Device for carrying out artificial abortion

FIELD: medical engineering.

SUBSTANCE: device has cylindrical uterine dilator. The dilator is manufactured from super-elastic material on the base of titanium nickelide as zigzag wire spiral rolled as cylinder and having end zigzag segments bent to 15-30° outwards. One or several distal zigzag end segments are elongated by 0.5-0.7 times cylinder diameter, closed and twisted and smoothly conjugated when being bent into cylindrical lumen in inclined position relative to its axis.

EFFECT: enhanced effectiveness of cervical canal dilation; simplified method for withdrawing the device.

1 dwg

 

The invention relates to medicine.

Artificial interruption of pregnancy (abortion) in the later stages (2nd trimester) social and multiple medical conditions is one of the difficult problems in obstetrics. According to who in the world is made annually to 30 million abortions, and about 15% of them in the second trimester [1] p. 1]. The technical complexity of medical interventions are exacerbated by the often concomitant somatic, extra genital diseases and pregnancy complications, dangerous for a woman's reproductive health. Therefore, the improvement of the known and the search for new ways and means of solving the problem the most safe and effective abortion up to date.

From the registry used method of abortion is the most gentle, conservative methods based on medical inducing contractions of the myometrium of the uterus, the expansion of the cervix and platoshyn. The extension of the cervix faster, and the risk of damage is less if it is prepared to abortion pre-dilatation with the use of technical means. Thus, the task is reduced to the search for effective, gentle and safe straddling the cervical canal of the cervix.

A device for the simultaneous expansion of the cervix and surgical removal is Oia ovum - the extender Hagara [1] p.10]. It is made in the form of a metallic cylinder with a diameter proportional to the duration of pregnancy. The extender Hagara used in major gynecologic hospitals with high professional skills of doctors. The extender traumatic.

The known device for the artificial termination of pregnancy [2], using as dilatator cervical canal cylindrical structure of the polymer compounds (lamisil, merocel, hydrogenii dilapan). The materials of these straddling hydrophilic. The device in the vaginal environment swells divisible by increasing the amount and extending the lumen of the cervical canal. Evacuation devices produce traction for thin thread attached to the distal end.

Low biocompatibility leads to spastic pain in patients. The increase in radial dimension when the swelling is accompanied by shortening of dilatator and its dysfunction in the inner mouth of the uterus.

A device for artificial termination of pregnancy, have been widely used in clinical practice [2, 3]. The device uses sticks millionai kelp seaweed, available for extraction in the cold Northern seas and the sea of Japan. The standard length sticks kelp 60-70 mm, a diameter of 2-3 mm Due to the hygroscopicity within 3-4 h after the falling liquid kelp swells in diameter, reaching maximum expansion (3-5 times) in 24 hours, and its consistence of thick turns into much more soft and resembles rubber. Extending the cervical canal up to 9-12 mm, kelp after swelling remains unchanged in length.

Sticks kelp injected into the cervical canal of the cervix of the uterus to its pre-expansion approximately 12 hours prior to the introduction of stimulants reduction of the myometrium of the uterus (prostaglandins, synthetic analogues, sodium chloride, and others).

Kelp affect the cervix not only mechanical dilation, but also by removing water from the cervical stroma, increased uterine activity through the Ferguson reflex.

The drawbacks - kelp:

1. The complexity of sterilization. Use of gamma-irradiation or long processing 99% solution of ethyl alcohol.

2. The device's ability to spontaneously move into the vagina or the uterus and damage amniotic bubble and the development of infectious process. This leads to the necessity of fixing salfetochnyj appliques or removed from the uterine cavity suction curette, and in case of an infection taking extraordinary measures.

3. The necessity and the difficulty of removing the device before infusion stimulant drugs.

4. Manifestation of acute pain in the introduction of the device and blasphemies character while in the cervical canal.

At the higher similarity of the analog adopted for the prototype proposal.

The technical result of the invention is improving the efficiency of dilatation of the cervical canal, the simplification of the evacuation device.

This technical result is achieved in that the device for artificial termination of pregnancy, containing dilatator cervical canal cylindrical shape, dilatator made of super-elastic alloy based on titanium nickelide in the form of a rolled up into a cylinder zigzag wire coil is bent outward at 15-30° integral parts of zigzags, one or more of the distal end sections of the elongated zigzag 0.5-0.7 diameter of the cylinder, zamknuto twisted and smoothly conjugate deflected into the lumen of the cylinder is inclined to its axis.

Achievable technical result due to the material properties, peculiarities of form and structure of the device and is explained by the following causal relationships.

