Method for evaluating the recovery of uterine wound after caesarean operation

FIELD: medicine, obstetrics.

SUBSTANCE: one should carry out clinical and ultrasound uterine testing, moreover, additionally, on the 3d and the 7th d of post-operational period it is necessary to detect conditional area of uterine sutures, systolo-diastolic ratio (SDR), percentage content of lymphocytes against total amount of cells in uterine aspirate to establish protein coefficient (PC) and leukocytic index of intoxication (LII) being necessary to state upon prognostic coefficients F1 and F2 by the following formulas: F1 = -6726.59 + 27.58 x K1 + 21.84 x K2 - 0.03 x K3 + 93.36 x K4 + 156.47 x K5 - 4.21 x K6 + 760.82 x K7 + 978.46 x K8 + 11.47 x K9 + 96.40 x K10 + 306.40 x K11 + 321.13 x K12 - 24.32 x K13 - 50.56 x K14; F2 = -57.81.76 + 35.89 x K1 + 26.50 x K2 + 0.00 x K3 + 96.81 x K4 + 146.78 x K5 - 3.89 x K6 + 500.76 x K7 + 651.60 x K8 + 4.83 x K9 + 34.83 x K10 + 276.16 x K11 + 535.35 x K12 - 14.26 x K13 - 17.28 x K14, where digital values - the constants of discriminant equation and discriminant coefficients, K1,2...14 - gradations and digital values of post-operational period flow: K1 - the length of uterine sutures on the 3d d, K2 - the width of uterine sutures on the 3d d, K3 - conditional area of sutures on the 3d d, K4 - the length of uterine sutures on the 7th d, K5 - the width of uterine sutures on the 7th d, K6 - conditional area of sutures on the 7th d, K7 - SDR right-hand on the 7th d, K8 - SDR left-hand on the 7th d, K9 - percentage content of lymphocytes against the total amount of cells in uterine aspirate on the 3d d, K10 - percentage content of lymphocytes against the total amount of cells in uterine aspirate on the 7th d, K11 - PC on the 3d d, K12 - PC on the 7th d, K13 - LII on the 3d d, K14 - LII on the 7th d, and at F1>F2 one should predict favorable nature in recovery of uterine wound and at F1<F2 - unfavorable nature.

EFFECT: higher accuracy and efficiency of evaluation.

2 ex

 

The invention relates to medicine, namely to obstetrics, and can be used to assess the optimality of wound healing in the uterus after cesarean section.

Currently, the number of caesarean sections ranges from 11,1 to 30-40%, so there is a need for accurate, rapid assessment of the nature of wound healing. This assessment is necessary for the timely appointment of adequate therapy and for further prediction method of delivery in a subsequent pregnancy.

There is a method of evaluation of wound healing on the uterus, including dynamic study of Cytology smears aspirate from the uterus after cesarean sections, reflecting the power phase of the healing wound surface, which may be compromised by changes in the immunological status of the organism and when expressed virulence of the infection in the wound surface area (Nikonov A.P. and other Clinical and morphological Parallels with postpartum endometritis // Akush. and gin., 1992, No. 1, .38-43).

The disadvantages of this method include the fact that the proposed method largely reflects the presence or absence of inflammation and the degree of severity, and not the nature of healing, because in the primary (physiological) healing occurs layering phases of wound healing one another, so the Yan is difficult to observe the sequence of stages of healing. Usually local inflammatory changes are permitted for 3-5 days, and the healing is completed to 8-10 days and during these days only planned phase of reorganization of the scar (Kuzin M.I., Kostyuchenok BM Wounds and wound infection. A guide for physicians. M.: Medicine, 1990. - 591).

The disadvantages of the method should also include the repetition of a fence material from the uterine cavity, which increases the risk of re-infection of the uterus (the Worlds IM Forecasting, early detection, treatment, and comprehensive prevention of purulent-inflammatory diseases after birth and caesarean section: author. dis ... Prof. the honey. Sciences. - M., 1996. - 49 S.).

The closest in technical essence to the present invention is a method for the assessment of wound healing on the uterus by ultrasound scan (Mareeva PS, Levashov I.I. and other information, and predictive value CCS of the uterine scar after cesarean section with spontaneous birth: in the book. Problems of obstetrics and gynecology MONIII, 1995, pp.42-45).

