Non-medicamentous methods of treatment in case of threat of abortion

Electroanalgesia. In the pathogenesis of abortion, the functional state of the central nervous system plays an important role. With adverse effects, it is possible to change activity, both the cerebral cortex and the hypothalamic-pituitary system, which regulates physiological changes in the body to ensure normal development of pregnancy. When miscarriages occur, changes most often occur in patients with a labile nervous system, often and long-term ill at pubertal age. In the interruption of pregnancy, the role of changes in the state of the nervous system that may arise as a result of pathological impulses from the receptors of the genital organs after inflammation, or frequent curettage of the walls of the uterine cavity and other pathological processes may play a role. Of great importance in the interruption of pregnancy is the emotional tension of the pregnant woman, the repeated interruption of the desired pregnancy, the fear of a new miscarriage, the instability of family relationships, etc. All this creates an unfavorable background for the progression of pregnancy.

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

In the 1970s, the electroanalgesia method used for the regulation of labor was introduced in obstetrical practice, to increase the effectiveness of psycho prophylactic preparation for childbirth, to treat mild forms of toxicosis of pregnant women, etc. Electroanalgesia makes it possible to effectively perform non-drug regulation of the functional state of the central nervous system and increase activity of cortical processes due to a decrease in the level of information coming from the periphery. This property of electroanalgesia makes it possible to apply it in a complex of therapeutic measures with the threat of abortion at all its stages.

Therapy with impulse currents is performed with the help of the domestic device Electronarcon-1 using frontimastoidal electrode leads. The course of treatment is 8-10 procedures lasting 1-1.5 hours. Treatment is conducted in the morning. The current parameters are selected depending on the threshold sensations of the patient taking into account the clinical manifestations of the threat of abortion.

When performing procedures, most patients have a sedative effect. Women become calmer, they believe in a favorable outcome of pregnancy, their sleep normalizes. The use of electroanalgesia in this category of patients can reduce the volume of drug therapy, and in some cases, abandon it.

According to the encephalography performed in these patients before and after the course of therapy, all women showed a normalization of the frequency-amplitude characteristics of the main EEG rhythm and its spatial distribution, and the signs of pathological activity decreased. Gradually decreased contractile activity of the uterus, after 5-7 procedures the tone returned to normal. As the manifestations of the threat of termination of pregnancy were eliminated, the condition of the fetus improved. The wiggling of the fetus became more active. According to electrocardiography and phonocardiography, the phenomena of chronic hypoxia disappeared. The parameters of thermostable alkaline phosphatase and excretion of estriol were normalized according to the term of pregnancy.

Magnesium electrophoresis by a sinusoidal modulated current.

Electrophoresis of magnesium SMT according to the principle of reflex-segment therapy is carried out according to a technique developed by AI Lyubimova and co-authors. (1974), with the help of domestic instruments "Amplipulse-3", "Ampliplus-4". Treatment is carried out daily with a two-day break after 5 procedures; on the course of treatment 10-15 procedures. Side effects in the treatment process is not established. Electrophoresis of magnesium SMT is advisable to be carried out with a prophylactic goal after surgical correction of ischemic-cervical insufficiency, in women with a burdened obstetric anamnesis in critical terms for the threat of termination of pregnancy.

Electro-relaxation of the uterus. The essence of the method of electrorelaxation consists in the action of alternating current on the neuromuscular apparatus of the uterus through electrodes located on the anterior abdominal wall and in the sacral-lumbar region. An alternating sinusoidal current is used in the frequency range 50-500 Hz, with a force of up to 10 mA on the amplitude value on the apparatus "Amplipulse-4".

After the first session, the pain stops, and after the second, the therapeutic effect is fixed. With the threat of interruption of pregnancy from 15-16 weeks, electrorelaxation is the method of choice before other methods of therapy for the threat of interruption, since there is no iatrogenic action of medications, and the effect occurs during the procedure. Electrorelaxation of the uterus gives effect faster than magnesium CMT electrophoresis, and can be used to provide emergency assistance in case of a threat of termination of pregnancy.

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

Indications for acupuncture are:

• signs of the threat of miscarriage, manifested by premature development of uterine contractile activity;
• failure of drug therapy for miscarriage;
• intolerance to medicines and other allergies;
• the need to reduce the dose and limit the duration of drug intake;
• increased uterine tone in case of ischemic-cervical insufficiency before and after surgery on the cervix;
• some complicating pregnancy diseases: vegetative-vascular dystonia, asthenia with signs of the threat of interruption;
• frequent stool retention, accompanied by signs of a threat of termination of pregnancy.

Relative contraindications are severe concomitant diseases and complications of pregnancy, in which continuation of pregnancy is contraindicated, signs of infection of fetal membranes, fetal development anomalies.

Acupuncture with the threat of termination of pregnancy is a multi-link process, which is accompanied by the normalization of the impaired functions of the central nervous system and the stabilization of vegetative-vascular reactions.

The introduction of needles at these points causes irritation of sensitive endings embedded in the skin, subcutaneous fatty tissue, perivascular plexuses encountered along the path of needle insertion. Local reaction manifests itself in the form of mild numbness, heaviness, heat and sensation of the passage of electric current. The resulting flux of impulses along the afferent somatic and vegetative fibers of the nerve trunks centripetally spreads into the corresponding segments of the stimulation segments of the spinal cord, causing a reaction not only within these segments, but also outside them, exerting a relaxing influence on the uterus. The flow of impulses is transmitted to the overlying parts of the central nervous system - the hypothalamus, limbico-reticular formation, the cerebral cortex, causing the development of a general reaction.

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

To achieve a stable relaxation of the uterus, eliminating signs of the threat of miscarriages and improving the general condition of pregnant women, 4-6 sessions per course are sufficient. However, with more pronounced manifestations of the threat of termination of pregnancy, the duration of the course can be 7-11 sessions. The duration of one session is no more than 10-15 minutes. The depth of needle insertion is determined by the appearance of the provided sensations in the form of mild heat, severity, numbness, and current flow. During the first 2 sessions, the fetal reaction may occur in the form of a more active stirring. This is due to the relaxation of the uterus and is one of the indicators of a clear decrease during the procedure of high uterine tone.

The first session, considered as an indicative one, lasts 10-15 minutes. In this case, the braking method of introducing a needle is used. At this time, it is necessary to find out the reaction of the body to the introduction of the needle, the nature of the sensations provided, to determine blood pressure and the pulse rate.

The duration of the following sessions is 10-40 min, depending on the initial state of the woman. Use point 36 E is more appropriate in the morning, 5TR and 2F - in the evening. Extraction of needles in all pregnant women is done in one movement with a preliminary fixation of the skin from two sides of the needle with two fingers. At repeated courses the number of sessions is 1 -3 less than in the previous course.

The use of percutaneous electrostimulation (BSEC) of the point of acupuncture BM-147 gives an excellent clinical result. The developed original technique consists in finding two symmetric points of VM-147, alternately passing a multi-polar microtron with a force of 15-20μA with a change in polarity every 5 seconds.

An effective method of treating the threat of interruption is laser reflexotherapy (LRT) in the pulse mode of the 4 Hz frequency at the organ-dependent points. The time of exposure to each point is 8-15 seconds. The course of treatment is 4-5 days. Under the influence of LRT, the utero-placental hemodynamics is restored to the physiological level, the metabolic and transport-trophic function of the placenta is improved.

[1], [2], [3], [4], [5], [6], [7]