Emptying the uterus. Curettage of the uterine cavity (curettage) - what are the main goals of the procedure? Treatment without surgery

Curettage of the walls of the uterine cavity is the instrumental removal of the functional layer of the uterine mucosa along with possible pathological formations. The procedure is performed for both therapeutic and diagnostic purposes. If possible, curettage of the walls of the uterine cavity should be performed under the control of hysteroscopy.

INDICATIONS FOR SCARLETING

Curettage of the walls of the uterine cavity is performed in case of uterine bleeding, dysfunctional uterine bleeding, suspicion of a hyperplastic process or a malignant tumor of the endometrium, incomplete abortion, placental polyp after an abortion or childbirth.

CONTRAINDICATIONS FOR SCRAPPING

Curettage of the walls of the uterine cavity is contraindicated in the detection of acute inflammatory processes of the genital organs, except in cases where curettage of the mucous membrane of the uterine body is performed for therapeutic purposes (for example, in acute endometritis due to retained placental tissue).

CONDITIONS FOR THE OPERATION

Absence of acute inflammatory process in the genitals.

METHODS OF PAIN RELIEF

The operation is performed under intravenous anesthesia or paracervical anesthesia.

OPERATIONAL TECHNIQUE

• treatment of the external genitalia and vagina;
• exposure of the cervix using mirrors and fixation of the cervix with bullet forceps;
• expansion of the cervical canal;
• scraping the uterine mucosa with a curette;
• treatment of the cervix with iodine tincture and removal of instruments.

After emptying the bladder, with the patient in the gynecological chair, immediately before the operation, a two-manual vaginal examination is performed, during which the size and position of the uterus are determined. After treating the external genitalia and vagina with alcohol and iodine tincture, the cervix is ​​exposed with spoon-shaped mirrors, which are handed over to an assistant.

The cervix is ​​grabbed by two pairs of bullet forceps by the front lip and brought down to the entrance to the vagina. The bullet forceps are transferred to the left hand. Using a uterine probe, the length and direction of the uterine cavity are determined. In most cases, the uterus is in an anteflexioversio position, so all instruments are inserted into the uterus with an anterior concavity. In the retroflexio uteri position, the direction of the instruments should be posterior to avoid injury to the uterus.

If necessary, the cervical canal is expanded with metal Hegar dilators to a size corresponding to the largest curette that will be used (most often up to No. 10–11). The dilators are inserted starting with a small size, without excessive force, pushing them only with the force of the hand, and not the whole arm. The expander is moved forward until it overcomes the obstacle of the internal throat. Each dilator is left in the canal for several seconds; if the next largest dilator enters with great difficulty, then the previous one should be inserted again.

Curettes are used for curettage. The forward movement of the curette should be careful to the fundus of the uterus; the reverse movement is performed more vigorously, with pressure on the wall of the uterus, while capturing and removing parts of the mucous membrane or fertilized egg. The anterior, posterior, lateral walls and corners of the uterus are scraped successively, gradually reducing the size of the curettes. Curettage is performed until the feeling that the wall of the uterus has become smooth.

Features of curettage of the walls of the uterine cavity depend on the nature of the pathological process. An uneven, bumpy surface of the uterine cavity can be observed with interstitial or submucous fibroids. In these cases, curettage should be performed carefully so as not to damage the capsule of the myomatous node. Such damage can cause bleeding, node necrosis and infection.

With endometrial adenocarcinoma, scraping can be very abundant, and if the tumor grows through the entire thickness of the uterine wall, the uterine wall can be injured with a curette during surgery. During pregnancy, you should not scrape the uterus until it “crunches,” since such scraping severely damages the neuromuscular apparatus of the uterus.

After curettage, the bullet forceps are removed, the cervix is ​​treated with iodine tincture, and the speculum is removed. The scraping is carefully collected in a container with a 10% formaldehyde solution and sent for histological examination. In all cases of suspected malignancy, separate diagnostic curettage should be performed. First, the mucous membrane of the cervical canal is scraped out, without going beyond the internal os. The scraping is collected in a separate tube. Then the mucous membrane of the uterine cavity is scraped out, and this scraping is placed in another tube. In the directions for histological examination, it is noted from which part of the uterus the scraping was obtained.

COMPLICATIONS AFTER SCURPATING OF THE WALLS OF THE UTERINE CAVITY

Among the complications, it should be noted perforation of the uterus, exacerbation of inflammatory diseases of the internal genital organs, and the development of intrauterine synechiae.

FEATURES OF MANAGEMENT IN THE POSTOPERATIVE PERIOD

In the postoperative period, antibiotic therapy is necessary. The patient should abstain from sexual activity for 1 month after surgery.

INFORMATION FOR THE PATIENT

The appearance of signs of acute (or exacerbation) of the inflammatory process of the genital organs after curettage of the walls of the uterine cavity is an indication for a visit to the local gynecologist.

In fact, both sides are right. A slight bend of the uterus is harmless and does not require treatment. If the deviation from the normal position of the uterus is serious, it can cause problems that require medical attention.

A similar pathology is more often observed in young women with an asthenic physique. The main thing if you suspect a bent uterus is to contact an experienced gynecologist in time and, if necessary, undergo a course of treatment.

What is uterine inflexion and where does it come from?

In a normal position, the body and cervix form an obtuse angle directed forward. In this case, deviation can be observed in any direction: back, forward, left and right.

About every fifth woman faces the problem of improper placement of the uterus. Most often, in about 70% of cases, this organ is bent forward or backward.

