Method for preventing endometritis after caesarean operation

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: uterine cavity should be drained in the course of operation, moreover, irrigator's distal end should be withdrawn through operation wound at anterior abdominal wall, and 2 h after the end of operation uterine cavity should be washed through irrigator with 400 ml of cooled 0.06%-sodium hypochlorite solution at perfusion rate being 200 ml/h, 6 times every 12 h up to 3-4 d; after each perfusion one should introduce 1 g kanamycin directly into uterine cavity, moreover, in case of availability of bacterioid and/or anaerobic flora in uterine cavity according to the results obtained due to pre-operational antibioticogram one should add 100 ml 3%-hydrogen peroxide solution into perfusion solution. The present innovation enables to efficiently sanitize uterine cavity due to intrauterine injection of antibiotics by taking into account antibioticogram performed at all stages of operative treatment.

EFFECT: higher efficiency of prophylaxis.

1 cl, 2 ex

 

The invention relates to medicine, namely to obstetrics.

The known method of prevention of inflammatory complications in obstetrics after birth and caesarean section, which consists in draining the uterus through the vagina in the postpartum period durovernum catheter for washing the cooled solution furacin and the introduction of antibacterial drugs (Worlds IM "Caesarean section"/ tutorial for students, interns and doctors// Ryazan. 1991. Pp.92. p.72-74. Worlds IM, Avdeev J.V., Solomatina L.M. "Intrauterine lavage in the treatment and prevention of postpartum endometritis" Obstetrics and gynecology No. 5, 1993, p.21-23). The authors offer at 2-3 days post-partum/post-operative period to expose the cervix in the mirror, taking a bullet forceps, hold the sensing cavity of the uterus, enter the mounted system of two (inlet and outlet) plastic tubing, and perform the lavage 2-3 liters of chilled solution of furacin, at the end of perfusion to enter 10-20 ml of 1% solution dioksidina. This method is used for the prototype.

The disadvantage of this method is deferred after birth the beginning lavage of the uterus, additional inconvenience for postpartum women and adolescent girls and the additional risk of introducing pathogenic flora from the vagina when draining the uterus, the use of ineffective against pain the merits of pathogenic bacteria and mixed infection solutions furacin and dioksidina. According to literature data (Summary A.N. et al. Akush. and gin. No. 5. - 1991. - P.37-42, Karimov SD et al. Akush. and gin. No. 7. - 1991. - P.51-53, Nikonov, A.P. et al. Akush. and gin. No. 1. - 1991. - P.31-33, V. Krasnopolsky et al. "Caesarean section", Kyiv. - 1993. - P.140-146, and others) it is known that for 3-4 days already happening, manifestirovanne endometritis (clinical, objective, ultrasonic and other signs). For a broad introduction into our clinic known way to prevent endometritis its efficiency was low, most of the known method included in the complex therapy of complications of the postpartum period.

The task of the invention is to improve the prevention of endometritis after cesarean section.

This object is achieved:

- drainage of the uterine cavity with the catheter, with removal of the distal end through the operating wound on the anterior abdominal wall;

- early, within 2 hours after the operation start of the drainage washing and injection of antibiotics directly into the uterine cavity;

- application for lavage chloractive cooled to 4-6° 0.06% of sodium hypochlorite;

- multiple (2-4 times) per day conduct of perfusion and the introduction of antibiotics without additional inconvenience;

- the presence of the irrigator in the uterine cavity allows for more manipulation to hold the fence contents of the uterine cavity for the bacteria is of bacteriological methods of research.

The method is as follows.

During caesarean section after removal of the placenta and the taking of smears for bacteriological examination in the uterine cavity is entered PVC sterile irrigator length 25-30 cm, the cross-sectional diameter of 1.5-2 mm with a simple reliable plug at the distal end, which is displayed through the anterior abdominal wall and is fixed during the suturing of the wound in the uterus and skin sutures on the anterior abdominal wall (for this we use disposable sterile umbilical catheter). In the postoperative period to the distal end of the irrigator is attached sterile system for in/infusions and is intrauterine perfusion cooled to 4-6° 0,06% sodium hypochlorite (400-800 ml) 2-3 times a day for 3-4 days of the postoperative period. For 3-4 days before the next session lavage we fence the contents of the uterine cavity (otsosov through irrigator sterile syringe) for bacteriological examination. At higher risk for the development of inflammatory diseases (duration of childbirth more than 12 hours, the dry period of more than 6 hours, the number of vaginal studies in childbirth more than 3 and others) at the end of perfusion entered antibiotics depending on the results of preoperative antibiogram or drugs with a broad spectrum actually is (we prefer 1 g of kanamycin, dissolved in 20 ml of solution). If the uterine cavity Bacteroides and/or anaerobic flora (according to the results of bacteriological examination) in the perfusion solution is added 100 ml of 3% hydrogen peroxide solution.

