weeks, and a postpartum uterus.

The phantom does not contain the placenta with the umbilical cord. A transparent anterior wall of the uterus is present only in those who have given birth to the uterus in the long term after delivery. The postpartum uterus is not transparent, and the size of the entrance to the cavity of the postpartum uterus is small and does not allow the hand to enter.

In the description of this device there is no indication of the possibility of its use for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta."

5. Known dummy of the uterus 10 minutes after birth - a spare part for the aforementioned gynecological simulator ZOE W45043 / 1005797 (https://www.3bscientific.ru/mater- through-10-min- after- rod-1017715-s5045,p_895_27332. html).

The model is an opaque balloon with a wide entrance into it, simulating an extended uterine pharynx after childbirth. There is no placenta with an umbilical cord.

In the description of the device there is no indication of the possibility of its use for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta."

6. Known "simulator-uterus" according to US patent No. 3766666. The device is a flexible hand-sized copy of the female uterus and is partially transparent to provide visual observation of the simulated process of intrauterine manipulations.

The device is intended for training medical personnel in the introduction of an intrauterine contraceptive device in women, as a result of which its shape corresponds to the shape of the uterus outside pregnancy and childbirth and does not correspond to its shape in the subsequent period.

The simulator does not have a placenta with an umbilical cord; it is impossible to insert a hand into the uterine cavity due to the small size of the entrance to it.

This device is not intended for training in intrauterine operations "manual separation of the placenta and the allocation of the placenta."

7. The F31 simulator is manufactured and offered for sale for testing the skills of examination of the uterine fundus (http://www.spb-maneken.ru/katalog/f31-trenazher-dlya-otrabotki-navykov-obsledovaniya-dna-matki-2.html) .

The simulator demonstrates normal physiological changes in a woman’s body after childbirth; allows you to conduct studies of the height of the bottom of the postpartum uterus and the development of massage skills.

The simulator contains the following interchangeable models of the uterus: the normal uterus, the postpartum uterus an hour after birth, the postpartum uterus on the second day, the postpartum uterus in the second week, and so on.

Uterus models are not transparent. There is no indication of the contents of the placenta with the umbilical cord. The product description does not contain information about the possibility of using the simulator for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta."

Disclosure of a useful divide

The technical result of the claimed utility model, which manifests itself in its use, is the property of the proposed utility model to provide the ability to demonstrate and control the intrauterine operation "manual separation of the placenta and the separation of the placenta" in the pathology of the posterior period, namely with tight attachment of the placenta and subsequent bleeding.

In the prior art, no devices having the same purpose as the proposed utility model have been identified. Realizations of the same purpose by the above-described devices are hindered by one or more of the following reasons:

1. the absence of the uterus with dimensions and shape corresponding to the subsequent period,

2. lack of a placenta with an umbilical cord,

3. opaque walls of the uterus,

4. the impossibility of introducing the hand into the uterine cavity due to the lack of entry into the uterus or its small size

5. the absence of an indication that the placenta is connected to the uterine wall with the possibility of its detachment by sawing movements of four fingers and the edges of the wrist.

The proposed simulator simulator for teaching the intrauterine operation "manual separation of the placenta and the allocation of the placenta" in the pathology of the posterior period, namely with tight attachment of the placenta, which is a model (phantom, dummy, simulator, simulator, mockup, simulator, simulator, simulator ) of the female uterus in the subsequent period with the placenta with the umbilical cord not detached from it (tightly attached), contains a transparent balloon (i.e., non-decaying) balloon (vessel, capacity, together the body), which imitates the female uterus without bringing its walls closer together, hereinafter referred to as the “uterus model”, with a hole in it that simulates the external uterine pharynx, with the body impervious to the placenta inside the uterus model, hereinafter referred to as the “placenta model” ; the placenta model is equipped with a flexible tube simulating the umbilical cord extending from it, hereinafter referred to as the umbilical cord model; moreover, the shapes and sizes of the models of the uterus, placenta, umbilical cord, external uterine pharynx correspond to the shapes and sizes of the female uterus, placenta, umbilical cord, external uterine pharynx in the subsequent period; the detachable connection of the placenta model with the uterus model is such that it allows the placenta model to be separated from the wall of the uterus model with sawing movements of the hand entered inside the uterus model, wound beyond the edge of the placenta model, and the materials used to make the uterus and placenta models allow the aforementioned detachable connection to be made.

