Non-medicamentous methods of treatment for threatened abortion

Electroanalgesia. The functional state of the central nervous system plays a major role in the pathogenesis of pregnancy termination. Unfavorable effects may alter the activity of both the cerebral cortex and the hypothalamic-pituitary system, which regulates physiological changes in the body to ensure normal pregnancy development. In case of miscarriage, changes most often occur in patients with a labile nervous system, who are often and long-term ill during puberty. Changes in the state of the nervous system that arise as a result of pathological impulses from the receptors of the genitals after inflammatory diseases, or frequent curettage of the uterine cavity walls and other pathological processes may play a role in pregnancy termination. Emotional stress of the pregnant woman, repeated termination of a desired pregnancy, fear of a new miscarriage, instability of family relationships, etc. are of great importance in pregnancy termination. All this creates an unfavorable background for the progression of pregnancy.

Studies conducted by a number of authors show the presence of complex changes in the nervous system function in women with miscarriage. Rapid fatigue, mood swings, psychoemotional instability, and autonomic disorders can be used as diagnostic tests to identify weakening of cortical control and prescribe preventive measures to such pregnant women to regulate the functional state of the central nervous system. This is especially important in cases of habitual miscarriage, since against the background of reduced functional activity of the cortex, any irritant can cause a violation of the physiological processes that ensure the preservation of pregnancy.

In the 1970s, the method of electroanalgesia was introduced into obstetric practice, used to regulate labor, to increase the effectiveness of psychoprophylactic preparation for childbirth, to treat mild forms of toxicosis in pregnant women, etc. Electroanalgesia makes it possible to effectively carry out non-drug regulation of the functional state of the central nervous system and to increase the activity of cortical processes by reducing the level of information coming from the periphery. This property of electroanalgesia allows it to be used in a complex of therapeutic measures in case of a threat of termination of pregnancy at all its stages.

Therapy with pulsed currents is performed using the domestic device "Electronarkon-1" using frontomastoid electrode lead. The course of treatment is 8-10 procedures lasting 1-1.5 hours. The treatment is performed in the first half of the day. The current parameters are selected depending on the threshold sensations of the patient, taking into account the clinical manifestations of the threat of termination of pregnancy.

During the procedures, most patients experience a sedative effect. Women become calmer, believe in a favorable pregnancy outcome, and their sleep is normalized. The use of electroanalgesia in this category of patients allows for a reduction in the amount of drug therapy, and in some cases, to abandon it.

According to the encephalography data conducted in these patients before the therapy and after the course, all women showed normalization of the frequency-amplitude characteristics of the main EEG rhythm and its spatial distribution, and the severity of the signs of pathological activity decreased. Contractile activity of the uterus gradually decreased, and after 5-7 procedures, the tone returned to normal. As the manifestations of the threat of termination of pregnancy were eliminated, the condition of the fetus improved. Fetal movement became more active. According to electrocardiography and phonocardiography, chronic hypoxia disappeared. The indicators of thermostable alkaline phosphatase and estriol excretion returned to normal in accordance with the gestational age.

Electrophoresis of magnesium with sinusoidal modulated current.

Magnesium electrophoresis SMT based on the principle of reflex-segmental therapy is performed using the technique developed by A. I. Lyubimova et al. (1974), using domestic devices "Amplipulse-3", "Amplipulse-4". Treatment is performed daily with a two-day break after 5 procedures; the course of treatment is 10-15 procedures. No side effects have been identified during treatment. Magnesium electrophoresis SMT is advisable to perform for prophylactic purposes after surgical correction of isthmic-cervical insufficiency, in women with a burdened obstetric history at critical times in terms of the threat of termination of pregnancy.

Electrorelaxation of the uterus. The essence of the electrorelaxation method consists in the effect of alternating current on the neuromuscular apparatus of the uterus through electrodes located on the anterior abdominal wall and in the lumbosacral region. An alternating sinusoidal current is used in the frequency range of 50-500 Hz, with a strength of up to 10 mA by amplitude value on the Amplipulse-4 device.

Already after the first session, the pain sensations cease, and after the second, the therapeutic effect is consolidated. In case of threatened termination of pregnancy from 15-16 weeks, electrorelaxation is the method of choice over other methods of therapy of threatened termination, since there is no iatrogenic effect of drugs, and the effect occurs during the procedure. Electrorelaxation of the uterus gives an effect faster than magnesium electrophoresis SMT, and can be used to provide emergency assistance in case of threatened termination of pregnancy.

