RU2366433C1 - Prevention method of abdominal delivery complications - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to operative obstetrics, and concerns integrated prevention of purulent-septic caesarean section complications that is ensured by intraoperative regional introduction of an antibiotic. Uterine cavity and abdominal cavity are irrigated with ozonised 0.9% normal saline of ozone concentration to 4 mg/l. During two postoperative days, ozonised 0.9% normal saline of ozone concentration 1-2 mg/l is introduced intravenously drop-by-drop in amount 400 ml. Starting from the end of the postoperative day, anterior vaginal fornix is exposed to low frequency pulse magnetic field generated by a vaginal inductor introduced therein for 15 minutes daily during 5-7 days.

EFFECT: method provides accelerated regress of pain syndrome, and involution of uterus, allows reducing introduction of antibiotics.

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Description

The invention relates to medicine, namely to surgical obstetrics, and is intended to increase the effectiveness of preventive and therapeutic-rehabilitation measures for abdominal delivery.

There is a method of treating inflammatory processes of the uterus with regional antibiotic therapy in the uterus round ligament [5]. However, this method relates to the conservative treatment of gynecological patients and includes a long course of antibiotic therapy, which is advisable for an existing inflammatory disease and is not entirely justified as a prophylaxis of obstetric complications.

There is a method of treating inflammatory processes of the internal genital organs of women [11], in which an ozone-oxygen mixture at a dose of 1000-1200 μg is injected lymphotropically into the projection of the uterine round ligament laterally from the pubic joint. This method is used in the conservative treatment of gynecological diseases, the introduction of an ozone-oxygen mixture is carried out in the subcutaneous tissue far from the target organs. Intraoperative administration of an ozone-oxygen mixture directly into the uterus and its ligamentous apparatus is unacceptable because of the danger of developing an air embolism.

Closest to the claimed are a method of intraoperative prophylaxis of purulent-septic complications with abdominal delivery [7] and a method of treating inflammatory diseases of female genital organs with a low-frequency pulsed magnetic field [1].

In the method [7], intraoperative prophylaxis of purulent-septic complications includes sanitation of the uterine cavity after removal of the placenta with ozonized 0.9% sodium chloride solution with an ozone concentration of 4 mg / l, suturing of the uterine wound with a single-row continuous suture; the use of synthetic absorbable suture material; the creation of a depot of antibiotics (2.0 g of cefotaxime) in the area of round uterine ligaments and vesicoureteral folds. However, in this method, only local prophylaxis is used; systemic changes in the body due to operating injury are not taken into account. In its pure form, the method can be used only in patients with low infectious risk, it does not provide for an individual tissue response to trauma and the injected drug mixture and the need for delayed rehabilitation.

In the method [1], the uterus and appendages are exposed to a pulsed magnetic field of low frequency using vaginal and 3 external inductors with magnetic induction of 0.1-0.2 T. At the same time, they act with a bipolar current. The method is designed for conservative therapy of gynecological diseases, can be used in the acute period of inflammation and from the early days of the postoperative period. The disadvantage of this method is the stimulation by electric current, which when using a vaginal inducer in puerperas can cause discomfort in the vagina and lower parts of the uterus, as well as the use of external inductors, which on the first day after cesarean section can cause additional pain due to mechanical pressure on the postoperative suture.

The purpose of the invention is to increase the effectiveness of preventive and treatment-rehabilitation measures for abdominal delivery.

This goal is achieved by the fact that preventive measures include the integrated use of local intraoperative prophylaxis: irrigation of the uterine cavity after removal of the placenta and abdominal cavity before suturing the abdominal wall with an ozonized 0.9% sodium chloride solution with an ozone concentration of up to 4 mg / l; the creation of a depot of the daily dose of an antibiotic (2.0 g cefotaxime) under the round ligaments of the uterus and the vesicoureteral fold in the avascular zone intravenous drip of an ozonized 0.9% sodium chloride solution in an amount of 400 ml with an ozone concentration of 1-2 mg / l during surgery and within 2 days after cesarean section; From the first day of the postoperative period, pulsed magnetic therapy with a low-frequency magnetic field is carried out using only a vaginal inducer dressed in a condom (which ensures the sterility of the procedure and the exclusion of electrical stimulation). A sensor (drawing, 1.1) is inserted, brought to the cervix (drawing, 1.2) through the anterior vaginal vault (drawing, 1.3). The amplitude of the magnetic induction of 0.1-0.2 T. The pulse repetition rate is selected individually according to the patient's pulse.

