Clinical and morphological parallels in pregnancy complicated by polyhydramnios

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Абдуллаева L., Каттаходжаева M., Сафаров A., & Сулейманова N. (2022). Clinical and morphological parallels in pregnancy complicated by polyhydramnios. in Library, 22(1), 4137–4141. извлечено от https://inlibrary.uz/index.php/archive/article/view/14758
Лола Абдуллаева, Самаркандский федеральный государственный медицинский институт

ассистент кафедры акушерства и гинекологии

Махмуда Каттаходжаева, Ташкентский государственный стоматологический институт

д.б.н., профессор, кафедра акушерства и гинекологии

Алиаскар Сафаров, Самаркандский государственный медицинский институт

к.м.н., доцент кафедры акушерства и гинекологии

Нодира Сулейманова, Ташкентский государственный стоматологический институт

к.м.н., доцент кафедры акушерства и гинекологии

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Аннотация

Despite the significant breakthrough of obstetric science and practice in the second half of the 20th century and the beginning of the 21st century, the introduction of innovative methods, the rapid development of the pharmacological  industry,  the  problem  of  obstetric  bleeding  remains  one  of  the  most  urgent  problems  of obstetrics  [2,5,7].  Of  the  550-600  thousand  maternal  deaths,  about  200,000  die  from  obstetric  bleeding. Bleeding is in the leading positions among the so-called "big five" causes of maternal mortality [1,3,9,10] At the  same  time,  125  thousand  women  die  due  to  massive  obstetric  bleeding,  almost  half  die from  uterine hypotension. The main reasons for the development of hypo and atonic bleeding may be the insufficiency of myometrial retraction and thrombosis in the vessels of the placental site, which has from 150 to 200 spiral arteries [4,5]

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background image

Turkish Journal of Physiotherapy and Rehabilitation

; 32(2)

ISSN

2651-4451 |

e-ISSN

2651-446X

4137

CLINICAL AND MORPHOLOGICAL PARALLELS IN PREGNANCY

COMPLICATED BY POLYHYDRAMNIOS

Lola Abdullayeva

1

, Makhmuda Kattakhodzhayeva

2

, Aliaskar Safarov

3

,

Nodira Suleymanova

4

1

Assistant, Department of Obstetrics and Gynecology of the Federal State Medical Institute of

Samarkand, Samarkand, Uzbekistan. Email address:2

DSc, Professor, Department of Obstetrics and Gynecology, Tashkent State Dental Institute, Tashkent,

Uzbekistan. Email address:3

Candidate of Medical Sciences, Associate Professor, Department of Obstetrics and Gynecology,

Samarkand State Medical Institute, Samarkand, Uzbekistan. Email address:

4

PhD, Associate Professor, Department of Obstetrics and Gynecology, Tashkent State Dental Institute,

Tashkent, Uzbekistan. Email address:ANNOTATION

Despite the significant breakthrough of obstetric science and practice in the second half of the 20th century

and the beginning of the 21st century, the introduction of innovative methods, the rapid development of the
pharmacological industry, the problem of obstetric bleeding remains one of the most urgent problems of
obstetrics [2,5,7]. Of the 550-600 thousand maternal deaths, about 200,000 die from obstetric bleeding.
Bleeding is in the leading positions among the so-called "big five" causes of maternal mortality [1,3,9,10] At
the same time, 125 thousand women die due to massive obstetric bleeding, almost half die from uterine
hypotension. The main reasons for the development of hypo and atonic bleeding may be the insufficiency of
myometrial retraction and thrombosis in the vessels of the placental site, which has from 150 to 200 spiral
arteries [4,5]

Keywords:

pregnancy, polyhydramnios, postpartum hypotonic bleeding, myometrium, edema and

hemorrhage.

I.

INTRODUCTION

Intensive retraction of the uterine muscle fibers after the birth of a child contributes to the compression, twisting

and retraction of the spiral uterine arteries into the thickness of the muscle, along with which the process of
thrombosis begins. The formation of dense, elastic blood clots provides reliable hemostasis. Violations of the
coagulation properties of blood, as well as a decrease in the contractility of the myometrium in combination with
each other, play a crucial role in the development of postpartum bleeding [7, 10]. Another reason for uterine
hypotension may also be connective tissue dysplasia. In connective tissue dysplasia, the frequency of AK is 1.7
times higher than in the general population. Maslyakova G. N. [1,6], in histological studies of queens removed
due to hypotonic postpartum bleeding of unclear genesis, showed that the uterus is not able to contract
sufficiently with tumors, overgrowth due to multiple births, polyhydramnios, a large fetus. It is believed that the
violation of the contractile function of the uterus is associated with overgrowth and "exhaustion" of the
contractile ability of the myometrium, with infection, as well as with anatomical/functional features of the uterus,
with the delay of parts of the afterbirth or blood clots in the uterine cavity [8,10,11].