1. Property sverkhelastichnosti alloy based on titanium nickelide corresponds gentle, soft and steady pressure on the walls of the cervical canal of the cervix, making the lumen of the channel smoothly and fairly deleterule optimally activates reflex Ferguson. Zigzag structure 1 (see drawing) wall dilatator increased the AET interval elasticity. Formed after activation of dilatator through the lumen allows you to enter the necessary preparations without removing device, and to perform the necessary manipulations.

The material allows the device to sterilize the device in a dry-heat Cabinet, i.e. simply and effectively, and the device is reusable.

2. Convex end sections of the zigzags 2 serve as a securing device in the cervical canal. The interval angles of the limb revealed experimentally and corresponds to the optimal combination of sufficient fixation, sparing prelaboratory tissues.

3. The lengthening of one or more distal end sections of zigzags and their development in the lumen of the cylinder 3 gives the device an additional property, namely: cut out the fruit in promotion dilational the lumen of the cervical canal meets the specified items that are angled toward the center of the cylinder and are thus an obstacle, the pressure on them, making the extraction device. Compared with the prototype eliminates the need for separate and early action by the evacuation device.

The twisting of the wire elements is a technique for the organization of this site. Blending limb prevents the possibility of the hooks when promoting device.

Thus, fix the steam curing can reduce the work of the doctor, to reduce the risk of injury and soreness, increase efficiency and consistency of operations.

The drawing shows: external view of the device for artificial termination of pregnancy: 1 - zigzag spiral, 2 - leaf plots, 3 - extension of zigzags (ejector).

Achievable technical result is verified and confirmed by clinical use of the proposed device in the gynecological Department of the maternity hospital No. 4 in Tomsk.

Example

Patient W., 35 years old, was admitted to the Department for abortion (21 week) medically - anencephaly fetal development. Ultrasonic inspection of the installed head previa fruit diameter prelease part 50 mm, the location of the placenta in the rear wall of the uterus, normal water content. The length of the cervical canal of the uterus 30 mm, pathological abnormalities in blood, urine, smear is not detected.

Used the device for artificial termination of pregnancy with the following characteristics: the device material and wire diameter 1,0), nickelide titanium grade T-10. The number of zigzags - 8. The diameter of the cylinder in the “cold” condition 50 mm, length 35 mm, ejector 3 has a length of 30 mm, bent into the lumen of the device at an angle of 45°.

Device during the operation works as follows: in aseptics what their conditions cervix naked in mirrors and fixed bullet forceps. Dilatator device cooled under chloroethyl, deformed in the radial direction in zamknuto-compressed state and placed in the proximal section of the tubular conveyor. Under visual control conveyor introduced into the cervical canal of the uterus to the location of dilatator in its borders. Using an ejector mounted in the lumen of the conveyor, dilatator recorded in the installed position, and the conveyor extracted. Under the influence of heat of a body sick dilatator returned to its original form and expanded the cervical canal of the uterus to the lateral dimension of 50 mm Vaginal examination and stretching for the device structure is attested reliable fixation of the latter.

After 3 hours after injection of dilatator activation of reflex Ferguson began labor activity with increasing dynamics. After 10 hours of waters have broken, began attempts, then after 15 minutes, took place late miscarriage dead female fetus weight 345 grams and height of 17 see the Passage of the fetus through the cervical canal due to its sufficient disclosure proceeded without difficulty. Anticipating the birth of the fetus, comodality dilatator. Blood loss during operation was 120 mg Completion of abortion and post-abortion period passed without complications. After 3 days the patient was discharged from the hospital in udovletvoritel the nom condition.

Expert assessment found achievable technical result, causing the relief work of the surgeon, reducing pain and emotional stress of the patient.

Sources of information

1. Abortion in the later stages. The methodological. recommendations. The Ministry of health of the Russian Federation, M. 1993

2. Rsheridan, Art. Abortion in I and II trimesters of natural and synthetic kelp. The overview. // Soviet medicine, 1989. No. 1. p.46.

3. Apikoros. Abortion in the second trimester using kelp. // Obstetrics and gynecology, 1988. No. 2. p.24-25 (prototype).

Device for artificial termination of pregnancy, containing dilatator cervical canal cylindrical shape, characterized in that dilatator made of super-elastic alloy based on titanium nickelide in the form of a rolled up into a cylinder zigzag wire coil is bent outward at 15-30° integral parts of zigzags, one or more of the distal end sections of the elongated zigzag 0.5-0.7 diameter of the cylinder, zamknuto twisted and smoothly conjugate deflected into the lumen of the cylinder is inclined to its axis.



 

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