RU2377032C1 - Method of treating urinogenital infections in pregnant women - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and covers treatment of urinogenital infections in pregnant women. Complex pharmacotherapy is combined with daily SCENAR-therapy with using pulse bipolar current without constant pulse component at frequency 90.7, including swept frequency mode within 30-120 Hz to pack pulses 2 to 8 and repetition frequency 540 Hz to 4.5 kHz. Said treatment is started in 16-18 weeks of pregnancy with applying the general exposure techniques. The exposure covers vertebral and perivertebral lines - three paths, then six points of trifacial exit, cervicocollar region and hepatic projection during 10-15 minutes. If any small asymmetry is observed, hepatic region is processed till elimination said signs. Therapeutic course involves 10 procedures, each 35-40 minutes.

EFFECT: offered method allows for considerable reduction of development and suppression level of cell and humoral immunity, as well as development and severity of inflammatory processes in afterbirth.

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Description

The present invention relates to medicine, namely to electrotherapy, and can be used in obstetrics and gynecology in the complex treatment of pregnant women with urogenital infections, including in pregnant women with miscarriage of infectious origin.

Urogenital infection in pregnant women, including pregnant women with miscarriage (NI) of infectious origin, is an urgent medical and socio-economic problem. Infection has an adverse effect on the course of pregnancy, the condition of the fetus and the newborn. The most common cause of infectious pathology in pregnant women is genital mycoplasmas, chlamydia, herpes simplex virus and cytomegalovirus (Sidelnikova V.M. Actual problems of miscarriage. A series of clinical lectures. Moscow, 1999, 138 pp .; Kulakov V.I., Ordzhonikidze N. V., Tyutyunnik VL Placental insufficiency and infection. - M .: MIA; 2004; 494 p.).

Infection can have a direct cytotoxic effect on the embryo due to the activation of cytokines and free radicals against the background of increased production of toxic substances produced during the destruction of microorganisms, and lead to the death of the embryo at any stage of gestation (Tikhomirov A.L., Lubnin D.M. Habitual miscarriage pregnancy: causes, diagnosis, and modern approaches to therapy, Pharmateka 2004; 1: 28-39).

Violation of the development of the embryo can lead to abortion not only due to the direct specific effects of infectious agents, but also be caused by the persistence of microorganisms and viruses in the endometrium against the background of chronic endometritis, as well as endocrinopathy and autoimmune disorders (Sidelnikova V.M. Habitual loss of pregnancy. - M .: Triad - X 2002, 304 p .; Kosheleva N.T., Bashmakova M.A., Pluzhnikova T.A., Urogenital infection and miscarriage (World of Medicine 1999; 3-4: 44-47). Physiological gestational immunosuppression aggravates immunological changes in pregnant women with miscarriage and can contribute to the development of acute or reactivation of chronic viral and bacterial infections (Dolgushina N.V., Makatsaria A.D. Viral infections in pregnant women. - M .: Triada-X; Moscow ; 2004, 144 p .; Kuzmin V.N., Adamyan L.V. Viral infections and pregnancy. - M .: Deepak, 2005. - 176 p.).

Under the influence of infectious agents, pregnancy is complicated by the threat of termination in 31.7-67.5%, early toxicosis - 32.4%, late gestosis - 23.7-49%, pyelonephritis - 7-21.4%, anemia - in 92%, the production of autoimmune antibodies - in 19%, the development of fetoplacental insufficiency - in 47.6-73.3%, preterm delivery in 8.8-16% of cases. Childbirth in women with urogenital infections is complicated by premature discharge of amniotic fluid in 27.7-39%, pathological preliminary period - in 6.6-7.1%, anomalies of labor activity - in 7.1-38.5%. The postpartum period in women with miscarriage proceeds with complications in 52.8%, is accompanied by subinvolution of the uterus in 13.5% of cases, postpartum endometritis in 8.4-21.4% (Maltseva L.I., Zefirova T.P. ., Chernova OA, Sharipova IM, Idiatullina ER Features of the clinical course of pregnancy, childbirth and the postpartum period in women with urogenital mycoplasma, chlamydial and mixed infections. Ros. Association of Obstetricians - Gynecologists 2000; 1:83 -86).

