Статьи

Pessary - what it is

Pessary - what it is

Pessary - This is a device that is entered into the vagina to maintain the uterus and / or bladder and the rectum.

Pessary are obstetric and gynecological (therapeutic).

Obstetric Pessary - This is a small plastic or silicone medical device, which is introduced into the vagina to hold the uterus in a certain position. An obstetric pessary is used in obstetrics for preventing premature births in pregnant women with Eastic-cervical insufficiency (ICN) and for the prevention of the development of this pathology. The effectiveness of this method of Correction ICH is 85%. Pessary Obstetric Unloading is used in a number of countries (Germany, France) for more than 30 years, in the CIS countries (Russia, Belarus, Ukraine) - more than 18 years.

The mechanism of action of obstetric pessary unloading It is based on a decrease in the load on the cervix due to a decrease in the pressure of the fetal egg.

Indications for the use of obstetric pessary:

  • Functional and organic exhaustic-cervical failure;
  • Prevention of easty-cervical insufficiency in pregnant women;
  • Prevention of seam insolvency during surgical correction ICN.

Gynecological (therapeutic) pessary or royal ring - This is a medical device, externally similar to the ring of the diaphragm. The royal rings are called so because the initial form of their form had the kind of ring. Pessary was used in antiquity; Accordingly, they meet in folk medicine. In modern gynecology, their practical application began with a suitja (Hodge, America, 1860, a ring of goody), after which numerous inventions appeared (Gl. American, ring of Meyer, and German authors, Arabine), a wide variety of types and method of application. In the present, time is used only to several forms. Therapeutic pessary is used to support the uterus, vagina, bladder or rectum. Pessary is most often used to treat the fallout of the uterus (prolapse). It is also used to treat urinary incontinence, the bend of the uterus and the hernia of the bladder.

Pessary can be introduced temporarily or constantly, and must be installed by a doctor. Most pessaris do not interfere with the sexual act. The correctly lying ring does not cause any sensations and does not interfere with urinating and defecation or a sexual act. Keeping the uterus in its normal position, the rings allow a relaxed ligament apparatus to return its tone.

In our online store "NELTON", the pessaries of the following manufacturers are widely represented:

  • Dr. Arabin (Dr. Arabine), produced in Germany, which distinguishes high quality manufacturing from a special medical silicone, which causes less complications than other materials (plastic, rubber). The most widely popular is the obstetric pessary ASQ, the range of which includes 13 sizes, which allows the most fully accounted for the features of each woman.
  • Simurg (common enterprise Rep. Blanc and Russia). In the assortment of obstetric and gynecological pessaries made from medical silicone, or from PVC (more affordable by price, but tougher).
  • Dr. Shneiderman, unique pessaries, made from medical silicone.
  • PORTEX (USA) - PVC uterine rings with a wide size near 50 mm to 100 mm in 5 mm increments.

Copying material is welcomed if there is an active reference to NELATON.RU.

Obstetric Pessary during pregnancy

"Children should be born on time" - this postulate is unshakable, because the presence is the most common cause of mortality among newborns. Pregnancy and prevent premature birth is the main way to reduce losses, and the use of obstetric pessary becomes a significant help in the prevention of child mortality.

About ICN

The main role in the development of premature birth plays Eastic-cervical insufficiency (ICH), which is the reason for the early appearance of 30-40% of premature babies.

Eastic-cervical insufficiency is characterized by partial disclosure of the cervical canal and shortening the cervix, as a result of which the fruit egg deprives the supports in the lower segment of the uterus. A systematic increase in intrauterine pressure as pregnancy progressing leads to the protrusion of the fetal shells into the cervical canal, which contributes to the further progression of ICN.

ICN opens the path of infection from the vagina to the fruit shells. The emerging inflammation leads to the destruction, the influence of the accumulating waters and the beginning of preterm labor.

The causes of the development of ICN during pregnancy may be different. The insufficiency of the cervix is ​​sometimes due to the functional inferiority, the presence of deep breaks on it after the previous birth or hormonal failure.

The inconsistency of the cervix in pregnancy is quite easily diagnosed and subject to correction by surgical or conservative methods. Regardless of factors that caused the development of ICN, in most cases, doctors recommend a woman to wear an obstetric pessary. The imposition of a seam on the cervix - surgical source is applied much less often due to its traumatic and high risk of infection during pregnancy.

What is obstetric pessary?

This device from the medical silicone or plastic intended for installation on the cervix during pregnancy. The timely installation of a support device allows to reduce the risk of miscarriage in a patient or premature birth. Due to the flexible material, the device after administration is easily adapted, taking into account the characteristics of the female anatomy, uniformly redepling the load on the weight of the fetus from the neck on the walls of the uterus.

Varieties of obstetric pessariev

In obstetrics, several types of pessaris are used:

  • Bow-shaped. Externally similar to a cup with a round hole in the center. Perforated walls in the product are provided for outflows.
  • Annular. It has a round shape with small recesses around the edges.
  • Trapezoidal. Reminds the butterfly in the form and more than the rest of the obstetric pessaries corresponds to the female anatomy. Due to its design, the product is reliably fixed when installing, maintaining the rectum and resting in a narrowed part into the closed bones.

Obstetric Pessary in the form of a ring or bowls are made of elastic silicone. "Butterfly" is performed from plastic and has a tougher design. According to feminine reviews, the installation of silicone adaptation on the cervix is ​​not so painful as the introduction of plastic pessary in the form of a trapezium.

