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ABSTRACT
Placental insufficiency (PI) is a syndrome caused by morphofunctional changes of the placental complex in response
to various pathological conditions of the placenta and the fetus [3, 6, 12].
KEYWORDS
Fetoplacental insufficiency (FPI), placenta, ozone therapy, mother-placenta-fetus system, fetal growth and
development retardation.
INTRODUCTION
At the same time, the syndrome causes a change in
compensatory-adaptive mechanisms of the placenta at
the levels of molecular, cellular and tissue structures as
a result of changes occurring in the fetus, uterus-
placental complexes. This, in turn, leads to a violation
of the functions of the placenta, that is, with a violation
of functions such as transport, trophic, endocrine,
metabolic, antitoxic, the probability of various
pathologies in fetuses and newborns increases [6, 8,
17, 24]. Pathogenetic aspects of PI in infectious
diseases depend on toxinemia, homeostasis disorders,
hemodynamic shifts, hemodynamic shifts in the
"mother-placental-fetus" system. The location and
duration of the pathological process, the duration of
the pathological process, the clinical manifestations of
the disease, the type and virulence of the pathogenic
microorganism, the route of transmission of the
microorganism from the mother to the fetus, the
adaptation of the microorganism to the placental
complex, the gestation period, the mother and the
fetus are of great importance in the case of damage to
the placenta and fetus by an infectious agent. state of
immunological protection. The time factor plays an
important role, since chronic PI is more likely to occur
with 2-3 repeated and long-term infections than with a
single infection [6, 9, 12, 18, 25].
Research Article
FETOPLACENTAL INSUFFICIENCY: CHANGES IN MATERNAL AND FETAL
HEMODYNAMICS
Submission Date:
April 15, 2023,
Accepted Date:
April 20, 2023,
Published Date:
April 25, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-15
Khudoyarova Dildora Rakhimovna
Doctor Of Medical Sciences, Associate Professor, Uzbekistan
Shavkatova Aziza Zafarovna
Master's Resident Samarkand State Medical University, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
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International Journal of Medical Sciences And Clinical Research
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Publisher:
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Servi
According to Alamazyan E.K. [1], the main pathogenic
levels of placental insufficiency are changes in the
metabolic and synthetic activity of the placenta,
disorders of the uterine-placental and feto-placental
blood circulation systems. Also, the growth of a
complete trophoblast into the spiral arteries leads to
its insufficient perfusion and changes in the secretion
of humoral factors.
Accordingly, the use of medical ozone in the treatment
of placental insufficiency, which has a multifactorial
nonspecific effect, seems promising [2, 5, 9, 17, 28].
Medical ozone is an ozone-oxygen mixture obtained
from ultrapure oxygen by decomposing it under a
weak electric charge or under the influence of
ultraviolet radiation. There are two mechanisms of
ozone action: direct and indirect [4]. The mechanism of
direct action is related to the disinfecting activity that
leads to the destruction of the integrity of the plasma
membrane of bacteria due to the oxidation of
phospholipids and lipoproteins, resulting in the loss of
the viability of the bacterial cell and its ability to
reproduce. The antiviral effect of ozone is carried out
by the oxidation of virion receptors, as well as by
disrupting the synthesis of viral proteins due to a
change in the activity of the reverse transcriptase
enzyme. There is evidence of a clear therapeutic effect
of ozone therapy in diseases of repeated viral
infection, which is associated with a large number of
lipids (up to 22%) in the viral capsule that easily interact
with ozone [11, 16, 23].
Goal: Improvement of ways of carrying pregnant
women with fetoplacental insufficiency using ozone
therapy.
RESEARCH MATERIALS AND METHODS. The results of
pregnancy and childbirth were studied in 38 patients
diagnosed with fetoplacental insufficiency, who
applied to the obstetrics department of the SamSMU
multidisciplinary clinic No. 1 between 2020 and 2022.
Somatic and obstetric-gynecological anamnesis data
were studied in all patients. Particular attention was
paid to past infectious and inflammatory diseases, as
well as reproductive function (miscarriage, premature
pregnancy, induced abortions, antenatal fetal death),
the course and results of previous pregnancies, the
course and complications of this pregnancy.
The study of objective examination data included a
general examination, div weight and height
measurements, and determination of div type. The
condition of the respiratory, cardiovascular, digestive,
urinary and nervous systems was evaluated. Obstetric
examination included determination of pregnancy
period, measurement of abdominal circumference and
the height of the uterine fundus, determination of its
tone, paying special attention to the correspondence
of the size of the uterus to the duration of pregnancy.