Inflammatory changes in the placenta during bacterial and viral infections are observed in 11-78.4% of cases, intrauterine infection - in 6-53%, and a high incidence of fetal infection is detected in the presence of viral-viral or viral-bacterial associations. Infectious diseases in newborns are observed in 36.8%, hypoxic syndrome at birth and an increase in the adaptation period - in 25%, late rejection of the umbilical cord - in 55.7%. Changes in cellular and humoral immunity in pregnant women with bacterial and viral infections can cause fetal immune disorders, as well as the development of neurological, somatic or endocrine disorders in the baby. In this regard, the search for new methods of treatment for pregnant women with urogenital infections remains relevant and timely.

To date, the following treatment methods are known:

- Plasmapheresis (PA).

PA is the method of choice for the treatment of chronic recurrent infection, as well as placental insufficiency in the II and III trimesters of pregnancy, and represents the removal of a certain volume of blood plasma, and has the following effects: detoxification (elimination of toxic products of cellular metabolism), immunocorrective (removal from the bloodstream antigens, antibodies, circulating immune complexes), re-corrective (decrease in blood viscosity).

Intermittent (discrete) PA is performed by puncture of the ulnar vein, the introduction of plasma-replacing crystalloid and colloidal solutions, blood exfusion with further separation of the formed elements from the plasma, reinfusion of the formed blood elements diluted with physiological solution. The procedure is performed 2-3 times, which allows you to remove 600-900 ml of plasma in one session. The course of treatment is 3 sessions of PA.

Indications for PA are: a severe course of the infection process with frequent and prolonged relapses, exacerbation of a viral infection in pregnant women with a burdened obstetric history, impaired immune and interferon statuses, changes in the hemostatic system (hypercoagulation, chronic form of DIC), and a decrease in the concentration of cell markers regulation and metabolic activity of the fetoplacental complex, inefficiency of traditional drug therapy of placental insufficiency, gestosis or sensitization tion of Rh factor.

Contraindications to the conduct of PA are expressed organic changes in the cardiovascular system, anemia (Нb below 100 g / l), hypoproteinemia (protein level below 55 g / l), hypocoagulation, immunodeficiency states, allergic reactions to anticoagulants, colloidal and protein preparations , lack of venous access, phlebitis of peripheral veins in the acute stage. Complications of PA include collaptoid states, allergic reactions to the introduction of infusion media, anemia, impaired blood electrolyte composition, cases of pulmonary edema and acute heart failure (Vladimirova N.Yu., Chizhova G.V., Dorofeev D.E. viral infection in pregnant women with a history of “fetal loss syndrome” and persistent viral infection. Materials of the I International seminar “Infection in obstetrics and perinatology 2007, Moscow, 180 p.).

- Ozone therapy.

Ozone is an allotropic oxygen compound, a light blue gas with a characteristic pungent odor, which is formed as a result of the splitting of an oxygen molecule into atoms by an electric discharge. Individual oxygen atoms react with molecular oxygen and form ozone.

Medical ozone activates oxygen-dependent processes, microcirculation and gas exchange in tissues, enhances the formation of energy substrates in the cell, stimulates phagocytosis, increases the antioxidant defense of the body, reduces (if present) blood hypercoagulation activity, has antibacterial, antiviral, immunomodulating, detoxifying effects. Ozone therapy is used when there is a threat of termination of pregnancy, at a critical period of miscarriage, to prevent fetoplacental insufficiency and intrauterine infection of the fetus.

Use ozonized saline solution, obtained by passing for 20-30 minutes through a sterile 0.9% solution of sodium chloride ozone-oxygen mixture with an ozone concentration of 500-700 μg / l / min, which is administered in a volume of 400 ml intravenously with at a rate of 8-10 ml / min daily in a course of 3-5 days, 1 time per day.

Contraindications to ozone therapy are: a miscarriage that has begun, the genetic causes of miscarriage, when pregnancy is not practical, hyperthyroidism, thrombocytopenia, ozone allergy, mental illness, acute myocardial infarction, tendency to seizures, acute alcohol intoxication. Complications of ozone therapy can be hypotension, hypertension, difficult venous access (Kulakov V.I., Serov V.N., Abubakirova AM, Kachalina TS, Grechkanev G.O., Shakhova N.M., etc. Medical ozone in the treatment of obstetric and gynecological pathology. A manual for doctors. - Nizhny Novgorod: Publishing House of the Nizhny Novgorod State Medical Academy, 2001. - 16 p.).

- Laser therapy.

Laser therapy (quantum therapy) is the therapeutic effect on the human body of the electromagnetic radiation of the optical range (light). Laser therapy activates metabolic processes, stimulates microcirculation, has antibacterial, virusocidal, immunomodulatory effects.

