Profilaktik tibbiyot va salomatlik
–
Профилактическая
медицина
и
здоровье
–
Preventive Medicine
and Health
Journal home page:
https://inscience.uz/index.php/preventive-medicine
Prevention of reproductive loses in women with genital
tract infections
Kamola NASRIDDINOVA
Andijan State Medical Institute
ARTICLE INFO
ABSTRACT
Article history:
Received April 2023
Received in revised form
10 May 2023
Accepted 25 May 2023
Available online
15 August 2023
The article discusses the complications of pregnancy in
women with sexually transmitted infections, including the risk
of miscarriage, miscarriage, preterm birth and their impact on
pregnancy. The problem of protecting the health of mother and
child is considered as the most important component of health
care, which is of paramount importance for the formation of a
healthy generation of people from the earliest period of their
life. Among the most important problems of practical obstetrics,
one of the first places is occupied by miscarriage. The frequency
of miscarriage is 10-25% of all pregnancies, 5-10%
–
preterm
birth. Premature babies account for over 50% of stillbirths,
70-80% of early neonatal deaths, and 60-70% of infant
mortality. Premature babies die 30-35 times more often than
full-term babies, and perinatal mortality in miscarriage is
30-40 times higher than in term births. Thus, miscarriage does
not lose its relevance in modern obstetrics. Miscarriage
–
spontaneous termination of pregnancy at various times from
conception to 37 weeks, is considered from the 1st day of the
last menstruation to 259 days from this date. According to the
World Health Organization, preterm births are defined as births
between 22 and 37 completed weeks of gestation, counting
from the first day of the last menstrual period, with a fetal
weight of 500 g or more. The most common causes of
miscarriage are: genital infections, endocrine disorders of the
reproductive system; erased forms of adrenal dysfunction;
damage to the receptor apparatus of the endometrium,
clinically manifested as an inferior luteal phase (NLF); chronic
endometritis with persistence of opportunistic microorganisms
and/or
viruses;
isthmic-cervical
insufficiency
(ICN);
Keywords:
high-risk pregnancy,
miscarriage,
genital infection,
preterm delivery,
management,
prevention.
1
Department of
Obstetrics and Gynecology №2, Andijan State Medical Institute
.
E-mail: www.kamolka-91@mail.ru
2
Department of Obstetrics and Gynecology, Traumatology and Orthopedics, Neurosurgery and Sports Medicine of
FAT, Andijan State Medical Institute. E-mail: www.oltinoy62@mail.ru
Profilaktik tibbiyot va salomlatlik
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Профилактическая медицина и здоровье–
Preventive Medicine and Health
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malformations of the uterus; intrauterine synechia;
antiphospholipid syndrome and other autoimmune disorders.
2181-3663
/©
2023 in Science LLC.
https://doi.org/10.47689/2181-3663-vol2-iss4-pp6-10
This is an open-access article under the Attribution 4.0 International
(CC BY 4.0) license (
https://creativecommons.org/licenses/by/4.0/deed.ru
Жинсий йўллар инфекцияси мавжуд бўлган аёлларда
репродуктив йўқотишлар профилактикаси
АННОТАЦИЯ
Калит сўзлар:
аборт
,
генитал инфекция
,
эрта туғилиш
,
тактика
,
олдини олиш.
Мақолада жинсий йўллар инфекцияси мавжуд аёлларда
ҳомила тушиш хавфи
,
эрта туғруқ ва уларнинг
ҳомиладорлик жараёнига таъсири муҳокама қилинади.
Она ва бола саломатлиги муаммоси соғлиқни сақлашнинг
энг муҳим таркибий қисми сифатида қаралади
,
бу эса
инсон ҳаётининг дастлабки давриданоқ соғлом авлодни
шакллантиришда
муҳим
аҳамиятга
эга.
