RU2063733C1 - Method for preparing pregnant women with high risk of abnormal uterine contraction activity development to labors - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves additionally applying thermopulsation treatment with special apparatus on the background of created estrogen glucose vitamin calcium background state. The treatment is made in the form of discrete heat exposure on the area of nasolabial triangle in the respiration rhythm with pleasant warmth being felt during 10 min daily within the 5-10 days period before labor. EFFECT: enhanced effectiveness of preparative treatment. 1 tbl

Description

 The present invention relates to medicine, namely to obstetrics, can be used to prepare for delivery of pregnant women at high risk for the development of anomalies of contractile activity of the uterus (ASDM).

 In connection with the current tendency to increase the frequency of ASDM, it is relevant to further search for more effective means of prenatal prevention of this pathology.

 Known non-pharmacological method of prenatal preparation of pregnant women by means of acupuncture (IRT). The method consists in influencing the pregnant woman’s reflexogenic zones using special needles inserted through the skin. The effectiveness of the method is 80% in the group of pregnant women with a high probability of anomalies of contractile activity of the uterus.

However, the method has significant disadvantages:
1) contains some danger to the pregnant woman:
the insertion of the needle is painful and can cause the patient’s fear,
the procedure does not exclude the possibility of infection as a result of its invasiveness,
with an atypical arrangement of blood vessels, their damage is possible with the subsequent formation of a hematoma,
2) has limitations in use:
IRT is contraindicated in a combination of pregnancy with organic diseases of the heart and kidneys, hyperandrogenism,
3) when using IRT, adverse reactions and complications are possible: dizziness, sweating, drop in blood pressure, fainting.

 A known method of preparing pregnant women for childbirth using central electroanalgesia (CEA). CEA is carried out using the domestic apparatus "Elektronarkon-1" using frontomastoidal electrode application. The course of treatment is 8 10 procedures lasting 60 to 90 minutes, carried out every other day.

The method has significant disadvantages:
the presence of adverse reactions: headache, sleep disturbance, irritability,
It is not combined with other types of physiotherapy, IRT, a number of drugs (psychotropic drugs, tranquilizers, anesthetics).

The closest in technical solution is the method of drug preparation for childbirth, selected as a prototype (1), which consists in the use of estrogens (300 500 IU per kg of body weight per day) for 5 7 days, haloscorbine (1.0 3 4 times per day), glutamic acid (1.0 to 3 times a day), vitamin B ₁ (1 ml of 5% solution per day), potassium chloride (1 tablespoon of 10% solution 4 times a day), calcium chloride (10 ml of 10% solution intravenously once a day), glucose (40 ml of 40% solution intravenously once a day).

The specified method has significant disadvantages:
1) contraindicated in case of individual intolerance to medicinal substances,
2) estrogens are not used in combination with pregnancy and uterine myoma,
3) the method has a relatively low efficiency of 69.02%
Thus, the currently available methods for preparing pregnant women for childbirth do not meet all the requirements of high efficiency, safety, and the absence of side effects.

 The aim of the invention is to increase the efficiency of preparing pregnant women for childbirth by using thermopulsation (TP) in combination with the drug method.

 This goal is achieved by the fact that the traditional drug preparation (creation of the above-described EHVC background) is combined with TP procedures consisting in thermal irritation of the nasolabial region rhythmic with breathing with a controlled intensity of exposure. The method is carried out using a special device "Thermopulsator" (copyright certificate N 308757), developed by V. A. Lichtenstein, for the clinical trial of which the permission of the Ministry of Health of the USSR was obtained in the clinic for miscarriage. The procedures were carried out after an explanatory conversation, in the morning after a 15-minute patient’s rest, in an isolated room, in the position of a woman lying on her side on the couch. After the thermodes were applied to the region of the nasolabial triangle, the frequency of thermal pulsation was established in the rhythm of respiration, the phase of heating of the thermo-coincided with the inhalation. The intensity of exposure was selected individually until a pleasant warmth was felt. The course of treatment consisted of 5 10 10-minute procedures.

 The method of thermal pulsation using the Thermopulsator device was proposed in 1972 by V.A. Liechtenstein. With this effect, the temperature of special heaters (thermodes) fixed on the surface of the nasolabial triangle changes alternately. In one phase of thermal pulsation, the temperature corresponds to the temperature of the skin and, therefore, the patient does not have a thermal sensation. In the next phase, the thermode acquires a higher temperature, and the subject has a feeling of pulsating heat. The ripple frequency and the intensity of the heat exposure are set individually. TP causes a sedative-hypnotic effect, an improvement in central hemodynamics. The indicated effects of TP are used in neuropathology in the treatment of neurosis and neurosis-like conditions, especially when combined with sleep disturbances.

 Previous clinical trials conducted studies of the effect of TP on the course and outcome of pregnancy in laboratory animals revealed a positive effect of the method on blood circulation in the placenta and the state of the offspring.

 In obstetric practice, the TP method is used to treat a threatened miscarriage in the 1st and 2nd trimesters of pregnancy.