Intravenous laser blood irradiation (VLOK) is performed using a ULF-01 apparatus that generates red helium-neon radiation with a wavelength of 0.63 microns and an output power of 1 mW. After intravenous administration of the fiber through the catheter into the ulnar vein, the toggle-switch of the “on” apparatus is turned on and intravenous blood irradiation is performed, the exposure time of each session is 15 minutes, the procedures are performed daily. For complex treatment of the threat of abortion in the I and II trimesters, 10 sessions of VLOK are performed. Pregnant women with herpetic and cytomegalovirus infection VLOK performed after 32 weeks of pregnancy, a total of 7 sessions.

Contraindications to laser therapy are: blood diseases, hypocoagulation of blood, thyrotoxicosis, hypotension, acute fever with an unclear diagnosis, acute infectious diseases, mental illness, diseases of the cardiovascular system in the stage of decompensation, diabetes mellitus in the stage of decompensation, severe exhaustion (somatic asthenia, psychasthenia), active forms of tuberculosis, actinomycosis, anthrax, syphilis, neoplasms of a malignant and benign nature of any localization, not erenosimost factor. Complications of VLOK are hypotension, hypertension (Afanasyeva V.M. Pathophysiological substantiation and use of antioxidants, antiplatelet agents and laser therapy for threatening abortion: Dis. Candidate of Medical Sciences. - Moscow. - 2007).

Thus, plasmapheresis, ozone therapy and laser therapy are invasive treatments, which represents a significant drawback.

Physiotherapy methods such as endonasal galvanization, magnesium electrophoresis with a sinusoidal modulated current, inductothermy of the kidney area, electrostatic relaxation of the uterus using alternating sinusoidal current, electroanalgesia affect central or peripheral mechanisms that regulate uterine contractility and are used only to treat the threat of abortion account of antispasmodic and analgesic effects (Strugatsky V.M., Arslanyan K.N., Portnov V.V. Physiotherapeutic appointments Nia in obstetric hospital Guidelines -.. Moscow, 1998. - 22 c)..

EHF-therapy (extremely high-frequency therapy, microresonance therapy, millimeter-wave therapy). The known method consists in the fact that millimeter-wave radio waves affect reflexogenic zones and biologically active points in an intensive mode, with a fixed wavelength of 5.6 mm, a fixed frequency of 53.534 + 0.01 GHz, the energy flux density does not exceed 10 mW / cm ² . (Rodshtat I.V. Physiological concept of the interaction of millimeter-wave radio waves with the human body // Int. .548-553).

Millimeter radio wave exposure causes an immunomodulating effect due to a decrease in the degree of inhibition of cellular and humoral immunity (the number of T-lymphocyte helper cells (CD 4+) increases, the immunoregulatory index increases, and the content of circulating immune complexes decreases), which allows the use of EHF therapy in the complex treatment of viral and bacterial infections. In the process of EHF exposure, an improvement in the psychoemotional state occurs, an increased level of anxiety decreases, and the frequency and intensity of autonomic disorders decreases.

However, the disadvantage of this method is that during pregnancy the use of EHF-therapy is contraindicated (Shaklein A.V., Kuleshov V.M. et al. Infectious aspects of an undeveloped pregnancy and methods for the prevention of postabortion endometritis. Bulletin SB RAMS No. 4 (110), 2003).

For the prototype of the present invention, a well-known method for the treatment of urogenital infections in pregnant women was selected, including complex drug therapy (Borovkova L.V., Kolobova S. "A modern view of the problem of miscarriage of infectious genesis", "Nizhny Novgorod Medical Journal", Publishing house of the State Educational Institution of Higher Professional Education Nizhny Novgorod State Medical Academy , Nizhny Novgorod, 2006, No. 1, pp. 90-94).

A known method is as follows.

Pregnant women with a diagnosis of urogenital infection are given traditional antibacterial and antiviral therapy. With chlamydia, mycoplasmosis and ureaplasmosis, josamycin is prescribed 500 mg 3 times a day for 10 days, pimafucin 400 mg 2 times a day for 10 days. With CMVI, a normal human immunoglobulin is administered at 12, 23-24 weeks. and 10-14 days before birth, 25 ml per 200 ml of physiological saline sodium chloride intravenously every other day, only 3 times per treatment course. With an exacerbation of herpetic infection, Zovirax 200 mg is prescribed 5 times a day for 5 days. Along with etiotropic treatment, immunocorrective preparations are used - viferon 100 thousand units. Rectal 2 times a day for 10 days, vitamin therapy - vitrum-prenatal 1 tab. per day, hofitol 2 tab. 3 times a day.

