The way to prevent subinvolution of the uterus in the postpartum period

 

The invention relates to medicine, in particular to obstetrics. Postpartum women intrawaginalno enter product "Cytotec", the dose of 100 µg. The introduction is carried out after 2, 24, 48 and 72 h after birth. The method reduces the side effects. table 4.

The invention relates to medicine, obstetrics and concerns the methods of prevention of subinvolution of the uterus in the postpartum period.

Known methods of prevention subinvolution of the uterus after childbirth, including the appointment of common drugs that increase uterine contractions: oxytocin, tincture of water pepper, quinine (1, 2, 5).

The closest to the clinical effect of the prototype is the way to prevent postpartum subinvolution of the uterus by intramuscular injection of oxytocin (5 IU per 1 ml), 2 times a day intramuscularly or intravenously (2).

However, the use of this drug often leads to anaphylactic reactions, transient hypotension, flushing and reflex tachycardia, nausea, vomiting, cardiac arrhythmias. Moreover, its application is limited due to the antidiuretic action. With the introduction of oxytocin in high doses for a long time may develop water intoxication with su effects that leads to more effective treatment.

This object is achieved in that the prescribed drug "Cytotec" intrawaginalno at a dose of 100 μg in 2, 24, 48, 72 h after birth.

These distinctive characteristics are not found in the medical-scientific and patent literature. Thus, the proposed method meets the criteria of the invention of "novelty."

The set of distinctive features is not obvious to a person skilled in the art. Thus, the proposed facility meets the criterion of "inventive step".

Based on the results of clinical trials, the method of prevention subinvolution of the uterus in the postpartum period proves that the drug "Cytotec" can be successfully used in clinical obstetrics as a means of stimulating the contractile activity of termiation after birth (in the form of intravaginal injection of 100 µg of the drug after 2, 24, 48 and 72 h after birth). Thus, the proposed method meets the criteria of the invention "industrially applicable".

The drug Cytotec" includes the active ingredient misoprostol (misoprostol). Is a synthetic analogue of prostaglandin E1. Manufacturer Searle (CoE prevent stomach ulcers, associated with the use of nonsteroidal anti-inflammatory drugs in patients with high risk of ulcer formation and for the treatment of acute peptic ulcer of the duodenum (3).

The method is as follows. After 2, 24, 48 and 72 h after birth, begin procedures for the prevention of subinvolution of the uterus, including intravaginal administration of the drug "Cytotec". The condition for the procedure is conservative delivery. The patient after 2, 24, 48 and 72 h after birth intrawaginalno (back set) injected with 100 micrograms of the drug "Cytotec" (1/2 tablet).

Clinical example.

Dream Interpretation C. N., 27 years old, was in the obstetric clinic with DS: Pregnancy 39-40 weeks. Urgent delivery in the head previa. Prenatal rupture of amniotic fluid. A long dry period. The primary weakness of labor activity. Radiosilence prostaglandins. Chronic cholecystitis. Chronic gastritis. Episiotomy, apitherapy.

Pregnancy 2nd. 1 pregnancy in 1996 ended in induced abortion in the period of 8-9 weeks without complications.

Birth occurred on 23/VI-01, at 14 h 25 m Born live, full-term boy weighing 3.860; growth of 55 cm, as assessed by the Apgar scale 8-9.

After 2, 24, 48 and 72 h of Astola. The postpartum period was uneventful. Held ultrasound at 3 and 5 days postpartum showed normal dynamics of the involution of the uterus.

The patient was discharged on the 5th day after birth home in satisfactory condition with the child.

For the first time shown that the drug causes contraction of the myometrium in women in the postpartum period and serves to prevent subinvolution of the uterus. Know the effect of prostaglandin E1on contractile ability termiation, based on the increased transport of ions of CA2+through cell membranes of intracellular organelles and mediated through specific receptors "target tissue". Thus, prostaglandin E1included in the reduction of the myometrium as local tissue hormone. The above action of prostaglandin E1is, according to the literature, to the uterus during pregnancy. The ability of prostaglandin E1influence contractile ability termiation in the postpartum period is not obvious.

Postpartum involution of the uterus is important for preventing complications such as hypotension and atonic bleeding, postpartum septic state, lohiometra. So, subanons is olivani (in 76.6% of cases of endometritis runs in the background of subinvolution of the uterus) (4).

Properties of the drug "Cytotec" influence of structural features of the uterus in the postpartum period and thus lead to its physiological postpartum involution are not described in literature.

Justification mode. The mode of use of the medicinal product based on clinical observations for the period from September 2000 to November 2001. Single dose of 100 μg (total 400 ág) sufficient for the phased impact on contractile ability myometrium prevention subinvolution of the uterus in the puerperal period. The interval of 24 h is optimal for a drug, since its introduction with a shorter interval may cause hypertonicity of the myometrium and, as a consequence, pain, and lengthening the interval will lead to insufficient effect. The concentrations of drug, 4 times, due to the necessity of uterotonic funds in the first three days postpartum prevention subinvolution of the uterus and confirmed by clinical observations, namely the lower doses were not given clinical effect, the use of large doses impractical. The route of administration (intrawaginalno) allows to create a primary passage of the drug through the uterus is the W of the drug "Cytotec" prevention subinvolution of the uterus in the postpartum period in women with a high risk of puerperal septic diseases became possible thanks received during the clinical trial results. A survey of two groups of women. The total number of surveyed amounted to 115 people.

group 1: control, consisting of 65 mothers, which in the postpartum period to reduce the uterus was administered oxytocin 5 DB intramuscularly with an interval of 12 h for 3 days (course dose of 30 IU).

group 2: the main, it includes 50 women in labour, which in the postpartum period to reduce the uterus was administered a drug "Cytotec" 100 mcg after 2, 24, 48 and 72 h intrawaginalno (course dose of 400 mg or 2 tablets).