One of the causes of reproductive losses is polyhydramnios during pregnancy. The frequency of this

complication, according to foreign and domestic authors, ranges from 0.12 to 8.4%. Among the causes leading to
polyhydramnios, there are: diabetes mellitus, acute and recurrent chronic infectious diseases, isosensitization by
the Rh factor, fetal malformations. An excessive amount of fluid is determined indirectly by ultrasound criteria,
usually with the help of IAZH (AFI). AFI is the sum of the vertical depth of the fluid column measured in each
quadrant of the uterus. Normally, the AFI is from 5 to 24 cm; values of

≥ 24 cm indicate polyhydramnios.


background image

Turkish Journal of Physiotherapy and Rehabilitation

; 32(2)

ISSN

2651-4451 |

e-ISSN

2651-446X

4138

Chronic hydramnion is more common, when excess amniotic fluid accumulates gradually [12] In the acute form,
the volume of amniotic fluid increases sharply (in a few hours or days). An important role in the development of
hypotonic postpartum bleeding is played by the rate of accumulation of amniotic fluid and their volume.
Morphological changes in fruit shells, detected during morphological and electron microscopic studies, are very
interesting from a scientific point of view. Morphostructural changes of the amnion were revealed, indicating the
predominance of the processes of amniotic fluid resorption over the processes of reabsorption, which is a
pathogenetic mechanism of excessive accumulation of amniotic fluid [5,7] . At the same time, morphostructural
changes occurring in the uterine wall during polyhydramnios remain insufficiently studied.

The purpose

of this study was to study the features of the clinic and the morphological structure of the uterine

wall in polyhydramnios of varying severity.

II.

MATERIALS AND METHODS OF RESEARCH

The peculiarities of the course of pregnancy and childbirth were studied in 49 women who developed

polyhydramnios at 32-40 weeks. All the observed patients underwent a full clinical examination in the conditions
of the city maternity complex No. 2 of the city of Samarkand for the period 2018 - 2019. The control was the
indicators of 40 women of the control group with the physiological course of gestation of the same age and
parity. Histological studies of myometrial tissues obtained during cesarean section surgery were performed in 23
patients of the main and 10 patients operated on as planned due to the presence of a scar on the uterus. Clinical
(obstetric), laboratory (general clinical and biochemical studies of blood, urine, secretions, coagulogram),
functional (ECG, dopplerometry, ultrasound). Special morphological studies were also used. Fragments of
myometrium measuring 2x1 cm, obtained during cesarean section, were fixed in 10% neutral formalin, poured
into paraffin with wax. The dewaxed sections were stained with hematoxylin and eosin, and the Van Gieson
method was used to detect collagen fibers of connective tissue. Based on the results obtained, qualitative and
quantitative changes in the myometrium were evaluated. Studies of micro-preparations and photographing were
carried out using a light microscope at magnification: About 40, about 10.

III.

THE RESULTS OF THE STUDY

The age of the subjects ranged from 20 to 36 years. The main mass -57% were pregnant women in the age group

