RU2805826C1 - Method of treating endometritis after childbirth - Google Patents

Abstract

FIELD: medicine; obstetrics; gynecology.

SUBSTANCE: basic antibacterial therapy is carried out, lochiometers are emptied and intrauterine instillation of an antimicrobial medicinal product is performed. A Nelaton catheter is inserted to the bottom of the uterine cavity. When removing the catheter from the uterus, hemolyzed blood and clots are sucked out with a syringe, the procedure is repeated until the uterine cavity is emptied. Then, 0.05 g of 5 cm³ catedgel — chlorhexidine dihydrochloride and 2 g of lidocaine hydrochloride are injected into the uterine cavity once with a sterile syringe.

EFFECT: method allows to increase the effectiveness of treatment of endometritis after childbirth, including after cesarean section, ensures the removal of the substrate that supports the inflammatory process, eliminates bacteria and their toxins, provides antimicrobial therapy with a local analgesic effect, which leads to rapid regression of the inflammatory process in the uterus.

2 cl, 1 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used for the treatment of endometritis in women after childbirth, including after cesarean section.

The relevance of the problem of postpartum inflammatory diseases (PIDs) is determined, first of all, by their frequency, severity and unfavorable outcome for postpartum women [Mazhidova Z.Sh., Yashchuk A.G., Musin I.I. The use of platelet autoplasma during cesarean section in pregnant women with a high risk of developing purulent-septic complications // Obstetrics and gynecology: news, opinions, training. 2021. T. 10, No. 1. P. 31-37. DOI: https://doi.org/10.33029/2303-9698-2022-10-1-31-37]. Postpartum sepsis is one of the five main causes of maternal mortality worldwide and ranges from 10 to 15% in the postpartum period [Nadeev A.P., Zhukova V.A., Novoselov V.P., Nizovtsev K.A., Loginova A. .B. Purulent-septic diseases in the nosological structure of maternal death // Bulletin of Forensic Medicine. 2021. T. 10, No. 2. P. 26-33.]. Postpartum infectious complications subsequently cause a number of disorders of specific functions of the body of women, including a decrease or loss in the future of reproductive function [Kogan Ya. E. Clinical significance of assessing endometrial infection in the early postpartum period in predicting the development of postpartum inflammatory complications and the implementation of intrauterine infection of the fetus in women at-risk groups. Abstract of dissertation. Ph.D. Kazan, 2009, 26 p.]. Despite numerous studies, as well as the introduction of new diagnostic and therapeutic methods, infectious complications of the postpartum period remain significant [Arakelyan B.V., Prokhorovich T.I., Libova T.A., Romanova L.A., Bezruchko L.F. ., Yakovlev A.V. and others. Postpartum sepsis. Purulent-septic complications (diagnosis, treatment) // Global Reproduction. 2021. No. S1. P. 1-11.].

Various methods of treating postpartum endometritis are known, consisting in the prescription of antibacterial agents and the use of intrauterine treatment methods: intrauterine irrigation with ozonated distilled water (RU Patent No. 2218162, IPC A61K 33/00, A61K 33/14, A61P 31/00 - 12/10/2003, Bulletin . No. 34), antiseptic solutions with simultaneous exposure to the source of inflammation and surrounding tissues of direct electric current (Patent RU No. 2016553, IPC A61B 17/42, A61N 1/04 - 07/30/1994); carrying out intrauterine installations with the proteolytic enzyme profezin (Patent RU No. 2267327, IPC A61K 38/43, A61P 43/00 - 01/10/2006, Bulletin No. 1); intracavitary administration of chitosan hydrochloride hydrogel containing metronidazole and dioxidine (RU Patent No. 2309744, IPC A61K 31/495, A61K 31/4164, A61K 31/722, A61P 15/00 - 11/10/2007, Bulletin No. 31); introduction of pyobacteriophage followed by the use of infrared pulsed laser radiation (Patent RU No. 2493863, IPC A61K 35/66, A61K 39/116, A61N 5/067, A61P 15/00 - 09.27.2013, Bulletin No. 27), use of sterile molded sorbent "All-Russian Scientific Research Institute of Carbon Black-1 Polyvinylpyrrolidone" (Patent RU No. 2646496, IPC A61K 33/44, A61K 31/40, A61P 31/04 - 03/05/2018, Bulletin No. 7), intrauterine exposure to low-frequency ultrasound (Patent RU No. 2537779, IPC A61N 7/00, A61M 31/00, A61K 31/345, A61P 15/00 - 01/10/2015, Bulletin No. 1), including with the introduction of poludan (Patent RU No. 2342173, IPC A61N 7 /00, A61K 31/711, A61P 15/00 - 12/27/2008, Bulletin No. 36), the drug “Betaleukin” (RU Patent No. 2634471, IPC A61N 7/00, A61K 33/14, A61K 38/20, A61P 15/00 -30.10.2017, Bulletin No. 31 ).

