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American Journal Of Social Sciences And Humanity Research
(ISSN
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2771-2141)
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1121105677
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ABSTRACT
The main function of CT is to provide structural support to other tissues. Cartilage and bone are the main types of
connective tissue, other types include areolar connective tissue, which holds organs together, and dense connective
tissue, which forms ligaments and tendons. We examined 47 pregnant women with uCDT and 15 healthy pregnant
women without uCDT aged 24-30 years. The threat of termination of pregnancy occurred in 50% of women with uCDT,
and the threat of preterm birth was observed 6 times more often than in healthy pregnant women. Thus, pregnant
women with signs of various forms of uCDT belong to high-risk groups of obstetric and perinatal pathology, and
therefore they need close monitoring during pregnancy, childbirth and the postpartum period, and it is also necessary
to examine newborns who have a high probability of inheriting this disease.
KEYWORDS
Undifferentiated connective tissue dysplasia (uCTD), tumor necrosis factor (TNF-), connective tissue (CT), interleukin-
1 (IL-1).
Research Article
DEBATABLE ISSUES OF PATHOLOGICAL COURSE OF PREGNANCY AND
CHILDBIRTH IN CONNECTIVE TISSUE DYSPLASIA
Submission Date:
January 31, 2024,
Accepted Date:
February 05, 2024,
Published Date:
February 10, 2024
Crossref doi:
https://doi.org/10.37547/ajsshr/Volume04Issue02-04
Khudoyarova D.R.
Prof. DSc, Samarkand state medical university, Samarkand, Uzbekistan
Shodiklova G.Z
Prof. DSc, Samarkand state medical university, Samarkand, Uzbekistan
Yunusova Z.M.
Samarkand state medical university, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajsshr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 02-2024
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American Journal Of Social Sciences And Humanity Research
(ISSN
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04
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SJIF
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FACTOR
(2021:
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7.
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
INTRODUCTION
The main function of CT is to provide structural support
to other tissues. Cartilage and bone are the main types
of connective tissue, other types include areolar
connective tissue, which holds organs together, and
dense connective tissue, which forms ligaments and
tendons. Undifferentiated connective tissue dysplasia
(uCTD) is a heterogeneous group of diseases that, in
turn, can lead to various chronic diseases. uCDT often
corresponds to abnormal structural and functional
changes in CT. This leads to disturbances in the
morphology and function of organs [11]. The clinical
and morphological manifestations of uCDT are
extremely diverse. They may include skeletal changes
associated with cartilage disorders, disproportionately
long limbs, arachnodactyly, chest deformities, spinal
scoliosis, flat feet, pathology of tooth development,
occlusion, cysts, joint pathology (tendency to
dislocation), hyperelasticity, thinning, a tendency to
traumatize the skin, varicose veins and external signs
of accelerated aging - early formation of wrinkles,
deformation of the oval of the face, including
gravitational ptosis (sagging soft tissues of the face)
[8,9]. Lesions of the cardiovascular system are very
diverse: mitral valve prolapse (the most common of all
cardiac anomalies in CTD is usually detected by
echocardiography), venous insufficiency, varicose
veins, and hemostasis pathologies [7].
Diagnosis of uCDT is based on these symptoms and
additional findings (e.g., anthropometry, external
respiration, reduced heart size, decreased blood
pressure, plethysmography, specific characteristics of
ECG and ultrasound phleboscanning) [10]. According
to the analysis of these phenotypic markers of uCDT,
its prevalence may be relatively high in the general
population (e.g., 8.5% in a sample of 400 people [9]).
Although it is often stated that the etiology of DST has
a genetic component, an exhaustive analysis of the
relative roles of environmental factors (nutrition,
environmental conditions, movement hygiene, psycho-
emotional background) and genetic factors has not
been carried out. The term "dysplasia" refers to the
abnormal growth/development of a tissue or organ.
The diagnosis of CDT is made based on a thorough
analysis of symptoms and the results of clinical trials.
However, the diagnosis of DST in practice is rarely
accompanied
by
any
specific
histological
confirmations. Accordingly, dysplasia detected at the
clinical level may correspond to numerous changes in
tissue structure.