In vivo, the uterus after the birth of the child before the placenta is in the form of a truncated ellipsoid or ovoid, the front and rear walls of the uterus are brought together under pressure from neighboring organs, but the proposed utility model does not take into account the proximity of the walls of the uterus, which was done for the convenience of demonstrating the operation "manual separation of the placenta and the allocation of the afterbirth. "

The model of the uterus is made in a form close to a truncated ovoid (ovoid) or ellipsoid, where the secant plane is the plane passing through the external uterine pharynx. The longitudinal size of the model of the uterus is 15-20 cm, the largest transverse size is 12-13 cm.

The hole in the model of the uterus, simulating the external uterine pharynx, has a shape close to a circle with a diameter of 10-12 cm.

Under natural conditions, the shape of the maternal surface of the placenta after it is expelled from the uterus has a different shape, in particular a shape close to a circle with a diameter of 15-18 cm and an area of 175-260 cm ² or to an oval with similar dimensions.

The distance between the farthest points of the placenta model, measured along its maternal surface, is 15-18 cm, the thickness of the placenta model (except for the edges where it decreases) is about 2 cm. The successive contracted uterus gives the shape of the shallow bowl that does not separate from the placenta. not necessarily symmetrical.

The placenta model has a similar form, i.e. the maternal surface of the placenta model is performed in the form of the inner surface of that segment of the uterine model with which the placenta is connected. The thickness of the placenta model along the edge is reduced, the edges are rounded and lag behind the wall of the uterus model, which allows you to insert a rib and / or four fingers of the hand beyond the edge of the placenta model to separate it.

The umbilical cord model is permanently attached to the center of the placenta model or to its lateral part or at a distance of 2-3 cm from the edge of the placenta.

The umbilical cord model has a diameter of 1.5-2 cm and a length of 50-52 cm. It can be made of transparent or opaque material. If it is made transparent, then three tubes imitating blood vessels are placed inside it: two are red, imitating arteries, and one is blue, imitating a vein.

Models of the uterus, placenta, umbilical cord can be made of elastic materials, such as elastic silicone, rubber, polyvinyl chloride (PVC), etc. The model of the uterus and umbilical cord can be made of transparent elastic silicone, rubber, PVC and similar materials, the placenta model, except Moreover, from elastic silicone rubber, sponge rubber, elastic polyurethane foam.

The detachable connection of the placenta model with the wall of the uterus model can be carried out using a contact self-adhesive Velcro tape (containing a loop tape and a hook tape), molded according to the surfaces to be connected; with the help of several small elastic suction cups, directly connected to the mother side of the placenta model; using cylindrical pins with rounded apices made on the maternal side of the placenta model, tightly inserted into the corresponding holes or cylindrical fossa with a rounded entrance to the wall of the uterus model (like a baby pin mosaic) and other methods known from the technique, taking into account the materials, of which models of the uterus and placenta are performed. The detachable connection of the models of the placenta and the uterus is made with the possibility of repeated separation and connection of the models of the placenta and the uterus.

The connection of the placenta model with the wall of the uterus model can be carried out over the entire area of the maternal side of the placenta model or only part of it, simulating the full or partial tight attachment of the placenta, therefore devices (means) for connecting the placenta and uterus models can be located on the entire maternal surface of the placenta model ( except for rounded thinner edges) or only on its part.

In the following description of the use of the proposed utility model, i.e. the description of the demonstration of the operation “manual separation of the placenta and separation of the placenta”, for the training of which the utility model is intended, for convenience of presentation, the expressions “uterus”, “placenta”, “umbilical cord” will be used to designate respectively the “uterus model”, “placenta model”, "Umbilical cord models."

When learning the operation "manual separation of the placenta and the allocation of the placenta", the uterus is fixed in the pelvic cavity of the dummy-simulator of the puerpera or on a plane, for example with adhesive tape. The uterus is fixed with one hand, the second hand in the position of the obstetrician’s hand is inserted along the umbilical cord into the uterus to the place of attachment of the umbilical cord to the placenta, the edge of the placenta is found, the edge and / or four fingers of the hand go beyond the rounded edge of the placenta between it and the uterine wall. Sawing movements of the hands of the hand separate the placenta from the inner surface of the uterus. After complete separation of the placenta with the hand inside the uterus, move the placenta to the exit from the uterus, and with the other hand located outside, pull it by the umbilical cord and remove it from the uterus.

