RU2017507C1 - Method for prophylaxis of infection-septic complications after cesarian section - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: vaginal irradiator of magnitotherapeutic device displaced inside one-time preservative is introduced into posterior vault of the vagina. Frequency of magnetic field is 5000 ± 5% Hz, intensity being 1.5 + 10% mT. Duration of the procedure is 10-15 min, treatment course has 10-15 procedures. EFFECT: decreases complications, improves efficiency of the method. 3 tbl

Description

 The invention relates to medicine, in particular to obstetrics.

 A known method for the prevention of infectious-septic complications after cesarean section by using electrical stimulation of the uterus on the background of uterotonic agents, in particular oxytocin (1).

 The disadvantage of this method is the relatively high frequency of infectious-septic complications of the postoperative period, where only the frequency of postpartum endometritis is 6.1%.

 The purpose of the invention is to reduce the incidence of infectious-septic complications, including wound infection in puerperas after cesarean section.

 This goal is achieved by the method of prophylaxis with an alternating magnetic field (PeMP) with a frequency of 5000 Hz ± 5% with a magnetic induction intensity of 1.5 mT ± 10% when exposed to the projection area of the uterus using a vaginal emitter.

 In practice, the method is as follows. A patient with previously emptied intestines and bladder was placed on a couch. In the supine position, the vaginal emitter of the Inductor-2 magnetotherapy device for gynecology was inserted into the posterior vaginal fornix and placed in a disposable condom. The frequency of the magnetic field is 5000 Hz ± 5%, the intensity is 1.5 mT ± 10%. The duration of exposure is 10-15 minutes. The course of physiological effects is 2-12 procedures.

 PRI me R 1. Puerpera P., 36 years old, the history of childbirth N 1352.

 History: measles, influenza; in 1976, a wedge-shaped ovarian resection for CJD. Childbearing function: 1st pregnancy (1983) ended in spontaneous abortion followed by curettage, 2nd (1986) - childbirth by cesarean section, this pregnancy is the third, second upcoming birth.

 Clinical diagnosis: Pregnancy 40 weeks., Head presentation of the fetus, burdened gynecological history, scar on the uterus after cesarean section.

 04/29/90 in the planned order the operation was performed: transverse suprapubic laparotomy with excision of the old skin scar, cesarean section in the lower uterine segment. The operation was typical. A fetus weighing 3500 g was extracted. Total blood loss - 600.0 ml.

From the 5th day after the operation, a course of physioprophylaxis of PeMP was started. A patient with a previously empty bowel and bladder was placed on a couch. In the supine position, the vaginal emitter of the Inductor-2 magnetotherapeutic apparatus for gynecology was inserted into the posterior vaginal fornix and placed in a disposable condom. The magnetic field frequency is 5000 Hz ± 5%, the magnetic induction intensity is 1.5 mT ± 10%. Duration of exposure - 15 minutes. Course - 3 procedures. Body temperature prior fizioprofilaktiki 36.6 ^C, after - 36.5 ^C; pulse - 76 and 76 beats / min; the height of the uterine fundus above the bosom is 13 and 10 cm, respectively.

 The postpartum woman was discharged home on the 11th day after the operation in satisfactory condition.

 PRI me R 2. Puerpera P., 36 years old, N history of childbirth 1071.

 In the anamnesis: Chronic pyelonephritis, chronic tonsillitis, vegetovascular dystonia by hypotonic type. This pregnancy is the first, proceeded with the phenomena of nephropathy of the 1st degree, anemia.

 Clinical diagnosis: Pregnancy 40 weeks., Head presentation of the fetus, premature discharge of water, 1 birth, 37 years old, nephropathy of 1 degree, anemia.

 An operation was urgently performed on 20.04.90: transverse suprapubic laparotomy, cesarean section in the lower uterine segment. The operation was typical. The fetus with a body weight of 3300.0 g was extracted. Total blood loss amounted to 700.0 ml. The anhydrous period was 3 hours 30 minutes.