Acupuncture. Studying the possibility of using acupuncture to inhibit premature contractile activity of the uterus is important because acupuncture as one of the methods of reflexotherapy has a normalizing effect on many links of pathogenesis in pathological conditions of the body. Prominent domestic and foreign scientists who have used acupuncture have established that this type of therapy practically does not cause adverse side effects. The latter is very important in the treatment of pregnant women.

Indications for acupuncture are:

• signs of threatened miscarriage, manifested by premature development of contractile activity of the uterus;
• failure of drug therapy for miscarriage;
• drug intolerance and other types of allergies;
• the need to reduce the dose and limit the duration of drug intake;
• increased uterine tone in case of isthmic-cervical insufficiency before and after surgical intervention on the cervix;
• some diseases complicating pregnancy: vegetative-vascular dystonia, asthenia with signs of threatened miscarriage;
• frequent constipation, accompanying signs of threatened miscarriage.

Relative contraindications include severe concomitant diseases and complications of pregnancy, in which continuation of pregnancy is contraindicated, signs of infection of the fetal membranes, and fetal developmental abnormalities.

Acupuncture for threatened miscarriage is a multi-link process that is accompanied by normalization of impaired functions of the central nervous system and stabilization of vegetative-vascular reactions.

The introduction of needles into the specified points causes irritation of the sensory endings embedded in the skin, subcutaneous fat, perivascular plexuses encountered along the path of needle insertion. The local reaction manifests itself in the form of a weakly expressed numbness, heaviness, warmth and a sensation of electric current. The resulting flow of impulses along the afferent somatic and vegetative fibers of the nerve trunks spreads centripetally to the corresponding segments of the spinal cord to the site of irritation, causing a reaction not only within the specified segments, but also beyond them, exerting a relaxing effect on the uterus. The flow of impulses is transmitted to the overlying parts of the central nervous system - the hypothalamus, limbic-reticular formation, cerebral cortex, causing the development of a general reaction.

Normalization of increased contractile activity of the uterus as a result of acupuncture is accompanied by stabilization of arterial pressure, improvement of general condition and sleep. The tocolytic effect of acupuncture causes positive changes in the concentration of substances involved in the regulation of contractile activity of the uterus: an increase in the content of progesterone and corticosteroids, a decrease in the blood level of serotonin, creatine phosphokinase, lactate dehydrogenase. The condition of the fetus improves.

To achieve stable relaxation of the uterus, eliminate signs of threatened miscarriage and improve the general condition of pregnant women, 4-6 sessions per course are sufficient. However, with more pronounced manifestations of the threat of termination of pregnancy, the course duration may be 7-11 sessions. The duration of one session is no more than 10-15 minutes. The depth of needle insertion is determined by the appearance of the expected sensations in the form of mild warmth, heaviness, numbness, and the passage of current. During the first 2 sessions, the fetus may react in the form of more active movement. This is due to relaxation of the uterus and is one of the indicators of a clear decrease in the high tone of the uterus during the procedure.

The first session, considered as indicative, lasts 10-15 minutes. The braking method of needle insertion is used. At this time, it is necessary to find out the body's reaction to the introduction of the needle, the nature of the expected sensations, determine the arterial pressure and pulse rate.

The duration of subsequent sessions is 10-40 minutes depending on the initial condition of the woman. It is more advisable to use point 36 E in the morning, 5TR and 2F - in the evening. The needles are removed from all pregnant women in one movement with preliminary fixation of the skin on both sides of the needle with two fingers. In repeated courses, the number of sessions is 1-3 less than in the previous course.

The use of transcutaneous electrical stimulation (TES) of the acupuncture point VM-147 gives excellent clinical results. The original technique developed consists of finding two symmetrical points VM-147, alternately passing a multipolar microcurrent of 15-20 μAs with a change in polarity every 5 seconds.

An effective method of treating the threat of miscarriage is laser reflexotherapy (LRT) in a pulsed mode of radiation with a frequency of 4 Hz on organ-dependent points. The exposure time for each point is 8-15 sec. The course of treatment is 4-5 days. Under the influence of LRT, uteroplacental hemodynamics is restored to a physiological level, the metabolic and transport-trophic function of the placenta is improved.

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