Method for interrupting uterine hemorrhage

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: due to instrumental technique one should pre-detect the volume of uterine cavity and its longest length against the cervix. Moreover, it is necessary to fix a woman's body in position at which the upper edge of uterine cavity bottom is below against the lower edge of uterine cervical opening till the moment of complete filling in uterine cavity with blood. With the help of a catheter one should introduce medicinal preparation heated up to +42- +45° C into uterine cavity through an opening in uterine cervix into area of cavitary bottom at the volume exceeding the half of cavitary volume. Moreover, as the above-mentioned medicinal preparation it is necessary to apply dehydrated silicone gel impregnated with equal volume of 3%-hydrogen peroxide solution. The innovation enables to interrupt postpartum hypotonic uterine hemorrhage efficiently and safely.

EFFECT: higher efficiency.

2 ex

 

The invention relates to medicine, in particular to obstetrics, and can be used to reduce blood loss in puerperas with postpartum Hypo - and atonic uterine bleeding.

A known method of stopping Hypo - and atonic uterine bleeding based on the massage of the uterus (open), the introduction of uterotonic funds intravenously and into the muscle of the uterus, local hypothermia, electrical stimulation of the uterus ligation or rescattering embolization of the internal iliac artery and uterine artery on one or both sides (Lud VI, Lud Vl.i., Lud IV Operative obstetrics, Minsk: Enterpriseservice; Book House. - 2002, - S-387).

The disadvantage of this method is low efficiency and safety in the treatment of uterine bleeding, as an outdoor massage of the uterus, the introduction of uterotonic funds intravenously and into the muscle of the uterus, as well as stimulation of the uterus, performed under local hypothermia, do not provide the cooling conditions of maximum development of hypertonicity smooth muscle myocytes of the uterus and rapid clotting of blood in the uterine cavity. In addition and independently of the considered local hypothermia conducting outdoor massage of the uterus without creating conditions for maintaining its isothermal level and without its local heating, injecting put the e in the muscle of the uterus solutions drugs without heating them up to normal temperature uterus immediately before injection introduction, electrical stimulation of the uterus through the use of electrodes with a room temperature (i.e. a temperature of about 24° (C)create conditions for the cooling of the uterus and the contents of the cavity "ignorance", "inexperience", "error". Cooling of the uterus and its blood inhibits thrombogenesis, oppressing contractile mechanisms in smooth muscle myocytes, located in the vascular walls of the uterine arteries. Besides massage, electro - and pharmacochemistry uterus produced without taking into account the shape, the dimensions of the uterine cavity and its location in space, accelerate the removal of blood from the uterus to the outside. Intense bleeding from the uterus does not provide its collapse inside the cavity. In addition, intravenous administration of drugs to stimulate the smooth muscle structures of the uterus, does not facilitate the creation of higher concentrations in the muscle and in the uterine cavity, creates the conditions for a General rather than local impact spastic funds, which reduces their stimulating effect on the uterus and its blood vessels, but increases the likelihood of development of spastic phenomena in other smooth muscle organs.

All this leads to reduced efficiency and safety of treatment aimed at stopping uterine bleeding.

The purpose of the invention - is improving the efficiency and safety of treatment of parturient women with postpartum hypotonic uterine bleeding.

The essence of the proposed method stops uterine bleeding, including local termoustoychivee on the uterus and the introduction of a catheter medicines, is that pre-instrumental methods define the shape of the uterine cavity, its volume and the maximum length from the neck, fix the body postpartum women and adolescent girls in the position in which the top edge of the bottom of the uterine cavity is below the bottom edge of the hole in the cervix prior to complete filling of the uterine cavity with blood, and the drug is injected into the uterine cavity heated to 42 - 45°through the hole in the cervix in the area of the bottom of the cavity in the volume greater than half of the volume of the cavity, at the same time as drug use dehydrated silicone gel, impregnated with an equal volume solution of 3%hydrogen peroxide.

