Procteirization

PROCTEIRIZATION, introduction of a rubber balloon (procteirin-ter) into the rectum of a parturient with the aim of stimulating and enhancing uterine contractions in cases of their primary weakness. P. was first proposed and tested in 1922 by Klein (Prague), who noticed that after repeated rectal examinations of parturients, stronger and more energetic uterine contractions appeared. The technique of P. is very simple; after a preliminary cleansing enema, a boiled or lysol-washed and checked for integrity rubber balloon of the Brown, Champetier de Ribes or Barnes type, with a capacity of 130-150 cm³, is folded into a shape, lubricated with vaseline, and with the aid of a finger is carefully inserted as high as possible into the ampulla recti. The balloon is then filled with boiled water or saline solution. It is preferable to fill the balloon to its full capacity, and preferably with water at a temperature of 40° to 50°, so that in addition to mechanical irritation, thermal irritation is also added. The procteirin-ter can remain in situ without hindrance for 6-8 hours (maximum 8 hours - Stoeckel). Usually 3-4 hours of its presence in the rectum is sufficient. The effect of P. begins to manifest itself after 1/2-3/4 hours and continues even after the balloon is expelled or extracted back. The action of the balloon is explained by the mechanical irritation of the Frankenhäuser nodes, which, according to Klein, surround the rectum and are located, according to the work of Roit cited by him, closer to the rectum than to the posterior vaginal wall. P. is indicated for primary weakness of uterine contractions, for premature rupture of the membranes with simultaneous weakness of contractions, and generally in cases where acceleration of the birth process is indicated. There are indications that direct pressure of the procteirin-ter on the portio vaginalis achieves more rapid effacement and dilation of the cervix. In hydramnios and other complications that disrupt the contractility of uterine muscle, when P. itself does not cause uterine contractions, it can be successfully used in combination with other means that enhance uterine activity (e.g. quinine). P. is effective only when labor activity has already begun; it is not suitable for inducing late abortion or premature labor. Nettesheim emphasizes that P. should be used only in cases where the presenting part has not yet entered the pelvis deeply. The use of P. is also contraindicated in parturients with increased nervous sensitivity, in whom the introduced procteirin-ter quite often causes distressing sensations that compel parturients to insist on its removal. Often it is expelled back despite repeated insertion. P. should not be used in hemorrhoids, although Klein asserts that careful and careful insertion of the rubber balloon is permissible even with significantly expressed hemorrhoidal nodes. On his own material, he never saw any damage or bleeding from the rectal mucosa. In the USSR, P. was tested by Timofeev and Khokhlov, who confirmed Klein's observations. Hannes tested P. radiographically, and found that the balloon is located in the ampulla recti, filling it up to the height of the promontory and (which is very important) does not change the position of the fetal head in the pelvis, as is usually observed with intrauterine balloon insertion. Hannes also proposed a new name: "Rectale Tokokinese". Klein, in 800 cases of P. application, obtained a positive result in 80% (with good results noted in 59.77%, moderate - in 20.70%) and complete absence of effect - in 19.53% (whereas Nettesheim obtained a positive result in 46%, absence of effect - in 35%). All authors who observed with P. agree that its extremely important advantage over vaginal or intrauterine use of the balloon is the simplicity of the technique, safety, and minimal chances of possible infection. Despite all these advantages, P. has not received particular spread.