However, the negative impact of an infection on the fetus and newborn depends largely on the severity and nature of changes in the immune status of a pregnant woman. Conducted comprehensive antibacterial and immunocorrective therapy in pregnant women does not prevent fetal infection, the development of placental insufficiency, anomalies of labor and does not improve perinatal outcomes.

The objective of the invention is to increase the effectiveness of treatment of urogenital infections in pregnant women, including pregnant women with miscarriage, reducing the frequency of intrauterine infection in pregnant women with bacterial and viral infections, and improving perinatal outcomes.

The problem in the known method for the treatment of urogenital infections in pregnant women, including complex drug therapy, is solved by the fact that every day simultaneously with complex drug therapy, SCENAR-therapy is carried out using pulsed bipolar current without a constant component in the form of pulses with a frequency of 90.7 Hz, including the mode oscillating frequency within 30-120 Hz with the formation of pulses in packets of 2 to 8 and a repetition rate of 540 Hz to 4.5 kHz, treatment begins at 16-18 weeks of pregnancy using the study of the general impact technique, namely, they influence the vertebral and paravertebral lines — three paths, then six exit points of the trigeminal nerve on the face, the cervical-collar zone and the area of the projection of the liver for 10-15 minutes, and if signs of small asymmetry occur the liver is treated until these signs disappear, while the course of treatment is 10 procedures daily, one procedure per day, 35-40 minutes each.

The use of SCENAR-therapy in practical public health was approved at a meeting of the Section on Traditional Methods of Treatment of the Academic Council of the Russian Ministry of Health (protocol No. 3 of December 20, 2000).

SCENAR-therapy has a rather small number of contraindications (the presence of an artificial pacemaker, severe mental illness, intoxication, acute infectious diseases of unknown etiology) and does not have embryotoxic and teratogenic properties (Borovkova L.V., Scherbatyuk T.G., Kozlov D .V., Kholmogorova I.E., Kolobova CO., Mayorova MA, Leonova E.I., Tereshchenko SV The effect of SCENAR-therapy on the course of pregnancy in female outbred rats. Remedium Volga region, special issue for doctors. Maternal health and ebenka Nizhny Novgorod -. 2006 - s.50-51).

The use of SCENAR-therapy in pregnant women was carried out with the permission of the local ethics committee at the State Health Institution “Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko ”(Minutes No. 7 of the meeting of the ethics committee at the State Institution“ Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko ”dated October 11, 2005). All women received informed written consent for SCENAR-therapy.

Treatment according to the proposed method begins at 16-18 weeks of gestation simultaneously with traditional drug therapy. During treatment sessions, a general exposure technique is used with a pulse frequency of 90.7 Hz, including processing of the vertebral, paravertebral lines and six trigeminal exit points on the face to correct the activity of the nervous, immune and endocrine systems, the cervical-collar zone to normalize the activity of the autonomic nervous system , areas of the projection of the liver in order to enhance anti-inflammatory and immunomodulating effects. The course of treatment is 10 procedures, daily for one procedure per day for 10 days.

The present invention meets the criteria of the invention of "novelty", since in the process of conducting patent information research, sources of scientific, medical and technical information that discredit the novelty of the proposed method are not identified.

The present invention meets the criterion of "inventive step", since no methods have been identified for the treatment of urogenital infections in pregnant women with essential features of the proposed method.

Electropulse therapy or SCENAR-therapy is widely used in therapeutic, surgical, neurological, pediatric and gynecological practice (Greenberg Y.Z. SCENAR-therapy. Efficiency from the perspective of electrotherapy methods. SCENAR-therapy and SCENAR-examination. Collection of articles, issue 2, p.18-33, Taganrog, 1996, Revenko AN SCENAR-therapy and SCENAR-examination. Textbook. Part I. - Yekaterinburg, Publishing House "Filantrop", 2004 - 408 p.).

