RU180154U1 - OBSTETRIC PESSARY - Google Patents

Abstract

The utility model relates to obstetric pessaries and can be used in the treatment of pregnant women with ischemic-cervical insufficiency and in pregnant women with a habitual miscarriage in history, and can also be used in non-pregnant women suffering from prolapse and prolapse of the pelvic organs, omission of the uterus , stress urinary incontinence, women suffering from prolapse and prolapse of the pelvic organs, prolapse of the uterus, urinary incontinence. The technical result of the utility model is the elimination of problems with distortion and displacement of the pessary inside the vagina while maintaining all the advantages of the prototype. The claimed technical result is achieved due to the fact that the obstetric pessary, made in the form of a ring of silicone, containing recesses located at an equal interval from the edges of the ring and the bulge inside the ring, facing the inner side of the central hole of the ring, the recesses being located opposite the bulges, recesses and bulges made with a symmetric arrangement, characterized in that it contains rounded protrusions located at an equal interval, mounted on the outer surface of the ring Glenn portions and extending in a direction along its axis so that the projections do not reach the edges of the recesses.

Description

The utility model relates to obstetric pessaries and can be used in the treatment of pregnant women with ischemic-cervical insufficiency and in pregnant women with a habitual miscarriage in history, and can also be used in non-pregnant women suffering from prolapse and prolapse of the pelvic organs, omission of the uterus stress urinary incontinence.

The problem of miscarriage is of great medical and social importance, first of all, due to the fact that an unfavorable outcome of pregnancy causes severe psychoemotional trauma to parents.

Despite the successes achieved in the prevention and treatment of threatening abortion and its usual loss, the frequency of spontaneous miscarriages remains stable and quite high. So, according to different authors, it ranges from 2% to 55%, reaching 50% in the first trimester.

The causes of miscarriage are numerous and varied. Among the causes of miscarriage are genetic, anatomical, endocrine, infectious, immunological and thrombophilic factors. About 15% of women with habitual miscarriage had anomalies in the anatomical structure of the uterus as the main cause. These anomalies can be divided into 3 categories:

- Violations of the normal process of fusion of the rudiments of the uterus (anomalies of the Muller duct),

- Violations of the size or blood supply to the uterus due to mimoma, endometrial polyps or connective tissue (Asherman's syndrome),

- Cervical dysfunction.

Anatomical changes in the genital organs include infantilism (underdevelopment of the uterus), malformations of the uterus, isthmic-cervical insufficiency, traumatic injuries of the uterus during abortion and childbirth, and various tumors (uterine fibroids). A common cause of premature birth is isthmic-cervical insufficiency - a condition in which premature cervical dilatation occurs.

uterus in pregnant women and, as a consequence, premature birth. There are various methods of treating this pathology — tocolysis, suturing the cervix (cerclage), devices that mechanically support the insolvent cervix. During pregnancy, with the progression of the opening of the cervical canal, the cervix is shortened and softened, the fetal membranes protrude into the enlarged cervical canal, and as a result, the physiological support for the fetal egg is deprived, infection and opening of the fetal membranes, the birth of the fetus from the uterine cavity. To prevent the development of the above complications, you can use the installation of an unloading medical pessary, which is inserted into the vaginal cavity and set in a certain physiological position. The mechanism of action of the pessary is to "close" the cervix by the elastic walls of the inner central opening of the pessary and prevent further disclosure of the cervix, as well as partial transfer of intrauterine pressure to the anterior wall of the uterus.

In recent years, more and more women are turning to doctors about a rather serious disease - omission and prolapse of the pelvic organs. Often, pelvic prolapse is accompanied by urinary incontinence with tension, sneezing, coughing and weight lifting, i.e. stressful type. The prolapse of the genitals in the early stages is characterized by a protrusion of the posterior or anterior walls of the vagina, often both walls, which is accompanied by a number of unpleasant sensations and leads to many problems in various aspects of the quality of life, including in the sexual and social spheres.

This disease occurs in women mainly after 40 years, but it also occurs in young, nulliparous women (2%). The main role in the occurrence of the disease is played by the violation of synergism of the muscles of the pelvic floor, anterior abdominal wall, diaphragm, perineal tears in childbirth, damage and stretching of the muscles of the pelvic floor, congenital or acquired disorders in the innervation processes.

Often, along with the anterior wall of the vagina, the bladder descends, and the prolapse and prolapse of the posterior wall of the vagina leads to the prolapse of the anterior wall of the rectum. As a result of this, urinary incontinence occurs during exertion (coughing, lifting weights), involuntary emission of gases, constipation.