 The novelty of the invention lies in the fact that the TP method was first used in obstetric practice to prepare pregnant women at high risk for the development of ASDM for childbirth.

The method has significant differences:
1) is applied at a gestational age of 37 to 40 weeks,
2) TP course from 5 to 10 procedures,
3) TP procedure is carried out in the rhythm of breathing, the phase of heating of the thermodes coincides with the inhalation.

 Example 1. Pregnant Sh. (History of childbirth N 353), 21 years old, was admitted to antenatal hospitalization in the period of 38 weeks. Works as a weaver, in connection with the presence of prof. harmfulness in weaving in the period of 12 weeks of gestation transferred to easy labor. Before pregnancy, she was sick with the flu, tonsillitis, and suffers from chronic pyelonephritis. Menstrual function is not impaired. This pregnancy is the first, occurred in marriage. The first half of pregnancy was uneventful. In a line of 30 weeks of gestation, she was treated in the department of pregnancy pathology in connection with an exacerbation of chronic pyelonephritis.

 Examination of a pregnant woman revealed mild iron deficiency anemia. According to cardiotocography, intrauterine hypoxia of the fetus was diagnosed. The pregnant woman began drug preparation for childbirth, which is supplemented by thermal pulsation procedures. With cardiotocography after the 6th TP procedure, signs of fetal hypoxia of the fetus were not detected. At 40 weeks old, the pregnant woman developed labor activity on her own, in the labor the GHB sleep-rest was provided in connection with the fatigue of the woman in labor. In general, labor lasted 9 hours 25 minutes. A perineal rupture of the 1st degree was sutured, wound healing occurred by primary intention. A live full-term girl was born with a mass of 3050, a length of 53 cm, with an Apgar score at birth of 8 9 points. The postpartum period in the puerpera and the early neonatal period in the child proceeded without complications, discharge home on the 6th day in a satisfactory condition.

 Example 2. Pregnant R. (history of childbirth N 1000), 25 years old, was admitted to antenatal hospitalization with a diagnosis of pregnancy of 37 weeks, neurocirculatory dystonia of a hypertonic type. A somatic history of pregnant flu, childhood infections. Menstrual function is not impaired. Real pregnancy is the third, married. The first pregnancy in 1989 ended in timely delivery (girl, 3100), without complications. After a year - medical abortion in line 9 weeks of gestation, without complications.

 An examination in the antenatal clinic at the age of 15 weeks of pregnancy revealed neurocirculatory dystonia of the hypertonic type (increase in blood pressure to 140/90 and 150/100 mm Hg). Antihypertensive therapy was carried out on an outpatient basis; a pregnant woman repeatedly refused hospitalization. At 32 weeks, ultrasound was diagnosed with moderate polyhydramnios, which did not progress in dynamics. Upon admission, pregnant R. complained of irritability, a sense of anxiety, and poor sleep. There were no abnormalities in clinical analyzes. According to cardiotocography, intrauterine hypoxia of the fetus was diagnosed. The ongoing drug preparation for childbirth (EGVK-background) was combined with the course of TP. After the 1st TP procedure, the pregnant woman noted improved sleep; after the 6th TP procedure, the cardiotocographic signs of fetal hypoxia disappeared. In total, 7 TP sessions were conducted. In the line of 39 weeks of gestation, pregnant R. had timely hearths that were fast (4 hours 40 minutes), without complications. Blood pressure during childbirth did not exceed 125/80 and 120/80 mm Hg. A live full-term girl was born with a weight of 3200 and a length of 52 cm. The postpartum and early neonatal periods in the mother and child proceeded without complications, and on the 4th day they were discharged home in satisfactory condition.

 Example 3. Pregnant P. (history of childbirth N 389), 16 years old, was admitted at 38 39 weeks of pregnancy for prenatal hospitalization. A somatic history of influenza, tonsillitis, measles rubella. Menstrual dysfunction by the type of algodismenorea. This is the first pregnancy in a marriage. At 27-28 weeks, the pregnant woman was treated in the department of pregnancy pathology due to the threat of termination of pregnancy. From 30 weeks, pathological weight gain and swelling of the arms and legs are noted, from 36 weeks, an increase in blood pressure to 130/90 mm Hg. Art. Upon admission, the patient was diagnosed with pregnancy 38 39 weeks, late gestosis of pregnancy (nephropathy 1 tbsp.). Ultrasound examination of the fetus and placenta revealed no signs of fetal hypoxia of the fetus. The treatment (EGVK-von, aminophylline, magnesia therapy) is supplemented with 5 TP procedures. Given the duration of preeclampsia and the presence of a full-term pregnancy, signs of fetal suffering of the fetus, 8 days after the start of treatment, Baraz was initiated. Childbirth proceeded without complications, within 8 hours. A live full-term boy was born weighing 3800, 54 cm long, with an Apgar score of 8 9 points. The postpartum and the child on the 6th day were discharged home in satisfactory condition.