It is known the use of SCENAR-therapy for the treatment of patients with external genital endometriosis (RF patent №2250785, publ. 04/27/2005, Bull. No. 12). In the known method 1-3 courses of SCENAR-therapy with intervals between courses of 1-3 months, while the first course begins with the first menstrual cycle after performing an endoscopic operation; each course is carried out according to the scheme of 15-20 sessions in the first menstrual cycle and 7-10 sessions in the second menstrual cycle, sessions are carried out daily for 25-40 minutes, the exposure zones are alternated and at the same time, the effects on the following skin areas are performed in each odd session: 3 paths of the spine, 6 points on the face - the place of the trigeminal nerve exit and the suprapubic region, and for each even session, the effect is applied to the following skin areas: the front and inner surfaces of the right thigh, the back and outer surfaces of the lion oh legs, large labia and the rear of both feet.

Thus, the authors of the well-known invention to increase the protective and adaptive reactions of the body and its nonspecific reactivity in patients with OGE after performing endoscopic surgery, used the electric pulse therapy using the SCENAR device (self-controlled energy-neuroadaptive regulation) (Russia, Taganrog, OKBM "Rhythm"). As a signal of the electric pulse effect of a pulsed bipolar current without a constant component, a dynamic informational neural-like signal is generated. The acting signal is supplied by the device in the form of pulses with a frequency of 90.7 Hz, including the oscillating frequency mode of 30-120 Hz, and has the ability to form them into packets of 2 to 8 and a repetition rate of 540 Hz to 4.5 kHz. The biological effect of pulsed currents includes phenomena associated with the realization of their influence on the functional and morphological state of tissues, intracellular metabolism, and a decrease in the voltage of regulatory processes. The peculiarity of SCENAR-therapy is an individual optimal effect on the patient, since the parameters of electrical stimulation vary in accordance with the skin impedance in biologically active zones, corresponding to the pathological focus according to the principle of feedback biofeedback.

However, the authors of the known method carried out treatment in non-pregnant women.

The authors of the invention used SCENAR-therapy for the first time in the complex treatment of urogenital infections during pregnancy, including in pregnant women with miscarriage of infectious genesis, while an unexpected technical result was obtained, namely, the frequency of intrauterine infection in pregnant women with bacterial and viral infections decreased, improved perinatal outcomes.

The authors of the present invention carried out experimental work on outbred white rats to study the effect of short-pulse SCENAR signals, in particular, the frequency of exposure (90.7 Hz), the duration of exposure and other parameters of the method were worked out. The absence of embryotoxic and teratogenic properties of these signals was established, which allowed us to conclude that SCENAR-therapy can be used in pregnant women.

The inventors conducted a comprehensive examination of 110 pregnant women with miscarriage of infectious genesis at the age of 18 to 30 years. All pregnant women were examined for urogenital infections (chlamydia, mycoplasmosis, ureaplasmosis, cytomegalovirus and herpetic infection). For the diagnosis of mycoplasmosis and ureaplasmosis, bacteriological culture of the contents of the cervical canal was used. In order to detect chlamydia, cytomegaloviruses and herpes simplex viruses, a detachable cervical canal (using the polymerase chain reaction) and blood serum were tested for antibodies (immunoglobulins A, M, G) to the above infections (enzyme immunoassay).

As a result of the examination, all women revealed urogenital infections (mycoplasmas, ureaplasmas, chlamydia, herpes simplex virus and cytomegalovirus) in the form of mono-infections (35%) or bacterial-viral associations (65%). All patients were divided into 2 groups, comparable in age, social status, previous gynecological and extragenital diseases. After 16-18 weeks, pregnant control group (50 people) underwent traditional antibacterial and antiviral therapy (for chlamydia, mycoplasmosis and ureaplasmosis - josamycin 500 mg 3 times a day for 10 days, pimafucin 400 mg 2 times a day for 10 days; with CMVI - the introduction of normal human immunoglobulin at 12, 23-24 weeks and 10-14 days before delivery 25 ml per 200 ml of physiological saline sodium chloride intravenously every other day, only 3 times per treatment course; with exacerbation of herpes infection - zovirax 200 mg 5 times a day for 5 days; simultaneously with etiotropic treatment, immunocorrecting drugs are used - viferon 100 thousand units rectally 2 times a day for 10 days, vitamin therapy - vitrum-prenatal 1 tablet per day, hofitol 2 tablets 3 times a day).

After 16-18 weeks, pregnant women of the main group (60 people), in combination with drug therapy, underwent SCENAR-therapy according to the proposed method.