However, the above-described methods of treating endometritis after childbirth are not always effective, since in some cases they do not allow achieving sufficient activity of the material to suppress the growth of pathogenic microflora, in others there is a need to carry out manipulations to expand the cervical canal, which increases the traumatic nature of the procedure, or there is a need to use endoscopic equipment, hardware treatment methods, special materials, which leads to an increase in the cost of treatment; often the complexity of the procedure requires the involvement of highly qualified employees, as well as a lot of time;

“Method for the treatment of chronic endometritis” was chosen as the closest analogue of the claimed invention (RU patent No. 2607590, IPC A61K 31/167, A61K 31/155, A61K 38/47, A61P 15/00 - 01/10/2017, Bulletin No. 1), consisting in a complex two-stage effect on the endometrium, characterized in that at the first stage systemic anti-inflammatory therapy is carried out and intrauterine administration of Cathegel with lidocaine, which has an antimicrobial, adsorbent and anesthetic effect, is carried out, 3-4 instillations of 12.5 g every other day per course of treatment; at the second stage, the antifibrosing drug Longidaza is administered in the form of vaginal suppositories, one suppository once every 3 days - 10 suppositories per course of treatment.

This patent is accepted as a prototype.

The disadvantage of this method is that it is used for chronic inflammation of the endometrium in women, but not for acute inflammatory disease after childbirth, accompanied by lochiometra, and includes repeated administration of the drug Katedzhel, as well as further therapy with the drug Longidaza.

The objective of the claimed invention is to increase the effectiveness of treatment of endometritis after childbirth, including after cesarean section.

The technical result of the claimed invention is the provision of local antimicrobial therapy that does not cause the development of dysbacteriosis, and also has a low allergenic potential.

The technical result of the claimed invention is achieved due to the fact that basic antibacterial therapy is carried out, emptying the lochiometer and intrauterine instillation of an antimicrobial drug, the peculiarity is that for the complete removal of hemolyzed blood and clots from the uterine cavity, a Nelaton female urethral catheter is used connected to a sterile syringe with a volume of 10 cm3, after which a single intrauterine injection of Cathegel with lidocaine, which has an antimicrobial, adsorbent and anesthetic effect, is carried out through a catheter using a sterile syringe with a volume of 5 cm3

The advantage provided by the given set of symptoms is the effectiveness and safety of treatment of endometritis, which is manifested in the rapid regression of the inflammatory reaction, contraction of the uterus in accordance with physiological involution, which reduces the length of hospital stay. The procedure is performed once, does not require dilation of the cervical canal, the use of anesthesia, and is easily tolerated by patients.

Implementation of the invention.

According to ultrasound data, there should be no formations with blood flow in the uterine cavity. The patient must indicate the absence of allergic reactions. The manipulation is performed without anesthesia. In the absence of hyperthermia, against the background of initiated antibacterial therapy under aseptic conditions, after treating the genital organs and vaginal mucosa with an aqueous solution of chlorhexidine bigluconate 0.05%, a disposable speculum is inserted into the vagina and the cervix is visualized, the mirror is fixed. First, the green adapter is cut off from the Nelaton urethral female catheter (size 14 on the Charrière scale Ch/Fr, internal diameter I.D. 3.3 mm) and the catheter is connected to a sterile syringe with a volume of 10 cm3. The choice of the Nelaton catheter is associated with the sufficient density of the polymer material, which allows it not to bend when inserted into the neck and eliminates the use of dilators. A Nelaton catheter is inserted into the uterine cavity to the bottom; when removed from the uterus, hemolyzed blood and clots are sucked out with a syringe. The syringe filled with lochia is emptied, and the procedure is repeated until the uterine cavity is completely empty. If technical conditions are available, ultrasound (ultrasound) monitoring of the effectiveness of the procedure is possible. Another sterile syringe with a volume of 5 cm3 is prepared, which is filled through the piston with Cathegel with lidocaine (chlorhexidine dihydrochloride 0.05 g and lidocaine hydrochloride 2 g). A syringe filled with Katedjel is connected to a Nelaton catheter, through which Katedjel is introduced into the uterine cavity. The patient remains in the examination chair for 10 minutes, after which she is transferred to the ward on a sitting gurney. The procedure is carried out once.

