Prevention method for infectious complications after cervix uteri cerclage surgery during pregnancy

FIELD: medicine.

SUBSTANCE: before and after cervix uteri stiching operating margins are treated with instilagel. Since the second day after operation vagina and vaginal part of cervix uteri are lavaged with epigen twice a day in day and night clinic - 3-4 days. Further treatment with epigen is implemented ambulantly twice a day during 5 more days.

EFFECT: prevention of surgical infection aganst background of progressive pregnancy.

3 ex

 

Scope.

The invention relates to medicine, namely to obstetrics.

The level of technology.

Isthmic-cervical insufficiency (ICN) is a common pathology of the cervix, which is the cause of spontaneous abortions in the second trimester of pregnancy and premature birth; occurs as a result of structural and functional changes isthmic Department of the uterus (2.5), and requires, as a rule, surgical correction during pregnancy.

Similar to this method may be the processing methods of the vagina and the vaginal part of the cervix in pre - and postoperative period disinfectant (furacin), chlorhexidine, yodopiron, hydrogen peroxide) and appliques on the vaginal part of the cervix ointments, promoting regeneration and has anti-inflammatory properties (calendula ointment, levomicol etc.) (6, 7).

The prototype of this method is systemic antibacterial therapy in pre - and postoperative period (1, 8), providing, however, adverse effects on the fetus and lead to the eventual formation of antibiotic-resistant microorganisms.

The essence of the invention. The purpose of the invention is to develop a method of prevention of infectious complications after surgery cerclage cervix with isthmic-cervical enough the tee in the near and long-term postoperative period.

The method is as follows.

stage 1: after appropriate treatment of external genital organs in aseptic conditions for 10 minutes before surgery cervix naked in mirrors, vaginal part of the cervix and the vaginal vaults dry sterile cotton swab, and then make processing of the vaginal part of the cervix, anterior, lateral and posterior vaginal fornix by INSTILLAGEL (farcot-Pharma, Germany), containing (1 g) of lidocaine hydrochloride monohydrate (20 mg), chlorhexidine digluconate 500 mcg, methyl-4-hydroxybenzoate 600 mcg, propyl-4-hydroxybenzoate 250 mcg (4).

After this mirror is removed.

After 10 minutes (exposure time instillagel) under intravenous anesthesia again introduce vaginal mirrors, neck lock pliers, Muso and produce operation cerclage of the cervix according to the modified method of MacDonald with fixation for the Sacro-uterine ligaments Mylar thread or mersilene tape (1).

After blending in a circular seam and tighten the ligature until full closure of the inner throat locking tongs remove, vaginal part of the cervix and the vaginal vaults dry sterile cotton swab and produce re-processing INSTILLAGEL, then the woman on the 1 day prescribe bed rest with holding tokoliticheskoe therapy (intravenous drip introduction what their solution ginipral or magnesium sulfate).

stage 2: one day the cervix is inspected in the mirrors, the vagina and the vaginal part of the cervix dry with a cotton swab and produce irrigation of the vagina and the vaginal part of the cervix EPIGENOME. Processing the epigenome repeat in the hospital twice a day for 3-4 days (in the evening, the patient performs the instillation by yourself under the supervision of medical staff), after which she was discharged home, where she continues processing the epigenome 2 times a day for 5 days.

The drug "Epigenome-sex" (Cheminova Internacional S.A., Spain) is available in spray form, the active substance is activated glycyrrhizin acid that has anti-inflammatory, antiviral, regenerating, anti-itching and immunostimulatory effects (3).

Example 1

IL No. 769

Kozlovskaya NB, powerseraya woman 35 years of age with recurrent pregnancy loss.

This fifth pregnancy, had the second child. History of rapid and premature births in the period of 33 weeks. girl weight 2050,0 (growing and developing normally), honey. abortion without complications and two regressing the gestation period of 7-8 weeks. and in 14 weeks. respectively. Gynecological anamnesis burdened hemorrhagic form of apoplexy left ovary, about which were crevoshay, suturing of the ovary.

For d is authorized pregnancy was complicated by development of ICN (by ultrasound internal orifice of 5 mm, the cervical canal 24 mm) on the background of traumatic deformity of the cervix. In clinical and laboratory examination revealed a ureaplasmosis (by polymerase chain reaction (PCR) in 10 weeks), colpitis (the analysis of a smear on flora: the urethra is the leukocytes 30-40, cervix - leukocytes 80-100 PSR., flora rich rod), the sowing of the cervical canal Candida 105, were symptomatic therapy. In the period of 15 weeks gestation superimposed circular Mylar seam on the cervix with fixation for the Sacro-uterine ligaments. Before surgery and immediately after surgery has been the treatment of cervical cancer "Instillagel", in the postoperative period was made irrigation seam drug "Epigenome sex" 3 days in the hospital, 5 days on an outpatient basis.

The suture is removed in pregnancy 37 weeks (the analysis of a smear on flora: the urethra leukocytes 20, cervix 50 in PSR., flora rod reasonable, the planting of the cervical canal - Lactobacter 105). Woman yourself odoratissimus 38 weeks of live full-term boy weighing 3800,0 length of 55 cm with a score on the Apgar 7/8 points. Discharged home on the 4th day.