Among the most common causes of a bent uterus:

• weakness of the ligaments that support the uterus;
• frequent inhibition of the urge to defecate and empty the bladder;
• constipation;
• difficult childbirth, complicated by muscle rupture;
• adhesive process that developed after inflammatory diseases;
• ovarian cysts, tumors of the bladder, colon;
• abortions resulting in inflammation;
• hard physical labor, excessive physical activity in the fitness club;
• endometriosis;
• uterine tumors (fibroids, fibroids, leiomyomas).

Also, the bend can be congenital and accompanied by underdevelopment of the uterus.

Symptoms of a bent uterus

Sometimes the bend of the uterus does not make itself felt at all. But in some cases it manifests itself with the following symptoms:

• menstrual irregularities, which are expressed in the appearance of severe pain, heavy bleeding and prolonged spotting before menstruation;
• discomfort during sexual intercourse;
• constipation (the bend of the uterus can put pressure on the rectum and interfere with its emptying);
• miscarriage;
• infertility.

Particularly acute pain can be felt with a combination of bending and rotation (twisting of the uterus), which causes compression of the fallopian tubes. In this case, the pain can be aching, dull, or vice versa - sharp, radiating to the rectum or lower back.

When the uterus is bent, pain can also be caused by long walking, standing, or a sudden change in body position - for example, when getting up from a chair after a working day.

All women who want to have a normal sex life and plan to give birth to a healthy baby must undergo a gynecological examination and rule out the presence of a uterine flexion. Considering the frequent asymptomatic nature of this pathology, it doesn’t hurt to get checked even if there are no complaints!

Diagnostics

The bend of the uterus is detected during an examination by a gynecologist and is confirmed by ultrasound examination of the pelvic organs. On an individual basis, the patient may be prescribed an extended colposcopy, cytological and microscopic examination of scrapings from the cervix and cervical canal.

Treatment of a bent uterus

The following treatment methods are also used:

• taking medications;
• gynecological massage, which increases the elasticity of adhesions if present and normalizes blood circulation in the pelvis;
• physical therapy for training intimate muscles;
• vitamin therapy;
• phytotherapy;
• physiotherapeutic procedures.

In especially severe cases, surgical intervention is resorted to to cut adhesions and fix the uterus in the correct position.

How to get pregnant with a bent uterus

To conceive, the gynecologist will recommend sexual positions in which sperm is most likely to penetrate the vagina. It will not be possible to choose such positions on your own, following the advice of loved ones or comments on the Internet, because you need to know in which direction the uterus is deviated. Only an experienced gynecologist will be able to examine the curve and determine which positions are easiest to get pregnant in each specific case.

Violation of the position of the uterus is not a disease, but a pathology, the occurrence of which has a number of reasons. There are several options for organ displacement. The nature of the symptoms depends on the individual characteristics of the organism. The consequences can affect reproductive capacity, the nature of the menstrual cycle, and the general health and well-being of the woman. Several methods are used to eliminate ailments due to the bending of the uterus.

Content:

What is uterine inflexion

Many women experience a pathology such as displacement of the uterus relative to its natural position in the pelvis. It is located approximately in the center, the cervix enters the vagina. In a normal position, sperm enter the organ cavity through the cervix and from there into the tubes, where fertilization of the egg occurs. If there is a deviation from the norm, the process may be disrupted, and various complications may appear. Their nature depends on the direction in which the bend occurs, as well as on the degree of deviation.

Types of bends

Depending on the direction of the bend, several types of such pathology are distinguished.

Retroflexion. The uterus is pushed back towards the rectum, which is why a woman sometimes fails to conceive a child. This displacement is observed most often. It is this pathology that is usually meant when talking about the occurrence of a bend.

Anteflexion. The uterus is tilted forward towards the bladder. In this case, the cervix is ​​not displaced. This bend is considered a normal variant in nulliparous women. Usually after childbirth the uterus returns to its natural position.

Anteversion. Simultaneous displacement of the uterus and its cervix towards the bladder.

Lateroflexion– displacement of the organ to the side, towards the right or left ovary.

Another variant of the pathology may be “twisting” of the uterus when it turns around the cervix.

Causes of pathology

The causes of a bent uterus can be:

• congenital disorders of the pelvic organs that arose during fetal development;
• weakening of the muscles and ligaments that hold the uterus in its natural position (for example, due to multiple pregnancies or age-related changes in the body);
• rupture of the muscles and ligaments connecting the organ to the walls of the abdominal cavity;
• the occurrence of adhesions between the body of the uterus and other organs;
• formation and growth of tumors on the outer surface of the uterus;
• inflammatory processes leading to the formation of scars and changes in the shape of the organ;
• diseases associated with hormonal disorders (endometriosis, cysts and ovarian tumors);
• abortions, surgical interventions, caesarean section;
• abdominal injuries;
• lifting weights, intense sports during menstruation;
• frequent births, especially difficult ones;
• sudden weight loss;
• intestinal diseases, as well as bladder tumors.

Note: There is an opinion that baby girls should not take the “sitting” position too early, as this will subsequently cause uterine inflexion. However, doctors refute this claim.

Symptoms of a bent uterus

The first signs that suggest that a woman has a uterine inflexion may be a violation of the regularity of menstruation, increased pain during menstruation and during sexual intercourse. In addition, if the uterus is tilted forward, there is a frequent urge to urinate.

A symptom of the occurrence of a bend may be an increase in the intensity of menstrual flow, the formation of clots of coagulated blood in it. The duration of menstruation increases due to spotting. Delays may occur due to impaired cervical patency due to bending.