The hand located in the uterine cavity is not removed, but the internal walls and uterine cavity are examined. The purpose of the examination in vivo is to verify the integrity of the walls of the uterus, to remove the remnants of the placenta and blood clots. Consistently, the wrist bypasses all the walls of the uterus from the inside, imitating an examination of its internal walls, collecting together lingering pieces of placenta tissue, parietal clots, membranes and removing them together with the hand from the uterus.

Utility Model Examples

Example 1

The model of the uterus with a wall thickness of 3 mm is made of elastic transparent silicone and has a shape close to a truncated ellipsoid, with a longitudinal size of 15 cm, a transverse size of 12 cm, a hole diameter of 10 cm. A model of an umbilical cord in the form of a tube 1.5 cm in diameter, 50 in length cm is also made of elastic transparent silicone; inside it are three tubes simulating blood vessels: two are red, imitating arteries, and one is blue, imitating a vein. The placenta model 2 cm thick, except for the rounded edges, is made of sponge silicone. The umbilical cord and placenta models are connected by glue for bonding silicone products.

The maternal side of the placenta model has a shape (curvature) corresponding to the shape of the inner surface of the uterus model segment (to which the placenta model will be connected), which is formed when the uterus model is cut with a plane perpendicular to the longitudinal axis of the uterus model and located from its top (center of the bottom of the uterus model) at a distance of 7.5 cm, measured on the inner surface of the uterus, i.e. the placenta model is located in the area of the bottom of the uterus model.

The detachable connection of the placenta model with the wall of the uterus model is carried out using contact adhesive tape, molded respectively to the connected surfaces; at the same time, the hook tape is glued to the mother surface of the placenta model, except for its rounded edges, and looped - to the corresponding part of the inner surface of the uterus model.

Example 2

The uterus model is made of transparent rubber 5 mm thick and has a shape close to a truncated ovoid, with a longitudinal size of 20 cm, the largest transverse size of 13 cm, a hole diameter of 11 cm. The umbilical cord model in the form of a tube 2 cm in diameter, 52 cm long, is also made of transparent rubber. Inside it are three tubes that simulate blood vessels: two are red and one is blue. The rubber placenta model has a thickness of 2 cm, rounded edges. The umbilical cord and placenta models are connected by glue for gluing a rubber product.

The maternal side of the placenta model is in the form of a segment of the uterus model, formed as follows. On a curved line on the inner surface of the uterus model, formed when it is cut by a plane passing through the longitudinal axis of the uterus, 16 cm is plotted in one direction from the center of the uterus model bottom. The maternal side of the placenta model has the form of a uterus model segment formed by a plane perpendicular to the above plane (passing through the longitudinal axis of the uterus model), as well as through the center of the bottom of the uterus model and through a point of 16 cm.

The placenta model is disconnected from the uterine model wall using cylindrical pins with rounded ends from the material of the placenta model, i.e. made of rubber. The diameter of the pins is 3 mm, the height is 4 mm. The pins are made on the maternal surface of the placenta model and inserted into the corresponding holes or pits in the wall of the model of the uterus with a diameter of 2.9 mm, having a rounded entrance.

Example 3

The models of the uterus and umbilical cord are made of transparent PVC. The placenta model is made of flexible polyurethane foam (foam), has a thickness of 2 cm, rounded edges. The umbilical cord model has the dimensions indicated in example 1; umbilical cord and placenta are connected by glue.

The maternal side of the placenta model is in the form of a segment of the uterus model, formed as follows. 3 cm to one side from the center of the bottom of the model of the uterus and 13 cm to the other side are plotted along a curve line formed on the inner surface of the uterus model when it is cut by a plane passing through the longitudinal axis of the uterus. The maternal side of the placenta model has the form of a segment of the uterus model formed by a plane perpendicular to the above plane passing through the longitudinal axis of the uterus model, as well as through points of 3 and 13 cm, i.e. the placenta model is located on the upper lateral part of the inner surface of the uterus model.

A detachable connection of the placenta model with the wall of the uterus model was performed as in example 1, except that contact adhesive tape was applied only to part of the maternal surface of the placenta, a pair of it was applied to the corresponding part of the inner surface of the uterus model.