Indications for installing Pessary on the cervix

During pregnancy, the installation of the obstetric ring is necessary when the patient is detected in the patient of erection-cervical insufficiency. In the occurrence of pathology, the walls of the uterus weaken, and the neck is shortened, which leads to the disclosure of the uterine zoom. The pessary after the installation supports the cervix, preventing her disclosure ahead of time.

Also, the installation of pessary during pregnancy is advisable in the case of:

  • ears of the cervix;
  • low location of the fetus or placenta in the uterine cavity;
  • multiple pregnancy;
  • multi-way;
  • Pathology of the structure of the uterus.

The specialist can designate the installation of an obstetric pessary during pregnancy, if in the past the patient had miscarriages, complex genera, abortions and other gynecological pathologies.

Timely installation of the supporting ring during pregnancy will reduce the load on the neck of the uterus and will help to endure the child until the deadline.

Contraindications to installation

Obstetric Pessary do not put in the following cases:

  • acute inflammatory processes of the uterus and vagina;
  • Later 34 weeks of pregnancy;
  • infectious diseases of sex tract;
  • in the presence of bloody secretions;
  • When protruding the fetal bubble at the last stage of ICN.

If the patient has such complications such as pickup or inflammation of the fetal shells, the selection of the vagina has become more sufficient, their smell and color has changed from the vagina, then they need to turn to the doctor. Perhaps the product has shifted or infection has penetrated into the vagina.

Obstetric Pessary with ICN

The use of pessary on the neck of the uterus during pregnancy or a conservative server occupies a special place among the methods of treatment of ICN. It is appreciated for simplicity, availability and safety for the mother and child. This is the best way to keep a child, giving him the opportunity to grow and develop in the womb.

The question of the need to install a supporting device on the cervix is ​​solved individually taking into account the state of the woman, the fetus and the timing of pregnancy. Most often, the conservative server has to be resorted on the period of 20-22 weeks of pregnancy. With pronounced cervical defects, the installation of an obstetric ring can be shown before, sometimes in addition to the applix of the seam on the neck.

Installation and removal of obstetric pessary are absolutely painless procedures, no anesthesia is required. For comfort, only a positive psychological attitude of the woman and its absolute confidence in the doctor is important.

Prevention of premature birth

The use of obstetric pessary during pregnancy is not only a means of treatment ICN. It is shown in order to prevent premature genera in women who are threatened by unbearable, in those who have in the past cases of early interruption of pregnancy, who have cervical breaks and is forced to engage in physical labor. It is also recommended to those who suffered from infertility and, finally, pregnancy came, or who shelters twins or triple.

Installation of obstetric pessary during pregnancy – Not only physical support of the uterus and an obstacle for premature births, it is psychological support for a woman, insecure in a safe tooling child.

The planned removal of the obstetric ring is made in the period of 37-38 weeks of pregnancy, its use does not affect the flow of labor and does not affect the development of the fetus.

Terms and techniques Installation of Pessary on the cervix

For the appointment of a doctor, the installation of obstetric pessary is possible on any period of pregnancy. More often, the procedure is carried out after 20 weeks of pregnancy, but no later than 35 weeks. In some situations, the installation can be appointed for 12 weeks in the threat of miscarriage. The exact date of the procedure is determined by the doctor after a complete examination of the patient.

The obstetric ring is introduced in outpatient conditions. With the hyperthonus of the uterus for half an hour before the procedure, a woman needs to take an antispasmodic. Before installing the doctor selects the product suitable and design, based on the diameter of the cervix and the number of previous births in the patient. The procedure itself is carried out in a gynecological chair and takes no more than 15 minutes. To reduce the unpleasant feeling of a woman and speed up the installation, the doctor uses a special gel.

After the installation procedure, some patients complain about weak pain at the bottom of the abdomen. In this case, doctors recommend "nos-pu" or candles "Papaverin".

The obstetric pessary is removed at the end of the III trimester of pregnancy or before the testimony of an obstetrician gynecologist. After removing the supporting device, it can begin both within 24 hours and a few weeks later. The direct relationship between the procedure for removing the obstetric ring and the beginning of the generic activity is not.

Features of wearing and limitations after installing Pessary

The doctor after installing the obstetric pessary on the cervix must prevent the patient about some restrictions. To protect yourself from infections and keep pregnancy to a woman need:

  • abandon sex contacts;
  • limit physical exertion;
  • Do not take a bath;
  • eliminate swimming in the pool and open water bodies;
  • Organize meals in such a way as to avoid problems with the intestines.

Also, after installing the rings on the neck of the uterus, regular techniques are assigned to the obstetrician gynecologist. Every two weeks the doctor takes a smear to the microflora and conducts a gynecological inspection to make sure that the device is correct.

Where to buy obstetric pessary?

The device is better to buy in specialized places - pharmacies or from suppliers of medical equipment. You can order an obstetric ring in an online store with home delivery. If you have to install Pessary during pregnancy, ask your attending physician, perhaps a specialist will help in ordering the right goods.

As for the cost, two brands of obstetric pessaris are in great demand on the Russian market - "Dr. Arabin" (Germany) and "Juno" (Belarus). German devices price is higher, but they are made, unlike Belarusian models, from soft silicone, and therefore more convenient in wearing.

Before buying a royal ring, be sure to visit the gynecologist, because From the correct product size depends on its efficiency and comfort when used. Obstetric Pessary "Juno" are manufactured in three sizes, the line of supporting devices "Dr. Arabin" is expanded to 13 sizes.

Attention! Obstetric and gynecological pessary differ not only constructively, but also by their destination. Before issuing an order, carefully read the description and characteristics of the product.