Ultrasonography of stitches on the uterus is well visualized infiltration of joints, presence of hematoma, fibrinous overlays and gas, as an indirect sign of infection.

The disadvantages of this method include the fact that, reflecting indirect signs of local inflammation caused by the injury t the Ani (incision on the uterus), and the possible presence of infection, ultrasound does not show the nature of the healing process (restitution or substitute). This method studies the inflammatory process in the joints and uterus install only 41.6% of the true manifestations (Summary A.N., Baev O.R. Clinical and instrumental assessment of the seam on the uterus and the choice of tactics of treatment of purulent-septic complications after caesarean section // Akush. and gin. 1999, No. 5, P.21-27). In addition, this method is subjective, requires special equipment and specialists as a research methodology, and interpretation of the information received.

The task of the invention is to develop ways to assess healing of the wounds in the uterus after caesarean section.

The technical result of the present proposal is to improve the accuracy of the assessment of wound healing in the uterus after caesarean section and the prediction method of delivery in a subsequent pregnancy.

The technical result is achieved by a method for the assessment of wound healing on the uterus after surgery cesarean section includes clinical and ultrasound examination of the uterus.

The difference method is that an additional 3 and 7 day post-operative period, ODA is really a conventional area of the seams on the uterus, systole-diastolic ratio (LMS), the percentage of lymphocytes of the total number of cells in the aspirate from the uterus protein ratio (Bq) and leukocyte index of intoxication (LII), which establish the prognostic factors F1and F2by the formulas:

F1=-6726,59+27,58×K1+21,84×2-0,03×3+93,36×4+156,47×5-4,21×6+760,82×7+978,46×K8+11,47×9+96,40×10+306,40×11+321,13×K12-24,32×13-50,56×14

F2=-5781,76+35,89×K1+26,50×2+0,00×3+96,81×4+146,78×5-3,89×6+500,76×7+651,60×K8+a 4.83×9+34,83×10+276,16×11+535,35×12-14,26×13-17,28×14,

where digital indicators are constants discriminatory equations and discriminatory factors,

K1,2...14- grades and numerical values of indicators of postoperative: K1- the length of the seams on the uterus on the 3rd day,2- the width of the seams on the uterus on the 3rd day,3- conditional area of the seams on the 3rd day,4- the length of the seams on the uterus on day 7,5- the width of the seams on the uterus on day 7,6- conditional area of the seams on day 7,7- SRE right on day 7, K8- LMS left at 7 the ducks, To9- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on the 3rd day,10- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on day 7,11- Bq on the 3rd day, K12- Bq on day 7,13- LEAH on the 3rd day,14- LEAH on day 7.

In determining the origin of birth to the first compact group (F1) predicts favorable nature of wound healing of the uterus after surgery, cesarean section, and in determining the origin puerperas second compact group (F2) - adverse nature of wound healing of the uterus, i.e. when the value of F1>F2the forecast is favorable, and a value of F1<F2predict adverse wound healing of the uterus.

The analysis of patent literature showed that this method differs not only from the prototype, but also on other technical solutions in this and related fields. So, the authors have not found ways to assess healing of the wounds in the uterus after caesarean section, which would include determining the length and width of stitches in the uterus at 3 and 7 days with the calculation of the conditional square joints, the definition of SRE, the percentage of lymphocytes of the total number of cells in the aspirate from the uterus, protein ratio, LEAH. Thus, the proposed technique is a mini solution meets the criteria of the invention of "novelty."

We offer modes allow you to achieve the technical result is to increase the accuracy of evaluation of wound healing on the uterus after surgery, caesarean section, which in turn, allows us to predict the method of delivery in a subsequent pregnancy. The authors found that the probability forecast of the nature of the wound healing of the uterus in childbirth exceeds 93%. The inventive method evaluation simple, accessible, accurate and can be used in obstetric hospitals at any level. Therefore, the evaluation method of healing the wounds in the uterus after caesarean section meets the criteria of "inventive step" and "industrial applicability".

The proposed method is as follows.