The studies showed the following results. In the control group, the frequency of the threat of abortion was 20%, fetoplacental insufficiency - 20%, intrauterine growth retardation of the first degree — 8%, chronic fetal hypoxia — 8%, anomalies of labor activity — 30%, mild asphyxia of 4 degrees.

In the main group, the rate of miscarriage is lower by 6%, fetoplacental insufficiency - by 8%, anomalies in labor activity - by 12% compared with the control group, there were no cases of fetal hypoxia and asphyxiation in the main group.

Using the proposed method for the treatment of urogenital infections in pregnant women, including pregnant women with miscarriage of infectious origin, allows us to establish the following positive effect.

- The method can significantly reduce the development and degree of inhibition of cellular and humoral immunity (from 56.7% of cases with a predominance of pronounced changes in the control group to 20% with mostly mild signs of immunosuppression in the main group).

- Significantly reduces the development and severity of inflammatory processes in the afterbirth.

During histological examination in 9 (60%) of the placenta of the main group (in women with isolated mycoplasma (ureaplasma), mycoplasma-ureaplasma, chlamydia, chlamydial-herpetic, mycoplasma-herpetic infection) there were no inflammatory changes; in 4 (26.7%) placentas (with chlamydial-cytomegalovirus, chlamydial-mycoplasma infection) a few small inflammatory foci in the fetal membranes were found, which were localized within the compact layer and cytotrophoblast, not reaching the amniotic epithelium, and in the basal plate; in 2 (13.3%) cases (in patients with chlamydial-cytomegalovirus, chlamydial-mycoplasma-cytomegalovirus infection), single small focal inflammatory infiltrates were found in the membranes, including the layer of amniotic epithelium and subchorial space, and in the basal plate.

In the study of the control group, only 2 (13.3%) placentas revealed changes in the form of small focal inflammatory infiltrates in the membranes, subchorial space, basal lamina, which were most common after treatment with mycoplasma (ureaplasma) infection; in 10 (66.7%) placentas, common inflammatory changes in the basal lamina, villi, intervillous space, fetal membranes, and subchorial space were detected, of which in 7 (46.7%) cases (mainly in patients with chlamydial, herpetic, chlamydial-herpetic infection) revealed signs of relative compensated chronic placental insufficiency (according to the criteria of morphological diagnosis of V.A. Zinserling et al., 1998) with mild focal involutive-dystrophic processes (och arterial dystrophic changes in syncytiotrophoblast, deposition of a fibrinoid in the intervillous space) and well-defined compensatory-adaptive reactions (hyperplasia and hypervascularization of terminal villi, an increase in syncytial nodules and syncytocapillary membranes), and in 3 (20%) cases of women with cytoma chlamydial-mycoplasma, chlamydial-mycoplasma-cytomegalovirus infection) - signs of relative subcompensated chronic placental insufficiency with a focus high impairment of maturation of the villi (presence of embryonic, intermediate immature and mature villi), diffuse deposits of the fibrinoid, and focal hemorrhages in the intervillous space, and active compensatory-adaptive processes; in 1 (6.7%) case, isolated small focal inflammatory areas were found in the membranes (without damage to the amniotic epithelium), and in the basal plate (with isolated mycoplasma and herpetic infection); in 2 (13.3%) patients there were no inflammatory processes (in patients treated for ureaplasmosis).

Thus, the application of the proposed method in pregnant women and pregnant women with miscarriage of infectious origin significantly reduces the development and severity of inflammatory processes in the aftercare (from 86.7% of cases with a predominance of pronounced changes in the control group to 40% with mostly mild signs of inflammation in the main group).

- Allows you to improve the prognosis of gestation in pregnant women with miscarriage of infectious genesis, as well as the condition of the fetus and newborn.

The proposed method is as follows. For a period of 16-18 weeks, complex drug therapy and simultaneously SCENAR-therapy are carried out. Traditional antibacterial and antiviral therapy includes:

- with chlamydia, mycoplasmosis and ureaplasmosis - josamycin 500 mg 3 times a day for 10 days, pimafucin 400 mg 2 times a day for 10 days;

- with CMVI - the introduction of a normal human immunoglobulin at 12, 23-24 weeks. and 10-14 days before birth, 25 ml per 200 ml of physiological saline sodium chloride intravenously every other day, only 3 times per treatment course;

- with exacerbation of herpetic infection - Zovirax 200 mg 5 times a day for 5 days.