Article author:

Klimovich Elina Valerievna

doctor obstetrician gynecologist

Work experience for more than 20 years

AkupisPremature birth is one of the most important problems of modern obstetrics. The etiology of premature birth is diverse and includes both maternal and fruit complications. One of the causes of premature birth is the functional insolvency of the cervix. After all, the health of the future child depends precisely from the functional state of the cervix, the health of the future child depends, because this body plays the role of "Zhoma", contributes to the prolongation of pregnancy, and hence the ripening of organs and systems of the child.

During pregnancy, various changes occur, which lead to functional and structural defects of the cervix. These may be infections that lead to a decrease in collagen synthesis. Collagen, in turn, is a component of the cervix component. The synthesis of collagen decreases, thereby leading to the shortening of the cervix. Also, changes in the cervical canal occur, which lead to a decrease in the development of a cervical mucus that plays a protective function. On average, in a healthy women, the cervical length is 4 cm. In disruption of collagen production, the presence of hidden infection, hormonal disorders, congenital uterine defects (counya uterus, saddot uterus), presence in the history of the gravity of the uterine cavity, turns its shortening, the extension of cervical Channel and, therefore, a failure in performing the main function of the cervix - mechanical. The neck of the uterus does not give out a fruit egg out of the uterus. During the birth, it actively opens, contributing to the careful passage of the fetus by the generic paths.

Because of the functional or structural defects, the cervical cervix arises of edema-cervical insufficiency, which manifests itself in shortening the cervix and expansion of the cervical canal.

One of the methods of correction of this pathological situation is the introduction of obstetric pessary. Installation of obstetric pessary in some cases is a simple and safe way to prevent the miscarriage and enable a woman to give birth to a healthy baby. Conduct with negative emotions caused by the need to use adaptation with an incomprehensible and frightening name will help knowledge about what it is and what is the functionality of Pessary.

Obstetric Pessary is such a medical device which is actively used in the threat of pregnancy interruption in order to create a support for the uterus, the exclusion of its offset and prevent the premature cervical disclosure under the weight of the growing fetus.

This device reduces the load on the cervix, also warns its disclosure and prolongs the process of carrying the baby.

The ring is installed on the cervix, maintaining its physiological form. The device simulates the normal form of the uterine ode during the beating period.

There are 3 main types of obstetric pessaries:

  • Domed. The adaptation in shape resembles a bowl having small holes around the perimeter "bottom", which are necessary to provide outflow of natural vaginal discharge. The function of the dome-shaped pessary is to adjust the position of the cervix, shifting it towards the sacrum, and prevent its disclosure.
  • Ring - The structure of the round shape with four recesses on the inner surface. It is made of a density silicone. (Obstetric pessary "Juno" type 1, 2, 3). Medical instrument allows you to squeeze the neck of the uterus, closing her lumen. The main purpose of the ring pessary is the restoration and retention of the physiological diameter of the internal zea.
  • Unloading. The main function is the redistribution and reduction of pressure on the lower part of the uterus. When installing on the cervix, the trapezoidal adaptation is based on its narrow part, it rests on the Lonatic articulation, and widespread - worst the rectum, creating a reliable support with the uterus and warning her offset. (Pessary Dr. Arabine)

Installation of pessary is recommended for women with a cervix length of less than 35 mm. Also, medical manipulation is shown by future mothers with softened and smoothed uterine zev.

The state of the cervix is ​​controlled by ultrasound and only by appointing a doctor. Indications for the introduction of obstetric pessary:

  1. Pregnant women with a history of late spontaneous miscarriage or premature births up to 34 weeks, if the ultrasound is revealed to shorten the cervical canal less than 35mm, with the exception of contraindications.

Contraindications:

  1. Started premature birth
  2. Premature placent detachment
  3. Acute infectious process

Before the introduction of pessary, it is necessary to carry out a bacteriological study of the separated urinary organs to eliminate the infectious factor. In the event of the identification of pathogenic agents, it is necessary to carry out a sanitation of sex tract, after which it is re-analyzed by the separated urinary organs. With a negative result, it is safe to introduce an obstetric pessary.

When acquiring Pessary, it is necessary to strictly adhere to the recommendations of the doctor, taking into account:

  • The diagnosis made by the future mother.
  • Anatomical features of the structure of its uterus and cervical canal.
  • The number of birth preceding the installation of the device.

An important criterion for choosing Pessary is not only its design features, but also material manufacturing.

It can be:

Material

Dignity

disadvantages

Silicone

Its products from it are easily installed and imperceptible during use.

When extracting, sometimes difficulties arise, since silicone has the tendency to "squeeze" to the mucous membrane.

Plastic

Plastic is securely fixed, easily and quickly removed.

The installation procedure for such pessary can be painful.

The introduction of pessary is painless manipulation, performed on an emptied bladder. Some future mothers experience light discomfort during the procedure. The unpleasant sensations pass 5-10 minutes after manipulation.

The optimal term for the introduction of obstetric pessary 15-20 weeks. But with certain situations, the deadlines may vary. Pessary is introduced to 37 weeks. Next, the pessary is extracted and the body is preparing for childbirth.

There are three main sized rings. The smallest is shown by young future mothers who do not have pregnancies and childbirth in history. The second diameter of Pessary is designed for women with 1-2 children or older patients. The third ring size is recommended by future mothers having two or more childbirth in the past. Before the introduction of pessary is treated with the help of an antibacterial drug. The procedure reduces the risk of infection. Sometimes the doctor lubricates the glycerin ring - the substance facilitates the promotion of the obstetric device.