The birth after caesarean section without clinical manifestations of inflammatory changes in the joints on the uterus, conduct clinical, laboratory and instrumental examinations. Thus determine the length and width of the stitches in the uterus at 3 and 7 days, which set the conditional area of the seams. Define LMS, the percentage of lymphocytes of the total number of cells in the aspirate from the uterus protein ratio and LEAH.

Then establish prognostic factors F1and F2according to the formula: F1=-6726,59+27,58×K1+21,84×2-0,03×3+93,36&x000D7; K4+156,47×5-4,21×K6+760,82×7+978,46×K8+11,47×9+96,40×10+306,40×11+321,13×K12-24,32×K13-50,56×14

F2=-5781,76+35,89×K1+26,50×K2+0,00×3+96,81×K4+146,78×5-3,89×6+500,76×7+651,60×K8+a 4.83×9+34,83×10+276,16×11+535,35×K12-14,26×13-17,28×14,

where digital indicators are constants discriminatory equations and discriminatory factors,

K1,2...14- grades and numerical values of indicators of postoperative: K1- the length of the seams on the uterus on the 3rd day,2- the width of the seams on the uterus on the 3rd day,3- conditional area of the seams on the 3rd day,4- the length of the seams on the uterus on day 7,5- the width of the seams on the uterus on day 7,6- conditional area of the seams on day 7,7- SRE right on day 7, K8- LMS left on day 7,9- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on the 3rd day,10- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on day 7,11- Bq on the 3rd day, K12- Bq on day 7,13- LEAH on the 3rd day,14- LEAH on day 7.

By the maximum value of F and evaluate belonging Rodi is init to one group or another. Thus, when the value of F1>F2predict favorable, and a value of F1<F2the adverse nature of the wound healing of the uterus after caesarean section in parturients who do not have clinical manifestations of inflammatory changes in the joints in the uterus.

The proposed method is illustrated by examples of specific performance.

Example 1. Zhovnitskaya S., 28 years old, no history of childbirth 1195.

The first pregnancy ended operative delivery with DS: operational Premature birth pregnancy 35-36 weeks. The placenta previa. Laparotomy for Pfannenstiel. Caesarean section on Rusakov. The woman operated routinely 14.12.1998 year. During surgery, the uterus is sutured double row wikilove seam. In the postoperative period 3 and day 7, the patient determined the levels of total protein in blood plasma and the aspirate from the uterus with the definition of BK is 2.4 and 2.6. The definition of Bq was performed according to the formula: BC=BP/BA, where Bq - protein ratio, BP - total protein in plasma, BA - total protein in the aspirate from the uterus. When the value of Bq≥2 - assess wound healing as a secondary, leading to the subsequent formation of a connective tissue scar, and a value of Bq<2 - as physiological, leading to the formation of the scar with a predominance of muscle tissue (RF patent No. 2169370, IPC G 01 N 33/48).

3 and on day 7 p and the ULTRASONIC study determined the size of the joints on the uterus, which were equal 58,0-24.6 mm over 3 days and 55,1-21.6 mm on day 7, on which the conditional area seams - 1426,8 and 1190,2 mm2. The conditional area of the joints are calculated according to the formula: S=D×W, where S is the area of the seams, D is the length of the seams and W is the width of the joints (RF patent No. 2175524, IPC And 61 In 8/00, 8/12).

LMS on day 7 was 2,58 right and 2.54 left. The percentage of lymphocytes of the total number of cells in the aspirate from the uterus at 3 and 7 days was equal respectively to 6.5% and 5.4%. LEAH was determined by the formula:

where Mi - plasmic order has been revealed; Ju - young; P - band; C - segmented; PL - plasma cells Turk; L, lymphocytes; Mo monocytes; e - eosinophils (Calf-the Caliph AA TO the characteristic practical value and role of leukocyte index of intoxication in the clinic of acute and chronic infectious diseases // Braces. case. - 1941, No. 5, S-344). LEAH was equal 3,15 3 day and 2,96 - on the 7th day.

Based on all the data obtained, prognostic factors: F1=5268,07 and F2=6169,10.