In the proposed method due to the preliminary determination of the shape of the uterine cavity, its volume and the greatest length of the fixing body postpartum women and adolescent girls in the same position in space at which the top edge of the fundus of the uterus is below the bottom edge of the hole in the cervix, for the period of time required to fill the uterine cavity blood, the conditions to move into the area of the bottom and delays in the uterine cavity portion of blood flowing from C is shining uterine vessels, that increases the likelihood of clotting inside the uterine cavity. The fact that at a temperature of about 37°With blood, expired in the uterine cavity from gaping vessels, turned off only after a few minutes, so the delay of blood in the uterine cavity necessary for the completion of the coagulation system. Introduction into the uterine cavity warmed up to 42-45°drug in excess of half the volume of the uterine cavity, provides effective local hyperthermic effects in a safe temperature, creating conditions to accelerate the process of blood clotting gaping blood vessels in the uterine cavity, but excluding the burn tissue. The introduction of a medicinal product in the region of the fundus of the uterus extends its presence inside the uterine cavity from flowing out of the blood and creates conditions for a more extended and complete physical interaction with it in the entire volume of the cavity. Use as a medicinal product dehydrated silicone gel, impregnated with an equal volume solution of 3%hydrogen peroxide, on the one hand, provides the thickening of the plasma and blood in the uterine cavity, arising due to their dehydration due to water retention by silicagel. This creates the conditions for accelerating the coagulation of plasma and blood and trombones the cation in the cavity of the uterus. On the other hand, it ensures a uniform mixing of the introduced portion of a medicinal product with a portion of the blood inside the uterine cavity, as due to the formation of hydrogen peroxide to molecular oxygen, forming gas bubbles, foaming blood and mixing it in the process of ascent of the bubbles of oxygen up (from the bottom towards the cervix). It also provides non-physiological (denaturing), physico-chemical coagulation of the whole blood volume (seal its proteins) inside the cavity of the uterus, occurring even when gipokoagulyatsii. The use of silicagel with hydrogen peroxide provides the formation in the physical and chemical interaction with blood foaming from the blood and gel thick consistency, about which we introduced a new concept peoplefrom. Because of the appearance of gas bubbles peoplefrom increases in volume, fills the entire cavity and pressed tightly against her walls, helping to increase intrauterine pressure, obstruction and compression of the gaping uterine vessels and the delay of blood inside the cavity, stopping uterine bleeding. The presence of a solution of 3%hydrogen peroxide provides optionally providing an antiseptic effect on the contents of the uterus, which in the days of involution of the uterus becomes infected.

Examples:

1. Patient P., 19 years old, was admitted into the hospital for urgent delivery. The post-operative period was complicated by uterine bleeding due to late involution of the uterus. To stop uterine bleeding were carried out daily massage of the uterus, electrical stimulation of the uterus, in the vein was injected with 1 ml (5 IU) of oxytocin. Despite treatment, the bleeding continued. On the 3rd day after birth bacteriological analysis of the contents of the uterus revealed its infection by pathogenic microorganisms, therefore treatment was supplemented intravenous solution cefamezin sodium salt at a dose of 2 g per day in 2 doses. Due to lack of efficacy of traditional way of stopping uterine bleeding on the 5th day by ultrasound were determined shape and size of the uterus postpartum women and adolescent girls. It turned out that the uterine cavity has an elongated cylindrical shape with a volume of about 19 cm3and a length of 82 mm from the outer edge of the cervix. Then put the travaileth in gynecological chair, where he continued visualization of the uterine cavity using ultrasound to determine the position of a woman's body, in which the upper edge of the uterine cavity has dropped below the lower edge of the hole in the cervix, fixed body postpartum women and adolescent girls in this position until the complete filling of the cavity with blood and began escaping from her Mat and into the vagina. Then 5 cm3crystalline anhydrous silicagel taken from diapers "Pampers" company "Procter & Gamble, was soaked with a solution of 3%hydrogen peroxide in a volume of 5 ml by prilipanie and mixing with each other. Formed from crystals and solution plastic gel is introduced into the syringe connected to the catheter, having a Vernier with a multiplier of 1 mm, was heated together with the gel to +45°and put the gel in the region of the fundus of the uterus through the catheter into the opening of the cervix to a depth of 82 mm In the uterine cavity formed peoplefrom, filled the whole uterine cavity and partially performed in the cavity of the vagina. Speaking through an opening in the cervix, the part of peoplefrom removed with a swab. After scarlet red blood from the uterus stopped after a few minutes. On the same day uterine bleeding has stopped completely. Bacteriological analysis of the contents of the uterus, held on the 7th day, confirmed the absence of infections by pathogenic microflora. Held on the 8th day ultrasound examination of the cavity of the uterus showed a decrease in its volume up to 2.1 cm3that confirmed the completion of its involution. The patient was discharged on the 8th day in a satisfactory condition without surgical treatment.