After processing, the gynecologist introduces a device to the genital path, reaching the cervix. Properly installed pessary does not cause feelings of pain and discomfort for the future mother.

Save Pessary and to convey the baby to the laid deadline will help adherence to the future mother of the rules of care for the obstetric ring:

  1. A woman can not touch the device and try to change his position.
  2. Regular examinations of the attending obstetrician-gynecologist are needed - at least once every 2 weeks.
  3. After the installation of the obstetric ring in the life of the future mother, constraints appear. She is prohibited to carry out sexual life, severe physical exertion.
  4. Pregnant woman should exclude sports, hiking in a bath and sauna.

Neither the use of pessary, nor surgical methods for the prevention of miscarriage do not give 100% guarantees that the woman has a safe convergence of pregnancy. Nevertheless, rejection of treatment, repeatedly increases the risk of adverse outcome.

Normal pregnancy is the main factors of the birth of a healthy child and preserve the health of a woman. Premature childbirth represent a greater danger to the future mother and baby. Timely appeal to the doctor, fulfilling the recommendations of the doctor, as well as the preservation of calm, will help you, to endure and give birth to a healthy child.

Doctor obstetrician gynecologist

KGBUZ "Maternity House number 3" Sveveva M.A.

Pessary (Lat. pessarium. ; Dr. Greek. πεσσός - oval stone) - silicone or plastic device, which is introduced into the vagina to maintain the internal pelvic organs (uterus, bladder, straight intestine). Refers to the class of medical facility used in obstetrics and gynecology as the prevention and treatment of urinary incontinence, the pelvic dyslapse, the dysfunction of the muscles of the pelvic bottom, as well as during the shorter of the cervix in pregnant women against the background of erectic-cervical insufficiency.

The appearance of pessaries in the form in which they are used now are preceded by a long way to develop an optimal ergonomic form of a device that retains its effectiveness. Since ancient times, physicians have used devices of a bowl or ring-shaped form to eliminate the discomfort of a woman into the vagina, due to the loss of the small pelvis organs.

  • Even at the time of the hypocratic (460-370 BC), round items and adapted rings were used to fix the resulting uterus. Pessary was made of bronze, cotton, wool and flax. T-shaped garters were used to hold Pessariev [one] . Similar devices are mentioned in Egyptian papyrus.
  • Finds on excavations in Pompei make it possible to assume that in those days of ABR Cornelius Celsis (25 g BC. E. - 50 g. E.) Applied Pessary in the form of a rings from bronze.
  • Later, the use of natural analogs of pessaris - grenades, which were introduced into the vagina, either entirely, or only a halter, resembling their form a cup, which is mentioned in the composition of the Efesse Cean (98-138. N. E.) "On Women's Diseases" [2] .
  • In the VII century n. e. Pavel Eginsky is the first man-obstetrician, suggested using a tampon from wool as a pessary, which was impregnated with drugs, and was summed up to the cervix, which, according to Lekary, contributed to the return of the uterus.
  • In the XI-XII century n. e. Salernian sideways - Italian female doctor made pessary balls from bed linen stripes.
  • In the XV century, a sponge was used, which was tightly folded, watered with wax and butter and installed in the vagina.
  • In the XVI century, Ambruz Pare was first suggested using pessary in the form of a ring to maintain a small pelvic organs. [3] .
  • Dutch surgeon Hendrik Wang Deventer (H. Van Deventer) in 1701 published the work "Manual operations - a new method for midwife" (Manuale Operatien Zynde Een Nieuw Ligt Voor Voor-Meesters En vroedvrouwen), where he gave a detailed description of the pessaris of his time. H. Wang Deventer mentioned four types of ring-shaped pessaris, which were flatter ("plate-shaped") and are presented in three forms (triangle, oval or circle) with a hole in the middle. Natural materials (wood, cork, silver and gold) were used for the manufacture. Devices from traffic jams and wood before administration to the vagina were treated with wax to avoid purulent processes. It is Peru Handrick Wang Deventer who owns detailed first instructions on the technique of introducing pessaris and their correct location relative to the cervix.
  • In 1839, Charles Hudridge made the discovery - rubber volcanization, which influenced the further development and production of pessaris for medicine. New devices possessed a longer use [3] .
  • Already by the middle of the XIX century, the first rubber vaginal rings (uterine rings) began to appear. In 1860, Hugh Lenoks Hodge, Professor of Gynecology at the University of Pennsylvania, developed a device known and in our time as "Mesary Khoja", which due to the oblong form more matched the anatomical shape of the vagina [3] .
  • In the 20th century since 1950, the used rubber pessaries were replaced by plastic, and later introduced into the production of a soft hypoallergenic silicone device that meet the requirements of modern medicine and the most comfortable for patients.

On the therapeutic effects of Pessary are divided into 4 groups:

Obstetric Pessary is a device used in pregnant women with Eastic-cervical insufficiency (ICN) in the diagnosis of the threat of premature labor. It is used to hold the uterus in the necessary natural position, as well as to fix the shortened cervix with threatening further disclosure. This conservative method of ICN correction is used in Russia for more than 18 years (in a number of countries - more than 30) and has high efficiency - more than 85% [four] . Selection of obstetric pessary and its installation only holds an obstetrician gynecologist. Installation is possible both in hospital conditions and outpatient.

Varieties of obstetric pessariev [edit | Code ]

Obstetric Pessary, performing the same function, there are three species: domed, ring, unloading.