Амалий
акушерликнинг энг муҳим муаммолари орасида биринчи
ўринлардан бири ҳомиладорликдир. Ҳомиладорликнинг
тушиши барча ҳомиладорликларнинг 10
-
25% ни
,
эрта
туғилишнинг 5
-
10% ни ташкил қилади. Эрта туғилган
чақалоқлар ўлик туғилишнинг 50% дан ортиғини
,
эрта
неонатал ўлимнинг 70
-
80% ва чақалоқлар ўлимининг
60-
70% ни ташкил қилади. Эрта туғилган болалар тўлиқ
туғилганларга қараганда 30
-
35 баравар тез
-
тез ўлишади ва
абортда перинатал ўлим тўлиқ туғилганларга қараганда
30-
40 баравар юқори. Шундай қилиб
,
аборт замонавий
акушерликда ўз аҳамиятини йўқотмайди. Аборт
–
ҳомиладорликнинг
концепциядан бошлаб 37 ҳафтагача
бўлган турли босқичларида ўз
-
ўзидан тугаши
,
охирги
ҳайзнинг 1
-
кунидан бошлаб шу кундан бошлаб 259 кунгача
ҳисобланади. Жаҳон соғлиқни сақлаш ташкилоти
маълумотларига кўра
,
эрта туғилиш ҳомиладорликнинг
22 дан 37 ҳафтагача тугалланган
,
охирги ҳайзнинг биринчи
кунидан бошлаб
,
ҳомила
оғирлиги 500 г ва ундан ортиқ
бўлган тугилиш деб таърифланади. Абортнинг энг кўп
учрайдиган сабаблари: жинсий йўл билан юқадиган
инфекциялар
,
репродуктив
тизимнинг
эндокрин
касалликлари;
адренал
дисфункциянинг
ўчирилган
шакллари; пастки лутеал фаза (ЛЛП) сифатида клиник
жиҳатдан намоён бўлган эндометриал рецепторлари
аппарати
шикастланиши;
оппортунистик
микроорганизмлар ва / ёки вирусларнинг давом этиши
билан
сурункали
эндометрит;
истмик
-
цервикал
этишмовчилик (ИЦЕ); бачадоннинг малформацияси;
интраутерин синехия; антифосфолипид синдроми ва
бошқа автоиммун касалликлар.
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Профилактика репродуктивных потерь у женщин с
инфекциями генитального тракта
АННОТАЦИЯ
Ключевые слова:
невынашивание
беременности
,
генитальная инфекция
,
преждевременные роды
,
тактика
,
профилактика
.
В статье рассматриваются осложнения беременности у
женщин с инфекциями
,
передающимися половым путем
,
включая риск невынашивания
,
преждевременных родов и
их влияние на течение беременности. Проблема охраны
здоровья матери и ребенка является важнейшей
составляющей
здравоохранения
,
поскольку
имеет
первостепенное значение для формирования здорового
поколения с самого раннего периода жизни. Среди основных
проблем акушерской практики одно из первых мест
занимает невынашивание беременности. Частота случаев
невынашивания составляет 10
-
25% всех беременностей
,
а
преждевременные роды составляют 5
-10%.
На долю недоношенных детей приходится более 50%
случаев мертворождения
, 70-
80% ранней неонатальной
смертности
и
60
-
70%
младенческой
смертности.
Недоношенные дети умирают в 30
-
35 раз чаще
,
чем
доношенные
,
а
перинатальная
смертность
при
невынашивании в 30
-
40 раз выше
,
чем при своевременных
родах.
Таким
образом
,
проблема
невынашивания
беременности остается актуальной в современном
акушерстве.
Выкидышем считается самопроизвольное прерывание
беременности на сроке до 37 недель
,
начиная с первого дня
последней менструации (или до 259 дней от этой даты). По
данным
Всемирной
организации
здравоохранения
,
преждевременные
роды
определяются
как
роды
,
происходящие между 22 и 37 полными неделями
беременности
,
при весе плода 500 г и более.
К основным причинам невынашивания беременности
относятся: половые инфекции
,
эндокринные нарушения
репродуктивной системы
,
скрытые формы дисфункции
надпочечников
,
нарушения
рецепторного
аппарата
эндометрия (например
,
недостаточность лютеиновой
фазы)
,
хронический эндометрит с персистенцией условно
-
патогенных микроорганизмов и/или вирусов
,
истмико
-
цервикальная недостаточность
,
а также пороки развития
матки
,
внутриматочные синехии
,
антифосфолипидный
синдром и другие аутоиммунные заболевания.
INTRODUCTION
Chlamydia, mycoplasmosis, ureaplasmosis, gardnerellosis, cytomegalovirus and
herpes virus) has become of particular importance in obstetric and gynecological
practice. It can cause infertility, and when pregnancy occurs, it can cause miscarriage;
with the progression of pregnancy, it can cause congenital malformations of the fetus and
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neuropsychiatric diseases in newborns. Infection of the genital tract does not leave
behind stable immunity; in pregnant women, they occur in a chronic or latent form,
without causing much concern [1, 2, 3, 4, 7]. Infection of the genital tract is the cause of a
wide range of antenatal pathologies: infectious diseases of the fetus, fetoplacentali
nsufficiency, stillbirth, miscarriage, fetal growth retardation and anomalies in its
development. Along with the acute course of infection in the fetus and newborn, a long-
term persistence of the pathogen can be observed with the formation of a latent, slow-
moving chronic infectious process. Infectious pathology of the fetus is often hidden
behind such diagnoses as intrauterine hypoxia, asphyxia, intracranial trauma of the
newborn. In many countries, more than 70-80% of the population becomes infected with
HSV-1 (HSV-1) during childhood. This to some extent protects against infection with
HSV-2 type (HSV-2), traditionally considered the causative agent of genital herpes.