Example 2

IL No. 664

Fedotov Anna Vladimirovna, powerseraya 33 years. Somatic diseases: chronic pyelonephritis, myopia II Art.

From the third pregnancy had II childbirth, history 1 mini-abortion, 1 CROC who's birth (boy weighing 3460,0 at birth, healthy).

This pregnancy occurred spontaneously, there were multiple pregnancy: monochorionic limniotisa twins. In the period of 24 weeks for admission in Institute of MME was identified traumatic deformity of the cervix, ICN (by ultrasound internal Zev 5.5 mm; the cervical canal 26 mm), which required, taking into account multiple pregnancy, conducting cerclage cervix. Before cerclage conducted clinical laboratory tests: PCR urogenital infections not detected in the analysis of a smear on flora: the urethra is the leukocytes to 10, the cervix up to 30 in PSR., flora rod; KPI 7%; in the sowing of the cervical canal Candida 103.

In the period of 24-25 weeks. held cerclage cervical fixation for the Sacro-uterine ligaments. Before surgery and immediately after surgery has been the treatment of cervical cancer "Instillagel", in the postoperative period was made irrigation seam drug "Epigenome sex" 3 days in the hospital, 5 days on an outpatient basis.

In pregnancy 34-35 weeks. in connection with monochorionic type of placentation was rodorazresheniye by abdominal routinely. The seam is cleared before the operation - wealthy. The analysis of a smear on flora: the urethra leukocytes 0-1, cervix 0-1, flora rod, the planting of the cervical canal - Lctobacter 10 5. 4 and 5 min extracted girls weight: first 2000,0, the second 2170,0; both length 44 cm with estimates for Apgar 6/7 and 4/7, respectively, transferred to hospital for further stages of nursing, was discharged home on the 26th day. in satisfactory condition.

Example 3

IL No. 1397

Umnov Anna G., Avtomobilnaya perforada woman 30 years of age with recurrent pregnancy loss (in history 2 spontaneous miscarriage with reabrasio in both cases, about residues of the ovum) on the background of congenital anomalies of the internal genital organs: intrauterine septum is resected during hysteroscopy. Entered the Institute MME in the period 20-21 weeks. to correct ICN.

Before the operation produced clinical laboratory tests: PCR negative (ureaplasmosis sanitized before pregnancy), in the analysis of a smear on flora: the urethra is the leukocytes 0-1, cervix up to 5 in PTR., flora rod; KPI 7%; in the sowing of the cervical canal microflora is not detected. Made cerclage cervical fixation for the Sacro-uterine ligaments were conducted pre - and post-processing instillagel. Postoperative complications was not conducted irrigation cervical cancer epigenome by exposure of the cervix in the mirror three times in the hospital, then out for 5 days. In further observed condition of the seam conditions addednew the second hospital in the period 26, 32 weeks., planned hospitalization in the period of 34 weeks. prevention of placental insufficiency, SDR fruit.

The seam was wealthy, filmed in the period 37-38 weeks.

Odoratissimus per vias naturalis in pregnancy 39 weeks. girl weight 3110,0 length 50 cm, with rating on a scale of Apgar 8/9 points, discharged home on day 7.

Thus, the proposed method of prevention of infectious complications in conducting cerclage cervix can improve perinatal outcomes in pregnant women with isthmic-cervical insufficiency, reduce time finding patients in the hospital, thereby reducing contamination of nosocomial flora.

Sources of information

1. Complex method of perinatal care to premature babies [Text]: Method. REC. - Sverdlovsk, 1986. - 27 S.

2. Ledina AV, Aboud YOU Isthmic-cervical insufficiency // diseases of cervix, vagina and vulva (clinical lectures). - M.: Publishing House "Medpress". - 2000. - S-120.

3. Drugs in Russia [Text]: a Handbook. - M.: Estrofem Service, 2005. - S

4. Drugs in Russia [Text]: a Handbook. - M.: Estrofem Service, 2003. - S

5. Lipman A.D., A. A. Ultrasound criteria isthmic-cervical insufficiency // Obstetrics and gynecology. - 1996. No. 4, Pp.5 - 7.

6. Lyubimova A.I., Mammadaliyev NN. The results of the treatment of IP is Miko-cervical insufficiency of the imposition of double U-shaped Mylar seam on the cervix // Obstetrics and gynecology. - 1981. No. 9. - P.40-43.

7. Hirsch HA, Kezer, O., Icle FA Operative gynecology: satin. TRANS. from English. / Ed. by V.I. Kulakov, Yevpatoria. - M.: GEOTAR Medicine, 1999. - 1200 C., Il.

8. Sidelnikov V.M. Miscarriage. - M.: Medicine, 1986.

The way to prevent infectious complications operations cerclage cervix during pregnancy, characterized in that before and after cerclage make processing of the surgical field by instillagel, and on the second day spend irrigation of the vagina and the vaginal part of the cervix epigenome twice a day for 3-4 days in the hospital, then out for 5 days.



 

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