Method for treatment of delivery activity weakness

FIELD: medicine, obstetrics.

SUBSTANCE: invention relates to a method for treatment of delivery activity weakness. Method involves simultaneous administration of prostaglandin F in the concentration 12.5 mcg/ml at the rate 8 mcg/min and adenosine triphosphate sodium in the concentration 0.25 mcg/ml at the rate 0.25 mcg/min. Infusion continues up to end of the second stage of delivery. Method provides enhancing the delivery activity, increasing rate of uterine orifice opening on the background of the reduced dose of prostaglandin.

EFFECT: improved treatment method.

3 ex

 

The invention relates to medicine, namely to obstetrics, and can be used to treat weakness of labor activity

There is a method of stimulation of labor activity with transbukkalno the use of oxytocin. Tablets dezaminooksitotsina (ODE 914) enter the cheek, starting with 25 UNITS at intervals of 30 minutes. If necessary, the dose can be increased to 100 UNITS (Abramenko CENTURIES of Active management of labour, 1997).

The known method of intravenous oxytocin. To which 1 ml of oxytocin (5 IU) was diluted in 500 ml of 0.9% isotonic sodium chloride solution or 5% glucose solution and injected drip, starting with 6-8 drops/min, gradually increasing the number of drops every 5-10 min to 5 drops to get the effect (but not more than 40 drops/min) (Abramenko CENTURIES of Active management of labour, 1997; American College of Obstetricians and Gynecologists, Practice Bulletin No. 10, 1999; Satin A.J. et al., High-versus low-dose oxytocin for labor stimulation. Obstet Gynecol 80:111, 1992).

The known method of intravenous prostaglandinor E2. For intravenous 5 mg prostaglandin(antepost) or 1 mg of prostaglandin E2 (prostenon) diluted in 500 ml isotonic sodium chloride or glucose solution and injected at a rate of from 6-8 drops/min, as needed, increasing the rate of injection depending on earnings impact (in the eat 25-30 drops/min) (Chernukha E.A. A generic block, 1991; Frigoletto F.D. et al., A clinical trial of active management of labor. N Engi J Med 333:745, 1995).

There is a method of combined intravenous oxytocin and prostaglandin. For intravenous injection of 2.5 IU of oxytocin and 2.5 mgthrow in 500 ml isotonic sodium chloride or 5% glucose solution and injected at a rate of from 6-8 up to 40 drops per minute (Abramenko CENTURIES of Active management of labour, 1997; Ailamazyan E.K. and other Prostaglandins in obstetrics and gynecology, 1992; Yeast J.D. et al. Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol 180:628, 1999).

However, all the above methods have several disadvantages, in General, these side effects of the drugs used, especially when it comes to large doses. Side effects of oxytocin include: afibrinogenemia, pelvic hematoma, heart arrhythmia, uterine rupture, water intoxication, fetal distress; prostaglandin- nausea, vomiting, hypertension, syncope, dysuria, diplopia, hematuria, thrombophlebitis.

The aim of the invention is to develop a new effective method for the treatment of weakness of the contractile activity of the uterus during childbirth. This goal is achieved by developing a new combination of drugs: low concentrations of ATP and prostaglandin .

The method is as follows.

After diagnosis of "primary" or "secondary weakness of labor activity began radiosilence the following combination of drugs: prostaglandin(Entoproct f, Gedeon Richter) at a concentration of 12.5 µg/ml, the infusion rate of 8 µg/min (5 mg entoprocta f is diluted in 400 ml of isotonic sodium chloride solution and injected intravenously at a rate of 10 cap/min) and ATP (Sodium triphosphate, "Microgen") at a concentration of 0.25 μg/ml, the infusion rate of 0.25 µg/min (0.05 ml sodium triphosphate is diluted in 200 ml of isotonic sodium chloride solution and injected intravenously at a rate of 20 cap/min). The infusion was continued until the end of the second stage of labor.

How rodoviaria low concentrations of prostaglandinin combination with low doses of ATP tested in the maternity Department of the Republican clinical hospital No. 3 in the diagnosis of the weakness of labor activity in 20 patients. Under supervision there were women in the active phase 1 stage of labor. The diagnosis of all patients was determined on the basis of clinical observation, doing partogram and according to the outer aerografia. The opening of the fallopian throat at the time of diagnosis was on average 3,8±0,56 see/p>

In the comparison group consisted of women who have also been diagnosed with weakness of patrimonial activity, but as an incentive funds they received only entoproct F. comparison Group composition was identical main.

The average time from the beginning of radiosilence until contractions greater frequency and strength that were recorded by clinical signs and data hysterography in the main group was 8.3±2,4 min, and in the comparison group -17,1±3.2 min (P<0,05). Moreover, to achieve the effect in the case of the combined use of drugs initial rate of introduction of entoprocta't have to increase in any case, while in the comparison group, 73% of women were required to increase the infusion rate by 2 to 4 times to achieve productive labor. The average dose entered entoprocta F. amounted to: in the main group - 112,3±a 27.4 μg, and in the comparison group 265,6±a 38.5 µg (P<0,05). In addition, every fourth case in the comparison group have any need for additional intravenous drip of oxytocin. The speed of opening of the cervix in the main group was 2.8±0.6 cm/h, in the comparison group 1,1±0,2 (P<0,05). As a result, total duration of labour in patients on combination agostinelli was twice shorter than when using the underwater of entoprocta, while remaining within the physiological norm (quick and rapid delivery, as a result of excessive stimulation was not observed in any case).