Example 4 is similar to example 1, except that the mother surface of the placenta model made of elastic silicone is equipped with ten silicone suction cups 1 cm in diameter connected to it, the centers of which are projected onto a circle with a radius of 5.5 cm (the radius is measured from the center of the model placenta), four suction cups whose centers are projected onto a circle with a radius of 3 cm, and one in the center of the placenta model.

Claims (19)

     1. A simulator for teaching the intrauterine operation "manual separation of the placenta and the separation of the placenta" with tight attachment of the placenta, which is a model of the female uterus in the subsequent period with the placenta with the umbilical cord not separated from it, contains a transparent balloon that imitates the female uterus without rapprochement of its walls, hereinafter referred to as the "model of the uterus", with a hole in it that mimics the external uterine pharynx; with the body inside the uterus that is detachably connected to it, simulating a placenta, hereinafter referred to as the “placenta model”; the placenta model is equipped with a flexible tube simulating the umbilical cord extending from it, hereinafter referred to as the umbilical cord model; moreover, the shapes and sizes of the models of the uterus, placenta, umbilical cord, external uterine pharynx correspond to the shapes and sizes of the female uterus, placenta, umbilical cord, external uterine pharynx in the subsequent period; the detachable connection of the placenta model with the uterus model is such that it allows the placenta model to be separated from the wall of the uterus model with sawing movements of the hand entered inside the uterus model, wound beyond the edge of the placenta model, and the materials used to make the uterus and placenta models allow the aforementioned detachable connection to be made. 2. The simulator simulator according to claim 1, characterized in that the uterus model has a shape close to a truncated ovoid. 3. The simulator simulator according to claim 1, characterized in that the uterus model has a shape close to a truncated ellipsoid. 4. The simulator simulator according to claim 1, characterized in that the longitudinal size of the model of the uterus is 15-20 cm, the largest transverse size is 12-13 cm. 5. The simulator simulator according to claim 1, characterized in that the opening in the model of the uterus simulating the external uterine pharynx has a shape close to a circle with a diameter of 10-12 cm. 6. The simulator simulator according to claim 1, characterized in that the maternal surface of the placenta model is performed in the form of the inner surface of that segment of the uterine model with which the placenta is connected; the edges of the placenta model are rounded. 7. The simulator simulator according to claim 1, characterized in that the distance between the most distant points of the placenta model, measured along its maternal surface, is 15-18 cm, the thickness of the placenta model, except for its edges, is about 2 cm. 8. The simulator simulator according to claim 1, characterized in that the umbilical cord model is permanently attached to the center of the placenta model. 9. The simulator simulator according to claim 1, characterized in that the diameter of the umbilical cord model is 1.5-2 cm, the length is 50-52 cm. 10. The simulator simulator according to claim 1, characterized in that the models of the uterus, placenta, umbilical cord are made of elastic materials. 11. The simulator simulator according to claim 1, characterized in that the models of the uterus, placenta, umbilical cord are made of elastic silicone, rubber, PVC, etc. 12. The simulator simulator according to claim 1, characterized in that the models of the uterus and umbilical cord are made of elastic transparent silicone, rubber, and PVC. 13. The simulator simulator according to claim 1, characterized in that three tubes simulating blood vessels pass through the transparent model of the umbilical cord: two are red, imitating arteries, and one is blue, imitating a vein. 14. The simulator simulator according to claim 1, characterized in that the placenta model is made of elastic silicone rubber, spongy rubber, flexible polyurethane foam. 15. The simulator simulator according to claim 1, characterized in that the detachable connection of the placenta model with the wall of the uterus model is carried out using a contact adhesive tape. 16. The simulator simulator according to claim 1, characterized in that the detachable connection of the placenta model with the wall of the uterus model is carried out using elastic suction cups on the maternal side of the placenta model. 17. The simulator simulator according to claim 1, characterized in that the detachable connection of the placenta model with the wall of the uterus model is carried out using cylindrical pins with rounded peaks on the maternal side of the placenta model, which are tightly inserted into the holes or pits with a round entrance in the model wall uterus. 18. The simulator simulator according to claim 1, characterized in that the means for connecting the models of the placenta and the uterus are located on the entire maternal surface of the placenta model, except for its rounded edges. 19. The simulator simulator according to claim 1, characterized in that the means for connecting the models of the placenta and the uterus are located on the part of the mother surface of the placenta model.