When the uterus is bent, leucorrhoea of ​​a yellowish or greenish color with an unpleasant odor often occurs. Their appearance indicates stagnation of mucus and the presence of a bacterial infection.

Compression of the intestines when a bend occurs leads to constipation and gas incontinence. Urination becomes more frequent.

Possible complications when the uterus is bent

When a bend of the uterus forms, the consequences are associated both with disruption of its functioning and with the impact on neighboring pelvic organs.

Menstrual irregularities (changes in the duration and nature of menstruation) are possible. The danger of pathologies (inflammatory processes, endometrial hyperplasia) increases.

Due to the bending of the uterus forward or backward, compression of the rectum or bladder occurs, which affects the functioning of these organs and complicates defecation or urination.

Deflection of the uterus and pregnancy

With a slight bend of a congenital or acquired nature, problems with the onset of conception, as a rule, do not occur if there are no other pathologies. During pregnancy, the uterus stretches, its position becomes more natural. Changes in shape and size can lead to the disappearance of pathology after childbirth.

If a significant bend occurs, the opening of the cervix rests against the vaginal wall, which makes it difficult or impossible for sperm to penetrate into it. The consequence is the woman's infertility. The same complication occurs if there is an inflection at the base of the uterine body. In this case, after sexual intercourse, sperm is retained in the vagina.

In many cases, pregnancy if a woman has a bent uterus becomes possible due to partial or complete restoration of its position relative to the vagina. Conceiving can be helped by a woman choosing the correct position during sexual intercourse, eliminating the bend with the help of a special massage and other measures recommended by the doctor.

If pregnancy has occurred, complications are most likely to occur if the uterus is tilted back. In this case, spontaneous abortion is possible. During childbirth, it becomes difficult for the cervix to open and the baby to pass through the birth canal, which threatens fetal hypoxia and injury. In some cases, the birth of a child is only possible through cesarean section.

Pregnant women who have a pathology such as bending are recommended to practice yoga and therapeutic exercises to strengthen the ligaments and muscles of the pelvis. Exercises often help correct the position of the uterus if there are no adhesions in the abdominal cavity. The presence of adhesions significantly complicates the course of pregnancy, since the growth of the fetus causes displacement of other organs. A so-called “strangulation” of the uterus occurs, which often ends in miscarriage.

Video: Possibility of pregnancy when the uterus is bent. Features of the course

Diagnostic and treatment methods

The bend is often diagnosed during a routine gynecological examination. To clarify the nature and extent of deviations, ultrasound of the pelvic organs is used, as well as hysterosalpingography (x-ray of the uterus using a contrast solution), which makes it possible to detect the cause of obstruction of the fallopian tubes.

To determine the cause of uterine flexion and assess possible complications, laboratory methods for examining blood and vaginal smears, biopsy (taking tissue samples for microscopic examination), and colposcopy are used.

The following methods for eliminating bends are used:

• drug treatment to speed up the resorption of adhesions;
• elimination of diseases that caused the organ to deviate from its normal position (hormonal therapy, anti-inflammatory treatment, physiotherapy);
• carrying out activities that help strengthen muscles and ligaments (physical therapy, Pilates classes);
• restorative treatment with vitamins.

A special gynecological massage allows you to correct the position of the organ.

In some cases, surgical treatment methods are used. For example, adhesions are removed using laparoscopy.

The uterus is often fixed by installing a pessary (a special ring that fixes it in the correct position). It is installed for a certain time and is removed after the tilt is eliminated.

Sometimes a method is used in which the doctor manually corrects the position of the organ. In this case, general anesthesia is used.

They boil down to the fact that women should not lift weights or be in a standing position for a long time. Participation in certain sports associated with tension in the pelvic muscles (strength exercises, prolonged cycling) is harmful.

You cannot endure the urge to urinate and have bowel movements for a long time. It is useful to sleep on your stomach. It is recommended to perform special exercises to strengthen the muscles of the pelvic floor, perineum and vagina.

You should carefully care for your genitals to avoid infection. It is necessary to receive timely treatment for gynecological diseases and undergo regular preventive examinations.

Video: Kegel exercises to strengthen the pelvic floor muscles

Non-developing pregnancy is a special form of miscarriage, characterized by the death of an embryo or fetus up to 20 weeks. in the absence of expulsion of the elements of the fertilized egg from the uterine cavity. The share of undeveloped pregnancies in the structure of early reproductive losses ranges from 45 to 88.6%, an indicator that increases annually by 7%. Careful emptying of the uterine cavity is an important factor in preventing complications of a non-developing pregnancy. To evacuate the fertilized egg from the uterine cavity, two main methods are used: surgical - vacuum aspiration of the contents of the uterine cavity and conservative - drug induction of miscarriage. There are various options for emptying the uterine cavity, and with all types of surgical methods, in most cases, dilatation of the cervix is ​​necessary. It can be mechanical and medicinal. In recent years, the hygroscopic cervical dilator Dilapan-S, made of hydrogel, has been used for this purpose. The article presents a clinical case of the successful use of the Dilapan-S dilator during a long period of non-developing pregnancy in combination with the use of antiprogestogens with prostaglandins. The use of the Dilapan-S dilator reduces the duration of the abortion procedure, promotes a more gentle opening of the cervix and emptying of its cavity, reducing the risk of trauma to the cervix and, thus, preventing cervical insufficiency.

Keywords: non-developing pregnancy, reproductive losses, miscarriage, isthmic-cervical insufficiency, Dilapan-S.

