METHOD FOR PREVENTING, MONITORING AND STOPPING UTERINE BLEEDING AT CESAREAN SECTION AND CATHETER FOR ITS IMPLEMENTATION

摘要

FIELD: medicine.;SUBSTANCE: group of inventions refers to medicine and medical devices, particularly obstetrics, and concerns a method for prevention, control and stoppage of uterine bleeding and a catheter for its implementation. Method for preventing, monitoring and stopping uterine bleeding in cesarean section, characterized by that after removing the post-transabdominally retrograde, proximal end forward is provided with a balloon catheter comprising a main tube, a balloon arranged at the boundary of the distal uterine and proximal outer parts of the main tube, and a balloon filling and emptying tube extending from the balloon along the proximal portion of the main tube; said catheter is delivered through an operative incision, an uterine cavity, a cervical canal, a vagina and into an external medium until the catheter balloon passes the uterine cervix and enters the vagina, and accordingly the proximal end of the catheter extends outward from the vagina, to the level of the middle of the thigh of the patient and becomes accessible for connection of accessories, in parallel the opposite distal end of the catheter is brought through the surgical incision into the uterine cavity, by controlling its median-longitudinal position in the uterine cavity and finding the distal end in the immediate proximity to uterine fundus center; to the external proximal end of the tube for filling and emptying the balloon, a device for filling and emptying the balloon is attached, and the balloon is filled with a solution, thereby sealing the uterine cavity on the side of the vagina and pressing the vessels feeding the uterus to the pelvic walls; to the external proximal end of the main tube, an aspirator is connected and a negative pressure of 10–15 kPa is created; when the aspirator collects less than 500 ml of blood, the wound on the uterus is sutured; thereafter, step-by-step increase of the negative pressure in the uterine cavity to 70–90 kPa; with continuation of bleeding and admission to the aspirator collection of 700–800 ml of blood, reducing vacuum to 0, activating the autohemotransfusion apparatus and switching to the surgical management of bleeding, wherein the blood from the aspirator collection is returned to the patient through an autohemotransfusion apparatus; in the absence of haemorrhage and if there is less than 700 ml of blood in an aspirator, negative pressure is maintained for 7–10 minutes, the anterior abdominal wall is sutured and the negative pressure is stepped for 5–7 min, up to 0 kPa, after that, the patient with the installed catheter and the filled balloon is transferred into the chamber, the catheter is left in place for 2–3 hours, at that, once a hour, the procedure of negative pressure in the uterine cavity is repeated to 70–90 kPa for 7–10 minutes, followed by stepwise emptying the balloon and leaving the catheter in place for an additional hour, if the bleeding is no longer, withdrawing the catheter through the vagina, filling the balloon solution with the haemorrhage, activating the autohemotransfusion apparatus and switching to the bleeding surgical management, wherein the blood from the aspirator collector is returned to the patient through an apparatus for autologous blood transfusion. Catheter for implementing said method comprises: a main tube comprising a distal uterine portion and a proximal outer portion; a balloon positioned at the boundary of the distal and proximal parts of the main tube and having a blown configuration wherein the balloon seals the uterine cavity from the side of the vagina, holds the catheter in place and presses the uterine tubes to the pelvic wall; and a balloon filling and emptying tube extending from the balloon along the proximal portion of the main tube beyond the proximal end of the main tube; wherein the distal uterine portion of the main catheter tube has two rows of lateral through aspiration holes and an open distal end with a wavy profile.;EFFECT: higher safety of the CS together with optimization of blood collection lost in CS.;15 cl, 5 dwg, 3 ex