Substantiation of the application of two-channel internal hysterography

The prognosis of labor and the strength of uterine contractions is almost impossible. Some authors begin to use in the birth of uterotrophic drugs (oxytocin, prostaglandin), when the uterine activity according to the internal hysterography when it is registered for an hour does not exceed 100 units. Montevideo. The problem of violations of the motor function of the uterus in terms of its regulation is mainly solved empirically in the clinic and therefore we can not talk today about the regulation of labor activity only because the amount of information that clinicians have about the physiology and pathology of the uterine contractile function is insufficient. And only the disclosure of the laws of physiology and pathology of the motor function of the uterus can be the basis for developing dynamic patterns of regulation of labor.

Very important is the opinion of Pinto, based on its own research, that the mechanical concept of the relationship between uterine activity and cervical dilatation is justified only for the end of the II period (the period of expulsion) and the post-natal period, but not the first stage of childbirth. Long-term prognosis of contractile activity of the uterus for the vast majority of births from a statistical point of view is not justified. In addition, the author claims that the observed significant unevenness of the qualitative and quantitative indices of contractile activity of the uterus in the process of the generic act, combined with significant individual variability in the dynamics and duration of the main phases of the generic act, significantly complicates the generalized partographic and tocographic characteristics of the genera as a whole.

On the high individual variability of indices of contractile activity of the uterus during spontaneous and induced labor, other authors indicate. Particular attention is paid to the evaluation of the symmetry of the shape of the uterine contraction wave recorded with different course of the birth act with different duration of the contraction phase and the phase of uterine relaxation.

Reported spontaneous changes in uterine contractility, that it does not always retain the same type of activity during childbirth, but in fact the form of its activity often changes. In normal births, a series of normal waves are observed, alternating with periods of uncoordinated labor or ascending waves of uterine contractions. When these waves prevail, the progress of labor slows down. During normal delivery, synergy of contractions of all parts of the uterus is revealed with the manifestation of the "triple descending gradient" according to Reynolds with the opening of the cervix for 2-3 cm. When the cervix is opened for 4-6 cm, there is a reciprocity in the contractile activity of the uterus, manifested by relaxation of its lower segment with simultaneous reduction of the bottom and body of the uterus. In the culmination phase of the disclosure period, all divisions, including the lower segment, are actively contracted while maintaining the "triple descending gradient". With the weakness of labor, the authors found that even with the opening of the cervix for 2-3 cm, relaxation of the lower segment of the uterus was observed, and an earlier appearance of contractions in the region of the body or lower segment was observed than in the bottom region on the left.

From the data given, it can be seen that until now there are no mechanisms known for self-regulation of the uterus during pregnancy and childbirth, leading to a successful completion of labor.

We developed a technique for two-channel internal hysterography, indications and its justification for use in childbirth. Two catheters are transcervical: the first one is 42-41 cm from the entrance to the vagina and the second - to the area of the lower segment of the uterus at 20-21 cm from the entrance to the vagina. Contraindications for the application of this method are placental attachment anomalies and fever in childbirth.

Justification for the application and development of two-channel internal hysterography served as the following circumstances. The lower segment of the uterus in comparison with the body is an independent segment of the uterus with certain boundaries both macro- and microscopically, as well as certain anatomical and functional features. The body of the uterus has 4 layers, and the lower segment of the two sections is external and internal.

We detected a difference in the values of intrauterine pressure in the region of the bottom and the lower segment of the uterus, which mainly depends on two physical factors: the height of the hydrodynamic column and the angle of inclination of the longitudinal axis of the uterus to the horizontal line. The difference in pressure in the indicated sections of the uterus at a different angle of its inclination to the horizontal line, can vary from 5 mm Hg. Art. (at an angle of 10) to 29 mm Hg. Art. At an angle of 90.

The second very important point of this technique is that knowing the amount of intrauterine pressure developed by the lower segment of the uterus, it is easy to calculate the force that promotes the advancing part through the birth canals in the normal and complicated course of labor and the detection of abnormalities in the contractile function of the uterus, these processes by various medications or methods (changing the position of the parturient, etc.). We carried out a hydrodynamic calculation of the force that promotes the movement of the head through the birth canals in the normal and complicated course of labor, which avoids the birth trauma of the mother, fetus and newborn child.