from 21 to 30 years. At the same time, the age groups were representative. We analyzed somatic diseases that
could contribute to the development of polyhydramnios and the risk of hypotonic bleeding. It is worth noting that
various somatic diseases were observed in 75% of pregnant women. Iron deficiency anemia occupies the leading
place in the structure of somatic diseases – 50.3%, varicose veins – 19.4%, digestive diseases – 16.6%, obesity -
31%, inflammatory diseases of the kidneys and urinary tract – 29%. Type 1 diabetes mellitus was diagnosed in 2
women, the second type-in 1. In the structure of concomitant genital pathology, the most common were chronic
inflammatory diseases of the uterus and appendages (74.2%), bacterial vaginosis (28.5%), cervical pathology
(33.4%), colpitis and cervicitis (43%). In 46% of pregnant women with polyhydramnios, sexually transmitted
infections such as CMV, HSV, mycoplasma were detected. It should be noted that in the main group, the
frequency of atrial abortions in the anamnesis was 1.5 times higher than in the control group (p In the indicators
of anamnestic data of previous pregnancies, it was found that women of the main group were significantly more
likely to have spontaneous miscarriages compared to women of the control group (p The diagnosis of
polyhydramnios was established at 28-34 weeks of pregnancy in 5 (10.2% ), 35-38 weeks - in 23 ( 46.9%) and at
38-42 weeks in 21 women of the main group ( 42.8%). Moderate polyhydramnios on the background of chronic
hydramnion according to the results of clinical studies (OH, VDM, "fluctuation" symptom) and ultrasound
(amniotic fluid volume AFI from 24 to 28 cm.) was diagnosed in 44 (89.9%) pregnant women of the main group.
In 5 cases, severe acute polyhydramnios with a volume of amniotic fluid of more than 3 liters occurred. Pregnant
women with polyhydramnios were treated according to the standards adopted in the republic. The most frequent
complications of pregnancy were hypertensive conditions (14%), premature detachment of the normally located
placenta (13%), placenta previa (5%), antenatal fetal death (1%). In 23 women of the main group, pregnancy
ended with cesarean section due to the above-mentioned complications of pregnancy and childbirth. 26 women
(53%) were delivered through the natural birth canal. In 8 cases of childbirth through the natural birth canal, a
manual examination of the uterine cavity was performed in connection with the onset of postpartum bleeding.
The average blood loss in childbirth in the main group was 437.7 + - 50.5 ml. In the control group, this indicator
reached 258.9+_35.9 ml. In order to stop the bleeding, all women in labor were treated with standard hemostatic
therapy with the use of Oxytocin, Methylergometrine, hemostatic drugs. In 7 cases, the PABAL drug was used in
standard doses. There were no cases of hysterectomy or other surgical interventions to stop bleeding. During the
cesarean section, the myometrial tissue was taken for morphological examination in all women with




background image

Turkish Journal of Physiotherapy and Rehabilitation

; 32(2)

ISSN

2651-4451 |

e-ISSN

2651-446X

4141

pancreas and thyroid gland. Of gynecological diseases, they are most often combined with inflammatory diseases
of the genital organs caused by viral and bacterial pathogens. In most cases, a picture of moderate
polyhydramnios develops against this background, but in 1-2% of cases there is pronounced polyhydramnios
with an amniotic fluid volume of more than 3 liters. In 12-15% of cases, along with polyhydramnios,
hypertensive syndrome and the threat of premature birth develop. Combined pathologies of pregnancy adversely
affect not only the health of the mother, but also the condition of the fetus, leading to cases of intrauterine death
in the antenatal period (1%). Despite the implementation of preventive measures to prevent bleeding in the
postpartum period, blood loss in polyhydramnion is significantly twice as high as those parameters in
physiological pregnancy. The study of the morphostructure of the uterine wall in polyhydramnios indicates the
presence of pronounced changes in it. At the same time, there are processes of hypertrophy and elongation,
changes in the shape and size of myocyte nuclei, interspersed with areas of decrease in the number of myocytes,
changes in blood vessels in the form of tortuosity of their forms, blood stasis with changes in the forms of red
blood cells. The most characteristic for this pathology are the processes of edema and hemorrhages of the
intermuscular space. All these pathological processes are aggravated directly proportionally with an increase in
the amount of amniotic fluid, that is, as the degree of polyhydramnios increases. The listed morphological
changes are one of the pathogenetic mechanisms of the development of postpartum hypotonic bleeding in these
patients.

Thus, the conducted studies indicate the presence of direct clinical and morphological relationships between the

severity of polyhydramnios and the severity of structural changes in the uterine wall. Despite the ongoing
preventive measures, the volume of blood loss is twice as high as during physiological pregnancy. All this
dictates the need to improve the methods of preventing hypotonic postpartum bleeding in women with
polyhydramnios.

USED LITERATURE:

1.

Vdovichenko, Yu. P., Zhuk, S. I., & Melnik, O. V. (2011). Pregnancy with twins is a double requirement for the maternal div (review of foreign
literature). Women's Health, (1), 64-67.

2.

Maslyakova, G. N., E. B. Malybayeva (2014). Morphological changes of the myometrium in various types of obstetric pathology. Saratov Scientific
and Medical Journal, vol. 10, No. 4, 603-607.

3.

Pechenkina, N. S., & Sedavnykh, E. A. (2020). FEATURES OF THE COURSE OF PREGNANCY AND CHILDBIRTH WITH AN UNTENABLE
SCAR ON THE UTERUS (CLINICAL OBSERVATION). Vyatka Medical Bulletin, (4 (68)).

4.

Sadchikov D. V., Marshalov D. V. (2015). Prognosis and intensive therapy of massive obstetric blood loss. Anesthesiology and resuscitation. 4, 30-
34.

5.

Salov I. A., Marshalov D. V. (2014). Prognosis and treatment of massive obstetric blood loss. Vopr. gynecology, obstetrics and perinatology, 2, 29-
33.