During the external examination, the position of the
fetus, its appearance and the part lying in front were
determined, the heartbeat of the fetus was heard.
Among the methods of laboratory examination,
indicators of general blood and urine analysis, smear
analysis, coagulogram and hemostasiogram were
studied. Among the instrumental methods, UST was
performed along with complete fetal dopplerometry.
According to the treatment tactics, patients were
divided into 2 groups: 1 main group 18 patients who
underwent complex treatment with FPI (in addition to
ozone therapy), 2 comparison group 20 pregnant
women with FPI detected during conventional
treatment Women.
To analyze and interpret the research results, the
StatSoft package "STATISTIC" (version 7), Microsoft
Excel 2010 spreadsheet for Windows (MS Office, USA)
data processing tools were used.
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RESULTS
The age of the patients ranged from 18 to 39 years,
with an average of 27.4±4.1 years. There was no
statistical difference in the age of pregnant women
between the groups.
No deviations from the population norms were found
in the analysis of mass-height ratio in the examined
women. Before pregnancy, the average div weight
was 61.2+2.5 kg, the average height was 165.3+5.8 cm.
When analyzing the marital status of pregnant women,
all women in the studied groups were in a registered
marriage.
The most common diseases were ENT diseases (33.3%
in group 1 and 35% in group 2) and urinary system
diseases (38.9% and 30% in groups, respectively). A
significant share of chronic diseases of the thyroid
gland (16.7% and 20%) and gastrointestinal tract (16.7%
and 20% in the groups, respectively) is also noteworthy.
In addition, we found that in both groups, chronic
extragenital pathology was present in several organs:
for example, the ratio of the frequency of pathology to
the number of patients with chronic pathology in the
group was 1.69 and 1.54. In patients with extragenital
diseases of different localization, the combination of
two was most often noted (22.2 and 25% in groups of 4
and 5 women, respectively), less often - the
combination of 3 or 4 extragenital chronic diseases
(16.77% and 20 % respectively) was observed.
Thus, approximately one-third of women in each group
had a combined extragenital pathology, a similar
percentage of patients did not have a severe somatic
background, and a slightly larger part had monoorgan
pathology. Statistical intergroup analysis of the
structure of extragenital pathology in pregnant
women did not reveal significant differences between
groups (p>0.05).
The age of menarche was almost the same in the
groups and was on average 13.1 ± 1.2 years. Menarche
was on time in most women (11 - 61.1% in group 1 and 13
- 65% in group 2), 7 women in groups (38.9% and 35%),
respectively, with a late onset of menstruation, no
statistically significant differences between groups
were detected.
The studied groups were compared according to the
incidence of uterine pathology: fibroids in one woman
in each group, endometriosis in 11.1% and 10%,
endometritis in 33.3% and 35%, respectively, as well as
salpingo-oophoritis (3 - 16, 7% and 3 - 15.0, p>0.05),
there were gynecological diseases such as polycystic
ovary syndrome (4 - 22.2% and 3 - 15.0%, p>0.05).
In patients with chronic salpingo-oophoritis and/or
endometritis of indolent character, treatment is
difficult and there is a tendency to many recurrences,
therefore, a complete examination was carried out
with identification of pathogens by microbiological or
molecular biological methods. Due to the high
frequency of infectious and inflammatory diseases of
the genitals (endometritis, salpingo-oophoritis), we
analyzed the spectrum of previously identified bacteria
and viruses in women from both groups. A number of
microorganisms such as Candida (38.9% and 35%),
herpes simplex virus (22.2% and 25%), cytomegalovirus
(5.56% and 20%) were at high levels in the examined
patients. Mycoplasmas (11.1% and 15%), gardnerella
(16.7% and 15%), and chlamydia (11.1% and 10%) were less
common, statistically significant differences between
groups were not detected.
According to the obstetric anamnesis of women in the
examined groups, all women were pregnant again,
there was no significant difference between the
groups in pregnancy and delivery parity, p>0.05. 18
(47.36%) women who gave birth for the first time, 20
(52.54%) women who gave birth again made up 20
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(52.54%) women. Of interest was the study of previous
pregnancy outcomes in patients.
When analyzing the reproductive activity of women, a
high frequency of non-developing pregnancy (33.3%
and 35% in the groups) and medical abortions was
revealed, the latter was 27.8% in the main group and
20% in the comparison group. In addition, the
frequency of spontaneous abortions was also high -
16.7% and 20% by group, respectively.