That is, F1<F2therefore, the woman assigned to the second group, in which the wounds of the uterus is regarded as unfavourable - with a high probability of developing signs of insolvency of the scar. In a subsequent pregnancy recommended re-operative childbirth. Issued at 8 days post op the walkie-talkie.

This same woman came into the hospital 10.02.2000, (no birth history 382) with full-term pregnancy. When ULTRASOUND at 36-37 weeks of gestation, the failure of the uterine scar is defined as irregularities of the anterior wall of the uterus and decrease of its thickness in comparison with adjacent areas. The average thickness of the lower segment in the scar area was 0.3 mm On the basis of the forecast 15.02.2000, operated routinely with DS: Urgent surgical childbirth during pregnancy 38-39 weeks. Burdened obstetric history. The failure of the uterine scar. Laparotomy for Pfannenstiel. Caesarean section on Rusakov. During the operation marked the presence of a connective tissue scar thinning. Taken biopsy material. According to the histological study of muscle tissue by 50% replaced by connective tissue with areas of hyalinosis. Within 3 days postpartum prevention of inflammatory complications were conducted antibacterial therapy. Discharged on day 7 after the operation.

Example 2.

Aneglina NV, 30 years, no history of childbirth 116.

The first pregnancy ended operative delivery with DS: Urgent surgical childbirth during pregnancy 38 weeks. Breech presentation of the fetus. Chronic pyelonephritis, remission stage. Laparotomy for Pfannenstiel. Caesarean section is about Rusakov. Woman prooperirovanna routinely 14.04.1999 year. During surgery, the uterus is sutured by the method Riverdene in one row wikilove seam. In the postoperative period 3 and day 7, the patient determined the levels of total protein in blood plasma and the aspirate from the uterus with the calculation of BK is 1.5 and 1.3. 3 and on day 7 when ULTRASOUND determined the size of the joints on the uterus, which were equal 51,2-20,2 mm over 3 days and 35.1-16,7 mm on day 7, defined conditional area seams - 1034,2 and 586,2 mm2. LMS 7 day amounted to 3.34 right and 3.40 on the left. The percentage of lymphocytes of the total number of cells in the aspirate from the uterus at 3 and 7 days was equal respectively to 10.5% and 14.8%, LII - 2,21 on the 3rd day and 1.06 - on the 7th day. Established prognostic factors:

F1=6702,41 and F2=5674,64.

F1>F2. The woman assigned to the first group and the healing of a seam is defined as physiological. Ill predict the possibility of delivery vaginal delivery in a subsequent pregnancy. Discharged on the 8th day.

This same woman came into the hospital 09.04.2002, (no birth history 1433) with full-term pregnancy. When ULTRASOUND at 36 weeks of pregnancy signs of insolvency of the scar on the uterus is not detected, the thickness of the lower segment before the birth was equal to 4.5 mm

On the basis of the forecast 14.04.2002, delivery through the natural the s vaginally with DS: Emergency childbirth during pregnancy 39 weeks. Burdened obstetric history. The scar on the uterus. Chronic pyelonephritis, remission stage. Amniotomy. In early pokerdownload produced control manual examination of the uterus and ultrasound in 3 days - scar is not detected. Within 3 days of the postpartum period for the prevention of inflammatory complications spend antibacterial therapy. Discharged on the 6th day after the operation.

The proposed method of evaluation of wound healing of the uterus used at 209 mothers. The accuracy of the evaluation method is 93%. Accuracy assessment is confirmed by ultrasound, hysteroscopic and cytological research methods and histological examination of tissue in the scar area with repeated caesarean section (number of observations).

The application of this method requires no additional material costs. This method can be used in medical institutions of any level, where the functioning of the office of ULTRASONIC diagnostics and determine protein in biological environments.

The widespread use of the proposed method will allow a more objective assessment of the nature of healing and, therefore, to build a forecast of the subsequent methods of delivery.

The proposed method allows to evaluate the physiology of the wound-healing process in the uterus or its deviations, which are accompanied by secondary for what illenium with the formation of scar tissue in puerperas, no clinical manifestations of inflammatory changes in the joints in the uterus.

Application of the proposed method will undoubtedly affect the natural level of delivery in women with a uterine scar after cesarean section, which will bring significant economic benefits due to the cost of conducting caesarean section and nursing mothers.