From 4 days after the operation, a course of physioprophylaxis of PeMP was started. A patient with a previously empty bowel and bladder was placed on a couch. In the supine position, the vaginal emitter of the Inductor-2 magnetotherapy device for gynecology was inserted into the posterior vaginal fornix and placed in a disposable condom. The magnetic field frequency is 5000 Hz ± 5%, the magnetic induction intensity is 1.5 mT ± 10%. Duration of exposure - 10 minutes. The course amounted to 6 procedures. Body temperature prior fizioprofilaktiki 37.4 ^C, after - 36.4 ^{° C,} pulse - 76 and 77 beats / min; the height of the uterine fundus above the bosom is 13 and 9 cm, respectively. An ultrasound examination of the pelvic organs was performed on the 6th day after the operation and after 3 physioprophylaxis procedures. The size of the uterus: 14.3 x 8.3 x 10.7 cm, the density is closed, the scar on the uterus without features.

 The postpartum woman was discharged home on the 11th day after the operation in satisfactory condition.

 PRI me R 3. Puerpera T. 26 years, N history of childbirth 1135.

 History: frequent colds, chronic tonsillitis, childhood infections, suffered pneumonia, chronic gastritis. In 1986, she was operated on for an abnormality of the uterus: a two-walled uterus, a vaginal septum. Childbearing function: 1st pregnancy (1986) ended in abortion at 8-10 weeks at the request of a woman, 2nd (1987) - premature birth for 36 weeks (antenatal death of the baby). This pregnancy - 3rd, proceeded with the phenomena of threatened abortion from the first weeks.

 Clinical diagnosis: Pregnancy 40 weeks, head presentation of the fetus. Anomaly in the development of genital organs. Burdened obstetric and gynecological history.

 In the planned order 04/16/90, the operation was performed: transverse suprapubic laparotomy, cesarean section in the lower uterine segment. The operation was typical. A fetus weighing 3200.0 g was extracted. Blood loss amounted to 500.0 ml.

From 2 days after the operation, a course of physioprophylaxis of PeMP was started. A patient with a previously empty bowel and bladder was placed on a couch. In the supine position, the vaginal emitter of the Inductor-2 magnetotherapy device for gynecology was inserted into the posterior vaginal fornix and placed in a disposable condom. The magnetic field frequency is 5000 Hz ± 5%, the magnetic induction intensity is 1.5 mT ± 10%. Duration of exposure - 15 minutes. Rate was 12 treatments, physical treatments to body temperature - 37,0 ^{° C,} after - 36.2 ^C; pulse - 80 and 74 beats / min; the height of the bottom of the mark is 15 and 6 cm, respectively. Ultrasound examination was performed on the 6th day after surgery and after 4 physiotherapy procedures. The uterus dimensions: 19.0 x 9.4 x 12.3 cm, the cavity is closed, the scar is without features. On the 13th day after the operation and after 11 physiotherapy procedures, a control ultrasound examination was performed. The uterus dimensions: 12.3 x 5.6 x 11.1 cm, the cavity is closed, the scar is without features.

 The postpartum woman was discharged home in satisfactory condition on the 14th day.

 PRI me R 4. Puerpera F., 21 years old, N history of childbirth 1407.

 History: childhood infections, frequent colds. Childbearing function: 1st and 2nd pregnancy (1987, 1988) ended in abortion at the request of a woman without complications; 3rd pregnancy - this one, proceeded without complications.

 Clinical diagnosis: Pregnancy 40 weeks. Pelvic presentation. 1 period of childbirth. Anatomical features of the pelvis. Rhesus negative blood without sensitization. Nephropathy 2.

 An operation was performed urgently on 29.04.90: transverse suprapubic laparotomy, cesarean section in the lower uterine segment. The operation was typical. A fetus weighing 3400.0 g was extracted. Total blood loss - 700.0 ml. The anhydrous period was 4 hours and 40 minutes.

Physioprophylaxis in the postoperative period was not carried out. The body temperature during the first day after the operation - 37.3 ^° C for a long time remained resistant low-grade fever, increased heart rate to 92 beats / min, uterine subinvoljutcija, allowing suspected and later confirmed diagnosis endometritis and infiltrate in areas of postoperative suture.

 Discharged on the 17th day after the operation home in satisfactory condition.

 PRI me R 5. Puerperas R. 29 years, N history of childbirth 1371.

 History: childhood infections. Chronic glomerulonephritis. Myopia of a high degree. Childbearing function: 1st pregnancy (1986) - childbirth by cesarean section, 2nd (1988) - termination of pregnancy in the period of 6-7 weeks at the request of a woman, 3rd pregnancy - this, was accompanied by an exacerbation of chronic glomerulonephritis.

 Clinical diagnosis: Pregnancy 40 weeks. Head presentation. Scar on the uterus. Hypotrophy of the fetus. Myopia of a high degree. Chronic glomerulonephritis.

