Uterine lavage technique

FIELD: medicine; gynecology.

SUBSTANCE: puerpera with puerperal subinvolution of uterus and/or puerperal endometritis is instrumentally examined for uterine bulk within neck greatest extension. Puerpera's body is positioned so that upper end of uterus fundus is located lower than low end of uterine neck opening till uterine cavity is completely filled with blood. Catheter is pre-inserted to uterine neck fundus. Then uterine cavity is filled with warmed-up +42 - +45°C solution of mixed 0.9% sodium chloride and 3% hydrogen peroxide, through catheter. Then uterine cavity is US examined for position of thick objects and catheter, which is consistently brought to contact each thick object within point of attachment to uterus, followed with renewed introduction of solution. This procedure is accompanied with longitudinal forward motions of catheter with transverse vibration is introduced to this points to provide objects torn away from uterine wall until complete removal of all thick objects from uterine cavity. Then uterine cavity is filled with warmed-up +42 - +45°C dehydrated silicone gel soaked with % hydrogen peroxide in amount exceeding half of cavity bulk.

EFFECT: provided non-traumatic clearance of thick blood bunches from uterine cavity; clearance of amniotic sac under visual control; stimulation of coagulating system; prolonged disinfection of uterine cavity walls and activated contractive activity of uterus.

1 ex

 

The invention relates to medicine, in particular to obstetrics and gynecology, and can be used to treat the puerperium with postnatal subinvolution of the uterus.

Known way to stop uterine bleeding, including the definition of instrumental methods of volume of the uterine cavity and the greatest length from her neck, the fixation 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 blood, the introduction through the opening in the neck in the region of the bottom cavity warmed up to +42 to +45°With dry silicone gel is soaked in an equal volume solution of 3% hydrogen peroxide in excess of half of the volume of the cavity, (EN 2288656 C1, 2006, Urakova N.A., Urakov A.L., Sokolova, NV, Kasimov A.D. Way to stop uterine bleeding).

The disadvantage of this method is the delay of infected residues fetal membranes and blood clots in the uterus, because the method provides not remove dense biological objects (fetal membranes, fluid and clotted blood from the uterus), and delay it. This method provides disinfection of the inside of the uterus only the liquid portion of blood, but did not provide effective disinfection located in the cavity dense bi is a Boolean object, such as infected remnants of the fetal membranes and the blood clots, adjacent to the inner surface of the uterine cavity. The method does not provide the disinfection portion of the inner cavity surface covered by these dense objects. Moreover, the method enhances their diligence to the walls of the cavity and provides long-term fixed contact them with each other, as is the increase in volume of the liquid portion of blood due to the formation of her peoplefrom, which, in turn, eliminates the imminent removal of these infected biological objects outside, and they facilitate the incubation of infectious agents in a confined space, and infection of the uterine wall that leads to the development of postpartum endometritis. Therefore, the method has a low efficiency and safety in postpartum subinvolution of the uterus, complicated by infection of the contents of the uterine cavity, including blood clots and the remnants of the fetal membranes, despite the hemostatic effect, because it is not conducive to rapid destruction of infected dense biological objects from the uterus to the outside, promotes infection of the uterine wall and does not prevent the development of endometritis.

The purpose of the invention is improving the efficiency and safety of treatment of parturient women with postpartum subinvolution Mat and by increasing the accuracy of removing residual fetal membranes and blood clots.

The essence of the proposed method uterine lavage, including the definition of instrumental methods of volume of the uterine cavity and the greatest length from her neck, the fixation 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 blood, the introduction of the catheter through the opening in the neck in the region of the bottom cavity warmed up to +42 to +45°With dry silicone gel is soaked in an equal volume solution of 3% hydrogen peroxide in excess of half of the volume of the cavity, is that pre - in the region of the fundus of the uterine cavity catheter and with it warmed up to +42 to +45°With a solution consisting of 0.9% sodium chloride solution and 3% hydrogen peroxide, to full fill the cavity formed in it foam, then using ultrasound visualize the position of solid objects and the catheter in the cavity, is consistently down the catheter to contact with each dense object in the place of its attachment to the uterine wall, and then resume the introduction of the solution, the catheter longitudinal translational movement transverse oscillations introduced in this place before the separation of the object from the wall and until the complete removal of all solid objects from the uterus.

Will prefix is inoe introduction to the area of the fundus of the uterine cavity of the catheter and using it warmed up to +42 - +45°With a solution consisting of 0.9% sodium chloride solution and 3% hydrogen peroxide leads to the formation of foam from the liquid portion of blood in a cavity of the uterus. When the foam begins to form in the bottom of the cavity. Foaming blood increases in volume and is pushed out through the opening in the cervix. Full filling the uterine cavity with a solution consisting of 0.9% sodium chloride solution and 3% hydrogen peroxide, excludes the presence and accumulation of liquid in the cavity blood, pus and lohii, because in the presence of hydrogen peroxide they foaming. The introduction of the hydrogen peroxide solution of 0.9% sodium chloride deprives the solution hypoosmolality and achieving isoosmotic level, namely the values osmoticnosti about 280 mOsm/l of water, which increases the security of finding a solution into the uterine cavity. Using the specified solution warmed eliminates cooling and hypothermia of the uterus, development of respiratory infectious diseases, inhibition of thrombus formation and reduction of contractile activity of smooth muscle. Heating the solution to a level of +42 to +45°excludes burns and provides the maximum possible stimulation of a protective immune forces of the blood coagulation system and the contractile elements of the smooth muscle formation in the uterus and in its cavity, which increases the efficiency and safely is any way in postpartum subinvolution of the uterus, complicated by infection of the contents of the uterine cavity. The use of ultrasound allows for efficient and safe to visualize the uterus and the contents of the cavity, especially in the formation in it of foam that is due to the gas bubbles reduce the density of a liquid content and increases with an ultrasound contrast dense (without gas bubbles) of biological objects, such as the remnants of the fetal bladder, blood clots, and also the catheter.