The problem of urinary incontinence includes three factors: medical, social and environmental. One in four women in the world suffers from urinary incontinence. Every eleventh woman in the world is operated on for omission of the genitals and urinary incontinence. Of these, 30% of women are operated repeatedly.

Among conservative tactics for treating pelvic dysfunctions in women, urogynecological pessaries are widely known.

There are supporting pessaries (ring, cup-shaped, etc.) and pessaries filling the internal space (cube, inflatable, mushroom-shaped, etc.). A study of the existing varieties of pessaries and uterine rings revealed a number of shortcomings in their design and upcoming complications in their use. The most common of these is the occurrence of pain and loss of pessaries inserted into the vagina. This is primarily due to the uncomfortable form of the pessary, poor-quality material from which it is made. The appearance of abundant vaginal discharge and the formation of ulcers on the cervix is also associated with the quality of the material used, its density, the possibility of infection and partial chemical decomposition. Infringement, fistulas, urinary or intestinal obstruction are the result of the unsuccessful form of pessaries, increased density of materials used, strong elasticity and deformation during prolonged use. In addition, existing pessaries do not take into account such factors as a wide sexual gap, a short vaginal length, a combination of vaginal prolapse and stress urinary incontinence. The disadvantage of existing uterine pessaries is the difficulty of their introduction by women themselves, especially in old age. All this makes us look for new forms of pessaries and new materials for their manufacture. This problem is solved by the presented new types of pessaries. The implementation of new models of obstetric-urogynecological pessaries allows to facilitate the insertion of the pessary into the vagina, its correct installation, the creation of additional ways of the outflow of the vaginal discharge, the reduction of the area of contact of the pessary from the mucous wall of the vagina, the facilitation of the removal of the pessary and retention of the uterus, bladder and vagina, fixation of the urethral angle in the correct anatomical and physiological position and prevents the disclosure of the cervix in the presence of pregnancy at periods of 12 to 39 weeks.

Known pessary "Juno" [http://medfarm.org/katalog/akusherstvo-i-ginekologiya/pessarij-matochnyj-yunona], made in the form of a ring located at the edges of the cup with a Central hole, and containing holes for the outflow of vaginal discharge perimeter of the central hole. The Juno uterine pessary is made of inert plastic and is used for the conservative correction of the prolapse and prolapse of the female genital organs.

The disadvantage of this pessary is the lack of the ability to fix the urethrovesical angle in the correct anatomical and physiological position, insufficiently effective outflow of the vaginal discharge, the complexity and inconvenience of extracting the pessary from the vagina.

Known obstetric pessary, made in the form of a ring of silicone, characterized in that it contains at least two cutouts from the edges of the ring and at least two bulges in the inner side of the Central hole of the ring (patent RU 142309 U, publ.: 06/27/2014).

The technical problem of the known solution is the periodic mowing of the pessary during the movements of a woman, the consequence of which is its subsequent loss.

The closest analogue is the obstetric pessary of Dr. Schneiderman [http://intimestetik.ru/glavnaya/product/akusherskiye-pessarii-doktora-shneydermana#shop2-tabs-2; published: 05.17.2017], which is intended for the treatment of pregnant women, support of the cervix in patients with additional complaints of prolapse (painful pressure "down" in the standing position and when walking), pregnant women who are prone to physical exertion (for example, which have to stand for a long time), with increased intrauterine pressure, for example, during repeated pregnancies or when ultrasound detects signs of cervical insufficiency.

In the prototype, the obstetric pessary is made in the form of a silicone ring, contains recesses located at an equal interval from the edges of the ring and the bulge inside the ring, facing the inner side of the central hole of the ring, and the recesses are located opposite the bulges, the recess and the bulge are made with a symmetrical arrangement.

The prototype provides additional fixation of the pessary in the vagina due to external cuts, is easily and painlessly inserted into the vagina by an obstetrician-gynecologist, during pregnancy reliably keeps the cervix from opening during isthmic-cervical insufficiency (due to the presence of bulges on the inner surface of the ring), does not cause pressure sores and ulcers on the vaginal mucosa, provides free outflow of the vaginal discharge (colpitis prevention), provides protection against stress urinary incontinence (with tension anemia, coughing, sneezing), the absence of allergic complications.

