Algorithm for performing manual separation of the placenta. Operation of manual separation of the placenta and discharge of the placenta

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Below will be presented detailed answers to questions related to adhesions of the intestinal area and in the area of \u200b\u200bthe fallopian tubes, uterus and ovaries.

The area of \u200b\u200bthe human body (woman) in which the uterus, fallopian tubes and ovaries are located in medicine is called the pelvic area,below, for the sake of simplicity of the presented material, we will use this term as well.

What causes can cause the appearance of adhesions in the intestines, uterus, fallopian tubes or ovaries?

We have already said above that the main reason for the appearance of adhesions is various operations or diseases, during which there was inflammation of the internal organs.

The adhesions formed between the organs located inside the abdomen in medicine are called peritoneal (this name comes from the term peritoneum which denotes the film covering the organs inside the abdomen; the Russian name of this film is peritoneum).

Of the surgical interventions, most often the formation of adhesions is an operation to remove appendicitis, , stomach surgery, bowel surgery, hernia surgery and uterus surgery.

Of the diseases (in women), the appearance of adhesions in the pelvic area most often leads inflammation of the uterine appendages.

The doctor told me that adhesions can cause intestinal obstruction. What is it? How dangerous is it?

Adhesions can harm health by putting pressure on different internal organs and by gluing internal organs together, limiting their natural mobility.

By pressing on the small intestine, adhesions can block its lumen and lead to the fact that the digested food cannot move through the intestine and begin to accumulate in it, and the intestine itself will begin to swell and become inflamed. In medicine, this condition is called intestinal obstruction.

According to some studies, the likelihood of developing intestinal obstruction after various operations, during which adhesions were formed, is about 0.15%.

Adhesions and prolonged abdominal pain

Can adhesions cause prolonged abdominal pain? How do adhesions hurt?

Despite the fact that prolonged abdominal pain (mainly in the lower abdomen) is noted in many women with adhesions in the pelvic or intestinal area formed after surgery or inflammation of the uterine appendages, it is still not known whether adhesions can actually provoke prolonged abdominal pain and if so, how exactly.

In particular, a number of studies have shown that prolonged abdominal pain is just as common in women who do have adhesions as they are in women who do not. Moreover, the strength of the pain does not depend on how much the community is adhered.

However, a number of studies have shown that surgeries that remove adhesions can actually relieve abdominal pain.

Many women describe the pain "associated with adhesions" as mild, but prolonged (lasting months and years), pulling, possibly more pronounced on the right or left. Women often report that pain increases during movement (for example, walking, sitting or bending over), during sex, or after sex. Some women note that the pain intensifies during prolonged sitting or after hypothermia.

Is it true that if there is no pain and no adhesions?

No, it’s not. As shown above, pain occurs only in some women who have adhesions in the pelvic area, while in other women they do not show any symptoms or can only cause difficulties in conceiving a child and (very rarely) intestinal obstruction.

Thus, if you do not have pain, this does not mean that you do not have adhesions in the pelvic area.

What if I have prolonged abdominal pain?

In recent years, the problem of prolonged pain in the lower abdomen and lower back in women has been the subject of intensive study.

One study published in 2011 found that prolonged abdominal pain may be associated not only with adhesions (which are associated with up to 24% of all cases of prolonged pain), but also with other gynecological conditions.

In particular, in almost a third of cases, prolonged pain is associated with endometriosis.

Other causes of prolonged abdominal pain include:

• Varicose veins of the small pelvis
• , or
• Remote ovarian syndrome

Since at home it is absolutely impossible to accurately determine the cause of abdominal pain and exclude their connection with such dangerous diseases as cancer - be sure to consult a doctor for an examination if you notice that you have stomach pains from time to time or have been going on for quite a long time time.

Your doctor may order a series of tests to determine the cause of your abdominal pain, including

• Bacteriological smear and smear for cytology;
• If necessary and / or ;
• If necessary, consult with other specialists (for example, a neurologist, urologist).

Treatment for prolonged abdominal pain depends on the cause. If the cause of the pain is found, the doctor will be able to prescribe treatment that will be aimed at eliminating it.