 04/15/90 in the planned order the operation was performed: transverse suprapubic laparotomy with excision of the old skin scar, cesarean section in the lower uterine segment. A fetus weighing 2850.0 g was extracted. Total blood loss 500.0 ml.

Physioprophylaxis in the postoperative period was not carried out. Body temperature in the postoperative period ranged from 36.6 to 36.4 ^about C, heart rate 86-72 beats / min. Due to the presence of hematometers detected by ultrasound, was transferred to the second obstetric department, where therapy was continued.

 Discharged home on the 14th day after surgery in satisfactory condition.

 Under our supervision, there were 35 puerperas of the main group and 32 puerperas of the control group. All puerperas in the early postoperative period received conventional antibacterial therapy, according to indications - sedative. The postpartum women of the main group were additionally physiologically exposed to a high frequency alternating magnetic field (PeMP). The selection of puerperas of the control group was carried out by random sampling. The clinical characteristics of the two groups, presented in tables 1 and 2, indicate the comparability of the material presented.

 Assessment of treatment results in women in both groups was carried out according to the criteria presented in Table 3.

 The following indicators were used as additional criteria for assessing the effectiveness of the assessment of physiological effects: changes in well-being during the procedure, the nature of the sensations in the impact zone, emotional reactions when reporting the purpose of the procedures and (or) their implementation, the convenience of introducing an inducer.

 According to the data presented in Table 3, the postpartum women of the main group did not show any longer hospital stay compared to the control group, as well as differences in the involution of the operated uterus by the end of the course of exposure in both groups. However, with the use of the physical factor in addition to the traditional use of medications, a significant decrease in the frequency of postpartum complications (t = 5.8; P <0.001) was revealed in the form of discrepancies in sutures, lochio and hematometers, endometritis, cystitis, lactostasis from 18.7 ± 1, 6% to 5.7 ± 1.64%.

 Improving the general well-being of puerperas of the main group was accompanied by a significant change in such clinical indicators as body temperature on the first day after surgery (t = 2.5; P, 0.01), duration of subfebrile condition (t = 4.9; P <0.001), heart rate (t = 2.54; P <0.01) in the direction of reducing the time to normalize these indicators compared to the control group (see table 3).

 The revealed negative correlation between the number of procedures and the height of the uterine fundus at the end of the course of physiological effects (r = -0.54; P <0.001), the dynamics of uterine involution and the time of onset of physical effects (r = -0.50; P <0.002), between the gradient of uterine involution and the heart rate at the end of physiological effects (r = -0.32; P <0.06), this may apparently indicate the presence of a local exchange-trophic effect of PEMP and an indirect detoxification effect of the physical factor.

 The subjective sensations in the zone of influence of the vaginal emitter Inductor-2 differed in a rather wide variety: from a feeling of slight vibration (in 2 puerperas), tingling (in 3 puerperas), pleasant heat (in 2 puerperas) to a burning sensation and pain in the vagina (in 12 puerperas). At the same time, none of the 19 (54.3%) patients with different degrees of sensitivity to the physical factor used had local negative reactions from the vaginal mucosa. Changes in health during the procedure and immediately after it were not observed in any woman, and negative emotional reactions were detected in only one (2.9%). This patient has aggressiveness, refusal of any medical procedures, due to fear of aggravation of skin allergic reactions to ongoing antibiotic therapy, did not allow for more than one procedure. Inconvenience during insertion, extraction or direct exposure of the emitter in the area of influence was not observed in any puerperas.

 The general clinical characteristics of the puerperas of the main (I) and control (II) groups (M ± SE) are shown in Table. 1.

 Indications for cesarean section in puerperas of the main (1) and control (2) groups are given in table. 2.

 The course of the postpartum period in patients of the main (1) and control (2) groups (M ± SE, P ± SE) is shown in Table. 3.

Claims (1)

 METHOD FOR PREVENTION OF INFECTIOUS-SEPTIC COMPLICATIONS AFTER CESARIAN SECTION by physiotherapy, characterized in that they are exposed to an alternating magnetic field with a frequency of 5000 Hz ± 5% at a magnetic induction intensity of 1.5 mT ± 10% for 10 - 15 minutes on the uterine projection area using a vaginal a radiator inserted into the posterior vaginal fornix, with a repetition of the procedure from 2 to 12 times.

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