Domestic obstetric pessary [edit | Code ]

Domestic obstetric pessary

The most used view of the obstetric pessary, which has a deep bowl shape, a large central hole for fixing on the cervix and small functional holes for the outflow of the vaginal secrecy. It is made of medical soft elastic silicone, which does not enter into chemical reactions with biological environments of the human body. Like all silicone pessaries, he is elastic, it can be bent and thus insert completely without pain.

Before installing, it is necessary to carry out a microscopic study of the contents of the vagina. If pessary is used for therapeutic purposes, the indication of its use is the situation when the transvaginal sonography indicates a cervical shortening and / or expansion of the inner session, usually between 15 and 20 weeks. The pessary is not intended to close the cervix, but rather to keep it and move the neck towards the sacrum, which prevents its further disclosure. In prophylactic purposes, obstetric pessary can be installed in women in women's risk risk (premature genera in history, multiple pregnancy) in terms of 13-16 weeks.

Dimensions: obstetric pessaries differ in their external diameter (65 mm or 70 mm), as well as in the height of the curvature (each 17 mm, 21 mm, 25 mm, 30 mm). The inner diameter for all models is either 32 mm or 35 mm. Higher models are preferable at more serious conditions.

Pessary domed-shaped is recommended for continuous use. In the case of pregnancy, it is set once and performs its functions until the deadline of docking pregnancy, that is, up to 36-37 weeks.

Obstetric ring pessary

Obstetric ring pessary, made of biologically inert medical silicone, deprived of allergenic and toxic properties. The product is available in two sizes: for giving birth and open women.

The ring is on its inner surface four identical excavation vessels. Thanks to these recesses, the Make Make Make Pessary acquires the shape of a quadrilateral, squeezes the neck and thus prevents its premature disclosure. The recesses on the outer surface of the ring make it easy to compress and hold the pessary during installation, and also easily and painlessly remove it at the end of treatment.

The composition of the silicone, from which the pessary is made, silver nanoparticles with pronounced antimicrobial activity against pathogenic bacteria are included. The surface of the ring is covered with a thin film of chlorhexidine and mirograms, complementing the action of silver and providing protection against vaginal infections and bacterial vaginosis when using Pessary. The inner part of the ring is made of dense elastic silicone (along Shore A - 60 units), which provides the necessary stiffness of the structure and its durable fixation on the cervix, eliminating radial and axial displacements of the device. The outer part of the ring is similar to the properties of the porous rubber soft elastic silicone (the hardness of the Shore A - 10 of the unit), has minimal pressure on the walls of the vagina, which eliminates the discomfort and injuries of the mucous membrane when using pessary.

Unloading obstetric pessary [edit | Code ]

The unloading obstetric pessary corresponds to its shape corresponds to the anatomical structure of female genital organs and provides reliable fixation of the product inside the vagina. Pessary resembles a trapezium with concave sides and rounded corners. The narrow side of the product trapezion rests on the Lonatic articulation, the wide part of the trapezium "covers" the rectum, without creating problems during defecation. There are several functional openings: a large central hole for the cervix and side for the unhindered outflow of the vaginal secret. It is made of harmless, biologically inert high-pressure polyethylene in three sizes.

The disadvantages of the model are considered: the stiffness of the material and abundant vaginal discharge after installation, the displacement of the pessary causes unpleasant sensations and requires urgent appeal to the doctor. In addition, the risk of developing an infection increases, which necessitates the periodic rehabilitation of sex tract.

Indications for the use of obstetric pessaris [edit | Code ]

Obstetric Pessary is designed to treat pregnant women, supporting the cervix in patients with additional complaints about the prolant (painful pressure "down" in the standing position and when walking), pregnant women who are susceptible to physical exertion (for example, have to stand for a long time) , with increased intrauterine pressure, for example, with multiple pregnancies or when the ultrasound examination is detected by the insolvency of the cervix. Main readings for the installation of obstetric pessary during pregnancy:

  • Diagnosed Eastic Cervical Insufficiency;
  • high risk of developing ICN (preventive use);
  • Combined ICN correction in the threat of miscarriage and premature genera: the imposition of surgical seams and a reduction in the load by installing an obstetric supporting pessary (not shown in the insolvency and / or cutting of seams).

The mechanism of action of obstetric pessariev [edit | Code ]

The mechanism of action of the obstetric pessary is based on a reduction in the load on the neck of the uterus due to a reduction in the pressure of the proposal part of the fetus. The action is carried out due to the following points:

  • Reducing the load on an insolvent neck due to the displacement of the cervix to the sacrum and reducing the pressure on it to the pretext of the fetus;
  • Redistribution of pressure inside the uterus;
  • The cervix is ​​closed by the walls of the central hole;
  • The mucosa stops in the neck, the risk of its infection, the fetal shells and the fetus is reduced.

Mounted different types of pessaris

The sizes of pessaris vary at certain limits. Selection of obstetric pessary and its installation only holds an obstetrician gynecologist. Installation is possible both in hospital conditions and outpatient. The product is selected by a doctor after a detailed examination in accordance with the anatomical features of the body of a woman. The optimal deadlines for installing Pessary - 13-25 weeks of pregnancy. Installation occurs painlessly, the product in the vagina does not cause discomfort in a woman.

Before installing the device (minutes for 30) to prevent the hypertonus of the uterus, the doctor may advise adopt spasmolitics (but-shpa, papaverine).

The procedure for installing Pessary takes a few minutes, but can deliver the unpleasant sensation of a woman.