Adhesions, problems conceiving a child (infertility), pregnancy and childbirth

Can adhesions cause difficulties in conceiving a child (infertility)?

Adhesions in the pelvic area can really make it difficult to conceive.

A number of studies have shown that healthy young women have an 80-90% chance of conceiving a child within 1 year. At the same time, in women with adhesions in the pelvic area who have not yet received treatment, the probability of conceiving a child can range from 11 to 16% within 2 years.

This means that adhesions can significantly reduce a woman's ability to conceive a child, however, even with a pronounced adhesion process in the genital area, a woman can retain the ability to conceive a child on her own.

Modern treatments for adhesions (in particular laparoscopic surgery during which the adhesions are dissected) can be very effective in treating adhesion-induced infertility.

Clinical observations show that the likelihood of conceiving a child after laparoscopic surgery increases to 45% within 2 years.

Monitor the health - a completely natural necessity for a person. Women are especially attentive to him, because it is known that an unhealthy woman cannot be truly beautiful. A tired look, pain or the outward symptoms of illness have never painted anyone. In addition, it is women who think about having a child, which also affects their attitude to health. But adhesions in the small pelvis can seriously complicate a woman's life ...

Spikes - how to get rid of them?

Spike is a pathological tissue fusion and is formed by a fragment of scar tissue. Adhesions can be in the form of thin strips of fabric, similar to plastic wrap, or thick, fibrous strips.

Adhesions are formed as a result of the inflammatory process, which can occur with diseases of internal organs, after surgery, with infections and injuries. Although adhesions can occur between different organs, it most often occurs between bowel loops, fallopian tubes, ovaries, uterus, bladder and heart.

Adhesions in abdominal cavity

Adhesions in the abdomen - a common complication surgery, which occurs in 93% of people who have had pelvic or abdominal surgery. Abdominal adhesions also occur in 10.4% of people who have never been on the surgical table.
In most cases, adhesions are painless and do not cause complications. However, adhesions are responsible for 60-70% of small bowel obstruction in adults and contribute to the development of chronic pelvic pain.
Adhesions usually begin to form within the first few days after surgery, but they may not cause any symptoms for several months or even years. As the scar tissue begins to restrict movement small intestine, the movement of food on digestive system... Intestinal obstruction is possible.
In extreme cases, adhesions can form fibrous bands around the bowel segment. This restricts blood flow and leads to tissue death.

Adhesions in the small pelvis

Adhesions in the small pelvis may be associated with pelvic organs, such as the uterus, ovaries, fallopian tubes, or bladder. They usually occur after surgery. Inflammatory diseases Pelvic organs and complications from infection (sexually transmitted diseases) often lead to the formation of adhesions in the fallopian tubes, through which eggs enter the uterus for fertilization. Tubal adhesions can lead to infertility and increase the risk of ectopic pregnancy.

Adhesions on the heart

Scar tissue can form inside the membranes that surround the heart (pericardium), thereby interfering with its normal function. Various infections, such as rheumatism, lead to the formation of adhesions on the valves of the heart and reduce the efficiency of its function.

Reasons for the formation of adhesions

Adhesions are formed when the body tries to protect itself and isolate the pathological focus from healthy tissues and organs. The adhesion process can begin after surgery, infection, injury, or radiation. When damaged cells are restored, tissue fusion occurs with the formation of scar tissue at the fusion site.

Symptoms

The signs and symptoms of the adhesions do not refer to the adhesions themselves, but to the complications that they cause. Therefore, the symptoms of adhesions are numerous and vary depending on the site of adhesion formation and the possible disorders that they provoked. As a rule, the adhesion process is asymptomatic and remains undiagnosed.

The most common symptom of adhesions is pain (due to stretching of the nerves in the adhesion organ or in the adhesions proper).

