Estimation of the Efficiency of the Combined Influence of Proserin, Methylergobrevin and Sinusoidal Modulated Currents on the State of the Uterus in Hypotonic Postpartum Endometritis Taking into Account the Syndrome of Systemic Inflammatory Response

Introduction. In the structure of obstetric morbidity, the leading positions are occupied by
postpartum endometritis, which is 40–44%.
Purpose. Pathogenetic substantiation of the effectiveness of complex treatment of hypotonic
postpartum endometritis using proserin, methylergobrevin, and sinusoidal modulated currents by
assessing the expression of cytokines and procalcitonin in the blood serum, as well as revealing
correlations between the level of interleukin-6, procalcitonin, and the size of the uterine cavity.
Materials and methods. 99 puerperas with hypotonic variant of postpartum endometritis
(average age – 25.2±2.2) were examined in the period 2017–2020. The main group included 51
patients, who received drug therapy in accordance with the treatment protocol in combination
with the course of proserin 0.05%, 1.0 ml of solution intramuscularly 2 times a day for 5 days;
methylergobrevine, 1.0 ml intramuscularly every 24 hours in combination with sinusoidal
modulated currents to the lower abdomen with the frequency of 50 Hz every day, once a day.
Proserin was prescribed after curettage of the uterine cavity. The comparison group consisted
of 48 patients, who received only drug treatment according to the protocol (intravenous drip of
100 ml of the 0.5% solution of metronidazole and gentamicin 240 mg in 250 ml of saline once a
day for 7 days).
Results. In hypotonic postpartum endometritis, there is observed a significant increase of the
PCT level up to 1.58±0.04 ng/ml (p=0.001) and hsCRP up to 56.4±3.2 mg/l (p=0.001), and the
concentration of TNF-α, IL-1β, and IL-6 up to 175.0±14.0 (p=0.007), 37.7±5.3 (p=0.016), and
36.2±3.3 pg/ml (p=0.003) respectively if compared to normal data. Under the influence of complex
therapy with the inclusion of proserin, methylergobrevin, and SMT, the normalization of IL-6, IL-
1β, PCT, and hsCRP values was demonstrated – 18.4±2.2 pg/ml (p>0.05), 26.1±2,7 pg/ml (p>0.05),
0.03±0.004 ng/ml (p>0.05), 10.3±1.1 mg/l (p>0.05), respectively; the decrease of TNF values -α up
to 98.7±8.2 pg/ml (p=0.008) if compared to baseline levels. In the comparison group, all indicators,
except for hsCRP and IL-1β, exceeded the control levels and, despite the observed downward trend,
had no significant difference from the baseline level.
Under the influence of complex therapy with the inclusion of proserin, methylergobrevin and
CMT for the first time in puerperas with hypotonic endometritis, the normalization of PCT and
IL-6 levels was demonstrated, which was associated with the decrease of the size of the uterine
cavity (correlation coefficients, respectively, r=0.78 (p<0.001; 95% confidence interval) and r=0.57 (p<0.001; 95% confidence interval). Conclusion. The treatment of hypotonic postpartum endometritis, accompanied by hypotension and congestion in the uterine cavity, should be aimed at increasing the contractile ability of the myometrium by prescribing drugs that stimulate contractions of the smooth muscles of the uterus.