For quotation: Dobrokhotova Yu.E., Ilyina I.Yu., Mikhneva D.A. Safe emptying of the uterus during non-developing pregnancy. Our opportunities today // RMJ. Mother and child. 2017. No. 26. S. 1983-1985

Safe uterus emptying in non-developing pregnancy. Our opportunities today
Dobrokhotova Yu.E., Ilina I.Yu., Mikhneva D.A.

Russian National Research Medical University named after N.I. Pirogov, Moscow

Non-developing pregnancy is a special form of miscarriage, characterized by the death of an embryo or fetus for up to 20 weeks without the expulsion of the elements of the ovum from the cavity of uterus. The proportion of non-developing pregnancy in the structure of early reproductive losses ranges from 45 to 88.6%, the rate increases by 7% annually. For evacuation of the ovum from the cavity of the uterus, two main methods are used: surgical - vacuum aspiration of the contents of the uterus cavity, and conservative - medication induction of the miscarriage. Safe uterus cavity emptying is an important factor in preventing complications of an non-developing pregnancy. There are various ways of emptying the uterus cavity and in most cases, in all types of surgical methods the cervix dilatation is necessary. There are mechanical and medicated cervix dilatation. In recent years, the hygroscopic cervix dilatator Dilapan-S containing hydrogel has been used. The article presents a clinical case of the successful use of Dilapan-S for long periods of non-developing pregnancy combined with the use of antiprogestagens with prostaglandins. The use of Dilapan-S reduces the terms of the termination of pregnancy, promotes more careful opening of the cervix and emptying its cavity, reducing the risk of cervical injury, and thus preventing cervical incompetence.

Key words: non-developing pregnancy, reproductive loss, miscarriage, cervical incompetence, Dilapan-S.
For citation: Dobrokhotova Yu.E., Ilina I.Yu., Mikhneva D.A. Safe uterus emptying in non-developing pregnancy. Our opportunities today // RMJ. 2017. No. 26. P. 1883–1985.

The article discusses the issue of safe emptying of the uterus during a non-developing pregnancy. A clinical case of successful use of the Dilapan-S dilator during a long period of non-developing pregnancy in combination with the use of antiprogestogens with prostaglandins is described.

Failure to develop pregnancy is one of the main problems of world medicine. The share of undeveloped pregnancies in the structure of early reproductive losses ranges from 45 to 88.6%, and the figure increases by 7% annually. Therefore, today the problem of reproductive losses continues to remain socially significant and relevant in the practice of an obstetrician-gynecologist.
A non-developing pregnancy is the death of an embryo or fetus up to 20 weeks. in the absence of expulsion of the elements of the fertilized egg from the uterine cavity, it is a special form of miscarriage.
It has been established that with each interrupted pregnancy, the risk of losing a subsequent desired pregnancy doubles and amounts to 36–38%. This forces us to consider the problem of undeveloped pregnancy as socially significant.
To evacuate the fertilized egg from the uterine cavity, two main methods are used: surgical - vacuum aspiration of the contents of the uterine cavity and conservative - drug induction of miscarriage. With a non-developing pregnancy, there is a high risk of developing coagulopathic bleeding and endometritis, either as an initial condition that caused a non-developing pregnancy, or as a result of exposure to pathologically altered tissues during their long-term presence in the uterine cavity. The risk of losing a subsequent pregnancy doubles, and this is associated with the development of chronic endometritis as a result of mechanical impact on the walls of the uterus during surgical emptying of its cavity.
Based on the above, we can conclude that careful emptying of the uterine cavity is an extremely important factor in the prevention of complications of a non-developing pregnancy.
After a thorough examination and appropriate preparation of the woman (carrying out treatment and preventive measures aimed at reducing the risk of developing possible complications), it is necessary to terminate a non-developing pregnancy. Various options are possible for gentle emptying of the uterine cavity during a non-developing pregnancy, the main thing is that when using various surgical methods, in most cases, dilatation of the cervix is ​​necessary, which is carried out in the following ways:
1. Dilatation of the cervix and vacuum aspiration of the contents of the uterine cavity.
2. Preparation of the cervix using prostaglandins or hydrophilic dilators and vacuum aspiration.
3. The use of antiprogestogens in combination with prostaglandins.
Dilatation of the cervix can be mechanical or medicinal. Mechanical expansion is carried out using instruments or means that expand the cervical canal, carried out using metal and plastic dilators. It is also possible to use natural dilators (kelp); in the literature there is information about the use of a Foley catheter as a mechanical dilator.
In recent years, the hygroscopic cervical dilator Dilapan-S, made of hydrogel, has been used for the purpose of dilatation. This is a rigid hydrophilic stick with a plastic handle, which, after insertion into the cervical canal, swells after 2–4 hours, absorbing moisture from nearby tissues, exerts radial pressure and dilates the cervix.
Antiprogestogens and prostaglandin analogs are used as a medical dilation of the cervix when terminating a non-developing pregnancy.
In its 2013 recommendations, the World Health Organization recognized the beneficial effects of osmotic expanders (kelp and Dilapan-S) and pharmacological agents (misoprostol, antigestagenic drugs). Russian scientists also recommend the use of the above methods of cervical dilatation.
The most gentle method of terminating a non-developing pregnancy, in our opinion, is the combined use of antiprogestogens and prostaglandins with the hydrophilic dilator Dilapan-S. This significantly reduces the time of the abortion procedure itself, promotes more careful emptying of the uterine cavity and, what is especially valuable, reduces the risk of trauma to the cervix, which is extremely important for subsequent pregnancies and the prevention of the development of isthmic-cervical insufficiency.

