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INVENTION
Patent of the Russian Federation RU2212201
METHOD OF PREVENTION OF COMPLICATIONS IN INTERRUPTION OF PREGNANCY
The name of the inventor: Natalia Bezrukova
The name of the patent holder: Bezrukova Natalia Ivanovna
Address for correspondence: 690001, Primorsky Krai, Vladivostok, Pushkinskaya Str. 37, FESTU, Patent Department
Date of commencement of the patent: 2001.11.01
The invention relates to medicine, to obstetrics, and can be used to prevent complications in abortion. From the material extracted from the uterine cavity, samples sufficient to identify the causative agents of sexually transmitted infection are selected, after detection of which, non-specific antibacterial therapy for antibacterial therapy is replaced taking into account the revealed pathogen in combination with nonspecific immunostimulating therapy, this process being regularly monitored by the patient Up to complete cure, in order to detect the causative agents of sexually transmitted infection and control of their cure, a comprehensive clinical laboratory study is carried out, which includes at least two diagnostic methods from a number of bacterioscopy, culture method, enzyme immunoassay, and polymerase chain reaction. The present invention contributes to a targeted effect on the causative agents of sexually transmitted infections, reducing the duration of treatment.
DESCRIPTION OF THE INVENTION
The invention relates to the field of medicine, or more precisely to methods for preventing complications in abortion, both after abortion and after delivery, and can be used to help a wide range of patients.
There is a known method of preventing complications during abortion, including increasing the degree of completeness of fetal removal and fetosystem elements and subsequent non-specific antibacterial therapy (see EK Ailamazyan et al., Obstetrics: A Textbook for Medical Universities .- 2 nd ed., Corr. - SPb .: SpecLit, 2000, p.406-407).
The disadvantage of the method is its insufficient effectiveness due to the inadequacy of antibiotic therapy to the composition of sexually transmitted pathogens.
There is also a known method for the prevention of complications during the termination of pregnancy, including gynecological examination, using methods of revealing the flora of the genital organs, removing the fetus and elements of the fetal egg and subsequent non-specific antibacterial therapy (see EK Ailamazyan et al. Obstetrics: A Textbook for Medical Universities , - 2nd ed., Rev. - SPb .: SpecLit, 2000, p.401-408).
The disadvantage of the method is its insufficient effectiveness due to the inadequacy of antibacterial therapy to the composition of pathogens of sexually transmitted infections, while revealing the composition of the microflora based on the study of the material taken in the cervical canal or vagina does not solve the problem. The composition of the microflora in the uterine cavity only 15-20% coincides with the composition of the microflora of the cervical canal and vagina.
The task, the solution of which is addressed by the declared decision, is expressed in reducing the risk of complications in the termination of pregnancy due to the manifestation of the effects of inflammatory processes in the uterine cavity.
The technical result achieved in the solution of the task is expressed in providing the possibility of a targeted impact on the causative agents of sexually transmitted infection and reducing the risk of gynecological diseases, in addition, the terms of the treatment process are shortened.
The stated task is solved by the fact that the method of preventing complications in abortion, including gynecological examination using methods for revealing the flora of the genital organs, removal of the fetus and elements of the fetal egg and subsequent non-specific antibacterial therapy, is characterized by the sampling of samples taken from the uterine cavity , Sufficient to identify the causative agents of sexually transmitted infection, after the detection of which they replace non-specific antibacterial therapy for antibacterial therapy in view of the detected pathogen, in combination with nonspecific immunostimulatory therapy, the said process regularly monitoring the patient's condition until completely cured of the causative agents of infection transmitted by sexual By way of, at the same time, a complex clinico-laboratory study is carried out for the detection of sexually transmitted pathogens and control of their cure, which includes at least two diagnostic methods, for example, bacterioscopy and / or culture method and / or enzyme immunoassay and (or) ) Polymerase chain reaction method.
A comparative analysis of the features of the claimed solution with the characteristics of the prototype and analogs indicates the compliance of the claimed solution with the criterion of "novelty".
Signs of the distinctive part of the claims are solved by the following functional tasks.
