RU2108756C1 - Method for accelerating labor - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering intramuscular estrogens, subcutaneous promedol, peroral potassium orotate. Glucose solution of Ethimisolum is administered as intravenous drop infusion. EFFECT: enhanced effectiveness of treatment course.

Description

 The invention relates to medicine, namely to obstetrics.

 A known method of birth management, including the introduction of estrogen - 20,000 units intramuscularly; promedol 20 mg subcutaneously; tyfenov 60 mg; pipolfen 25 mg (or diphenhydramine 50 mg) orally. The combination of estrogens, antispasmodics of central anticholinergic action and promedol enhanced by the action of pipolfen was a practical recommendation for the correction of the pathological preliminary period [1].

 Due to the combined effect of estrogens, promedol, and thiefen with pipolfen, a pronounced antispasmodic effect was achieved on the lower segment and cervix, which facilitated the onset of labor and created a favorable background for their development.

 At the same time, this complex of antispasmodic drugs was not recommended for use in women in labor with already developed labor because of the possible adverse depressive effect on the central nervous system of the mother and fetus and a decrease in the muscular activity of the mother and fetus in childbirth.

 The purpose of the invention is the use of pharmacological agents combining antispasmodic, analgesic, sedative, timoleptic and psychoenergetic effects to create conditions for physiological self-regulation of the process of childbirth in women with pathology of contractile function of the uterus.

In comparison with the previously proposed method, taken as a prototype, the proposed method is characterized in that
allows you to remove asthenodepressive and asthenovegetative reactions characteristic of women in labor with anomalies of labor;
normalizes the contractile function of the uterus due to the central antispasmodic effect of promedol, amitriptyline and etymizole, used once;
It has a timoleptic and psycho-energetic effect on the mother's body, which allows to strengthen not only the contractile function of the uterus, but also the general muscle activity necessary for the physiological course of the second stage of labor and the prevention of weakness of attempts;
thanks to the combined sedative, timoleptic and antispasmodic effect, it facilitates the management of childbirth and does not interfere with the use of birth control agents, if necessary;
activates the function of the feto-placental complex, stimulating the synthesis of glucocorticoids in the fetus, estrogens in the placenta, surfactant in the lung tissue of the fetus due to the combined effect of atimisod, amitriptyline and glucose, improving the adaptation of the fetus during childbirth and the newborn during the transition to the postnatal period of life.

 The method is as follows.

 If the cervical dilatation rate does not correspond to the time from the onset of labor, treatment is carried out with a combination of the following drugs: amitriptyline 25 mg and potassium orotate 1000 mg orally, promedol solution 2% - 1.0 ml (20 mg) subcutaneously and 1.5% solution of etimizole 3 , 0 in a solution of 5% glucose 200.0 ml intravenously at a rate of 40 drops in 1 min.

 In case of insufficient “maturity” of the cervix by the beginning of labor, the treatment complex should be supplemented with 300 units of intramuscular administration of estrogen. per 1 kg of woman’s weight.

 Within 1.5-2 hours from the start of treatment, labor activity intensifies, contractions become less painful, coordinated and effective, the process of opening the cervix accelerates to 1.5 cm per 1 hour, and the duration of labor at an early - up to 4 cm of disclosure cervix, the application of the method does not exceed 12 hours

 Example 1. A.N.V., 25 years old, re-pregnant, primiparous.

 Somatically healthy.

 Menses from 13 years to 6 days, after 30 days, moderate, painless. Date of last menstruation 02.08. Sexual life since 20 years. The first pregnancy in 1992 ended in a miscarriage in the period of 21-22 weeks. This pregnancy proceeded in the 1st half with the threat of interruption; preventive treatment was carried out twice from 5 to 9 weeks and from 19 to 21 weeks of pregnancy.