The device is introduced without anesthesia, on reception in the female consultation (less often in the hospital) after the emptying of a woman's bladder. The doctor examines the pregnant in the gynecological chair, processes the pessary glycerin (to facilitate its introduction) and has a device at the entrance to the vagina with a wide base down. First, the bottom (wide) semolf will be entered into the posterior arch of the vagina. Then, a little joined on it and the rear wall of the vagina, the top (wide) semiring is introduced. Next, the entire pessary is introduced. After administration, the pessary unfold in the vagina in such a way that it is in the referee plane in relation to the longitudinal axis of the body of a pregnant woman. From the inside it looks like this: a wide foundation is in the rear edge of the vagina, and the narrow is located under the Lonnie articulation (which determines the picture of the "oblique" location). In this case, the cervix is ​​located in the central hole of the pessary.

After establishing a pessary, a woman passes regularly (every 2-3 weeks) strokes from the vagina (so as not to miss the development of collision). And also every 3-4 weeks the ultrasound of the cervix is ​​carried out and the assessment of its condition. Every 14 days, the vagina and pessary (without extraction) are treated with antiseptic solutions (furacilin, aqueous chlorhexidine solution).

The device is removed to 37-38 weeks or by emergency testimony (premature expulsion of water, the appearance of bloody discharges started by delivery).

Urbitenecological pessaries Designed to solve problems in women associated with manifestations of muscle dysfunction of the pelvic bottom: the omission of small pelvis organs, urinary incontinence and associated sexual dysfunction.

Types of yorknecological pessariev [edit | Code ]

For the correction of different degrees of severity of the dysfunction of the pelvic bottom, as well as for combined symptoms, there are seven major varieties of yorkiological pessaris:

  • To correct the pronounced symptoms of urine incontinence with slightly pronounced symptoms of the omissions of the organs or in their absence - the urethral pessary;
  • To correct the prolapse of 1-2 degrees with a weakly pronounced or missing symptoms of urinary incontinence - ring and cup of pessari;
  • To correct the prolapse of 3-4 degrees with a weakly pronounced or missing symptoms of urinary incontinence - mushroom pessary;
  • For the correction of 3-4 degree prolapse and pronounced symptoms of urinary incontinence - a cup and urethral and cubic pessari. Cubic pessary is also recommended after operations to remove uterus and appendages;
  • To correct the dysfunction of the pelvic floor in women with a violation of the topography of the pelvic bottom and organs located in a small pelvis (congenital anomalies, injuries, consequences of operations) - Pessary Khoja;
  • There is also a tandem pessary - for cases when cubic pessary cannot fully perform the function of supporting the internal organs.
  • Urbitenecological pessaries
  • Chescho-urethral pessary

  • Ring Pessary (Fat)

  • Ring Pessary (Slim)

Mechanism of the Urrognecological Pessary [edit | Code ]

The essence of all types of urzynecological pessaris in the supporting effect. Being placed in the vagina, they fix the organs of the small pelvis in their natural position, thereby eliminating discomfort caused by a woman (whether the urine incontinence or the omission of the organs).

In the early stages of diseases caused by the dysfunction of the muscles of the pelvic bottom, the pessary can perform a therapeutic function, preventing regression. In cases of explicit manifestations of the prolapse of the abodes of a small pelvic or incontinence of urine, Pessary bears more function of maintaining the quality of life until the moment when the treatment with a laser or surgical is carried out.

Recently, leading experts recommend the preventive purpose of urvynecological pessaries to patients in the postpartum period, in order to prevent the development of the symptoms of the pelvic dysfunction.

Selection and use of yorknecological pessary [edit | Code ]

Currently, the market presents urvynecological pessaries from hypoallergenic silicone, which does not react with the inner medium of the vagina and, due to its flexibility, it allows it to apply it daily.

The selection of urhinecological pessary is made by the attending physician with the help of a set of special adaptation rings that help determine the optimal pessary diameter for each case, depending on the characteristics of the anatomy of the woman and the clinical course of the disease.

After determining the appropriate size and model of Pessary, the doctor should train the patient to independently install and extract the product for daily processing. To facilitate the introduction of the product in the vagina, lubricants can be used on a water basis. The frequency of extracting Pessary appoints the attending physician. After extraction, pessary is processed by conventional running water with a soaring agent, or an intimate hygiene tool, or using chlorine-containing solutions, such as octenisept, chlorhexidine, Miramistin or others. If the doctor is allowed to carry pessary with interruptions, then the storage of the processed product is possible in an individual container with a mandatory re-processing before the introduction into the vagina.

Pharmaceutical Pessary (The most common name - suppository, or vaginal candles) is used as an effective means for administering medicines that are easily absorbed through the mucous membrane or for local action, for example, when inflammation or infection. Alternative option - rectal candles or suppositories, which, as a rule, are used to introduce into the rectum.

Occlusive pessary As a rule, used in combination with spermicides as a means of contraception.