Clinical observation

Patient P.E.V., 28 years old, admitted on January 10, 2017 at City Clinical Hospital No. 1 named after. N.I. Pirogov on the referral of a antenatal clinic doctor with a diagnosis: “Pregnancy 21–22 weeks. Bichorionic di-
amniotic twins. Not developing. Aggravated obstetric and gynecological history (OAGA). Scar on the uterus after a cesarean section in 2013. Mild anemia.” Upon admission, the patient complained of lack of fetal movement since January 1, 2017.
From the anamnesis: menstruation from the age of 14, every 5 days, after 28 days, became established immediately, regular, moderately painful. Beginning of sexual activity at the age of 18, in marriage. Past gynecological diseases: candidal colpitis. This pregnancy is the 2nd, 1st pregnancy in 2013 ended with timely surgical delivery due to primary weakness of labor (according to the patient), without complications.
Regarding this pregnancy, she has been registered at the antenatal clinic since 10 weeks and is monitored regularly. At screening at 12 weeks. no pathology was found. At 16 weeks. pregnancy suffered an acute respiratory viral infection, without a rise in body temperature. From December 10, 2016, she noticed fetal movement. The somatic anamnesis is not burdened. Since January 1, 2017, I have not felt any movement of the fetuses. On January 09, 2017, she went to the antenatal clinic with complaints about the lack of fetal movement. Ultrasound examination (US) did not detect fetal heartbeat. For further examination, she was sent to City Clinical Hospital No. 1 named after. N.I. Pirogov.
Objectively: the condition is satisfactory. The skin is of normal color and moisture. Lymph nodes are not enlarged and painless. The mammary glands are soft, there is no discharge. In the lungs there is vesicular breathing, no wheezing. Respiratory rate 17/min. Heart sounds are clear, rhythmic, no murmurs. Blood pressure 120/80 mm Hg. Art. The tongue is moist, not coated. The abdomen is soft, painless on palpation in all parts, enlarged due to the pregnant uterus up to 22 weeks. The symptom of effleurage is negative on both sides. Physiological effects are normal. Gynecological status: female-type hair growth. The external genitalia are developed correctly. The vagina is narrow. When examined with the help of mirrors, the cervix is ​​clean, cylindrical, not hypertrophied, dense, the external os is closed. The body of the uterus is enlarged to 22 weeks. pregnancy. The uterus is soft on palpation and painless in all parts. Appendages on both sides are not identified. The vaults are deep and free. Discharge from the genital tract is mucous and scanty.
Diagnosis: pregnancy 22 weeks. Bichorionic diamniotic twins. Not developing. OAGA. Scar on the uterus after a cesarean section in 2013.
After a clinical and laboratory examination, a decision was made to induce a medical miscarriage. On January 10, 2017 at 9:00, in order to prepare the cervix for a late drug-induced miscarriage, the patient was prescribed a one-time antigestagen drug. On January 11, 2017, at 8:00 a.m., the patient noted nagging pain in the lower abdomen. During a gynecological examination, a shortening of the cervix up to 2 cm was noted, the cervix was soft, the cervical canal was difficult to pass for 1 finger. Taking into account the data of the vaginal examination and in order to further prepare the cervix for late drug-induced miscarriage, at 9:00 am, 1 piece of Dilapan-S was introduced into the cervical canal behind the internal os. 01/12/2017 at 8:00 the cervix is ​​cylindrical, not hypertrophied, soft, the cervical canal is passable for 2 fingers. On January 12, 2017, in order to induce a late medical miscarriage, the patient was prescribed misoprostol 400 mg orally once at 9:00 and an additional 400 mg orally once at 12:00. On January 12, 2017, at 2 p.m., complaints of cramping pain in the lower abdomen appeared. The uterus is painless on palpation in all parts.
On 01/12/2017 at 15:10, at the height of the contraction, a miscarriage occurred with a dead male fetus weighing 305.0 g, length 12.5 cm; after 3 minutes, at the height of the contraction, a miscarriage occurred with a dead male fetus weighing 295.0 g and length 12.0 cm. After
Within 5 minutes the placenta separated on its own and the placenta came out. Blood loss – 100 ml.
On January 13, 2017, a control echographic examination of the uterine cavity was performed. According to its results, no pathology was found, the patient was discharged from the hospital with recommendations under the supervision of a gynecologist at her place of residence.

Thus, it is obvious that when inducing a medicated miscarriage at a later stage of pregnancy, it is advisable to combine antiprogestogens with prostaglandins and the hydrophilic dilator Dilapan-S, which can shorten the duration of the abortion procedure. In case of late miscarriage when using a medical method of termination of pregnancy, the process of evacuation of the contents of the uterine cavity takes more than 2.5–3 days (60–72 hours); sometimes a repeated course of prostaglandins is required. In this clinical case, the entire process (from the moment of taking the antiprogestogen to the moment of spontaneous evacuation of the contents of the uterine cavity) took 54 hours, which indicates a reduction in the duration of abortion in this period. Also, rapid emptying of the uterine cavity is necessary in case of non-developing pregnancy, which will help prevent disseminated intravascular coagulation syndrome, progression of inflammatory diseases and septic complications. In addition, this combined method promotes a more gentle opening of the cervix and emptying of its cavity, reduces the risk of trauma to the cervix and, thus, prevents isthmic-cervical insufficiency. The use of one stick, which provides adequate expansion of the cervical canal, is technically more convenient. And finally, the hydrogel base is hypoallergenic.
Thus, the correct use of modern methods of abortion is accompanied by minimal side effects and complications.