There is a rapid regression of the inflammatory reaction in the form of normalization of white blood counts, a decrease in C-reactive protein (CRP), thrombocytosis and hyperfibrinogenemia, and the reverse development of polyserositis. The uterus contracts in accordance with physiological involution.

In the absence of an allergic reaction immediately after administration, there is no change in the patient’s condition. After a few hours, there is an improvement in the condition associated with a decrease in the severity of the inflammatory process and a decrease in the intoxication syndrome

Clinical examples.

Example 1. Patient I., 35 years old, received therapy according to the proposed method for acute endometritis on the 23rd day after birth. Before treatment, I was bothered by pain in the lower abdomen and elevated body temperature. Laboratory tests showed an increase in CRP, procalcitonin, fibrinogen

Analyzes 07/01/2022 12:08:48

Ultrasound from 07/01/22 The body of the uterus is 110x76 mm in AVF, pear-shaped, the contours of the uterus are clear, even, the structure of the myometrium is homogeneous, the uterine cavity is heterogeneously expanded to 19 mm due to heterogeneous hypoechoic contents with hyperechoic structures. The border between the endometrium and myometrium is fuzzy and uneven. In the Color Doppler mode, vascularization is without features. Free fluid in the pelvic cavity is not visualized.

Conclusion: Ultrasound signs of metroendometritis.

Sanitation of the uterine cavity 07/02/22. Under aseptic conditions, without the use of anesthesia, without dilating the cervical canal, a Nelaton female urethral catheter (size 14 on the Charrière scale Ch/Fr, internal diameter I.D. 3.3 mm) was inserted into the uterine cavity, the adapter of which was previously cut off and connected to a sterile syringe with a volume of 10 cm3. Using a Nelaton catheter, hemolyzed blood and clots were removed with a syringe until the uterine cavity was completely emptied. Another sterile syringe with a volume of 5 cm3 filled with Catedjel with lidocaine (chlorhexidine dihydrochloride 0.05 g and lidocaine hydrochloride 2 g) was injected into the uterine cavity through the Nelaton catheter. After 10 minutes, the patient was transferred to the ward in satisfactory condition.

After sanitation of the uterine cavity on 07/02/22 in combination with basic antibacterial therapy, including ceftriaxone, metoronidazole, the patient’s condition improved significantly, sleep, appetite, body temperature normalized, pain in the lower abdomen stopped, and in blood tests:

Analyzes 07/05/2022 19:15:20

Ultrasound from 07/06/2022: Body of the uterus 67x56 mm in AVF. The uterine cavity is slit-like expanded to 3 mm with hypo-anechoic contents, the endometrium is 2 mm, clear contours, moderately increased echogenicity. Arcuate veins up to 2.5 mm, the lumen is colored during colorectal dosage. Free fluid in the pelvic cavity is not visualized.

During treatment, a rapid regression of the inflammatory response is observed in the form of a decrease in CRP, procalcitonin, and D-dimer. The uterus contracts in accordance with physiological involution.

Based on the above, we can conclude that the method is highly effective for the treatment of endometritis, accompanied by the formation of lochiometra.

Claims (2)

1. A method of treating endometritis after childbirth, which consists of carrying out basic antibacterial therapy, emptying the lochiometer and intrauterine instillation of an antimicrobial drug, characterized in that a Nelaton catheter is inserted to the bottom of the uterine cavity, when removing the catheter from the uterus, hemolyzed blood and clots are sucked out with a syringe, the procedure is repeated until emptying the uterine cavity, then 5 cm ³ catedgel - chlorhexidine dihydrochloride 0.05 g and lidocaine hydrochloride 2 g - is injected into the uterine cavity once with a sterile syringe. 2. The method according to claim 1, characterized in that the treatment of endometritis is carried out after a cesarean section.