SU1710008A1 - Method for treating the postnatal hematoma - Google Patents

Abstract

This invention relates to medicine, namely obstetrics. The aim of the invention is to prevent complications. Wives with postpartum hematomas of the vagina cut through the tissue in the area of the hematoma, the contents are removed, layer-by-layer closure of the vaginal walls is performed. In the method, additional external drainage of the uterus and a tight plugging of the vagina are performed, followed by removal of the tampon and drainage in 3-4 hours, and before plugging the tampon is moistened at 40-42 ° C. Treatment by the proposed method allows to reduce the number of different postpartum complications, for example, recurrence of hematoma, endometritis, etc. The hospital stay is reduced from 14 to 9 days.

Description

This invention relates to medicine, and specifically to obstetrics.

.The goal is to prevent complications. . The method is carried out as follows. , . ,,; ; -, ... :

In puerpera, with postpartum hematogenous. my vagina, under operating conditions, exposes a hematoma in the mirrors and a scalpel dissects the tissue in the hematoma area, removes the contents, thoroughly sutures the vaginal wall and installs a drainage tube into the uterus, which is an elastic tube with tight inserts and provides an unobstructed outflow the contents of the uterus from the level of the internal pharynx to the outside, then the vagina is tightly plugged with a tampon moistened at 40-42 ° C and nocrte, the state of the uterus cavity is periodically monitored and olovlagalischnogo hpo space, e.g., using ultg razvukoaogo scanning computer

tomography, etc. After 3–4 hours, a tampon and a drainage tube are removed.

Example 1. Ill B., 28 years old, diagnosis: 1 delayed delivery at week 41, large fetus, which started with the intrauterine hypoxia, early postpartum period.

Received during the period of childbirth. On admission produced by interim i water

light

After 45 minutes after the discharge of the water, the head of the fetus fell to the pelvic floor and attempts began after 2-3 minutes for 40-50 seconds. The condition of the woman and the fetus is satisfactory. After 20 minutes, the fetal heartbeat decreases to 100-110 beats per minute after cutting the head of the fetus, with no tendency to recovery.

The diagnosis was made: the 5th period of the 1st late birth at the 41st week of labor, headache, anterior view, starting with hypoxia, amniotomi. Perinetomy was performed to accelerate labor due to the onset of fetal hypoxia. The child gave birth to a boy with a single tight cord entanglement around the neck and an Apgar score of 6-8 points and a body weight of 4500 g. After 4 min, the afterbirth with all the lobules and shells separated out, and hemorrhage was lost 150 ml. The uterus is well preserved, there is no bleeding. Produced inspection of births {1x ways. Not detected with a hematoma of the vagina 5x7 cm, located on the right and rear walls of the vagina in its upper third. A scalpel dissected the tissue of the vaginal wall in the hematoma area, removed the contents of about 150 ml of dark liquid with clots, hemastasis was performed by sewing the tissue, layer-by-layer suturing of the vaginal wall, external drainage was established from the level of the internal pharynx and through the genital slit; , eliminating the growth of bacteria (for example, phys .. r-rum) with a temperature, after that, every 20-30 minutes, the state of the uterus and the vaginal space was monitored Real-time ultrasound scanning allows us to determine the size of the uterine cavity and promptly diagnose uterus hypotension and the development of lochyometers, as well as the occurrence of hematoma recurrence in the surrounding vaginal space. Produced stratified restoration of the gap. After 4 h, swab and drainage from the vagina was removed. There is no bleeding from the pathways. The uterus is dense. The condition of the vaginal walls is good, there are no bulges, the sutures are good. The postpartum period was uneventful. The seams in the perineum are removed for 5 days. Healing of stitches by primary tension. On the eighth day of labor, the puerperal and the newborn in a satisfactory condition were discharged home under the supervision of antenatal clinics.

PRI mme R 2. Sick D., 18 years old, was admitted to the maternity hospital with a diagnosis of 40 weeks gestation, headache, prenatal discharge of water, the 1st period of labor, colpitis. 5 hours after the intake, attempts began after 1-2 minutes for 40-50 seconds. The head of the fetus is on the pelvic floor. Fetal heartbeat - clear, rhythmic - 136 beats in 1 min. Discharge from the genital tract - blood. After 25 minutes was born alive donoshen girl. Cried immediately after sucking mucus from the upper respiratory tract. The cry is loud, there are no defects in development. The rating on the scale of Ap g p 8-9 points.

The body weight of a newborn is 4200 g. Height is 53 cm.

After separation of the afterbirth, a 4x6 cm postpartum hematoma, located on the posterior wall to the right in the upper third of the vagina, was found upon examination of the soft genital tract. Under the anesthetic-oxygen anesthesia and using local anesthesia with a 1/4% solution of novocaine in the mirrors, tissue dissection in the hematoma area, removal of the contents, layer-by-layer closure of the vaginal wall, establishment of external drainage were performed. Then made a tight plugging

the vagina with a tampon moistened with a saline solution at a temperature of 40 ° C for 4 hours. During this time, the state of the uterine cavity and the vaginal space is monitored periodically after 20-30 minutes using ultrasound scanning. During the observation period for 4 hours, about 40 ml of dark blood lochia were discharged through the drainage. According to ultrasound,

carried out in dynamics every 2030 min, it was found that the anteroposterior size of the uterus cavity decreased from 12 to 8 mm with a liquid content, which indicates a satisfactory contractile activity of the uterus in the early postpartum period. In the okolovaginalnom space in this period of time, hematoma recurrence was not detected. After 4 h after surgery removed

from the vagina swab. There is no bleeding from the cavity. the seams are good. In the postpartum period, sanitization of furacilin pacTfopoM vagina was performed. On the 9th day, the puerperal woman was discharged in satisfactory condition with the child home under the supervision of antenatal clinic.

The proposed method treated postpartum hematomas in 14 puerperas. Comparative analysis of indicators

the effectiveness of treatment of postpartum hematomas of the vagina showed significant advantages of the proposed method (table

one). ..,:., -.

Clinical trials have shown that the proposed method significantly but reduces the number of various complications, prevents the occurrence of recurrent hematomas, reduces the number of inflammatory diseases and reduces the time of stay of patients in the hospital from 14 to 9 days.

Claims (1)

The proposed method of treating postpartum hematomas of the vagina can be used in obstetric departments of hospitals and maternity hospitals due to its ease of implementation and high efficiency. The invention The method of treatment of postpartum hematomas of the vagina, including emptying the hematoma and suturing the walls of the vagina, about 5 liters, and with the fact that, in order to prevent complications, external drainage of the uterus and plugging the vagina with subsequent removal a tampon and a drainage tube through 3-4 ts, and before tamponirovaniye a tampon is moistened at 40-42 C.