Using the proposed method does not require a specially trained medical personnel. The inventive method can also be used to assess the effectiveness of remedial measures aimed at improving the process of healing of wounds in the uterus.

The method of evaluation of wound healing on the uterus after surgery, caesarean section, including clinical and ultrasound examination of the uterus, characterized in that additionally at 3 and 7 days post-operative period determine the conditional area of the seams on the uterus, systole-diastolic ratio (LMS), the percentage of lymphocytes of the total number of cells in the aspirate from the uterus, establish protein ratio (Bq) and leukocyte index of intoxication (LII), which establish the prognostic factors F1and F2by the formulas F1=-6726,59+27,58·K1+21,84·K2-0,03·3+93,36·4+156,47&#HWC 5-4,21·6+760,82·7+978,46·K8+11,47·9+96,40·10+306,40·11+321,13·K12-24,32·13-50,56·14

F2=-5781,76+35,89·K1+26,50·2+0,00·3+96,81·4+146,78·5-3,89·6+500,76·7+651,60·K8+a 4.83·9+34,83·10+276,16·11+535,35·K12-14,26·13-17,28·14where digital indicators are constants discriminatory equations and discriminatory factors, K1,2...14- grades and numeric values of the postoperative period, K1- the length of the seams on the uterus on the 3rd day,2- the width of the seams on the uterus on the 3rd day,3- conditional area of the seams on the 3rd day,4- the length of the seams on the uterus on day 7,5- the width of the seams on the uterus on day 7,6- conditional area of the seams on day 7,7- SRE right on day 7, K8- LMS left on day 7,9- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on the 3rd day,10- the percentage of lymphocytes of the total number of cells in the aspirate from the uterus on day 7,11- Bq on the 3rd day, K12- Bq on day 7,13- LEAH on the 3rd day,14- LEAH on day 7, and F1>F2forecast favorable, and a value of F1<F2-adverse nature of wound healing of the uterus.



 

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FIELD: medicine.

SUBSTANCE: method involves making lumbar puncture and measuring liquor pressure, taking pleocytosis into account, making ultrasonic transcranial Doppler flowmetric examination of brain, determining linear blood circulation speed on interior carotid artery and posterior cerebral artery, detecting intracranial venous discharge disorders through orbital and vertebral veins. Regression coefficient is calculated from a formula

where X1 is patient age (in years); X2 is the pleocytosis in the first lumbar sample (in cells number per 1 mcl of liquor); X3 is the meningitis symptoms duration (in days); X4 is the focal symptoms availability (1- yes, 0- no); X5 is the general cerebral symptoms duration (in days); X6 is the liquor pressure when taking the first lumbar puncture (in mm of mercury column); X7 is the linear blood circulation speed in interior carotid artery (in Hz/s); X8 is the linear blood circulation speed in posterior cerebral artery (in Hz/s); X9 is the intracranial venous discharge disorders based on ultrasonic transcranial Doppler flowmetric examination data; retrograde discharge through orbital veins, increased one through vertebral veins and others (1- yes, 0- no). Value of y≤0.5, unfavorable outcome is to be predicted with cerebroasthenic, asthenoneurotic and hypertension syndromes being formed. If y>0.5, favorable infectious process outcome is to be predicted.

EFFECT: high accuracy of diagnosis.

4 tbl

FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic examination with acoustic amplification phenomena being created. The results are interpreted in terms of nature, intensity and structure of a pathological process. Flexible container filled with sterile liquid is set into stomach cavity, duodenum or abdominal cavity. Manipulations are carried out. The container is used for making manipulations leaving optimum acoustic window allowing ultrasonic beams to pass to the pathological process.

EFFECT: high accuracy of diagnosis.

2 dwg

FIELD: veterinary science.

SUBSTANCE: during the first 1-3 h of life one should measure umbilical diameter and at its diameter being above 18 mm it is possible to diagnose earlier manifestation of omphalitis that, in its turn, enables to perform antibacterial therapy in due time and avoid mortality in animals.

EFFECT: higher accuracy of diagnostics.

1 ex, 1 tbl

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