The device for magnetic stimulation of the Serdolik series operates in a predetermined mode, creates a magnetic pulse shape close in shape to the action potential of the biomembrane. Session duration up to 15 minutes. A course of 5-7 procedures.

Thus, the distinctive features of the proposed method, compared with prototypes, include the following:

1. Systemic and local use of ozonized physiological solution, which allows to increase the effectiveness of ozone therapy, to strengthen its antibacterial, immunomodulating, antioxidant effects.

2. Additional irrigation of the abdominal cavity with ozonized saline to eliminate blood residues, amniotic fluid, reduce the degree of bacterial contamination of the peritoneum, and prevent adhesion formation.

3. Magneto-pulsed stimulation of the wound pool enhances antibiotic resorption, eliminates edema and infiltration caused by the introduction of the drug mixture, improves microcirculation and evacuation of the contents of the uterine cavity due to the antispasmodic and reocoagulation effects of the used form of the magnetic field, helping to prevent lochiometers and uterine subinvolution.

4. The row of sutures on the uterus, as well as the suture material used, can vary depending on the operating situation and do not significantly affect the outcome of cesarean section with the used amount of preventive measures.

5. The proposed method can significantly reduce the use of antibiotics, not excluding the use of a prolonged regimen of antibiotic therapy in case of high infectious risk.

6. The proposed scheme contributes to accelerated regression of pain, the restoration of the adaptive capabilities of puerperas by the 3rd day of the postoperative period, which makes it possible to put the baby to the chest in the early stages.

7. During the course of the proposed preventive measures, the indicators of local hemodynamics indicate an increase in arterial blood flow due to the removal of arterioles spasm, the growth of the capillary network, and the elimination of venous stasis in the pelvic organs, as evidenced by lower SDO (systolic-diastolic ratio in uterine arteries) compared with the control group of puerperas (see table. No. 1).

The average age in the control group was 27.96 ± 0.84 years, in the main group - 27.33 ± 0.88 years.

Example 1

Patient P., 18 years old, was admitted to the antenatal department with DS: Pregnancy 39 weeks. Pelvic presentation. Late gestosis. Chronic intrauterine hypoxia of the fetus. Anemia of pregnant women. Diffuse non-toxic goiter, II art.

Real pregnancy is the first. Gynecological history: cervical erosion.

Pregnancy proceeded with a threat of interruption at 10 weeks; from 36 weeks - with late gestosis.

Childbirth began spontaneously. After 12 hours from the onset of labor, she was operated on in connection with the persistent weakness of the labor forces. Caesarean section was performed under endotracheal anesthesia. The uterus is sutured with a 2-row suture with the synthetic polyglycolide suture. The uterine cavity and abdominal cavity were irrigated with an ozonized 0.9% sodium chloride solution with an ozone concentration of 4 mg / l; at the same time, 400 ml of an ozonized 0.9% sodium chloride solution with an ozone concentration of 1 mg / L was transfused intravenously. 2.0 cefotaxime was introduced under the round uterine ligaments and vesicoureteral fold in the avascular zone.

Given the high risk of inflammatory complications in this patient, which was determined by the duration of the anhydrous period, the urgency of the operation, the presence of gestosis and anemia in the pregnant woman, as well as diffuse goiter of the second degree, antibiotics were administered twice more, after 12 and 24 hours. On this, the course of antibiotic prophylaxis was completed, and from the end of 1 day pulsed magnetic therapy with a vaginal inducer was started for 15 minutes for 6 days.