 In the second half of pregnancy, pathological weight gain, proteinuria 0.066 g / l, blood pressure 120/80 - 120/70 mm Hg

 Clan activities developed independently from 7 o’clock

 Upon admission to the roadblock: satisfactory condition, no complaints. Pulse 76 beats in 1 min., BP 120 / 80-120 / 70. Height - 162 cm, weight 72 kg. The size of the pelvis: 26-29-32-22 cm. The height of the bottom of the uterus is 34 cm, the circumference of the abdomen is 104 cm. Contractions for 25 seconds after 5-6 minutes. The position of the fetus is longitudinal, the head is presented, pressed to the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic, 144 beats in 1 min to the left below the navel. Water did not pour out.

 Vaginal examination data for 8 hours 30 minutes the cervix is smoothed out, the edges are thick, unstable, opening the cervix 3 cm. The fetal bladder is intact, sluggishly responds to contractions, flat, opened during examination, a small amount of green water poured out.

 Diagnosed with childbirth: 1 urgent, the beginning of the first period, the head present. Gestosis of the second half of pregnancy. Primary weakness of labor. Flat fetal bladder. Rigid cervix. Chronic fetal hypoxia.

 Estimated fetal weight 4000.0.

 In order to accelerate childbirth, a complex of pharmacological agents was used: estrogens 30,000 units. intramuscularly, promedol 20 mg subcutaneously, etimizol 1.5% - 3.0 ml intravenously in the form of infusion in 200.0 ml of 5% glucose, inside amitriptyline 25 mg and potassium orotate 1000 mg.

 Labor activity intensified, indicators of pulse, blood pressure, fetal heart rate did not go beyond physiological fluctuations. Biomonitor control was carried out.

 The duration of the first stage of labor was 9 hours 30 minutes, the second 30 minutes, the third 10 minutes. The total duration of labor is 10 hours 10 minutes.

 She gave birth to a live girl weighing 3800.0 g, length 54 cm, head circumference 37 cm at 5 pm. Apgar score 8/8 points.

 Blood loss during childbirth 200.0 ml.

 The postpartum period in the mother and the neonatal period in the newborn proceeded without complications. Discharged home on day 6.

 Example 2. B.E.V., 19 years old, re-pregnant, primiparous.

 The somatic history is aggravated by hypertensive type neutrocirculatory dystonia from the age of 14.

 Menses from 14 years to 4 days, after 21 days, moderate, painful. Date of last menstruation: September 2, 1993

 Sexual life since 17 years. The first pregnancy ended in a miscarriage at 10 weeks in 1993.

 This second pregnancy was complicated by combined gestosis of the second half from 35 weeks (hypertension up to 150/90 mmHg, proteinuria 0.066 g / l, periodically pathological weight gain, hypoxia and fetal hypotrophy according to ultrasound and dopplerometry of the umbilical cord vessels). Complex treatment of gestosis was carried out.

 The labor activity developed independently from 15 hours. Fights for 25 seconds after 4-5 minutes are weak, pulse is 78-84 strokes in 1 minute, blood pressure 130/90 - 140/90 mm Hg. Art. Height 160 cm: weight 57 kg. The size of the pelvis: 25-27-30-20 cm. The height of the bottom of the uterus is 31 cm, the circumference of the abdomen is 93 cm. The position of the fetus is longitudinal. Slated to be head, pressed to the entrance to the small pelvis. The fetal heartbeat is muffled, rhythmic up to 144-150 beats in 1 min to the left below the navel.

 The data of the vaginal examination at 18 o’clock: the cervix is smoothed, the edges are thick, slightly extensible, the opening of the external pharynx is 3 cm.The fetal bladder is intact, the membranes are dense, opened during the study, a small amount of green water poured out. Slated to be head, pressed to the entrance to the small pelvis. Bone pelvis - without pathology.

 Diagnosed with first birth, urgent pregnancy 38 weeks, first stage of labor, head presentation. Combined late gestosis. Flat fetal bladder. Primary weakness of labor. Chronic hypoxia and fetal malnutrition. Amniotomy.