Along with etiotropic treatment, immunocorrecting drugs are used - viferon 500 thousand units rectally 2 times a day for 7 days or kipferon 500 thousand units rectally 2 times a day for 10 days, vitamin therapy - vitrum, prenatal 1 tab. per day, hofitol 2 tab. 3 times a day).

SCENAR-therapy is carried out simultaneously with drug treatment in the period of 16-18 weeks of pregnancy (after completion of the organogenesis process). SCENAR-therapy is applied according to the general method, with a pulse frequency of 90.7 Hz. The course of treatment is 10 procedures, one procedure per day, daily for 10 days. The duration of the entire session is 35-40 minutes.

General exposure techniques:

- “three tracks, six points”, carried out in individually-dosed mode (Diag 1).

- “Cervical-collar zone”, carried out in an individually-dosed mode (Diag 1).

- Treatment of the liver zone is carried out from top to bottom, from left to right (in accordance with the accepted rules of SCENAR-therapy).

To ensure hygienic requirements, the electrode of the apparatus is treated with a swab moistened with a 3% solution of hydrogen peroxide with the addition of detergent of the Lotus type (with obligatory subsequent drying).

An example of a specific implementation. As a clinical example, we present data on the results of treatment of one patient.

Pregnant G. (outpatient card number 1142), 23 years old. Pregnancy is 10 weeks. Concerned about the abundant homogeneous discharge from the genital tract with an unpleasant odor for 2 weeks. The second pregnancy. A history of spontaneous miscarriage in a period of 8-9 weeks. Gynecological diseases - Trichomonas colpitis, bacterial vaginosis. Extragenital diseases - vegetovascular dystonia by hypotonic type.

Examination for urogenital infections revealed chlamydia, mycoplasmosis, cytomegalovirus infection. An examination of the immunogram at 10 weeks of gestation revealed depression of the T-cell immunity link and a decrease in the level of serum IgG.

Diagnosis: Pregnancy 10 weeks. RSA. Chlamydial-mycoplasma-cytomegalovirus infection. Hypotonic vegetative-vascular dystonia.

At 16 weeks of gestation, the traditional treatment of urogenital infections with the additional use of SCENAR-therapy according to the described rules has been started.

1 session. Complaints of weakness, dizziness, bad mood, irritability, anxiety, restless and short night's sleep. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

2 session. Complaints remain. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

3 session. Overall health has improved. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

4 session. Overall health has improved. I felt a surge of energy. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

5 session. The general state of health is good, sleep has improved. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

6 session. He feels well and is in good spirits, a surge of strength and vitality, a sound sleep, a calm. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

7 session. There are no complaints. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

8 session. There are no complaints. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

9 session. There are no complaints. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

10 session. There are no complaints. Methodology: “3 tracks, 6 points” in individually-dosed mode; "Cervical-collar zone" in an individually-dosed mode (Diag 1); treatment of the liver zone.

A total of 10 sessions.

When studying the immunogram after complex treatment of urogenital infections using SCENAR-therapy, indicators of cellular and humoral immunity in the periods of 22 and 37 weeks. pregnancy was normal. Pregnancy was uneventful. No cases of exacerbation of infections were noted.

When conducting an ultrasound examination of the fetoplacental complex and dopplerometry of the uteroplacental blood flow at 22-24 and 32-34 weeks. pregnancy pathological abnormalities not detected. At 40 weeks, an independent birth occurred, proceeded without complications. A girl was born, weight 3200 g, height 50 cm, with an Apgar score of 10 points. No infectious agents were found in the lacrimal fluid and umbilical cord blood. In a morphological study of the placenta, inflammatory changes were absent. The postpartum period was uneventful. Violations of the physical and neuropsychic development of the child in the first year of life have not been identified.

Claims (1)

A method for the treatment of urogenital infections in pregnant women, including complex drug therapy, characterized in that SCENAR-therapy is carried out daily along with complex drug therapy using pulsed bipolar current without a constant component in the form of pulses with a frequency of 90.7, including the oscillating frequency mode within 30 -120 Hz with the formation of pulses in packets of 2 to 8 and a repetition rate of 540 Hz to 4.5 kHz, treatment begins at 16-18 weeks of gestation using general methods of exposure namely, they act on the vertebral and paravertebral lines — three paths, then on six exit points of the trigeminal nerve on the face, the cervical-collar zone and the area of the projection of the liver for 10-15 minutes, and if signs of slight asymmetry occur, the liver zone is treated the disappearance of these signs, while the course of treatment is 10 procedures, 35-40 minutes each.