In the case of connective tissue, dysplasia (i.e.,
"abnormal growth") can occur due to: 1) abnormal
collagen synthesis or assembly; 2) synthesis of
abnormal collagen; 3) excessive collagen degradation;
4) disorders of the structure of collagen fibers due to
insufficient cross-linking; 5) similar anomalies related
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Publisher:
Oscar Publishing Services
Servi
to elastin fibers; 6) tissue destruction through
autoimmune reactions [5,7]. According to Y. Chia,
mitral valve prolapses accounts for 60.8% of congenital
heart diseases in pregnant women [3]. Clinical
polymorphism of mitral valve prolapse is often
combined with other signs of connective tissue
dysplasia: asthenic physique, pathological joint
mobility, myopia, flat feet, as well as prolapse of other
heart valves, patent foramen ovale, nephroptosis,
biliary dyskinesia, varicose veins, and increased
bleeding. It is known that in patients with mitral valve
prolapse, additional pathways are found 3 times more
often than in the general population [2].
Most often, mitral valve prolapse is asymptomatic, has
a favorable prognosis, but is sometimes associated
with
cardiac
arrhythmias,
heart
failure,
thromboembolism, infective endocarditis, and sudden
death. The peculiarities of the hemodynamics of the
gestational period, namely an increase in the volume of
circulating blood, cardiac output, increase the load on
the cardiovascular system and can provoke the
development of these complications. In some cases, it
is during pregnancy that signs of heart failure and
paroxysmal cardiac arrhythmias manifest themselves
in women with mitral valve prolapse [6]. The greatest
threat is posed by patients with hemodynamically
significant mitral regurgitation and myxomatous
degeneration of the valve leaflets, which are the
source of blood clots and the cause of thromboembolic
complications [12].
In recent years, the problem of the course of
pregnancy and childbirth in women with uCDT, which
is a genetically determined disorder of its development
in the embryonic and postnatal periods, has been
actively discussed. As a result of various mutations in
the genes encoding the structure of collagen and
elastin, defects in fibrous structures and the main
substance of uCDT are formed, followed by the
development of various morphofunctional disorders of
a systemic and local nature [6].
The morphological basis of uCDT is a decrease in the
content of certain types of collagen or a violation of the
ratio between them, which leads to a decrease in the
strength of the connective tissue of many organs and
systems. The external manifestation of uCDT is the so-
called "dysembryogenesis stigmas", which can
manifest themselves as both obvious deformities and
subtle signs. Up to 35% of healthy people have some
degree of uCDT, and 70% of them are women [3]. The
variety of mutagenic effects on the development of
this pathology determines a wide range of its clinical
variants - from well-known gene differentiated
syndromes (Marfan, Ehlers-Danlos) - to numerous
hereditary undifferentiated (nonsyndromic) uCDT.
uCDTs are thought to be "phenotypic" copies of known
syndromes [8]. The generalized nature of connective
tissue damage affects the pathological development
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of the organs of the reproductive system, which
further provokes the manifestation of a number of
obstetric problems [12]. In contrast to syndromic
forms, uCDT is manifested mainly by mild
heterogeneous symptoms and syndromes, united
under the general name of "dysembryogenesis
stigmas" [1,3]. The peculiarities of the course of
pregnancy and childbirth in women with uCDT have
not been sufficiently studied and are the subject of
close attention of researchers. Pregnancy pathology
occurs significantly more often in women with uCDT
than in healthy women - 85.5% versus 53.3%, there are
indications in the literature of a higher incidence of the
threat of early and late termination of pregnancy in
women with uCDT. There is also a higher incidence of
preeclampsia and eclampsia in women with uCDT [7,8].
METHODS
Methods of investigation: We examined 47 pregnant
women with uCDT and 15 healthy pregnant women
without uCDT aged 24-30 years. The threat of
termination of pregnancy occurred in 50% of women
with uCDT, and the threat of preterm birth was
observed 6 times more often than in healthy pregnant
women. The main cause of recurrent miscarriage in this
group of patients was isthmic-cervical insufficiency. At
the same time, according to our data, the threat of
termination of pregnancy at a period of up to 20 weeks
occurred in almost 1/3 of cases, the threat of premature
birth - in 17.2%, pregnancy ended in premature birth in
4.6% of cases. Analysis of the course of the gestational
process in pregnant women with uCDT revealed that
one of the most common complications was early
gestosis, which occurred in 48.6% of cases. At the same
time, there was a direct significant correlation
between the severity of the clinical picture and the
incidence of early gestosis. According to our data, the
most common complication of the second half of
pregnancy in women with uCDT was preeclampsia
(49.8%), and the course of childbirth in these patients
was characterized by frequent complications. It is
known that preeclampsia occupies the 2nd-3rd place in
the structure of causes of maternal mortality and is one
of the main causes of premature birth and perinatal
fetal death. One in five children born to a mother with
preeclampsia has some degree of abnormality in
physical and psycho-emotional development. Also,
placental dysfunction was very common in uCDT - in
37.5% of cases. At the same time, there was a violation
of uteroplacental and fetal hemodynamics, transport,
trophic, endocrine, metabolic functions of the
placenta, which led to fetal malformations (12.1%).