Thus, the combination of prostaglandinand ATP is an effective treatment for primary and secondary weakness contractile activity of the uterus in the active phase of labor. It allows you to effectively correct the weakness of the contractile activity of the uterus, increase the speed of opening of the fallopian throat and to use lower doses of prostaglandins.

Examples of specific performance

1. Patient F. was admitted to the Department of pathology of pregnant women maternity ward RCH 3 February 8, 2004 Ds: Pregnancy 40-41 weeks. Bout the harbingers. Autres. Anemia of 1 degree. Colpitis. The Department produced clinical and laboratory examination, therapy aimed at improving placental blood flow, preparation of generic paths vitamin.

10.02.04 6.00 began regular family activity, which was complicated by the primary weakness of the contractile activity of the uterus.

In 13.25 at the opening of the fallopian throat 3 cm, it was decided to start radiosilence using new combinations of approved drugs - Entoprocta F. and sodium triphosphate.

In 15.15 bout took potoglou character. Potoglou the period without features a duration of 30 minutes. The woman gave birth to a live healthy baby. Vaginally whole. The physiological blood loss of 150 ml of the Mother and baby were discharged on the 5th day after birth in a satisfactory condition.

Final diagnosis: first Childbirth at term 41 week. The primary weakness of the contractile activity of the uterus. Radiosilence. Autres. Anemia of 1 degree. Colpitis.

2. Patient W. 22 years old, was admitted to the Department of pathology of pregnant women maternity ward RCH 3 February 9, 2004 Ds: Pregnancy 39-40 weeks. Swelling pregnant. Chronic chlamydial infection, chronic pyelonephritis latent currents. The Department produced clinical and laboratory examination, therapy aimed at improving placental blood flow, preparation of generic paths vitamin.

12.02.04 at 9.15 came premature rupture of amniotic fluid. After the instrumental breeding okoloplodnykh shells started racoviteanu the inderal.

At 13.00, given the inefficiency of racoviteanu-inderal and tendency to the formation of the primary weaknesses of the contractile activity of the uterus, decided to start radiosilence combination of entoprocta F. and sodium triphosphate.

At 16.15 bout took potoglou character. Potoglou period without features a duration of 20 minutes. The woman gave birth to a live healthy baby. The neck match the whole. Crack the back wall of the vagina sutured under local anesthesia. The physiological blood loss of 150 ml of the Mother and baby were discharged on the 5th day after birth in a satisfactory condition.

Final diagnosis: first Childbirth at term 40 weeks. High strain fetal bladder. Instrumental breeding shells. The primary weakness of the contractile activity of the uterus. Radiosilence. Swelling pregnant. Rupture of posterior wall of vagina. Suturing. Chronic chlamydial infection, chronic pyelonephritis latent currents.

3. Patient A.25 years, was admitted to the Department of pathology of pregnant women maternity ward RCH 3 February 19, 2004 Ds: Pregnancy 41 weeks. Dystonia on hypertonic type. Grodno-lumbar osteochondrosis. The Department produced clinical and laboratory examination, therapy aimed at improving placental blood flow, vitamin.

Given the gestation 41 week and prepared the birth canal, 20.02.04 at 6.00 made amniotomy and started racoviteanu the inderal.

At 10.00, given the inefficiency of racoviteanu-inderal and tendency to the formation of the primary weaknesses of the contractile activity of the uterus, decided to start radiosilence using new combinations of approved drugs - Entoprocta F. and sodium adenosines the ATA.

At 12.50 bout took potoglou character. Potoglou period without features a duration of 25 minutes. The woman gave birth to a live healthy baby. Vaginally whole. The physiological blood loss of 250 ml. Mother and baby were discharged on the 5th day after birth in a satisfactory condition.

Final diagnosis: first Childbirth at term 41 week. Amniotomy. Dystonia on hypertonic type. Grodno-lumbar osteochondrosis.

The sources of information.

1. Abramenko CENTURIES of Active management of labour. - Saint-Petersburg. Special literature, 1997.

2. Ailamazyan E.K., Abramenko CENTURIES Prostaglandins in obstetric-gynecologic practice. - SPb, Petropol, 1992.

3. Chernukha E.A. Generic unit. - M.: Medicine, 1991.

4. American College of Obstetricians and Gynecologists: Induction of Labor and. Practice Bulletin No. 10, November, 1999.

5. Frigoletto FD et al. A clinical trial of active management of labor. N Engi J Med 333:745, 1995.

6. Satin AJ et al. High-versus low-dose oxytocin for labor stimulation. Obstet Gynecol 80:111, 1992a.

7. Yeast JD et al. Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol 180:628, 1999.

A method of treating weakness of patrimonial activity, characterized in that at the same time intravenous solution of prostaglandin F2α at a concentration of 12.5 μg/ml, at a rate of 8 g/min and a solution of sodium triphosphate at a concentration of 0.25 µg/ml, with a speed of 0.25 mcg/min infusion continued until the end of the WTO the second stage of labor.



 

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