Examples of specific applications.

Example 1. Pregnant K. 29 years old was admitted into the hospital with complaints on a regular contractions for 6 hours, the fluid is poured out upon receipt. The opening of the cervix was 4 see diagnosed 1st period 1st term labor latent phase. Pure breech presentation of the fetus. Early rupture of amniotic fluid. After 4 hours of birth was complicated by discoordinating labor. Given breech presentation of the fetus and complications during childbirth combined readings conducted a delivery by cesarean section. During the operation conducted by the drainage of the uterine cavity by microirrigation (umbilical catheter) with removal of the distal end through the wound on the anterior abdominal wall. Antibacterial drugs in the postpartum period was not appointed. After 3 hours after the operation started drainage irrigation of the uterine cavity 400 ml of 0.06% of sodium hypochlorite with an infusion rate of 200 ml/hour. Over the next 3 days postpartum were lavage of the uterus 2 times daily at the same dose. At 4 days after a caesarean section drainage of the uterine cavity BPM is flax. Bacteriological examination of intraoperative smear of the uterine cavity revealed the growth of opportunistic epidermal Staphylococcus 103CFU/ml, the aspirate from the uterine cavity, taken through the irrigator in 3 days - flora is not selected. The hemogram, biochemical indices in the postpartum period were without pathological changes. Control ULTRASONIC examination of the uterus for 4 days - without a pathology. Sutures were removed on the 6th day and 7th day after caesarean section the travaileth with child was discharged home.

Example 2. Pregnant M,30, perforada again pregnant (in history 3 pregnancy came to a standstill in the early period) entered into the second obstetric Department regarding rupture of membranes 10 hours ago, immature cervix during pregnancy 36-37 weeks. The woman is married, pregnancy is extremely desirable. The body temperature of 37.6°With, in the hemogram leukocytosis 11,5×109, neutrophilic left shift formula (7 band). Diagnosis: pregnancy 36-37 weeks. Age perforada. The OAS. Premature rupture of the waters, when unripe cervix, the critical dry period. The chorioamnionitis. In an emergency order of rodorazresheniye by extraperitoneal caesarean section. Born alive girl with a body mass 2630 g and growth 49 see Bacteriological examination intraoper the operating strokes of the cavity of the uterus revealed the growth of epidermal Staphylococcus and Escherichia coli 10 6CFU/ml during the operation was conducted in the/in infusion of 2 g of Cefazolin and performed the drainage of the uterine cavity by the irrigator with removal of the distal end through the wound on the anterior abdominal wall. 2 hours after the operation started drainage irrigation of the uterine cavity 400 ml of 0.06% of sodium hypochlorite with the introduction at the end of the perfusion of 1 g of kanamycin, dissolved in 20 ml of physiological solution. Lavage of the uterus with the introduction of the antibiotic was carried out in 12 hours to 3 days. In the postoperative period twice in 8 and 16 hours spent in/drip infusion of 2 g of Cefazolin (as perioperative antibiotic prophylaxis). Second day normalized leukocytosis and leucoformula. Bacteriological control of aspirate from the uterus on the 4th day - flora is not selected. Drainage from the uterus removed on the 4th day. Ultrasound of the uterus on the 5th day of pathological changes it is not revealed. Skin sutures were removed on the 6th day. On the 9th day a woman with a child in a satisfactory condition and was discharged home.

Thus, drainage of the uterus during caesarean section with removal of the distal end through the operating wound allows for early and multiple effective reorganization of the uterine cavity disinfectant solutions; at elevated risk factors to conduct a rational antibiotic, injecting drugs directly into the spine of the uterus, that allows robust enough to prevent the development of postpartum endometritis, 't inconvenience for postpartum women and adolescent girls with conduct lavage and sampling the contents of the uterine cavity for bacteriological examination, economically significantly profitable than conventional antibiotic therapy) and shortens the stay postpartum women and adolescent girls after caesarean section in the hospital.

1. The way to prevent endometritis after cesarean section, including preoperative antibiotikogrammou, characterized in that the uterine cavity drain during the operation, while the distal end of the irrigator is output through the operating wound on the anterior abdominal wall, and 2 hours after the operation, the uterine cavity is washed through the irrigator 400 ml of chilled 0,06% solution of sodium hypochlorite with a perfusion rate of 200 ml/hour, 6 times in 12 hours to 3-4 days; after each perfusion directly into the uterine cavity injected with 1 g of kanamycin.

2. The method according to claim 1, characterized in that in the presence of the uterine cavity bacterioides and/or anaerobic flora on the results of preoperative antibiogram in perfusion solution add 100 ml of 3% hydrogen peroxide solution.



 

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