Literature

1. Early pregnancy / ed. V.E. Radzinsky, A.A. Orazmuradova M.: Status Praesens, 2009. 480 p. .
2. Noskova I.N., Onishevskaya G.P., Trishkin A.G., Artymuk N.V. Non-developing pregnancy, the main causes of abortion // Mother and Child in Kuzbass. 2010. No. 4 (43). pp. 39–42.
3. Mandrykina Zh.A. Early embryonic losses. Possible etiological factors: Author's abstract. dis. ...cand. honey. Sci. M., 2010. 25 p. .
4. Agarkova I.A. Non-developing pregnancy: assessment of risk factors and prognosis (review) // Medical almanac. 2010. No. 4(13). pp. 82–88.
5. Karmyshev A.O., Ryskeldieva V.T. Modern methods of abortion in the first trimester // Science and new technologies. 2014. No. 4. pp. 114–118.
6. Hayat T. A comparative Study of vaginal Misoprostol and Cervical Catheter for Priming the Cervix in First Trimester Missed Abortion // ANNALS. 2010. Vol. 16(3). P. 179–183.
7. Wang Y.-X., Huang M.-J., He T. et al. Comparison of clinical efficacy of three methods for cervical ripening followed by surgical evacuation in early missed abortion // Journal of Reproduction and Contraception. 2012. Vol. 23(2). P. 103–110.
8. Dicke G.B., Sakhautdinova I.V. Modern methods of late pregnancy termination // Obstetrics and gynecology. 2014. No. 1. pp. 83–88.
9. Agarkova I.A. Non-developing pregnancy: the problem of preconception preparation and reduction of reproductive losses // News of medicine and pharmacy. 2011. No. 1. P. 381.
10. Dobrokhotova Yu.E., Jobava E.M., Ozerova R.I. Non-developing pregnancy. M.: GEOTAR-Media, 2010. 144 p. .

Prolapse of the uterus is a consequence of the failure of the pelvic floor muscles to hold the internal organs of the small pelvis in their places, which, under pressure from the abdominal organs, are displaced, which leads to prolapse, and in the final stage, prolapse of the uterus.

This diagnosis is very common in gynecology. Unfortunately, early detection of this pathology is very difficult. For no apparent reason, women confuse the disease with other female problems with similar symptoms and only when the next stage occurs do they consult a doctor.

In this article, you will learn the theory you need to understand the onset and course of the disease, which will allow you to avoid this disease in the future or prevent its further development. And also in the practical part of the material, you will find useful information on physical exercises, which have proven to be very effective in restoring muscle tone.

1. A nagging pain occurs in the lower abdomen. Sometimes women are bothered by problems with urination and defecation (frequent urge, constant feeling of a full bladder, constipation).
2. There is a constant aching pain in the abdomen. If a woman sits for a long time, the pain increases. After changing body position, the pain effect decreases.
3. There is a feeling of the presence of a foreign body in the vagina. Thus, the patient feels a swollen uterus. This is an unpleasant and dangerous sign that confirms that the uterus has begun to descend.
4. Constant problems begin with the intestines and bladder, on which the uterus puts pressure.
5. The walls of the vagina settle and it gradually becomes inverted.
6. The pelvic organs descend, the contents of the peritoneum enter the pelvic floor. It is quite difficult to correct this situation.

Signs of uterine prolapse can manifest in different ways. Everything here is individual. Some women experience abdominal pain when walking, others lose libido, and still others complain of problems with the excretory system.

Every sign deserves attention. You cannot start the process of uterine prolapse that has begun. If the disease is not treated, the displacement of the pelvic organs will progress.

Symptoms:

• nagging pain in the abdomen, lower back, sacrum;
• sensation of a foreign object in the vagina;
• pain during sexual intercourse;
• spotting and leucorrhoea;
• changes in menstrual function;
• urological disorders (frequent and difficult urination, urinary incontinence);
• infection of the urinary tract due to stagnation (cystitis, urolithiasis, pyelonephritis develops);
• proctological complications (incontinence of gases and feces, colitis, constipation).

If the prolapse progresses, the woman may independently detect the protruding part of the uterus. It is a surface that can be seen from the genital slit. The protruding formation is subject to trauma when walking. Therefore, bedsores form on its surface. They can become infected and bleed.

With this pathology, blood circulation in the pelvic organs is always impaired. Congestion, tissue swelling and cyanosis of the mucous membrane appear. If the uterus has shifted quite significantly, then sexual activity becomes impossible. All this is accompanied by varicose veins, as venous outflow in the lower extremities is disrupted.

When the cervix prolapses, a woman’s sex life is disrupted. Sex is not fun. She does not receive positive emotions and experiences pain. In this case, the vagina does not encircle the man’s sexual organ, so there is no pleasant sensation.

What complications can there be?

• strangulation of the uterus;
• strangulation of intestinal loops;
• bedsores of the vaginal walls;
• partial or complete prolapse of the uterus.

Known causes of the disease

1. Damage to the muscles covering the pelvic floor. This may occur due to trauma during childbirth. Deep tears in the perineal area can also cause muscle problems.
2. Congenital defects of the pelvic area.
3. Pathological processes occurring in connective tissue.
4. Pathological innervation of the pelvic floor muscles.
5. The prolapse process can be triggered by some surgical operations.
6. Sometimes the uterus drops after childbirth.
7. Significant weakening of muscles in old age. Prolapse often appears during menopause.
8. Constant hard physical labor. Regular lifting of weights leads to this disease.
9. Chronic severe cough, constant constipation.
10. Heredity. If your close relatives have this disease, then there is a possibility that you will develop it. Therefore, it is worth taking care to prevent the disease. A preventive measure is to strengthen the pelvic muscles.
11. Gynecological diseases - fibroids, cysts, fibroids put too much stress on the ligament system, which leads to prolapse.