The study was conducted according to the following parameters: 1. Measuring the size of the uterus (the height of the symphysis of the uterus, the transverse size of the uterus) according to the external examination.

2. Ultrasound scan of the uterus (length, width and anteroposterior size of the uterus; length, width and anteroposterior size of the cavity; the presence and nature of inclusions in the cavity; the thickness of the anterior and posterior walls of the uterus).

3. Cytological examination lohii.

4. General analysis of blood.

5. Axillary thermometry.

6. The presence of complications in puerperium (subinvolution, lohiometra, endometritis).

All women of the main group received for the prevention of postpartum subinvolution drug "Cytotec". The latter was introduced instatone expressed stimulating effect of the drug "Cytotec" on the contractile function of the postpartum uterus, one of the key elements in the prevention of postpartum endometritis. The reduction of the uterus under the influence of the drug "Cytotec" in the postpartum period ended its complete involution that can be associated with achievement of the appropriate concentration of prostaglandins in the uterus, with uterotonics effect (table. 1).

During clinical follow-up showed a significant decrease complications in the postpartum period (table. 2) and the size of the uterus by ultrasound (table. 3) patients of the main group. Significant differences in weight and length of newborns were observed (table. 4).

Specific examples confirming the stimulating effect of the drug "Cytotec" to reduce postpartum uterus.

1) the Patient Y. , 23 years old, history of childbirth 346. Enrolled in the midwifery clinic SSMU 10.09.01. Diagnosis. Pregnancy is 40 weeks. Urgent delivery in the head previa. Once loosely cord entanglement around the neck of the fetus. Partial firm attachment of the placenta. Manual separation and allocation of the placenta. Rupture of the cervix I tbsp.

The child was born on 14/IX-01, at 0 h 05 min, girl, weight 3.120, the growth of 53 cm, estimation on Apgar scale 8-9 b.

In the postpartum period after 2, 24, 48, 72 h, the patient was prescribed medication "Cytotec to involution mA the period was uneventful. Ultrasound at 3 and 5 days postpartum showed normal dynamics of the involution of the uterus. In they lohii signs of inflammatory reaction have been identified. On the 6th day after birth was discharged home with a child in a satisfactory condition.

2) the Patient Was, 25 years old, history of childbirth 108. Enrolled in the midwifery clinic SSMU 21.06.2001. Diagnosis: Pregnancy 39-40 weeks. Urgent delivery in the main presentation on the background of pathological preliminary period. Piperacetazine the pelvis. Chronic intrauterine hypoxia. Flat fetal bladder. Amniotomy. Episiotomy. Apitherapy. Chronic pyelonephritis in remission. Rupture of the cervix I tbsp.

The child was born on 21/VI-01, at 18 h 50 min, girl, weight 3.640, a growth of 55 cm, estimation on Apgar scale 8-9 b.

In the late postpartum period postpartum women to involution of the uterus has been prescribed "Cytotec" according to the author the way in the form of intravaginal injection of 100 µg of the drug after 2, 24, 48 and 72 hours post-operative period was uneventful, as confirmed by ultrasound genitalia at 3 and 5 days and cytological studies lohii. On the 5th day after birth was discharged from the hospital in satisfactory condition.

Thus, the obtained results pozvolyayuschie on the involution of the uterus in women in the postpartum period. This impact is realized through the stimulation contractile ability termiation postpartum uterus and the positive effect is achieved by the proposed optimal mode and method of administration.

Thus, the use of the proposed method in clinical practice for the prevention of subinvolution of the uterus in the postpartum period allowed to achieve by a specific original regimens of the drug Cytotec" new technical result, namely reducing the side effects (subinvolution of the uterus, sociometry, postpartum endometritis) and increase the effectiveness of treatment.

Literature 1. Abramenko Centuries, Bogdashkin N. G. Prostaglandins and the reproductive system of women. - K.: Health, 1988.- 168 C.

2. Mashkovsky M. D. Medicines. - M.: Medicine, 1988. - T. 2.- 576 C.

3. On The Main Page. Drugs in Russia: a Handbook.- M: Etherseries, 1995. - S. 750-751.

4. Fursova H. K., Nikonov A. P. and others the Value of cytological study lohii in assessing the condition of the uterus in the postpartum period // Obstetrics and gynecology. - 1991 - 11. - S. 45-49.

5. Chernukha E. A., Strugatsky C. M. and others Our experience of postpartum management of women groups you what persons prevention subinvolution of the uterus in the postpartum period, including the appointment of pharmacotherapy, characterized in that travaileth intrawaginalno administered 100 μg of drug Cytotec" after 2, 24, 48 and 72 h after birth.

 

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