The postoperative period was uneventful. Monitoring of uterine involution and the state of its cavity was carried out by ultrasound and ultrasound on the 3rd, 5th, 7th day of the postpartum period. These changes are presented in table 2.

table 2 The results of treatment of patient P. using the proposed method Day after childbirth The size of the uterus, mm The volume of the uterus, mm ³ Pi Ri SDO Uterine cavity, mm 3rd 106 × 61 × 106 358.9 0.84 / 0.41 0.54 / 0.31 2.19 fourteen 7th 92 × 62 × 89 265.8 0.42 / 0.68 0.38 / 0.51 2.05 3

The volume of the uterus was reduced by 1.4 times, the uterine cavity was significantly narrowed with a persistent moderate asymmetry of the vascular tone of the uterine arteries. The scar area is not infiltrated. The patient was discharged home with her child on the 8th day after birth.

Literature

1. AS No. 2118184, cl. A61 No. 2/04, 1/32, Bull. No. 24, 1998. - S.

2. AS No. 2234925, cl. A61 33/00, 33/14, 38/43, A61P 31/00. BI, 2004, No. 24, S.389.

3. AS No. 1768171 A1, cl. A61K 31/43, 31/65, Bull. No. 38, 1992. - S.

4. Grechkanev G.O. "The use of ozone therapy in the complex treatment of endometritis." Nizhny Novgorod Medical Journal, 2002, No. 2, pp. 80-81.

5. Kolgushkina T.N., Paceev S.V., Varlamova V.N. "Treatment of inflammatory processes of the uterine appendages with regional antibiotic therapy in the round ligament of the uterus." - Actual issues of obstetrics and gynecology: Sat. scientific labor. - Minsk, 1998. - P.72-73.

6. Komissarova L. M. "Cesarean section and its role in reducing maternal and perinatal pathology." Abstract of dissertation degrees MD, M., 1998, 82 S.

7. Mazurenko L.N. "Intraoperative methods for the prevention of purulent-septic complications in abdominal delivery." Abstract of diss. for the degree of candidate of medical sciences, Voronezh, 2005, 20 p.

8. Rusova M.R. "The use of ozone in obstetrics and gynecology." Obstetrics and Gynecology, 2003, No. 4, p. 4-7.

9. Strizhakov A.N., Baev O.R., Starkova T.G., Rybin M.V. "Physiology and pathology of the postpartum period." Moscow, ed. House "Dynasty", 2004, 120 p.

10. Chernukha EA, Strugatsky VM, Kochieva SK, Korotkiva NA, Bogdanova TP, Rozanova LA, Zheleznova EB, Dragun I.E. “Our postpartum management experience for high-risk women.” Obstetrics and Gynecology, 2000, No. 2, pp. 47-50.

11. Patent 2260435 (RU). A method for the treatment of chronic inflammatory processes of internal genital organs in women from 2005.09.20.

Description to the drawing: "Layout of the vaginal inducer"

1.1 - vaginal inducer

1.2 - cervix

1.3 - anterior vaginal fornix

1.4 - postoperative suture on the uterus

1.5 - uterine body

Claims (1)

A method for the comprehensive prevention of purulent-septic complications after cesarean section, including the use of regional antibiotic therapy, ozone therapy and a pulsed magnetic field of low frequency, characterized in that they use the combined local and systemic effects of ozonized 0.9% sodium chloride solution of various concentrations: uterine cavity and the abdominal cavity is irrigated with an ozonized 0.9% sodium chloride solution with an ozone concentration of up to 4 mg / l, an ozonized 0.9% sodium chloride solution is intravenously administered and in an amount of 400 ml with a concentration of ozone of 1-2 mg / l; infusions of an ozonized 0.9% sodium chloride solution are prescribed during the first 2 days after surgery, from the end of the first day they are exposed to a low-frequency pulsed magnetic field using a vaginal inducer inserted into the anterior vaginal fornix, a course of 5-7 days, daily for 15 minutes

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