The technical problem of the prototype is the periodic displacement of the pessary during the movements of a woman, the consequence of which is its subsequent loss. The technical result of the utility model is the elimination of problems with the distortion of the pessary inside the vagina while maintaining all the advantages of the prototype. The claimed technical result is achieved due to the fact that the obstetric pessary, made in the form of a ring of silicone, containing recesses located at an equal interval from the edges of the ring and the bulge inside the ring, facing the inner side of the central hole of the ring, the recesses being located opposite the bulges, recesses and bulges made with a symmetric arrangement, characterized in that it contains rounded protrusions located at an equal interval, mounted on the outer surface of the ring Glenn portions and extending in a direction along its axis so that the projections do not reach the edges of the recesses.

The bulges on the inside of the ring can be rounded in shape and repeat the shape of the recesses on the outside of the pessary.

Preferably, the protrusions are made in the form of segments of a circle. Preferably, the protrusions and the pessary are molded in a single integral form.

The utility model is illustrated in the drawing.

In FIG. shows the construction of the pessary, where 1 is the pessary, 2 is the recess on the outside of the ring, 3 is the bulge on the inside of the ring, 4 is the protrusion, 5 is the axis of the pessary ring.

Utility Model Implementation

The utility model may be made in the form of a ring of silicone, preferably high-quality silicone of a certain elasticity and density, specially selected for optimal use as a pessary. In the obstetric pessary 1, a notch 2 is made along the borders of the ring, and convexes 3 on the inside of the ring. A necessary condition is the presence of such a number of notches and convexities, which ensures the possibility of their placement at equal intervals. If the grooves and bulges are two pieces each, then they are made through an interval of 180 degrees, if there are three pieces, then they are made through an interval of 120 degrees, if the grooves and bulges are four pieces (as in the example in Fig.), Then they are made through an interval of 90 degrees, if there are five of them, then they are performed through an interval of 72 degrees, etc.

From this principle of placement at equal intervals, the condition is formed that the notches 2 and the bulge 3 are made with a symmetrical arrangement. The recesses on the outer 2 sides of the ring allow you to conveniently grab your fingers and squeeze the device. The bulges 3 on the inner side of the ring give additional elasticity with pressure on the walls of the vagina and keep the cervix from progressive opening in the presence of a fetal egg in the uterine cavity (with isthmic-cervical insufficiency).

Equal gaps between the bulges and recesses are necessary for uniform compression of the device and uniform elasticity with pressure on the walls of the vagina.

Also, the recesses 2 on the outer side of the ring reduce the area of contact of the pessary with the mucous membrane of the vaginal walls (prevention of pressure sores) and are additional openings for free outflow of the vaginal discharge and easy removal of the pessary from the vaginal cavity by the woman herself.

The above properties of the device are also partially ensured by the fact that the pessary pressures on the walls of the vagina in the area of its dome and prevents it from moving down to the genital gap of the body and neck, uterus, vagina and bladder. What is new is that the pessary 1 contains rounded protrusions (petals) 4 located at equal intervals, mounted on the outer surface of the ring in rounded portions and extending in the direction along its axis 5 so that the edges of the protrusions do not reach the recesses 2.

While the bulge 2 on the inner side of the ring can be made rounded and repeat the shape of the recesses 3 on the outer side of the pessary.

The protrusions 4 can be made of silicone as the pessary itself, as well as in the form of segments of a circle. Preferably, the protrusions 4 and the pessary itself are molded in a single integral form. In the process of using the pessary, the protrusions 4 inside the vagina form a large contact area with its walls, thereby preventing the pessary from skewing and shifting inside the body while maintaining all the advantages of the prototype. Equal gaps between the protrusions 4 are necessary for a uniform distribution of elasticity with pressure on the walls of the vagina. The protrusions 4 should be installed from the outer surface of the ring in rounded sections and extend in the direction along its axis 5 so that the edges of the protrusions do not reach the recesses 2 so that the recesses 2 can function as openings for free outflow of the vaginal discharge. If the protrusions 4 overlap the recesses 2, this outflow will not be.

Claims (4)

1. The obstetric pessary, made in the form of a ring of silicone, containing recesses located at an equal interval from the edges of the ring and the bulge inside the ring, facing the inner side of the central hole of the ring, the recesses being located opposite the bulges, the recesses and bulges are made with a symmetrical arrangement, characterized in that contains rounded protrusions located at an equal interval, mounted on the outer surface of the ring in rounded sections and extending in the direction along its axis so that the projections do not reach the edges of the recesses. 2. The obstetric pessary according to claim 1, characterized in that the bulges on the inside of the ring are rounded and repeat the shape of the recesses on the outside of the pessary. 3. Obstetric pessary under item 1, characterized in that the protrusions are made in the form of segments of a circle. 4. The obstetric pessary according to claim 1, characterized in that the protrusions and the pessary are cast in the form of a single integral form.

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