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IMMUNE RESPONSE AND CLINICAL MANIFESTATIONS OF ORAL
INFLAMMATORY DISORDERS CONTRIBUTING TO SEPTIC
COMPLICATIONS FOLLOWING CHILDBIRTH
Davlyatova Aziza Aripjanovna
Doctoral student resident
Samarkand State Medical University
https://doi.org/10.5281/zenodo.15244267
Annotation
. According to modern research, the prevalence of dental
pathology among pregnant women reaches 90%, while inflammatory
periodontal diseases are detected in 30-40% of women. It has been established
that chronic foci of odontogenic infection can serve as a reservoir of pathogenic
microorganisms and a source of endogenous intoxication, creating prerequisites
for the development of systemic inflammatory reactions. Of particular
importance is the study of the immunological mechanisms mediating the
influence of dental pathology on the development of postpartum complications.
Keywords:
pregnancy, dental diseases, oral cavity, clinical and laboratory
diagnostics, periodontal disease, prevention of dental diseases, gestational
period.
Introduction:
Modern research shows that inflammatory processes in the
oral cavity are accompanied by significant changes in both local and systemic
immunity, which can significantly increase the risk of septic complications in the
postpartum period. Despite a significant number of studies devoted to this
problem, many aspects of pathogenesis remain insufficiently studied. In
particular, the mechanisms of the relationship between local inflammation in the
oral cavity and systemic immunological disorders, the role of various immune
links in the development of postpartum complications, and the importance of
microbial translocation in the pathogenesis of septic conditions need to be
clarified.
The urgency of the problem is also determined by the lack of clear
prognostic criteria and algorithms for the prevention of postpartum septic
complications in women with inflammatory diseases of the oral cavity. Existing
approaches to prevention and treatment do not always take into account the
peculiarities of the immunological status of patients and the nature of microbial
colonization.
The interdisciplinary nature of the problem requires the coordination of
efforts by obstetricians, gynecologists, dentists, and immunologists to develop
effective prevention and treatment strategies. An integrated approach is needed,
taking into account both the clinical and immunological aspects of the problem.
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The social significance of the study is determined by the high prevalence of
dental pathology among pregnant women, the severity of postpartum septic
complications and their impact on the health of mother and child. The economic
damage associated with the treatment of these complications is also a significant
problem for the healthcare system.
In modern conditions, the development of personalized approaches to
prevention and treatment based on the assessment of individual clinical and
immunological characteristics of patients is becoming particularly relevant. This
requires an in-depth study of pathogenetic mechanisms and the search for new
biomarkers that can predict the risk of complications.
The aim of the study is to establish the clinical and immunological
mechanisms underlying the relationship between oral inflammatory diseases
and postpartum septic complications, and to develop evidence-based criteria for
risk assessment and prevention strategies.
Materials and methods of the study: The
present At the first stage of the
study, a screening dental examination of 500 pregnant women in the 1st, 2nd
and 3rd trimester of pregnancy was conducted in order to determine the
condition of the oral cavity, identify the frequency of diseases, determine the
hygiene index and CPI – the study was performed in the period from 2021 to
2024.
The main group I (n-152) consisted of maternity women with postpartum
complications of a septic nature in the presence of oral diseases;
Group II (n= 150) consisted of pregnant women at risk of developing septic
complications in the postpartum period (presence of oral diseases, treatment
and prevention of postpartum complications during pregnancy);
The control group (n-50) consisted of pregnant women without oral
diseases.
The purpose of monitoring these women is to study the features of the
pathogenesis of purulent—septic diseases of the postpartum period in pregnant
women with oral diseases and to develop a program for their prevention.
Research materials and methods: At this stage, the microflora of the oral
cavity was studied in maternity patients with purulent-septic diseases in the
postpartum period. A relationship was established between the severity of the
patients' condition and the state of oral microbiocenosis. The key risk factors for
purulent-septic diseases in the postpartum period and the role of inflammatory
processes in the oral cavity in the development of postpartum infectious
complications were also analyzed.
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Pregnancy is a critical period for a woman's dental health and is
characterized by changes in the level and structure of oral diseases. Severe and
long-term pathologies of the oral cavity tissues during pregnancy have an
adverse effect on antenatal, perinatal and postnatal outcomes.
The results of the study:
In women with oral diseases, pregnancy
occurred against the background of iron deficiency anemia in 94% of cases (287
patients).
The analysis of anamnestic data on menstrual function showed the
following results In the main group, menarche began on average at the age of
12.4 ± 3.4 years, which is slightly earlier than in the control group (13.5 ± 4.8
years), while the difference is not statistically significant (p > 0.05). The majority
of women in both groups had menarche between the ages of 11 and 15. The
regularity of the menstrual cycle is an important indicator of menstrual function.
The data obtained show that in the main group, 135 women (88.8%) had regular
menstruation, while 11.2% had an irregular cycle. In the control group, irregular
menstruation was significantly more common — in 28% of women (p < 0.05).
The duration of the menstrual cycle in most women in both groups was 27-
28 days (in the main group — 27.4 ± 1.9 days, in the control group — 25.6 ± 2.4
days). Cycles lasting 29-30 days were more often observed in patients of the
main group (10% vs. 8%, p > 0.05).
As for the duration of menstrual bleeding, 62% of women in the main group
and 52% of the control group had 4-6 days (on average 4.3 ± 1.1 days). 28% and
40% of women had periods lasting 2-3 days (on average 2.1 ± 0.9 days), and
10% and 8% had periods lasting 7 days or more. An assessment of the volume of
menstrual bleeding showed that moderate menstruation was observed in the
majority of women in both groups (80% in the main group and 76% in the
control group, p > 0.05). At the same time, the number of women with heavy and
meager menstrual bleeding was significantly higher in the control group: in the
main group, polymenorrhea was observed in only 6% of patients, while in the
control group — in 16% (p < 0.05).
The largest proportion of women (88.2% and 86.7%) in both the main and
comparison groups had from 1 to 5 pregnancies. One third of all the surveyed
women became pregnant more than 5 times. An important indicator
characterizing childbearing function is the outcome of pregnancy. As follows
from the table.2.5, there were 11.8% and 13.3% of first-time pregnancies and
first-time births in both groups compared, respectively (p<0.05), which can
explain the significantly lower number of pregnancy and childbirth
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complications in the comparison group. However, attention is drawn to the fact
that there are a large number of pregnancies – more than 5 in 15.9%, which
could not but affect the condition of the oral cavity in these pregnant women.
According to the data obtained, vomiting of pregnant women and
preeclampsia were observed with almost the same frequency in both groups:
vomiting was recorded in 24% of women in the main group and 20% in the
control group, while preeclampsia was more common in women in the main
group (12% versus 8% in the control group).
Bleeding, especially in the second half of pregnancy, is a serious
complication. In our study, placental previa and premature placental abruption
were more often reported in women in the control group (5.4%), while in the
main group this complication was observed in 4% of cases. Pregnancy in 70.8%
of the women in the main group ended with an emergency delivery, while the
frequency of premature birth was higher (14.9%) compared with the control
group (9.2%). Significant complications of childbirth include weakness of labor,
diagnosed in 9% of women in the main group (while in the second group this
figure was 4.6%). Fetal distress was also more common in the main group
(15.7% versus 9.2%).
Conclusions:
The study has demonstrated a significant correlation
between oral inflammatory diseases and the development of postpartum septic
complications, with a 3.5-fold increased risk in women with active periodontal
disease compared to those with healthy oral status.
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