Signs "... of material extracted from the uterine cavity are sampled sufficient to identify the causative agents of sexually transmitted infection" provides the possibility of applying further targeted antibiotic therapy, and thereby preventing possible complications, while ensuring the adequacy of antibiotic therapy to the composition Causative agents of sexually transmitted infections, as the selection of material from the uterine cavity is ensured (the composition of the microflora in the uterine cavity is only 15-20% coincident with the composition of the microflora in the cervical canal or vagina), and no additional manipulations in the cavity are carried out for sampling The uterus.
Signs "... after detection of which, replace non-specific antibacterial therapy with antibacterial therapy in view of the identified pathogen" provide the possibility of a targeted effect on the pathogens of the infection and thus the most accurate, and therefore effective, impact on them, which speeds up the treatment process.
The signs "... in combination with nonspecific immunostimulating therapy" provide a favorable background for carrying out antibiotic therapy and increasing its effectiveness by mobilizing the body's defenses.
Signs "... the named process conducts a regular monitoring of a condition of the patient up to full cure of the causative agents of the infection transferred sexual by" set duration in time of a rate of antibacterial therapy.
Signs "... for the detection of sexually transmitted infection pathogens and control of their cure, a complex clinical and laboratory study is performed that includes at least two diagnostic methods, for example, bacterioscopy and / or culture method and / or enzyme immunoassay and (or) ) Polymerase chain reaction method "ensure the reliability of the results of the infection cure control by more accurate verification of pathogens, provided that at least two diagnostic methods are used simultaneously.
Theoretical background of the proposed method of artificial termination of pregnancy. Relatively frequent complication after termination of pregnancy (0.5-5% of cases) is an infection of the upper genital tract. Often it affects the fetal egg and proceeds without any clinical manifestations in the woman's body, accompanied only by echographic changes. At the same time, a clinical examination before an abortion involves the detection of concomitant gynecological diseases (vaginitis, vaginosis, etc.) that are not "tied" to the uterine cavity, followed by sanation of foci of infection. That is, women can have vaginal smears of 1-2 degrees of purity, sufficient for the safe production of abortion and simultaneously pathogens of sexually transmitted infections can be present in the uterine cavity. The proportion of women carrying carriers of certain types of pathogenic microflora (in the uterine cavity), in% of the total number of examined, can be represented as follows: Micoplasma hominis - 25%; Micoplasma genitalium - 10%; Ureaplasma urealyticum - 6%; Chlamidia trachomatis - 35%; Neisseria gonorroeae - 20%; HPV16,18 - 10%; Trichomonas vaginalis - 15%; Herpes simplex virus I, II - 20%; Cytomegalovirus - 10%. A total of 39 pathogens were detected, more often a combination of their two species was observed. Thus, using the generally accepted antibiotic therapy methods, the risk of initiating a chronic or acute infection of the upper genital tract is great, especially considering the traumatic effect of abortion on the tissues of the uterine cavity.
The very operation for the destruction and removal of fetal material (with the artificial termination of pregnancy) or childbirth is carried out in accordance with the standard procedure, with observance of the adopted sterility measures. It is advisable in the conduct of abortion all manipulations in the uterine cavity, including sounding, carried out under the control of transabdominal echoscopy.
Then, from the fetal material of the uterus removed from the uterine cavity, samples in a volume of approximately 1 cm 3 are taken with sterility and placed in a special plastic container with saline solution.
These samples are used to identify pathogens of sexually transmitted infections, for which a comprehensive clinicaboratory study of the selected material is carried out, which includes at least two diagnostic methods, for example, bacterioscopy and / or culture method and / or enzyme immunoassay and / Method of polymerase chain reaction (basic methods of microbiological diagnosis: microscopic examination, culture method, molecular diagnostics, ie detection of DNA / RNA fragments (molecular biological methods of research) - polymerase chain reaction (PCR) and ligase chain reaction (LCR); Immunological methods - direct immunofluorescence (PIF) method, indirect immunofluorescence (NIF) method, enzyme immunoassay (ELISA), microimmunofluorescence (pMIF), serological methods).