2. The patient Century, 20 years old, was admitted into the hospital for cf is cnyh birth. The post-operative period was complicated by uterine bleeding due to late involution of the uterus. To stop uterine bleeding were carried out daily massage of the uterus, its stimulation, the introduction of non-1 ml (5 IU) of oxytocin. Despite treatment, the bleeding continued. On the 3rd day after birth due to the low effectiveness of the treatment it was supplemented intravenous methylergonovine. For this, 0.2 mg of drug was dissolved in 10 ml of 0.9%sodium chloride solution. From the resulting solution methylergonovine in Vienna postpartum women and adolescent girls have introduced 2 ml bolus. After 5 minutes after administration appeared excessive increase of the magnitude of the systemic arterial pressure up to 210 and 120 mm Hg, followed by dizziness, headache, nausea, and single vomiting. These side effects lasted for about 60 minutes, then disappeared. Methylergonovine was cancelled. Continued treatment of the event included a massage, electrostimulation uterus and intravenous oxytocin. Due to lack of efficacy of traditional way of stopping uterine bleeding on day 7 by ultrasound were determined shape and size of the uterus postpartum women and adolescent girls. It turned out that the uterine cavity has an elongated cylindrical shape with a volume of about 15 cm3and a length of 75 mm from the outer edge of the cervix. The ZAT is placed travaileth in gynecological chair, where he continued visualization of the uterine cavity using ultrasound to determine the position of a woman's body, in which the upper edge of the uterine cavity has dropped below the lower edge of the hole in the cervix, fixed body postpartum women and adolescent girls in this position until the complete filling of the cavity with blood and began draining it from the uterus into the vagina. Then 7.5 cm3crystalline anhydrous silicagel taken from diapers "Pampers" company "Procter & Gamble, was soaked with a solution of 3%hydrogen peroxide in a volume of 7.5 ml by prilipanie and mixing them with each other. Formed from crystals and solution plastic gel is introduced into the syringe connected to the catheter, having a Vernier with a multiplier of 1 mm, was heated together with the gel to +45°and put the gel in the region of the fundus of the uterus through the catheter into the opening of the cervix to a depth of 75 mm In the uterine cavity formed peoplefrom, filled the whole uterine cavity and partially performed in the cavity of the vagina. Speaking through an opening in the cervix, the part of peoplefrom removed with a swab. After scarlet red blood from the uterus stopped after a few minutes. On the same day uterine bleeding stopped completely and finally. Bacteriological analysis of the contents of the uterus, held on the 8th day, confirmed the absence of infections PA is agenoy microflora. Held on the 8th day ultrasound examination of the cavity of the uterus showed a decrease in its volume up to 1.5 cm3that confirmed the completion of its involution. The patient was discharged on the 9th day in a satisfactory condition without surgical treatment.

The way to stop uterine bleeding, including local termoustoychivee on the uterus and the introduction of its medicines, characterized in that the pre-instrumental methods to determine the volume of the uterine cavity and the maximum length of her from the neck, fix the body postpartum women and adolescent girls in the position in which the top edge of the bottom of the uterine cavity is below the bottom edge of the hole in the cervix prior to complete filling of the uterine cavity with blood, and the drug is injected into the uterus using a catheter warmed up to 42-45°through the hole in the cervix in the area of the bottom of the cavity, in excess of half of the volume of the cavity, at the same time as drug use dehydrated silicone gel, impregnated with an equal volume solution of 3% hydrogen peroxide.



 

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