Volume 03 Issue 11-2023
37
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
CS often has a certain impact on the subsequent reproductive activity of women: infertility, miscarriage, spontaneous
abortion, menstrual irregularities. The study of its long-term consequences and the development of rehabilitation
after cesarean section is a pressing issue in obstetrics and gynecology. The purpose of the study is to develop methods
of rehabilitation in the postoperative period for the clinical assessment of the condition of women after cesarean
section in order to improve subsequent outcomes of pregnancy and childbirth. The study was conducted at the
Department of Obstetrics and Gynecology No. 1 of SamSMU for 2020-2022 on 103 women of reproductive age.
Rehabilitation measures (magnetic therapy and ultrasound therapy) led to an improvement in the general condition
of women; in the main group, an increase in the amount of type XXVI collagen by 20% was observed; according to
ultrasound data, there was a rapid restoration of the postoperative area, doubling during this period.
KEYWORDS
Cesarean section, uterine scar, pregnancy, rehabilitation, magnetotherapy, ultrasound therapy.
INTRODUCTION
Research Article
THE EFFECTIVENESS OF REHABILITATION MEASURES IN WOMEN WITH
A UTERINE SCAR
Submission Date:
November 01, 2023,
Accepted Date:
November 05, 2023,
Published Date:
November 09, 2023
Crossref doi:
https://doi.org/10.37547/ijmef/Volume03Issue11-05
Kurbaniyazova Venera Enverovna
Department of Obstetrics and Gynecology №1, Faculty of Medicine No. 2, Samarkand State Medical University
,
Uzbekistan
Khudoyarova Dildora Rakhimovna
Department of Obstetrics and Gynecology №1, Faculty of Medicine No. 2, Samarkand State Medical University
,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmef
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 11-2023
38
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
CS often has a certain impact on the subsequent
reproductive activity of women: infertility, miscarriage,
spontaneous abortion, menstrual irregularities. In
addition, a CS cannot always ensure the birth of a
healthy child. Thus, in late pregnancy, infectious
diseases of the mother, severe hypoxia, and especially
in cases of very early premature birth, the health of the
unborn child depends on many factors. Although CS for
preterm birth reduces perinatal mortality, it does not
affect the incidence of perinatal morbidity, especially in
children born with low and very low birth weight. The
health of children born before the 32nd week of
pregnancy is often associated with underlying
maternal diseases (extragenital, infectious diseases,
etc.), as well as pregnancy complications (severe
gestosis, premature separation of a normally located
placenta).
The study of its long-term consequences and the
development of rehabilitation after cesarean section is
a pressing issue in obstetrics and gynecology.
The purpose of the study: to develop methods of
rehabilitation in the postoperative period for the
clinical assessment of the condition of women after
cesarean section in order to improve subsequent
outcomes of pregnancy and childbirth.
Material and research methods: The study is based on
a clinical and laboratory examination of 103 women of
reproductive age with a history of one uterine scar,
who were under observation in the obstetrics
department of the multidisciplinary clinic of
Samarkand State Medical University for the period
from 2020 to 2022. During clinical and laboratory
examination, pregnant women were divided into 2
groups: Group I - with a stable scar (n=66), Group II
with an incompetent scar (n=37). Each of these groups
was divided into subgroups according to birth
outcomes: “A”
-
with natural birth, “B”
- birth by
cesarean section. According to the method of
rehabilitation, women were divided into a main group
(n=68 - using rehabilitation methods) and a
comparison group (n=35 - treated according to the
standard).
All laboratory studies were carried out in the
laboratory department of the multidisciplinary clinic of
SamSMU, instrumental methods - in the radiology
department, morphological research - carried out by
Associate Professor of the Department of Pathological
Anatomy B.S. Abdullaev. Type XXVI collagen was
determined by ELISA in the private clinic "Biostomnur"
during pregnancy, 3 and 6 months after birth.
Ultrasound therapy and magnetic therapy were used
as rehabilitation methods. The duration of the
procedure was up to 15 minutes for each zone, once a
day on an outpatient basis for 10 days. The first
ultrasound therapy procedure began 15 days after
birth, and magnetic therapy on the 4th day after birth.
The procedure was repeated after 6 months.
Variation-statistical processing of the research results
was carried out using the Statistica 6.0 program,
determining the main indicators of variation: average
Volume 03 Issue 11-2023
39
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
values (M), average errors (m), standard deviation (p).
The reliability of the results obtained was determined
using the Student's test. The difference between two
means is considered significant if the p-parameter is
less than 0.05. The confidence level was at least 95%.
The correlation between the indicators was calculated
using the Excel 2010 table, the correlation coefficient
was calculated according to Spearman.