However, this assumption cannot be considered
indisputable. The main clinical manifestation of
placental dysfunction in pregnant women with uCDT
was fetal distress. Microscopy of the placenta in
puerperas with uCDT showed various forms of
impaired placental maturation. Another, no less
important complication for obstetrics - untimely
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discharge of amniotic fluid - was observed in 40.0% of
cases in women with uCDT. The incidence of premature
and early rupture of amniotic fluid in our pregnant
women with uCDT ranged from 37.4% to 41.7% of cases.
The microscopic picture of fetal membranes in uCDT
was characterized by thickening of the compact layer
of the amnion of varying degrees of severity due to the
proliferation of collagen fibers in it. Of the features of
the course of labor associated with uCDT, a
relationship with a rapid and rapid course of labor was
revealed, and in severe cases of uCDT, the frequency of
rapid and rapid labor in primiparous women reached
47%, and in mild signs of uCDT was about 14%. Recently,
a new concept of the development of labor weakness
(DLW) has been put forward, in which its causal factor
may belong to the uCDT. The data of the literature
review indicate a fairly high incidence of ECS, which is
2-10% in parturient women with its primary
development and 2.5% in its secondary development. In
women over 30 years of age, ECS is 2 times more
common than in women aged 20-25 years. ECS leads to
a protracted course or complete cessation of labor, the
appearance of signs of fetal distress, which leads to
prompt delivery. In the structure of emergency
caesarean section, ECS ranks 2-3rd, reaching 37% [9,10].
It is known that during pregnancy there are significant
changes in the structure of muscle tissue and collagen
fibers of the cervix. The volume of muscle tissue
increases by more than 2 times due to the growth of
the vascular link with the simultaneous destruction of
collagen fibers. In the course of many studies, it was
found that in 15-20% of women such changes were not
observed, which made it possible to attribute such
patients to the risk group for the development of
abnormalities in labor [14]. Another discussed cause of
DRD is the pathology of immune status. As is known,
endogenous prostaglandins and endothelial growth
factors play an important role in the nature of labor
[13]. It has been established that the main role in the
development of labor belongs to the fetus. At the
junction of maternal and fetal tissues in the uterus,
there is a release of the main modulators of myometrial
contractile activity - prostaglandins of fetal and
maternal origin. As a result, another mechanism of
childbirth is triggered - immunological rejection of the
fetus [10]. Cytokines such as interleukin-1 (IL-1), IL-6, IL-
8 and tumor necrosis factor (TNF-) are of great
importance in the mechanism of labor [11]. The study
of the peculiarities of the course of pregnancy and
childbirth in 47 patients with small and large signs of
uCDT made it possible to establish that abnormalities
of labor in the first stage of labor occurred in 75.3% of
parturient women against 23.7% in the control group
without uCDT. Caesarean section in the study group
was performed in 15% of pregnant women and only in
3% of patients in the control group. Hypotonic bleeding
in the third stage of labor occurred in 7.8% of mothers
with uCDT and was absent in the control group. Pubic
joint divergence was diagnosed in 8.3% of women with
uCDT and was not detected in the control group. Signs
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of prolapse of the internal genitals, confirmed by
clinical and ultrasound data, were found in 45% of
patients in the main group, in the control group this
pathology was not revealed. Birth injuries of newborns
from mothers with uCDT were diagnosed in 38% of
cases versus 3.9% in the control group. This study
showed that patients with generalized manifestations
(involvement of three or more organs in the
connective tissue defect) of uCDT, even in the absence
of severe forms of this pathology, are at high risk for
the formation of obstetric and neonatal pathology [4].
CONCLUSION
Thus, pregnant women with signs of various forms of
uCDT belong to high-risk groups of obstetric and
perinatal pathology, and therefore they need close
monitoring during pregnancy, childbirth and the
postpartum period, and it is also necessary to examine
newborns who have a high probability of inheriting this
disease. The high incidence of complications during
pregnancy, childbirth and the postpartum period in
patients with uCDT determines the relevance of this
problem in obstetrics and the thoroughness of
examination of this category of women. However,
ambiguous and sometimes contradictory data on the
association and incidence of these complications with
uCDT require further research to determine a set of
diagnostic and preventive measures.
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