Thanks to the developed technique of two-channel internal hysterography, the functional hydrodynamic cavity in the lower uterine segment, formed during the contraction and limited by the uterus wall in the lower segment, the fetal shoulders and the fetal head, was first discovered .

The presence of this functional hydrodynamic cavity is proved by the zone of increased intrauterine pressure during registration of fights with a two-channel internal hysterography in the area of the lower segment of the uterus due to its active contraction during the bout, otherwise there would not be a zone of increased pressure. In addition, the presence of a hydrodynamic cavity was also revealed in the manufacture of X-rays of the uterus and fetus in the first stage of labor with the introduction of 120 ml of veropram in the uterine cavity, diluted 2-fold with an isotonic sodium chloride solution. On the radiographs in the area of the lower segment of the uterus, a cavity with clear contours is revealed, not communicating at the time of the contraction with the rest of the uterus. This functional cavity in the area of the lower segment of the uterus is important in the mechanisms of uterine self-regulation in childbirth.

Scientific and practical use of two-channel internal hysterography and the phenomenon of a functional hydrodynamic cavity in the lower segment of the uterus. In the field of scientific use, it is possible to theoretically develop the causes of various anomalies of labor. Based on the comparison of intrauterine pressure and placental location (in the bottom, body or lower segment of the uterus), one can try to find out why the different length of labor is observed taking into account the hydrodynamic cavity. On the basis of theoretical calculations, it is possible to calculate, based on intrauterine pressure, developed at the bottom and lower segment of the uterus, the optimal variants of their values, at which normal labor will be noted. It is possible to study the influence of various drugs on different parts of the uterus (tonotropic drugs, antispasmodics, analgesics, epidural anesthesia, etc.).

The method of two-channel internal hysterography is used for the purposes of early diagnosis of weakness of labor and the prognosis of labor by the ratio of the force of uterine contractions and coordination of fights in the region of the lower segment of the uterus and its bottom.

It was established that the normal course of labor is observed with a sufficiently high activity of the lower segment of the uterus. In addition, due to the revealed information about the values of intrauterine pressure in the region of the bottom and the lower segment of the uterus, it is possible to calculate physically the force of contraction that will be sufficient to advance the present part and at the same time to contribute to the prevention of birth trauma both for the mother and the newborn. Traumatism of the newborn remains to this day high.

The most common type of birth trauma is a fracture of the collarbone (56.8%) with a large child and with abnormalities of labor. The birth traumatism in children remains high, despite the expansion of indications for cesarean section in the interest of the fetus, the use of various means in the process of births that regulate labor activity. The calculation of the generic forces necessary to advance the present part allows more rational use of various antispasmodic and other agents in the process of delivery, as well as to develop optimal doses, the way and time of administration of drugs taking into account the nature of labor.

An important direction is the further study of biomechanism in physiological and pathological births and elucidation, with the help of this technique, of the role of the lower segment of the uterus in the biomechanism of genera, the causes that cause the configuration of the head, the internal rotation of the head,

Important in practical terms is the contraction of labor during normal delivery and the opening of the uterine pharynx by 4-7 cm, which indicates the elements of self-regulation of the uterus.

It is also very important to study the motor function of the uterus in the postpartum period, especially with the simultaneous study of the coagulation system of the blood. As it was shown in studies, with hypotension of the uterus, there are violations of coordination of the upper and lower segments of the uterus. In this case, in cases of abnormal blood loss, uterine contractions were rare, short, and there was a noticeable lag in the contractions of the lower segment from those of the upper segment. In the absence of abnormal blood loss, uterine contractions were frequent, prolonged, and the contractions of the lower segment of the uterus did not lag behind the contractions of the uterus, ie, the ratio was 20 and 24 (lower segment), and then also 23 and 25, 26 and 24, 31 and 30, respectively mm (intensity of contractions).

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