 In order to accelerate childbirth, a complex of pharmacological agents was introduced: estrogens 30,000 units. intramuscularly, promedol 20 mg subcutaneously, a solution of etimizole 1.5% - 3.0 intravenously drip on 5% glucose 200.0 ml, inside amitriptyline 25 mg and potassium orotate 1000 mg.

 Generic activity is intensified, biomonitor control, antihypertensive therapy, and aminophylline continue. Heart rate, blood pressure, fetal heart rate within physiological parameters.

 Duration of labor: total - 8 hours 25 minutes, by period: 7 hours 45 minutes, 30 minutes and 10 minutes.

 At 22 hours 45 minutes a live full-term girl was born weighing 2600.0 g, 51 cm long, head circumference 34 cm. Apgar score 7-8 points.

 Blood loss during childbirth 200.0 ml.

 The postpartum period proceeded favorably, manifestations of gestosis and NCD quickly passed.

 In a newborn, during a routine examination by a neonatologist, pediatric neuropathologist and ultrasound of the brain, no pathology was detected.

 The postpartum woman with the newborn was discharged home in satisfactory condition on the 6th day after the birth.

 Example 3. U. T.V., 22 years old, primogenous.

 Somatic history is burdened with childhood infections.

 Menses from 13 years, 5 days, after 28 days. The date of the last menstruation is 1.08.1993.

 Pregnancy from 24 weeks was complicated by hypochromic anemia (HB 76 g / l), treatment with iron preparations was carried out.

 Clan activities developed independently from 24 hours.

 Height 160 cm, weight 57 kg, pelvis size: 23-26-29-19 cm. Abdominal circumference 95 cm, height of the bottom of the uterus 34 cm. The position of the fetus is longitudinal, the head is pressed to the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic up to 156 beats in 1 min.

 When a vaginal examination was performed at 5 hours 30 minutes, cervical dystocia was revealed: the cervix is smoothed, the edges become denser during contractions, opening 3-4 cm. The fetal bladder was opened during the study, light amniotic fluid up to 100 ml poured out.

 Diagnosed with childbirth, first urgent, first period of labor. Occipital presentation. Commonly narrowed pelvis, 1 degree of narrowing. Pregnant anemia, chronic fetal hypoxia. Discoordinated labor.

 In order to accelerate childbirth in this obstetric situation, the following medications were introduced: estrogen 20,000 units. intramuscularly, promedol 20 mg subcutaneously, etimizol 1.5% 3.0 intravenously in the form of infusion on 5% glucose - 200.0 ml, amitriptyline 25 mg and potassium orotate 10000 mg.

 Clan activities acquired a coordinated character, its effectiveness has improved significantly. The total duration of labor is 9 hours 10 minutes; by periods: 8 hours 30 minutes, 30 minutes, 10 minutes

 At 8.30 am, a full-term full-term boy was born on his own, weighing 3600.0 g, length 53 cm, head circumference 37 cm. Estimated by Apgar - 8/8 points.

 Blood loss during childbirth 200.0 ml.

 In the newborn, in the first days, the effects of chronic fetal hypoxia — hyper-excitability syndrome — were noted. Pathogenetic and symptomatic treatment was performed according to the prescriptions of a neonatologist and pediatric neuropathologist.

 Mother and child were discharged on the 10th day in satisfactory condition home.

 Thus, the proposed method is a new approach to the regulation of labor, since in this case drugs are used predominantly of psychotropic action, and not uterotolytics, which stimulate the uterus directly and adversely affect the fetus and the newborn ("oxytocin children").

Claims (1)

 A method of accelerating labor with labor abnormalities by using a complex of formacological agents, which provides for the administration of estrogen at a dose of 20,000 units intramuscularly and promedol at a dose of 20 mg subcutaneously, characterized in that the complex includes the administration of 25 mg of amitriptyline and 1000 mg of potassium orotate oral and 3 ml 1, A 5% solution of ethylmizole in a glucose solution of 50-200.0 ml intravenously, and the dose of estrogen may be 30,000 units.