Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 220 - файл

Uterine contractions induced by uterine trauma are the result of two processes. First is when a traumatic uterine injury destabilizes lysosomal enzymes that can initiate prostaglandin produc­tion. Second, thrombin produced by actively clot­ting blood interacts with the protease-activated receptors in the myometrium, resulting in robust uterus contractions, even without prostaglandin production [118]. Thrombin at concentrations 1–100U/mL represents less thrombin generated by 1mL of clotting blood and stimulates myome­trial contractions in a dose-dependent fashion. Thrombin activates the phosphatidylinositol sig­naling pathway and generates cytosolic calcium oscillations [119].

a search of its cause and other potential causes of

An alkaline vaginal pH (6.0–6.5) and a “fern­ing” pattern on microscopic examination of dried vaginal secretions are supportive (normal vaginal secretions have a pH of 5.0, whereas amniotic uid has a pH of 7.0) when visual inspection is equivocal. False-positive ndings are due to cer­vical mucus, blood, semen, alkaline antiseptics, or bacterial vaginosis. False-negative results are from prolonged leakage and oligohydramnios. Repeat speculum examination after prolonged bed rest may provide diagnostic information if initial testing is negative despite a suspicious his­tory. In the absence of fetal growth restriction or urogenital abnormalities, US evidence of oligohydramnios is suggestive but not diagnostic of ROM. The diagnosis can be conrmed by indigo carmine amnioinfusion with the transvagi­nal passage of dye. A search for concomitant maternal and fetal injuries is mandatory, and pro­longed continuous fetal monitoring is advocated.

TVU CL ≥30 mm have a less than 1%

Compared with metronidazole, clindamycin has similar activity against anaerobes. However, it is far superior concerning broad-spectrum activity, group B streptococcus (associated with PTL when present as heavy colonization), and many other bacterial vaginosis-related organ­isms, particularly fastidious organisms such as M. hominis [152, 153]. Also, clindamycin has anti-inammatory properties [154, 155]. There is merit in oral and intravaginal administration of clindamycin to eradicate abnormal genital tract ora/bacterial vaginosis in pregnancy. Vaginal administration delivers the highest con­centration of antibiotics to the site of the heavi­est bacterial load. On the other hand, bacterial vaginosis could be associated with subclinical endometritis [156], so if vaginal organisms have already gained access to the choriodecidua, these organisms may not be accessible to vagi­nal administration. Therefore, systemic therapy may provide benets. There are no studies on the combined use of oral and vaginal clindamy­cin. Even if this reverts to normal, abnormal genital tract ora in early pregnancy is still associated with LM and PTB.This suggests that whatever damage is done by infection/inam­mation occurs early and persists [157]. Suppose antibiotics are used late in pregnancy when inammatory tissue damage may have already occurred, with irreversible changes in the cer­vix, myometrium, decidua, placenta, and extra­placental membranes. In that case, antibiotics are unlikely to be benecial [158, 159]. Unfortunately, some of these studies were not adequate.

Tocolytic treatment after the onset of contrac­tions could not prevent PTL and should be ordered for patients with delayed presentation and advanced gestational age to prevent PTL and fetal loss [180]. Tocolysis only delays PTD for several days, but PTD is not prevented [181].