Liver adhesions cause pain when inhaling deeply.
Intestinal adhesions cause pain due to intestinal obstruction when physical activity or stretching.
Adhesions to the vagina or uterus cause pain during intercourse.
Pericardial adhesions cause chest pain.
It should be noted that the painful sensations are not always caused by adhesions, and not all adhesions cause pain.
Adhesive obstruction of the small intestine requires urgent surgical intervention.
Adhesions in the small intestine cause cramping pain in the stomach that can last from a few seconds to a few minutes, and are aggravated by eating foods that increase intestinal activity.
In the first seconds pain attack vomiting is possible. Vomiting relieves some of the pain.
The sensitivity of the abdomen increases on palpation, the abdomen is inflated.
Intestinal murmurs are heard in the stomach, accompanied by profuse gas and diarrhea.
The temperature rise is negligible.

This bowel obstruction can go away without treatment. However, to avoid complications, you should see your doctor.

If the condition worsens, the following symptoms are possible:

The intestines continue to stretch.
The pain becomes intense and constant.
Intestinal noises stop.
Flatulence and diarrhea cease.
The abdomen is enlarged.
The temperature rises.

If the obstruction progresses, ruptures of the intestinal wall and infection of the abdominal cavity with intestinal contents are possible.

What are adhesions, their types and causes of formation

Adhesions (synechiae, moorings) are connective tissue adhesions between adjacent organs or surfaces. Adhesions are divided into congenital and acquired. Congenital adhesions occur when congenital defects development of a particular organ. Acquired adhesions develop after inflammatory processes or bleeding into the internal cavities of the body: non-absorbed inflammatory fluid or blood gradually thickens and grows with connective tissue (organized). At first, the connective tissue is loose and the adhesions are easy to disconnect, but over time it becomes strong and can even be saturated with calcium salts, it is very difficult to separate such ossified adhesions. Over time, blood vessels and nerves appear in the adhesions.

Adhesions can be single and multiple, sometimes they envelop the entire organ or organs, causing their displacement and deformation. Abundant deposits of calcium salts in the outer shell of the heart after its inflammation (pericarditis) leads to the formation of a calcareous shell - the so-called armor heart. When organizing an inflammatory fluid in the pleural cavity (two layers of the pleura cover the lungs, forming a pleural cavity between themselves), dense numerous adhesions are often found, which in some cases contain adipose tissue that acts as a shock absorber. With inflammation of the peritoneum (it covers the inside of the abdominal cavity), a common adhesion process rarely develops, however, adhesions in the abdominal cavity can lead to adhesive disease.

Adhesions can support smoldering inflammatory processif they limit the focus of inflammation from all sides, creating a capsule around it (for example, enclosed processes in the pleural and abdominal cavity).

Restriction of mobility of internal organs, pain and mechanical obstruction (for example, intestines) often require surgical intervention. In some cases, small and incompletely organized adhesions resolve after physiotherapy.

Adhesive disease

Adhesive disease - This is the formation of adhesions in the abdominal cavity in a number of diseases, after injuries and operations. Most often, adhesive disease develops after inflammation of the appendix and its removal (appendectomy). Adhesions can also develop after operations for intestinal obstruction, gynecological and urological operations.

In the formation of adhesions in the abdominal cavity, the leading place is occupied by inflammation of the peritoneum. But they can also appear after mechanical damage to the peritoneum (injury), exposure to any chemicals (for example, iodine burn). In case of abdominal injury, prolonged paresis (immobility) of the intestine is important, in which favorable conditions for fusion of intestinal loops due to their prolonged contact with each other.

In a number of cases, the formation of adhesions acquires a progressive course, the causes of which are not completely established, but they are certainly associated with the degree of spread of the inflammatory process. In these cases, bowel deformation occurs, its motor activity and the passage of intestinal contents are disrupted.

Signs of adhesive disease

Adhesive disease can proceed in different ways. Sometimes it begins in the form of a sudden or gradually increasing attack of pain, increased peristalsis (movement) of the intestine, accompanied by vomiting and a rise in temperature. Signs of intestinal obstruction appear quickly, worsens sharply general state (dehydration appears due to repeated vomiting, weakness, a sharp decrease in blood pressure).