When the complications that occurred during previous
pregnancies were studied, they were often
complicated by the threat of abortion in the early
stages of pregnancy in women: 12 - 66.7% in group 1 and
60% in group 2, as well as chronic placental insufficiency
- 8 (44.4 %) and 9 (45%) women, respectively, by group,
p>0.05. Also, cases of premature birth in group 1 - 5
(27.8%) women, in group 2 - 4 (20.0%) and uterine
infection - 3 women by group, respectively 16.7% and
detected in 15%, p>0.05. The rate of anemia during
previous pregnancies was very high - in 12 patients in
group 1 (66.7%), in group 2 - in 10 patients (50%), p<0.05.
The most common complications of childbirth are
premature infusion of amniotic fluid (4 in group 1 - 22.2%
and in group 2 5-25%) and acute fetal hypoxia (3-16.7%
and 3-15%). In group 1, the postpartum period was
complicated by endometritis in one patient (5.56%),
subinvolution in 3 cases (16.7%), and in group 2, the
postpartum period was complicated by subinvolution
in 4 cases (20%) complicated, p>0.05.
When analyzing the characteristics of pregnancy, its
pathological changes in all trimesters attract attention.
At the same time, the most frequent complication was
early toxicosis: in 7 (38.9%) pregnant women in group
1, in 7 (35%) in group 2. Threatened abortion, clinically
characterized by pain in the lower abdomen, bloody
discharge from the genital tract, increased uterine
tone, was detected in 6 (33.3%) women in group 1 and
5 (25%) in group 2 in the first trimester. In the II
trimester, from 4 people in groups (22.2% and 20%,
respectively). When the groups were compared in
terms of pregnancy complications in the first and
second trimesters, no significant differences were
found (p>0.05).
Anemia was also more common - observed in 13 (72.2%)
and 15 (75%) women in the groups, respectively. When
ozone therapy was used in the complex treatment of
chronic FPY, a positive trend was identified from the
point of view of clinical blood analysis. The initial
number of erythrocytes in the studied groups did not
have a statistically significant difference (3.59x10 "/or
3.61x10 / l, p> 0.5). After introducing efferent methods
into the standard course of treatment in the group of
pregnant women, group 2 (from 3.61x10/l to
3.71x1012/l) a statistically significant (p<0.001) trend of
increase was revealed (from 3.59x10"/l to 3.85x10"/l).
Hemoglobin level, without significant differences
between groups before therapy, in group 1 - 93.6 g / l
and in group 2 - 92.4 g / l, (p> 0.2), after the respective
treatment both although it increased in the group, its
increase was statistically significant (p<0.001) only in
the 1st group. From 93.6 g/l to 124.1 g/l in group 1, from
92.4 g/l to 105.2 g/l in group 2.
Initially, patients in both groups had decreased serum
protein (59.3 and 60.4 g/l in the groups, respectively),
but none of the patients had clinical manifestations of
hypoproteinemia. It can be seen that the protein level
in pregnant women of group 1 after 3 weeks of ozone
therapy sessions did not change clinically and was 62.8
g/l, p<0.001. In group 2, the amount of total protein in
the blood plasma did not change significantly and was
61.2 g / l.
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The average level of bilirubin, urea and creatinine
decreased significantly after efferent methods of
therapy. The data presented show a statistically
significant decrease in the level of liver enzymes after
the complex method of therapy.
The results of the study showed that both groups had
signs of activation of intravascular coagulation, which
is characteristic of patients with chronic placental
insufficiency against the background of pregnancy
complications, in which high levels of fibrinogen were
noted. Patients in the main group were prescribed
ozone therapy + anticoagulants, pregnant comparison
groups were given anticoagulant therapy with low
molecular weight heparins.
After therapy, the level of fibrinogen in both group 1
and group 2 (by 25% and 4.2 g/l in group 1, by 15.8% and
4.8 g/l in group 2 increased), indicators of platelet
aggregation (in group 1 decreased by 24.3% to 44.3%, in
group 2 - decreased by 20.8% to 45.4%) and
prothrombin index (1 - group decreased by 18.5% to
96.4%, in group 2 - decreased by 15.5% to 99.2%)
significantly decreased (p<0.01-0.001).
CONCLUSIONS
Thus, the timely complex therapy of FPI using
traditional and ozone therapy methods helped to
correct the changes in the blood coagulation system
and normalize the hemostasiological indicators of the
examined patients, in our study, in the main group, the
blood clotting potential due to plasma and platelet
connections was significantly increased. stabilization
was observed. At the same time, the biochemical blood
analysis showed a slight increase in the total protein
content, a decrease in the level of liver enzymes, an
improvement in the functioning of the div's natural
detoxification systems, and a significant decrease in
the level of endogenous intoxication.
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