What are the degrees of the process?

First- the walls are slightly lowered, and the genital slit is gaping.

Second- the walls of the rectum, bladder and vagina descend.

Third- the cervix falls below the normal level (before the entrance to the vagina).

Fourth- partial prolapse of the uterus occurs (its cervix is ​​located below the entrance to the vagina).

Fifth- the uterus falls out completely (this is accompanied by eversion of the vaginal walls).

Uterine prolapse is always accompanied by vaginal prolapse. In some cases, the vagina prolapses. Sometimes you can see its back or front wall.

Types of treatment for prolapse of the uterine walls

The treatment regimen depends on the following aspects:

1. The degree of uterine prolapse.
2. Concomitant gynecological pathologies.
3. The need to preserve reproductive function.
4. Degree of surgical and anesthetic risk.
5. The degree of disturbance of the colon, as well as the sphincters of the intestines and bladder.

All these factors must be taken into account. Next, the doctor determines the tactics of treatment, which can be conservative or surgical. In the initial stages of the disease, drug therapy is used. It includes the use of drugs containing estrogens.

The patient is also prescribed ointments that contain estrogens and metabolites. They must be inserted into the vagina. Conservative treatment includes physical therapy and massage. Women with uterine prolapse are advised to refrain from heavy physical labor. If therapy does not lead to positive changes, then experts suggest surgical intervention.

If the situation is severe, but surgical treatment is impossible, then doctors prescribe special pessaries. These are rings of different diameters made of thick rubber. Inside each pessary there is air, which gives the ring special firmness and elasticity. A pessary inserted into the vagina serves as a support for the displaced uterus. The ring rests against the vaginal walls and secures the cervical canal.

The pessary should not be left in the vagina for a long period of time, as it may contribute to the formation of bedsores. Such devices are usually prescribed to older women. If the patient is undergoing a course of treatment with a pessary, then she is recommended to do regular vaginal douching with decoctions of medicinal herbs, potassium permanganate or furatsilin. She should visit a gynecologist at least twice a month.

Women suffering from uterine prolapse are advised to follow a diet. Its goal is to normalize the functions of the gastrointestinal tract and prevent constipation. Doctors also prescribe wearing a bandage and therapeutic exercises.

Gymnastic exercises

The main part of the exercises works the vaginal and pelvic muscles. Thus, the emphasis is on contracting and relaxing the vaginal muscles. Home gymnastics does not require special skills. All exercises are easy and simple to perform without the help of an instructor. You don't need any equipment. Gymnastics does not take much time, but brings excellent results.

The most effective exercises are those included in the Kegel system. Let's list them:

1. Sphincter contraction.

2. Tightening the lower abdomen. Pull in the muscles located at the bottom of the pelvis. They need to be pulled up, as it were, (towards the diaphragm).

3. Imitation of pushing. Push the uterus out. This exercise can only be performed in combination with others.

It is best to practice while sitting. The back should be straight. Breathe evenly and do the exercises without haste. Each movement must be repeated several times. Gradually increase the load on the muscles. You can also include the following exercises in your home workout:

1. Performed in a standing position. The feet are shoulder-width apart, and the hands are clasped behind the back. Raise your clasped hands behind your back. Rise up onto your toes and point your pelvis forward. At this time, you need to squeeze the vaginal muscles. Stay in this position for a couple of seconds. Then take the starting position. Repeat 10 times.

2. Place a small rubber ball between your knees. Walk in this position in a circle for 2-3 minutes.

3. You need to lie on your back and bend your knees. Spread your legs shoulder width apart. Bring your knees together, squeezing your vaginal muscles. Stay in this position for a few seconds. Feet should be pressed to the floor. Take the starting position. Repeat 10 times.

4. The starting position is the same as in the previous exercise. Perform upward lifts of the pelvis while squeezing the vaginal muscles. 10 times.

5. The starting position is the same. The pelvis and lower back are pressed tightly into the floor. Raise your straight legs to a right angle. Straighten your knees as much as possible. Hold for a few seconds, then lower your legs. Take a break and do it again. It is advisable to do 10 approaches.

6. Lie on your stomach and crawl on your bellies. We perform movements forward and backward. About two minutes.

A good prevention of prolapse is classical yoga. As a result of practice, the disease gradually disappears. By exercising regularly, you will be able to achieve good results in a few months.

Operative method of treatment

This problem is often solved with surgery. This method has been used for quite some time. But before, doctors performed abdominal surgeries.

Surgical intervention was performed if the woman wanted to preserve reproductive function. Nowadays, the operation is performed laparoscopically.

Already on the third day after the intervention, the woman was discharged. The recovery period continues for about a month.

There are no scars left after laparoscopy. This reduces the likelihood of adhesions occurring. The operation does not have any effect on the condition of the vagina. Therefore, a woman can lead a normal sex life after recovery. The essence of the operation is that the uterus is supported in the form of a mesh. The latest technologies and materials make it possible to leave the mesh inside the body.

At the same time, nothing threatens the woman’s health. The material is elastic. During pregnancy, the mesh simply stretches. The operation allows you to achieve good results in the shortest possible time. A woman does not need to train muscles or use other methods of conservative therapy.