In some cases, attacks of pain appear periodically, the intensity is different, at times diarrhea, constipation and vomiting disturb.

There is also a long course of the disease with aching abdominal pains, a feeling of discomfort, constipation, impaired general well-being and periodic attacks of acute intestinal obstruction.

Diagnosis and treatment of adhesive disease

The diagnosis of adhesive disease is made on the basis of its typical manifestations, as well as after X-ray examinations of the abdominal organs.

Treatment of adhesive disease depends on its manifestations. Nevertheless, conservative therapy should be the leading one, and surgical intervention should be carried out only when the patient's life is threatened. Thermal procedures are most often used: mud, paraffin and ozokerite applications, clay cakes, electrophoresis with medicinal substances (pain relievers, absorbents) and so on.

When acute attacknot resolved by conservative measures within one to two hours is carried out surgery (elimination of obstacles to the movement of feces), with repeated attacks - surgical treatment aimed at preventing acute attacks.

Adhesions are adhesions that connect different tissues and organs. The presence of adhesions in the uterus and appendages contributes to the development of infertility.

Human organs are covered with a serous membrane, which makes them slippery, they slide freely when in contact with each other, without causing harm. In this case, the organ fully fulfills its functions, is in good condition, and has a full blood supply. With the formation of adhesions, there is a restriction of the movement of an organ, its attachment to another organ or tissue. This leads to impaired blood supply, decreased functionality, congestion and development various diseases and pathological conditions.

Adhesions can occur for various reasons - they can be congenital and acquired. Congenital adhesions are formed in the presence of a congenital pathology of organ development. Acquired adhesions are formed as a result of intracavitary bleeding, in the place of which connective tissue subsequently grows, after inflammatory processes. It is difficult to remove adhesions that have become strong, sometimes it is already impossible to remove them.

Adhesions are divided into two types: external adhesions are located between organs, and internal adhesions are located inside the organ. They can be single or multiple - adhesive disease develops. Connective tissue grows into serous membranes organs, disrupting their mobility and functioning. In almost all cases, adhesions form after surgery. Adhesive tissue looks like a thin film at the beginning of development, or thick fibers when the disease reaches far. Adhesions can grow in all organs, from the heart to the genitals. Also, adhesions are formed after severe inflammatory and infectious processes, as a result of organ trauma. The formation of adhesions can begin long after the injury, at the sites of hematoma formation in the mesentery, in the retroperitoneal space. The outflow of blood is disturbed, exudation into the abdominal cavity is disturbed, the "lubrication" of the organs disappears, which allowed them not to injure each other, to be in sliding. As a result, the organs begin to rub against each other, adhesions are formed.

Will the development of adhesive disease begin or not after the surgery, for the most part depends on the skill of the surgeon, on the quality of the operating materials used by him and the equipment of the clinic. After the operation, the surgeon applies stitches to the operated organ using certain materials. If the surgeon has good skills in suturing, then the suture will quickly heal, the adhesion process will begin, which belongs to the normal recovery processes in the body. If the suture was imposed unprofessionally, a large scar is formed, the tissues of the injured organ will begin to grow together with other organs and tissues - postoperative adhesive disease will develop. The formation of collagen fibers begins on the third day, connective tissue on the seventh day, the formation of adhesions ends on the twenty-first day. Soft and loose tissue in twenty-one days turns into very dense, germinated blood vessels, after a month, nerve endings will form in the adhesions. Adhesive disease is very dangerous, so it should be treated as early as possible.

Adhesion symptoms

The main symptom of adhesions after surgery is pain in the area of \u200b\u200bthe surgical suture, which becomes pulling and aching. Pain increases during physical exertion, running, jumping, turning and bending the body. The formation of adhesions after lung surgery causes pain with a deep breath, with sudden movements, pain occurs after surgery on the intestines, after surgery on the uterus or ovaries - pain during intercourse.