6.

Erkinovna, M.S., Rubenovna, A.L. (2021). Prognosis and early diagnosis of preeclampsia is based on clinical-genetic and endothelial predictors.
International Journal of Current Research and Review, 13 (2), 71-75.

7.

Gaybullaev, E.A., Rizaev, J.A., Abdullaev, B.Sh (2020) Clinical and instrumental evaluation of the effectiveness of surgical treatment of chronic
generalized periodontitis using RANK-RANKL-OPG biomarkers. Indian Journal of Forensic Medicine and Toxicology, 14 (4), 7454-7456

8.

Lalonde A., Daviss B.A., Acosta A., Herschderfer K.(2016). Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int. J. Gynecol.
Obstet., Vol. 94, 243-253.

9.

Makhmudova, S. E., & Agababyan, L. R. (2020). SIGNIFICANCE OF PROGNOSTIC MARKERS IN THE DEVELOPMENT OF
PRECLAMPSIA. International scientific review, (LXX).

10.

Rubenovna, A.L., Boltaevich, N.B., Erkinovna, M.S., Xamzaevich, X.X. (2021). Preeclampsia – a modern view to the problem, methods of

prognosis and early diagnosis based on clinicо

-genetic predictors. Annals of the Romanian Society for Cell Biology, 25 (1), 192-202.

11.

Rubenovna, A.L., Ibragimovich, K.A. (2021). The efficacy of different methods of haemostasis for postpartum haemorrhage. Annals of the
Romanian Society for Cell Biology, 25 (1), 134-139.

12.

Yelese Y.O, Scorza W.E., Mastrolia R., Smulian J.C. (2014). Postpa

rtum hemorrhage. Obstet. Gynecol. Clin. North Am, Vol. 34, №3,

421-441.

Библиографические ссылки

Vdovichenko, Yu. P., Zhuk, S. I., & Melnik, О. V. (2011). Pregnancy with twins is a double requirement for the maternal body (review of foreign literature). Women's Health, (1), 64-67.

Maslyakova, G. N., E. B. Malybayeva (2014). Morphological changes of the myometrium in various types of obstetric pathology. Saratov Scientific and Medical Journal, vol. 10, No. 4, 603-607.

Pechenkina, N. S., & Sedavnykh, E. A. (2020). FEATURES OF THE COURSE OF PREGNANCY AND CHILDBIRTH WITH AN UNTENABLE SCAR ON THE UTERUS (CLINICAL OBSERVATION). Vyatka Medical Bulletin, (4 (68)).

Sadchikov D. V., Marshalov D. V. (2015). Prognosis and intensive therapy of massive obstetric blood loss. Anesthesiology and resuscitation. 4, 30-34.

Salov I. A., Marshalov D. V. (2014). Prognosis and treatment of massive obstetric blood loss. Vopr. gynecology, obstetrics and perinatology, 2, 29-33.

Erkinovna, M.S., Rubenovna, A.L. (2021). Prognosis and early diagnosis of preeclampsia is based on clinical-genetic and endothelial predictors. International Journal of Current Research and Review, 13 (2), 71-75.

Gaybullaev, E.A., Rizaev, J.A., Abdullaev, B.Sh (2020) Clinical and instrumental evaluation of the effectiveness of surgical treatment of chronic generalized periodontitis using RANK-RANKL-OPG biomarkers. Indian Journal of Forensic Medicine and Toxicology, 14 (4), 7454-7456

Lalonde A., Daviss B.A., Acosta A., Herschderfer K.(2016). Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int. J. Gynecol. Obstet., Vol. 94,243-253.

Makhmudova, S. E., & Agababyan, L. R. (2020). SIGNIFICANCE OF PROGNOSTIC MARKERS IN THE DEVELOPMENT OF PRECLAMPSIA. International scientific review, (LXX).

Rubenovna, A.L., Boltacvich, N.B., Erkinovna, M.S., Xamzacvich, X.X. (2021). Prccclampsia - a modern view to the problem, methods of prognosis and early diagnosis based on clinico-genetic predictors. Annals of the Romanian Society for Cell Biology, 25 (1), 192-202.

Rubenovna, A.L., Ibragimovich, К.Л. (2021). The efficacy of different methods of haemostasis for postpartum haemorrhage. Annals of the Romanian Society for Cell Biology, 25 (1), 134-139.

Yelese Y.O, Scorza W.E., Mastrolia R., Smulian J.C. (2014). Postpartum hemorrhage. Obstet. Gynecol. Clin. North Am, Vol. 34, №3,421-441.

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