  1. Bash K.L. Review of Vaginal PESARIES // ObStet. Gynecol. SURV. 2000. Vol. 55. No. 7. P. 455-460
  2. Scott Miller D. CONTEMPORARY USE OF THE PESSARY // Gynecol. ObStet. 1991. Vol. 39. P. 1-12
  3. 1 2 3 Vierhout M.E. The Use of Pessaries in Vaginal Prolapse // EUR. J. Obstet. Gynecol. Reprod. Biol. 2004. Vol. 117. No. 1. P. 4-9
  4. Yegorova Ya. A. Fishing A. N. Unloading obstetric pessary as an addition to the treatment of exhausco cervical insufficiency. Crimean magazine of experimental and clinical medicine. 2014; 4 (2): 17-21.
  • Tihg Yh, Lao TT, HUI SYA, CHOR CM, Lau TK, Leung Ty. ARABIN CERCLAGE PESSARY IN THE MANAGEMENT OF CERVICAL INSUFFICIENCY. Jorn Matern Fetal Neonat MED 2012; 08. DOI: 10.3109 / 14767058.2012.712559
  • Apolikhina I. A., Chokhueva A. S., Saidova A. S., Gorbunova E. A., Kagan I. I. Modern approaches to the diagnosis and treatment of Genitaly prolapse in women. Obstetrics and gynecology. 2017; 3: 26-33.
  • Barinov S.V., Shamina I. V., Lazareva O. V., Ralko V. V., Slabarina L. L., Dudkova G. V., Klelementeva L. L., Vladimirova O. V. A comprehensive approach to making patients with the use of obstetric pessary in pregnant groups of high risk on premature births. Obstetrics and gynecology. 2016; 1: 93-100.
  • Baskakov P. N., Torsuyev A. N., Tarkhan M. O., Tatarinov L. A. Correction of Eastic Cervical Insufficiency by obstetric unloading pessarium. Protection of motherhood and childhood. 2013; 1 (21): 49-52.
  • Dickka G. B. Pathogenetic approaches to the choice of the treatment method of the pelvic bottom dysfunction. Pharmac. 2017; 12 (345): 30-36.
  • Kochyev D. M., Dickka G. B. The dysfunction of the pelvic bottom before and after delivery and preventive strategies in obstetric practice. Obstetrics and gynecology. 2017; 3: 9-15.
  • Tsaregorodetseva M. V., Dickka G. B. Obstetric Pessary in the prevention of pregnancy without pregnancy. Status is pres. 2012; 3 (9): 59-62.

Prolapse of small pelvis organs

These pessaries are used for the following purposes:

  • prolapse small pelvis organs,
  • urinary incontinence,
  • Muscle dysfunction pelvic bottom .

These pessaries have a lot of forms: ring, mushroom, cubic, cup, etc. This is necessary in order for the doctor to make the optimal option for its patient, depending on its age, the degree of prolapse and the severity of the symptoms of urinary incontinence, as well as what is the associated violation in the location of the small pelvis authorities - injury, operations, innate defects and T ..

It would seem that the pessary device is so simple that we can safely take the goods from any manufacturer from the shelves. But do not rush with the conclusions! In fact, from how precisely the size of the product is accurate, what the material from which it is manufactured is and how serious the scientific base is based on the production of pessary, it depends so much. The product of inadequate quality can injure the mucous membrane, and therefore it is best to choose a reliable manufacturer's company.

  1. Pessary Arabbin from Dr. ARABIN (Germany)
  • The first advantage of Pessariev is a huge selection of sizes in all line of products. Due to this, discomfort is completely excluded when using them. You can always choose the most convenient option.
  • The second plus is a very wide range of clinical cases under which pessary from Dr. ARABIN, whether it is a threat of premature births, miscarriage or prolapse of a small pelvic organs.
  • The third plus is a hypoallergenic flexible silicone, from which Pessary is made. During the wearing of the product, the patient does not feel it, which is very important in cases where pessaria is set not long.
  • Fourth plus - price justifies quality
  1. Pessary from Simurg (Belarus)
  • The manufacturer releases 14 varieties of pessaris. 12 models are made from the medical silicone, manufactured by German technologies and 2 products from medical plastic.
  • All silicone pessaries have their own dimensional line, which allows you to accurately select the desired size for each patient. Elastic and soft products do not cause any pain when administered and are not felt throughout the course of treatment.
  • Plastic pessaries are introduced with a little discomfort, but also be worn without any unpleasant sensations. The main advantage of plastic pessaris is the price, it is several times less than at silicone analogues.
  • In fact, the most important thing is for which the patient is selected by Pessary. The diagnosis and severity of the problem is the two most important characteristics when choosing a product.
  • To properly define the type and size of Pessary, you should contact a doctor who has experience with pessari. After all, only with a personal inspection, given all the features of the anatomical structure of the pelvic floor organs, the doctor will be able to choose the appropriate type and size of the product.
  • All products presented in Russia are accompanied by quality certificates, which makes the purchase of goods of a manufacturer available for everyone.

The obstetric pessary picks up and installs the doctor - an obstetrician gynecologist. He can do it and at home in the patient, and stationary, i.e. in the hospital. Pessary is set most often on the 13-25 week of pregnancy. The procedure itself should pass painlessly (although there is an unpleasant feeling), and correctly chosen and installed pessary - do not cause discomfort.

In order to avoid the hypertonus of the uterus, the doctor may prescribe the reception of spasmolitics 30 minutes before installing the pessary. Be sure to first empty the bladder. Actually, the installation lasts only a few minutes and passes without anesthesia.

After examining the patient on the gynecological chair, the doctor handles the pessary lubricant to facilitate the introduction. If this is unloading pessary, the doctor has it at the entrance to the vagina with a wide base down. The procedure goes like this:

  1. First - the introduction of the lower half risk in the rear Vault arch .
  2. With a slight pressure on it and the rear wall of the vagina, the doctor enters the top half-trip.
  3. Then the doctor introduces the entire pessary and turns it so that it is in a referee plane towards the longitudinal axis of the body of a pregnant woman. Those. A wide base is located in the rear edge of the vagina, and narrow - under Lonnie articulation . The cervix must be in the central hole of Pessary.

The installation of a dome-shaped pessary is easier: the doctor introduces it to the vagina, squeezing so that when Pessary has turned around, his convex surface of Pessary was addressed to the cervix.