Adhesions can cause disorders in the form of complete absence of stool, constipation, constant nausea, vomiting, debilitating aching pains, high temperature, redness and swelling postoperative suture, shortness of breath. After surgery on the uterus or ovaries, adhesions can cause menstrual irregularities, discharge, in severe cases, infertility, and large weight loss. The formation of adhesions in the uterus can occur after spontaneous abortion or curettage, as a result of the development of endometriosis, pregnancy pathologies, after the use of an intrauterine device.

Adhesions (synechiae) in the abdominal cavity are pathological growths of connective tissue between organs or between organs and the wall of the peritoneum, arising from a variety of reasons. As a rule, the development of adhesions is due to the presence of a long-term inflammatory process, as well as as a result of surgery (removal of the appendix, cesarean section etc.)

The adhesion process in the fallopian tubes and uterus is one of the causes of female infertility. Adhesions in the fallopian tubes occur due to inflammation (salpingitis, adnexitis, endometriosis). Adhesions can close the entire lumen fallopian tube, after which the advancement of the egg through them becomes impossible, and conception cannot occur.

Adhesive disease after surgery on a woman's urogenital organs or intestines can provoke the development of acute intestinal obstruction, necrosis of intestinal areas, obstruction of the fallopian tubes. As a result, necrosis of the intestinal areas may occur, a new operation will be required, during which the area of \u200b\u200bintestinal necrosis, adhesions that provoked impaired blood circulation in the organs will be removed.

Extensive adhesive disease begins after peritonitis, the process includes the intestines, kidneys, uterus, and appendages. An infection that enters the abdominal cavity during peritonitis contributes to the increased development of adhesive disease. Adhesive disease can lead to ovarian necrosis, which will die as a result of circulatory disorders, the process can spread further and provoke complete infertility. The development of adhesive disease in the ovary is characterized by irregular menstruation.

The development of adhesive disease can be affected by a hereditary predisposition to the formation of adhesions. This is due to an increase in the synthesis of enzymes that react to any damage to cells by active formation of adhesions, provoking the proliferation of connective tissue.

Radiation therapy can provoke the development of adhesive disease. During treatment oncological diseases adhesions often occur after tumor irradiation.

For the diagnosis of adhesive disease used: ultrasound, PCR (diagnosis of pathogens using polymerase chain reaction), diagnostic laparoscopy, MRI - magnetic resonance imaging.

Treatment of adhesive disease

The fight against adhesions includes both conservative and surgical methods of treatment.

Conservative methods are aimed at resolving adhesions; in this case, the use of anti-inflammatory medications (for example, a course of aloe injections) is shown, as well as physiotherapy, with the help of which the adhesions soften and become more elastic.

Prevention of the development of adhesive disease after surgery consists in the appointment of anti-inflammatory drugs, in certain physical activity, which reduces the possibility of organ fusion. For the prevention of adhesions after surgery, injections are prescribed with enzymes that inhibit the development of adhesions, a diet. The prescribed therapeutic diet consists of fractional nutrition, excludes fatty foods with preservatives and dyes, takes into account the body's needs for enzymes and amino acids.

Surgical treatment of adhesions

The operative methods of treating adhesions include, first of all, laparoscopy. Surgical intervention is indicated at the later stages of the adhesion process, when it is not possible to remove adhesions in another way (and restore the patency of the fallopian tubes). Recovery after laparoscopy is faster, and the likelihood of adhesion re-formation is low.

Second surgical method to remove adhesions is a laparotomy. This operating method is used in cases where it is impossible to remove all adhesions by laparoscopic access. Laparotomy is an open approach performed with an incision in the anterior abdominal wall... Laparotomy is used with a large number of adhesions, with advanced adhesive disease, with severe disorders in the functioning of organs, where an urgent operation is required.

In most cases, the onset of the adhesive process is asymptomatic. At the moment when a woman asks for help, adhesive disease has already developed. Surgical removal of adhesions does not always solve all problems. Removal of adhesions cannot restore the impaired functionality of organs, restore the destroyed structure. Many women have undergone many years of treatment for adhesions in the fallopian tubes, but the pregnancy never came. Violation of the structure and functionality of the organ led to infertility. The main factor influencing the reduction of adhesion formation is minimization of damage during surgery, thorough sanitation of the abdominal cavity, rapid stopping of bleeding, prevention of foreign bodies into the abdominal cavity, the use of special methods that reduce the risk of developing adhesive disease.