Relapses are excluded here. During the operation, the surgeon, if necessary, adjusts the position of the intestines, bladder and vagina.

Treatment of uterine prolapse with folk remedies

1. Take 2 cups of cold pressed sunflower oil. Heat it and add about 200-250 g of natural wax to it. After this, add the pre-chopped yolk of a boiled egg to the mixture. Mix everything thoroughly, remove from heat and cool. You will get an ointment that needs to be applied to tampons. Insert them into the vagina at night.
2. It is recommended to warm the genitals using tar. To do this, place hot stones, chopped garlic and tar in an enamel container. Wrap the edges of the container with cloth so that you can sit on it. The procedure takes about 10-15 minutes.
3. Take an alcohol tincture of lemon balm or astragalus roots. It is best to use the product before meals three times a day. You can make the tincture yourself. Mix the desired plant with alcohol (proportion 1:9). Leave for about 10 days.
4. Take a bath with a decoction of dandelion leaves. To do this, pour 20 g of leaves with 2 liters of boiling water. Infuse the decoction for 2-3 hours. After this, add it to a warm bath. The procedure lasts about 15 minutes.

Massage treatment

Massage of the uterus is considered a very effective way to treat the disease. The procedure is performed by an experienced gynecologist. It normalizes the condition of the uterus and improves blood circulation in the pelvic organs. At the same time, the bend of the uterus is eliminated, intestinal functions are improved, the tone of the body increases and adhesions disappear. The session is usually carried out on a gynecological chair.

Massage should only be performed by a specialist who knows the technique of performing it. He takes into account the individual characteristics of the patient, knows possible reactions and selects the optimal intensity of movements. The duration of the session is also determined individually. If pain occurs during a massage, then the tactics change.

The doctor acts on the uterus using palpation. With one hand he works the organ from the inside, and with the other he massages the corresponding area on the abdomen. This makes it possible to thoroughly palpate the uterus from all sides. Some women experience positive results only after a significant number of sessions.

The duration of the procedure is from 5 to 20 minutes. Much depends on the initial state of the uterus. During the course of such treatment, patients are recommended to sleep only on their stomach. The effect of gynecological massage exceeds all expectations - metabolic processes are normalized, sensitivity improves, and long-awaited conception occurs after infertility.

Bandage as the most convenient method of treatment

The most convenient way to recover from pelvic organ prolapse is a bandage. It maintains the uterus at a normal level. This is its main advantage.

Wearing a bandage system does not cause any trouble for a woman. But the bandage is not used as a permanent measure. It is used only temporarily.

Doctors often prescribe a bandage for uterine prolapse. It must be used until the muscles acquire normal tone.

The design of the bandage for supporting the uterus differs from the design of other bandage systems. It encircles the thighs and passes through the perineal area. Thus, the device supports the uterus from below and from the sides.

Fixation of the structure is ensured by Velcro. If necessary, it can be easily removed. The bandage is not recommended to be worn for more than 12 hours a day. Otherwise, it will have an excessive impact on the pelvic organs. To give the body rest, it must be removed during rest.

Impact of the disease on current and future pregnancies

In some women, uterine prolapse leads to rapid conception and childbirth. Very often, patients find out that they have prolapse when they undergo their first pregnancy examination. A mild form of the disease may go unnoticed, but childbirth with uterine prolapse is accompanied by difficulties. Therefore, doctors advise being examined for this pathology even before conception.

Treatment of prolapse should be carried out before pregnancy. Expectant mothers suffering from this disease experience nagging pain in the abdomen. It is difficult for them to stand and walk. Prolapse threatens the health of mother and baby. Therefore, most pregnant women with prolapse are admitted to the hospital for conservation. Such women hardly walk to avoid premature birth.

If a doctor has diagnosed prolapse in a pregnant woman, she is prescribed mandatory wearing of a bandage. This is the easiest way to support the internal organs in the correct position. The bandage removes excess stress from the spine, which is also very important. Sometimes gynecologists recommend performing Kegel exercises during pregnancy. Trained muscles make it easy to endure pregnancy.

If such methods do not help, then the woman is prescribed a pessary. A ring inserted into the vagina will help keep the uterus in place. When choosing the optimal remedy, the doctor takes into account the individual characteristics of the patient. The safety of the fetus comes first. Sometimes gynecologists approve of the use of traditional medicine methods.

During pregnancy, the position of the uterus is monitored by a doctor. The weight of a pregnant woman is of great importance. It should not exceed the norm. Therefore, a woman is recommended to adhere to a diet. If the fetus is too large, the uterine ligaments may not support its weight. Then premature birth will occur.

The process of childbirth in women with prolapse should occur in such a way that a gentle effect is exerted on the woman’s internal genital organs. The best option is to select special positions during the birth of the baby. In this case, doctors do not artificially extend the head. In addition, the baby's arms and legs must also be taken out very carefully. Professional suturing of tears formed during childbirth is important. If they were processed unsuccessfully, then the prolapse moves to the next degree.

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Intimate life during uterine prolapse

The disease creates many problems in intimate life. The stage of development of the pathology is important. The question of the possibility of sexual relations should be decided by a doctor. For many patients, marital pleasures are contraindicated during uterine prolapse. Sexual intercourse can accelerate the process of pelvic organ prolapse.

In the initial stages of the disease, a woman may not feel any discomfort. But if you are worried about severe pain, then marital debt should be excluded. If this is not done, uterine swelling may occur. This threatens with very severe pain, in which the question of pleasure disappears on its own. If you have sex with the anterior vaginal wall drooping, inversion may occur. This will be followed by uterine prolapse.

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