Consistent sizing catheter to the places of attachment of each solid object against the wall of the uterus and resume when the solution provides efficient mechanical and hydrodynamic effects of the spray solution and foam, as well as the end of the catheter in dense biological objects to their full separation from the uterine wall and avoiding injury to the uterus. Occurs during this longitudinal movement of the catheter with the transverse oscillations increase the area of mechanical and hydrodynamic effects on the attachment of dense objects to the wall of the uterus and increase the efficiency of their separation from it. The implementation of these actions under ultrasound until the complete removal of all heavy objects from the uterine cavity ensures the effectiveness and safety of the method by removing all infected dense biologicalsciences of the cavity.

Example. The patient Century. 23 years due to lack of efficacy basic intensive medical therapy regarding incurred by it after term labor postpartum subinvolution of the uterus and postpartum endometritis, on the 4th day after birth using ultrasound determined the volume of the uterine cavity (it was equal to 20 cm3and the greatest length from the cervix (the length of the cavity was set to 10 cm). Then the puerperal placed in a gynaecological chair and under ultrasound fixed body in the position in which the upper edge of the uterine cavity has dropped below the lower edge of the hole in the cervix prior to complete filling of the uterine cavity lahiani and blood. After 6 cm3crystalline anhydrous silica gel from diapers company "Procter & Gamble" has infiltrated the 6 ml solution of 3% hydrogen peroxide, the resulting gel was collected in a syringe connected to the catheter, heated them up to +45°and introduced in the region of the fundus of the uterus through the catheter to a depth of 10 cm in a few seconds the uterine cavity was filled with peopletravel. The expiration of the uterus lohii streaked with scarlet red blood decreased significantly, but not completely stopped until the following day. Bleeding from uterine lochia had a bad smell, clinical signs of endometritis has not decreased. On this basis b is lo made an assumption about the presence in the uterus of infected residues fetal membranes or blood clots and it was decided to remove them from the cavity together with peopletravel. To do this, under ultrasound control in the region of the fundus of the uterine cavity was entered catheter and with it warmed up to +43°With a solution consisting of 0.9% sodium chloride solution and 3% hydrogen peroxide, to full fill the cavity with foam. Then, using ultrasound cavity found dense object that is attached to the uterine wall and projecting into the cavity one oscillating end, and put into the cavity of the catheter. Under ultrasound summed up the catheter to contact with the identified object in the place of its attachment to the uterine wall and resumed the introduction of the solution, observing the object. Because the object remains attached to the uterine wall, then under the control of the ultrasound catheter longitudinal translational movement transverse oscillations introduced under his base and he broke away from the wall. After this object has been removed from the uterine cavity, the introduction of the solution was stopped. After that held ultrasonic revision of the contents of the cavity and confirmed the absence of any solid objects.

Then he fixed the body postpartum women and adolescent girls in the position in which the upper edge of the uterine cavity has dropped below the lower edge of the hole in the cervix, waited for the moment to full fill the uterine cavity blood and introduced in the region of its bottom with a syringe and catheter 12 ml of warmed up to 45°With silica gel impregnated equally the m volume of 3% hydrogen peroxide. After a few seconds, the uterine cavity was filled with peopletravel. The expiration of the uterus stinking lohii streaked with blood decreased significantly, and in the evening ceased completely. Clinical symptoms of postpartum endometritis decreased. Bacteriological analysis of the contents of the uterus, held on the 6th day, confirmed the absence of infections by pathogenic microflora. If this were found clinical signs of nephritis puerperal endometritis. On the 7th day after birth symptoms subinvolution of the uterus and postpartum endometritis disappeared. Held on this day ultrasound examination of the cavity of the uterus showed that its volume was reduced to 2.1 cm3. These data confirmed the completion of the process of involution of the uterus. The patient was discharged on the 8th day in a satisfactory condition.

The way uterine lavage, including the definition of instrumental methods of volume of the uterine cavity and the greatest length from her neck, the fixation 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 blood, the introduction of the catheter through the opening in the neck in the region of the bottom cavity heated to 42 - 45°With dry silicone gel, propiano is about an equal volume solution of 3%hydrogen peroxide in volume, over half of the volume of the cavity, wherein the pre in the region of the fundus of the uterine cavity catheter and with it warmed up to 42 - 45°With a solution consisting of 0.9% sodium chloride solution and 3% hydrogen peroxide, to full fill the cavity formed in it foam, then using ultrasound visualize the position of solid objects and the catheter in the cavity, is consistently down the catheter to contact with each dense object in the place of its attachment to the uterine wall, and then resume the introduction of the solution, the catheter longitudinal translational movement transverse vibrations enter in this place before the separation of the object from the wall and up to the complete removal of all solid objects from the uterus.



 

Same patents:

FIELD: medicine; surgery.

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2 ex, 1 dwg

FIELD: medicine.

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3 ex, 2 dwg, 5 cl

FIELD: medicine.

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FIELD: medicine, surgery.

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3 cl, 4 ex

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4 tbl

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1 ex

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8 cl, 2 tbl, 6 ex

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1 ex

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4 l, 16 dwg, 4 ex

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3 tbl, 1 ex

FIELD: medicine, obstetrics, gynecology.

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2 ex

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EFFECT: higher efficiency.

1 ex

FIELD: medicine, surgery.

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EFFECT: higher efficiency.

1 ex

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7 ex

FIELD: medicine.

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6 cl, 4 tbl

FIELD: medicine.

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EFFECT: method allows preventing of systemic fat embolism development in perioperative period.

2 tbl, 1 ex

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