 The proposed method, we prepared for delivery of 82 pregnant women at high risk for ASDM hospitalized in the period 37-40 weeks with late gestosis (dropsy, nephropathy 1 tbsp.) And extragenital diseases in the compensation stage (chronic pyelonephritis, mild to moderate anemia , neurocirculatory dystonia, obesity, enlargement of the thyroid gland without disturbing its function).

 Along with the collection of anamnestic information, general clinical and obstetric studies, ultrasound scanning and dynamic monitoring of the fetus were carried out using cardiotocography according to generally accepted methods. The effectiveness of treatment was evaluated by comparing the characteristics of the course, the total duration of labor and their individual periods, the condition of the child at birth and in the early neonatal period.

 According to the clinical characteristics of the group of women using TP in prenatal preparation and the prototype method were identical (p> 0.05). The age of pregnant women in both groups ranged from 16 to 39 years old, patients of 20 25 years prevailed. Real pregnancy was the first for 54.88% in the first and 65.12% of women in the second group, and among re-pregnant women, half did not give birth. More than a third of women observed before pregnancy were treated for gynecological diseases, among which there were more frequent inflammations of the uterus and appendages, and infertility. A somatic history was dominated by respiratory diseases (respiratory infections). Upon admission to the hospital, 75% of pregnant women of the first and second groups had extragenital pathology, in the structure of which anemia of mild and moderate severity came first (31.71% and 25.58%, respectively). In 90% of women in both groups, pregnancy proceeded with complications. Up to 20 weeks, 40 to 50% of the pregnant women examined had a threat of abortion or early gestosis. In the second half, late gestosis prevailed (39.02% in the TP group and 51.15% in the prototype method group). Every sixth pregnant had a threat of preterm birth. The distribution of these complications by groups of features did not have (p> 0.05).

 Upon admission to the hospital, pregnancy complications were diagnosed in 64.63% of women with TP and 76.74% of women in the prototype method group, among which mild forms of late gestosis hydrocele, nephropathy 1 tbsp. (43.9% and 41.86%, respectively). In every tenth pregnant woman of both groups, chronic fetal hypoxia was detected.

 A positive effect when using TP was observed in 72 pregnant women (87.81%) (table). No negative effects were found during therapy. In the group of women preparing for childbirth using TP, pregnancies ended in timely childbirth in 80 cases (97.5%), in two there were belated deliveries.

 The duration of labor in the group with TP was less than in the group of the prototype method and amounted to 529.38 ± 25.48 min (p <0.05). The course of childbirth in the group of the proposed method was significantly less complicated by ASDM in the form of pathological preliminary, discoordination and weakness of the uterine contractility, which generally occurred in this group in 12.19% of cases with 32.6% in the group of the prototype method (p <0, 05). Along with the positive effect of TP on the course of labor, a decrease in perinatal pathology was noted when using TP in prenatal preparation. Women who received TP before giving birth did not have cases of giving birth to children with asphyxia of moderate and severe severity. The course of the early neonatal period in children whose mothers were preparing for childbirth TP was 1.8 times less complicated by diseases of the newborn (20.73%) compared with the prototype method group (37.2% p <0.05).

 When studying the effect of TP procedures on the blood circulation of the lower third of the abdomen using bipolar and tetrapolar impedance plethysmography, it was found that TP normalizes the blood circulation of the studied area, while the pulse blood filling and the volume of blood circulating in the venous channel increase while maintaining the venous outflow.

 The prototype method carried out preparation for the birth of 43 pregnant women. Therapy was carried out according to the generally accepted technique. Treatment was effective in 29 women (67.4%). In this group, 39 women (90.69%) gave birth on time, four had late deliveries, the duration of labor was 628.42 - 44.68 minutes (p <0.05).

 Thus, the effectiveness of the proposed method for preparing for childbirth was 87.81% of the prototype method 67.4%. The difference in the effectiveness of the compared methods was 20.4% (p <0.05).

Using the proposed method of preparation for childbirth provides, in comparison with the prototype, the following advantages:
1) has a wider scope, as it can be used in preparation for childbirth for pregnant women with many somatic diseases in the compensation stage, including when combined with late gestosis (pregnant dropsy, nephropathy 1 tbsp.),
2) is an effective way of prenatal preparation favorably affects the course of the birth act, reducing the frequency of ASDM, and the condition of the fetus, reducing the frequency of birth of children with pathology in the early neonatal period.

 3) harmless and safe for both the mother and the fetus.

 Therefore, the claimed method of preparation for childbirth provides, along with greater efficiency, the absence of adverse side effects and wider indications for use. TTT1

Claims (1)

 A method of preparing pregnant women with a high risk of developing anomalies of contractile activity of the uterus, including drug therapy to create an estrogen-glucose-vitamin-calcium background, characterized in that they additionally carry out intermittent thermal effects on the nasolabial triangle in the breathing rhythm in the mode of feeling pleasant heat for 10 minutes daily for 5-10 days before childbirth.

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