Research results and discussions: In the main group,
20.5% of pregnant women showed a decrease in blood
hemoglobin levels from normal (91.1±1.24 g/l on
average for the group). A low level of leukocytes was
detected in 8.82% of pregnant women in the main
group (group average 5.89±1.31x103/mm3).
According to ultrasound data, in 29 (42.64%) women
in the main study group and in 35 (100.0%) women in
the comparison group, ultrasound revealed the
presence of various elements located between full-
blooded capillaries and small-caliber capillaries,
indicating the “consistency” of the uterine scar.
37 (54.41%) pregnant women in the main study group
had an echo picture of the scar on the uterus,
characterized by the presence of atrophy and the
formation of a thin fibrous cover, a defect in the
uterine wall in the area of the scar, and inadequate
blood circulation along the scar.
During ultrasound 3 months after birth, the thickness
of the uterine wall in the area of the scar in the
postpartum women of the comparison group was
1.9±0.08 mm (1.6; 4.0); they were diagnosed with
defects in the scar area during Dopplerography,
whereas in the main group the average thickness of the
scar area was 2.4±0.04 mm (2.0; 4.0), the scar area was
assessed as thin. 6 months after birth, the echographic
thickness of the scar area was 3.6±0.03 mm in the main
group and 3.2±0.05 mm in the comparison group. As
can be seen from Fig. 1 regeneration of the scar area
was positive in the main group for 6 months, but in the
comparison group the regeneration process was
slower and showed negative dynamics after 3 months
and positive dynamics after 6 months.
Volume 03 Issue 11-2023
40
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Figure 1. Ultrasound indicators for scar thickness over time
When studying the amount of type XXVI collagen over
time, a sharp change was observed in both groups (Fig.
2). 3 months after birth, the amount of collagen
increased from 328.22±17.5 ng/ml to 363.1±48.4 ng/ml
in the main group, while in the comparison group its
amount decreased by 2 times (from 322.28 ±34.5 ng/ml
to 164.12±16.25 ng/ml). Based on the fact that this type
of collagen is specific to the genital organs, it can be
concluded that in this group it was used to restore the
uterus to its original state, which led to a decrease in
the overall score. In the main group, the local impact of
rehabilitation procedures created good conditions for
regeneration, improved recovery, had a positive effect
on collagen synthesis and prevented its decline.
1.8
2.4
3.6
3
1.9
3.2
0
0.5
1
1.5
2
2.5
3
3.5
4
дородовое
обследование
через 3 месяца после
родов
через 6 месяцов после
родов
основная
группа сравнения
328.22
363.1
388.42
322.28
164.12
221.18
0
50
100
150
200
250
300
350
400
450
до родов
после 3х мес
после 6 месяцев
Основная группа
Группа сравнения
Volume 03 Issue 11-2023
41
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Figure 2. Indicators of the amount of type XXVI collagen over time
When assessing the results after 6 months, positive
dynamics were observed in both groups, the amount
of collagen in the main group was 388.42±14.22, and in
the comparison group - 221.18±13.11. The positive
dynamics in the comparison group were below the
threshold values considered alternative, which in turn
is a risk factor for complications in subsequent
pregnancies and childbirth.
Based on ultrasound data and indicators of the amount
of collagen type XXVI in dynamics, we calculated the
correlation relationship and the Spearman correlation
coefficient. It was found that there is a direct linear
relationship between these indicators. That is, an
increase in the amount of type XXVI collagen is
reflected in an increase in the ultrasound data of the
scar area (Fig. 3), while the Spearman correlation
coefficient was R = 0.015.
Figure 3. Correlation between collagen type XXVI parameters and ultrasound
The development and use of non-invasive methods in
modern medicine is becoming relevant. At the
moment, modern obstetrics is aimed at minimizing the
practice of cesarean section and serves to increase the
frequency of vaginal births. These studies prove the
correlation between ultrasound indicators - Doppler
measurements and type XXVI collagen, which leads to
a more accurate diagnosis of the condition after a
surgical scar.
In the early postpartum period, the use of
rehabilitation methods in women who gave birth
naturally, despite CS and scar insufficiency, showed an
improvement in their general condition, rapid
0
50
100
150
200
250
300
350
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Volume 03 Issue 11-2023
42
International Journal Of Management And Economics Fundamental
(ISSN
–
2771-2257)
VOLUME
03
ISSUE
11
P
AGES
:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
7.
448
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
restoration of the genital organs after childbirth and a
reduction in hospital stay.
Conclusions: In order to improve the course of
subsequent pregnancies and childbirth, rehabilitation
measures were carried out (magnetic therapy and
ultrasound therapy), as a result of which an
improvement in the general condition of women was
observed, in the main group there was an increase in
the amount of type XXVI collagen by 20%, according to
ultrasound, there was a rapid recovery of
postoperative zones twice over this period.
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