When using pessary, it is necessary every 2-3 weeks to hand over vaginal strokes to prevent Colport And every 3-4 weeks to pass the ultrasound of the cervix. Once in 2 weeks, the vagina and pessary are treated with antiseptic solutions. Removing pessary when it is not necessary.

The doctor will remove the pessary to 37-38 weeks or in case of emergency testimony (bleeding, prematurely wounded water, etc.).

The size of pessary is selected with the help of adaptation rings:

  • After administering the approximate size of the properties, the doctor will ask to get up to the patient and be like a 10-15 minutes, as well as rebel and dance if Pessary has shifted or causes discomfort, then the product is removed and the size is extracting more / less, depending on the sensations described.
  • If the patient when moving, straining and cough does not feel any inconvenience, then the size is correct. Rings extracted and the necessary pessary is installed.
  • During the installation of Pessary, the attending physician teaches a patient to independently introduce and extract the product at home, because There are filling models that are worn during wakefulness, and extracted at night.

Articles on the topic:

Author: Voinova A.V., Obstetrician Gynecologist, is continuous since 2001.

One of the reasons for inconvenience of pregnancy is the Eastic-cervical insufficiency or inconsistency of the cervix. This pathology may be anatomical or functional genesis.

An alternative to the surgical treatment of exhaustic-cervical insufficiency during the launch of the fetus is the installation of an obstetric pessary. This device is made of flexible plastic or silicone, the gamma rays (sterility ensuring) is processed and is a concave pyramid from several interconnected rings with smooth and semicircular edges.

A wide base of pessary is directed towards the rectum, and narrower towards the Lonatic joint. Due to the concave shape base, the rectum and the bladder are unloaded and not squeezed. In the center of the device there is a hole intended for the cervix, which shifted to a wide base. On the sides of the central opening there are holes with a smaller diameter required for the outflow of vaginal discharge. Jumpers located between the holes support the rigidity and strength of the device.

 Photo: Y.DRANITSKAYA AT RU.WIKIPEDIA.ORG

The mechanism of action of pessary

The action of the obstetric pessary is carried out at the expense of the following points:

  • Reducing the load on an insolvent neck due to the displacement of the fusion of the embryo;
  • Redistribution of pressure inside the uterus;
  • The cervix is ​​closed by the walls of the central hole;
  • The mucosa stop in the neck is preserved, the risk of its infection, the fetal shells and the fetus is reduced.

Indication testimony

Pessary during pregnancy is set in the following cases:

  • Eastic-cervical insufficiency (both functional and organic);
  • Prevention of discrepancies of seams on the cervix after surgical treatment of the insolvency of the neck;
  • multiple pregnancy (high risk of premature birth);
  • High risk of exhaustion-cervical insufficiency.

Photo: Madhero88 at ru.wikipedia.org

Contraindications

An obstetric pessary cannot be installed in the presence of the following circumstances:

  • Blood or submarine seals from sex tract;
  • no pregnancy is not excluded;
  • The presence of inflammatory processes in the vagina and the cervix (colpites, cervicitis);
  • Rubbing the fetal bubble into the vagina;
  • the presence of a woman with diseases contraindicated to drying pregnancy;
  • Rough malformations of fetal development.

How to install Pessary

An obstetric pessary is established after 20 weeks, but in some cases it is possible and an earlier introduction (12-17 weeks).

Before installing the device (minutes for 30) to prevent the hypertonus of the uterus, the doctor may advise adopt spasmolitics (but-shpa, papaverine).

The procedure for installing Pessary takes a few minutes, but can deliver the unpleasant sensation of a woman.

The device is introduced without anesthesia, at the reception in women's consultation (less often in the hospital) after emptying the woman's bladder. The doctor examines the pregnant in the gynecological chair, processes the pessary glycerin (to facilitate its introduction) and has a device at the entrance to the vagina with a wide base down. First, the bottom (wide) semolf will be entered into the posterior arch of the vagina. Then, a little joined on it and the rear wall of the vagina, the top (wide) semiring is introduced. Next, the entire pessary is introduced.

After administration, the pessary unfold in the vagina in such a way that it is in the referee plane in relation to the longitudinal axis of the body of a pregnant woman. From the inside it looks like this: a wide foundation is in the rear edge of the vagina, and the narrow is located under the Lonnie articulation (which determines the picture of the "oblique" location). In this case, the cervix is ​​located in the central hole of the pessary.

After installation

After establishing a pessary, a woman pulls regularly (every 2-3 weeks) strokes from the vagina (so as not to miss the development of collision). And also every 3-4 weeks the ultrasound of the cervix is ​​carried out and evaluating its condition. Every 14 days, the vagina and pessary (without extraction) are treated with antiseptic solutions (furacilin, aqueous chlorhexidine solution).

The device is removed to 37-38 weeks or by emergency testimony (premature expulsion of water, the appearance of bloody discharges started by delivery).

Side Effects and Complications

From side effects after the installation of obstetric pessary is possible:

  • The appearance of unpleasant sensations after a long seating;
  • The displacement of pessary in the vagina with the further development of the collision;
  • Strengthening vaginal discharge.

The complications include the development of the collision (in the absence of the effect of treatment within 10 days, pessary is removed) and chorioamnionitis (inflammation of the membranes of the fruit bubble and infection of amniotic fluid).

Efficiency of use

According to statistics, the effectiveness of the use of pessary during pregnancy (prolongation of pregnancy to the alleged date of birth) reaches 70-80%.

Some studies during pregnancy


Добавить комментарий