The female organs located in the abdominal cavity and the pelvic area are covered with a smooth membrane - the peritoneum. This smooth shell allows the uterus, fallopian tubes, and ovaries to move freely, which ensures their normal functioning. If the organs get an infection, pathogenic organisms, an inflammatory process occurs, which is called peritonitis. Inflammation - peritonitis is a rather serious disease in which a woman can even be admitted to the hospital for the purpose complex treatment and operations.

When peritonitis begins in a woman's body, there is a response of the body's defensive reaction and the production of fibrin (a protein that helps to localize the focus of inflammation by gluing adjacent areas). Adhesions are just the process of gluing together areas in order to limit the spread of infection.

Adhesions: causes of occurrence

The predisposition of the female body to adhesions is an individual feature of each person. Basically, adhesive disease depends on immune system... Inflammation of the appendages in women - adnexitis - often leads to the appearance of an unpleasant complication - adhesions. You will be surprised, but complication of adhesions after operations is possible due to the ingestion of small particles from the doctor's gloves, fibers from gauze, cotton wool into the abdominal cavity. And if a woman has endometriosis, then during critical days small amounts of menstrual blood may enter the abdomen.

If the body is strong and the immune system is working well, then foreign particles are destroyed by the body on its own and the appearance of adhesions is excluded, otherwise, the presence of small multiform particles can lead to complications in the form of adhesions.

The reasons for the appearance of adhesions in women:

• inflammation of the genitals;
• operations on the abdominal cavity and small pelvis;
• endometriosis;
• childbirth with complications.

Why are adhesions dangerous?

Adhesions are dangerous because, if they are present, the normal operation of internal organs is impeded, namely, mobility is impaired, as mentioned at the beginning of the article. Also, blood circulation, lymph flow is disturbed, spasms occur, which causes problems in the inflow and outflow of blood and leads to stagnation of blood. Even adhesions in women are fraught with ectopic pregnancy or infertility, since the egg cannot get into the fallopian tube, the movement of sperm through the fallopian tube or the movement of the embryo into the uterine cavity is difficult. This is due to the fact that adhesions can block the lumen of the fallopian tube and change its diameter.

How to suspect adhesions

If you feel pain in the lower abdomen while changing body position or have pain when going to the toilet in a big way, it is likely that there are adhesions in the body.

Only laparoscopy (in which, with the help of special optical devices, it is possible to diagnose the presence of adhesions in the abdominal cavity, as well as to dissect them), and not an ultrasound, will help to accurately determine whether or not there are adhesions in a woman's body.

During laparoscopy, a woman is made 3 small punctures (do not worry, they do not injure muscle tissue at all) in the anterior abdominal wall and a tiny video camera with a light source is introduced. And the other two holes serve as micromanipulators for performing the operation.

Alternative to surgery

For the treatment of adhesions after laratoscopy, the gynecologist can prescribe a gynecological massage, which takes a lot of the doctor's time. Therefore, not every gynecologist will want to prescribe it. Gynecological massage lasts about 30 minutes and requires preliminary anesthesia. Anti-adhesion course - at least 10 sessions. Massage with both hands, with the fingers of one hand acting from the side of the vagina, and the fingers of the other hand from the side of the abdomen.

The positive effect of gynecological massage is as follows:

• rupture of adhesions
• elimination of uterine bend
• improvement of blood circulation and lymph flow in the pelvic organs
• strengthening the abdominal muscles and pelvic floor.

If a woman is not sexually active or suffers from infertility, uterine fibrosis, amenorrhea, salpingitis, muscular hypotonia of the uterus, prolapse of the uterus, and also after an abortion or difficult labor, gynecological massage is indicated and very useful.

Thank you for your help in preparing the material of the obstetrician-gynecologist of the Kiev maternity hospital No. 3 Baksheev Sergey Nikolaevich.