Diagnosis of causative agents of sexually transmitted infection can not be limited to the use of one method, it is currently very useful to use two different diagnostic methods for more accurate verification of pathogens and the validity of subsequent treatment interventions.
The results of the study are prepared 2-3 days, at this time the woman is prescribed nonspecific antibacterial therapy (the use of sulfonamide drugs or metronidazole, preferably in combination with local therapy (vaginal balls or suppositories containing antibacterial drugs (antibiotics, metronidazole, etc.).
Since the day of abortion, monophasic low- and micro-dosed oral contraceptives (micro-gonon, marvelon, logest, regulon, etc.) can be prescribed. In addition, after mini-abortion, they are prescribed antispasmodics (taking them for 5 days (metacin 0.002 g, 0.1 g, 0.14 g, 0.04 g, any of them 1 tablet 3 times a day) .All patients are prescribed sexual Abstinence 10 days, then with a condom before the next menstruation.
After identifying the causative agents of sexually transmitted infections, treatment is selected depending on the type of pathogen detected - from 1 to 3 courses of antibacterial and immunostimulating (adaptogens, sorbents, vitamin-mineral complexes) therapy. More often than other antibacterial drugs, doxycycline (medomycin, unidox) is used in 70% (73 cases), given its wide enough range of action for myco-ureaplasmic, chlamydia and other sexually transmitted infections in 18% (19 people). Cases used antimicrobial drugs group of macrolides: erythromycin (klatsid, rovamycin); In 11% (12 people) of rulid and others.
A total of 39 species of pathogens were detected, more often a combination of two species was observed. All women received appropriate treatment, without waiting for clinical manifestations of exacerbation of infectious diseases. As a result, no cases of acute or exacerbation of chronic pelvic inflammatory diseases were observed in the main group. Women of the control group were assigned only empirical antibiotic therapy immediately after the mini-abortion performed. It included the use of sulfonamide drugs (for example, biseptol = septrim 480 mg 2 tablets 2 times a day for 3 days, then 1 tablet 2 times a day for 4 more days) or metronidazole (eg, 250 mg klyon 2 tablets 3 times Per day 5-7 days), preferably in combination with local therapy (vaginal balls or suppositories containing antibacterial drugs (antibiotics, metronidazole, etc.) .Their trade names are polyginacs, terzhinan, clay D-100, kandbeene, canestes and t .P.).
Simultaneously from the date of abortion monophasic low- and micro-dosed oral contraceptives (micro-gonon, marvelon, logest, regulon, etc.) are prescribed. They also have a slight anti-inflammatory effect, albeit indirect (they thicken the mucus of the cervical canal, sealing the mucous "stopper" and infections and spermatozoa difficult to penetrate into the uterine cavity.
In addition, after mini-abortion, antispasmodics are prescribed for 5 days (metacin 0.002 g, 0.1 g, 0.14 g, 0.04 g, any of them 1 tablet 3 times a day).
All patients are prescribed sexual abstinence for 10 days, then with a condom before another menstruation.
As a result, in women of the control group, exacerbation of chronic adnexitis was noted in 2 cases (22.2%) and chronic endometritis in 1 case (11.1%). Of course, a small number of observations do not allow us to draw definitive conclusions, but the proposed method of preventing complications in abortion is sufficiently effective and can be recommended for use in women's clinics and gynecological hospitals.
CLAIM
A method for preventing complications in abortion, including gynecological examination using methods for revealing the flora of the genital organs, removing the fetus and elements of the fetal egg and subsequent non-specific antibacterial therapy, characterized in that samples taken from the uterine cavity are sampled sufficient to identify the causative agents of the infection , Sexually transmitted diseases, after the detection of which they replace non-specific antibacterial therapy for antibacterial therapy taking into account the pathogen identified in combination with nonspecific immunostimulating therapy, the said process being carried out by regularly monitoring the patient's condition until complete recovery from sexually transmitted infections, while for detection The causative agents of sexually transmitted infection, and control of their cure, a comprehensive clinical laboratory examination is carried out, which includes at least two diagnostic methods from a number of bacterioscopy, culture method, enzyme immunoassay, and polymerase chain reaction.
print version
Date of publication 07.01.2007gg
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