Serological studies show that 15-70% of the population have antibodies to HSV-1 and
approximately 20% of the population to HSV-2 [2, 4, 8]. Intrauterine infection in the first
trimester of pregnancy may result in spontaneous miscarriage. There are cases of
congenital herpes, manifested by microphthalmia, choreoretinitis and microcephaly [1, 3,
6, 7]. Ureaplasmaurealyticum, a member of the Mycoplasmataceae family, is often part of
the vaginal microflora. This microorganism has been found in fetal membranes
duringpreterm birth and has also been isolated from the lung tissue of newborns who
died of pneumonitis. [6, 7, 8]. Mycoplasma genitalium causes a spectrum of diseases
similar to chlamydial infection (cervicitis, inflammatory diseases of the internal genital
organs, non-gonococcal urethritis) [6, 7, 8]. Cytomegalovirus belongs to the herpesvirus
family and therefore is capable of causing a latent current infection. The frequency is 1 in
200 pregnant women. In 40% of cases, intrauterine infection of the fetus occurs. The
main symptoms of intrauterine cytomegalovirus infection include microcephaly,
blindness and deafness, pneumonitis, choreoretinitis, brain calcifications and IUGR [1, 6,
7, 8]. Once in the human div, the cytomegalovirus multiplies and is released from it for
weeks, months (when an adult is infected) and even years (when a child is infected).
Penetrating into lymphocytes, it remains in the human div throughout his life and
therefore can be transmitted through blood transfusion or organ transplantation. From
time to time, reactivation of the virus occurs, accompanied by its release from the host
div through the genitourinary or respiratory tract. [1, 2, 5, 6, 8]. Infection of the genital
tract does not leave behind stable immunity; in pregnant women, they occur in a chronic
or latent form, without causing much concern.
The purpose of the work:
to assess the impact of genital tract infections on the
reproductive function of women.
MATERIAL AND METHODS OF RESEARCH
We analyzed 50 case histories of women admitted to the gynecological department of
the maternity hospital No. 2 in Andijan with a threat of abortion in 2022. All women, along
with clinical, laboratory and instrumental research methods, underwent a comprehensive
bacteriological examination of secretions from the genital tract. The study was carried out
using microbiologicalresearch methods to determine the type of flora.
RESULTS OF OWN RESEARCH
By age, patients were distributed as follows: under 20 years old
–
7, from 21 to
30 years old
–
34, from 31 to 35 years old
–
9 women. The gestational age at admission
was up to 16 weeks in 40 women, from 17 to 20 weeks and more
–
in 10. Of the
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50 patients admitted, 10 were primigravid, the remaining 40 were re-pregnant: 18 of
them had one abortion in history, 12 had 2 -3, 10-more than 3 abortions. 14 women had a
history of spontaneous miscarriages, 17 had given birth in the past and 3 were operated
on for ectopic pregnancy, 37 had gynecological diseases in the past: 16 women had
chronic adnexitis, 14 women had cervical erosion, chronic gonorrhea in 2, and one had
violation of the menstrual cycle, another one had isthmic-cervical insufficiency, which
required the imposition of a circular suture on the cervix during pregnancy. A burdened
somatic history was detected in 14 women: 12 women had chronic pyelonephritis,
2 women had chronic hypertension. The observed pregnancy in all proceeded with the
phenomena of threatened miscarriage. During examination for urogenital infection,
chlamydia was found in 7 women, gardnerellosis in 7, trichomoniasis in 6,
mycoplasmosis in 4, ureaplasmosis in 7, cytomegalovirusinfection was detected in
3 women and herpes virus in 2 women. Bacteriological examination revealed
streptococcus, enterococcus in 3 women and E. coli in 3 women; candidiasis was detected
in 9 patients. Mixed infection was noted in 11 examined pregnant women: gardnerellosis
and streptococcosis, gardnerellosis and chlamydia, etc. Of the 50 women hospitalized
because of the threat of abortion, only 11 did not have infectious inflammatory diseases.
In the hospital, patients received conservation therapy: no-spa, papaverine suppositories,
aevit, hormone therapy with duphaston or utrozhestan, as well as, if indicated, antibiotic
therapy. Of the 50 patients, 48 were discharged with a progressive pregnancy, 2 women
had a spontaneous miscarriage.
CONCLUSION
Thus, infections of the genital tract have a significant impact on the course of both
present and subsequent pregnancies. Therefore, the prevention and treatment of genital
tract infections in the preconception program improves the outcomes of both pregnancy
and childbirth.
REFERENCES:
1. Campbell S T., Lisa K., eds. Obstetrics from ten teachers: Per. from English. 17th
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2. Radzinsky V.E., Orazmuradov A.A. Early pregnancy. M., 2005.
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4. American College of Obstetricians and Gynecologists. Management of recurrent
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5. Azam AZ, Vial Y, Fawer CL, et al: Prenatal diagnosis of congenital
cytomegalovirus infection. obstetGynecol 97:443, 2001
6. Baud D, Greub G: Intracellular bacteria and adverse pregnancy outcomes. Clinic
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