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 August 2024
Received in revised form
10 September 2024
Accepted 25 September 2024
Available online
15 October 2024
The article discusses the complications of pregnancy in women
with sexually transmitted infections, including the risk of
miscarriage, premature birth and their impact on pregnancy. The
problem of protecting the health of mother and child is considered
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. One of the most
important problems of practical obstetrics is miscarriage. The
frequency of miscarriages is 10-25% of all pregnancies, 5
–
10%
–
premature births. Premature babies account for over 50% of
stillbirths, 70-80% of early neonatal deaths, and 60
–
70% of infant
mortality. Preterm babies are 30
–
35 times more likely to die than
full-term babies and perinatal mortality is 30
–
40 times higher for
miscarriages than for term births. Thus, miscarriage is not losing
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 menstrual
period to 259 days after 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 inferior luteal phase
(NLF); chronic endometritis with persistence of opportunistic
microorganisms and/or viruses; isthmic cervical insufficiency
(ICN);
uterine
malformations;
intrauterine
synechia;
antiphospholipid syndrome and other autoimmune disorders.
2181-3663
/©
2023 in Science LLC.
DOI:
https://doi.org/10.47689/2181-3663-vol3-iss5-pp77-81
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
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, ASMI Andijan, Uzbekistan. E-mail: www.oltinoy62@mail.ru
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Профилактическая медицина и здоровье
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Preventive Medicine and Health
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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
хомила тушиш хавфи, эрта туғруқ ва уларнинг
ҳомиладорлик жараёнига таъсири муҳокама қилинади. Она
ва бола саломатлиги муаммоси согғлиқни сақлашнинг энг
муҳим таркибий қисми сифатида қаралади, бу эса инсон
ҳаётининг дастлабки давриданоқ согғлом авлодни
шакллантиришда
муҳим
аҳамиятга
эга.
Амалий
акушерликнинг энг муҳим муаммолари орасида биринчи
ўринлардан бири ҳомиладорликдир. Ҳомиладорликнинг
тушиши барча ҳомиладорликларнинг 10–25% ни, эрта
тугғилишнинг 5–
10
% ни ташкил қилади. Эрта тугғилган
чақалоқлар ўлик тугғилишнинг 50% дан ортигғини, 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
концепсиядан 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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Preventive Medicine and Health
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Профилактика репродуктивных потерь у женщин с
инфекциями генитального тракта
АННОТАЦИЯ
Ключевые слова:
не вынашивание
беременности,
генитальная инфекция,
преждевременные роды,
тактика,
профилактика
.
В статье рассматриваются осложнения беременности у
женщин с инфекциями, передающимися половым путем, в
том
числе
риск
невынашивания
беременности,
преждевременных родов и их влияние на течение
беременности. Проблема охраны здоровья матери и
ребенка рассматривается как важнейшая составляющая
охраны здоровья, имеющая первостепенное значение для
формирования здорового поколения людей с самого
раннего периода их жизни. Среди важнейших проблем
практического акушерства одно из первых мест занимает
невынашивание беременности. Частота невынашивания
беременности составляет 10–25% всех беременностей,
5
–
10%
–
преждевременных родов. На долю недоношенных
детей приходится более 50% мертворождений, 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 беременности в 30–40 раз выше, чем при
рождении в срок. Таким образом, невынашивание
беременности
не
теряет
своей
актуальности
в
современном акушерстве. Выкидыш –
самопроизвольное
прерывание беременности на различных сроках от зачатия
до 37 недель, считается с 1
-
го дня последней менструации
до 259 дней от этой даты. По данным Всемирной
организации
здравоохранения,
преждевременными
родами считаются роды в период между 22 и 37 полными
неделями беременности, считая с первого дня последней
менструации, с массой плода 500 г и более. Наиболее
частыми
причинами
невынашивания
беременности
являются: половые инфекции, эндокринные нарушения
репродуктивной системы; стертые формы нарушения
функции
надпочечников;
поражение
рецепторного
аппарата эндометрия, клинически проявляющееся в виде
нижней лютеиновой фазы (НЛФ); хронический эндометрит
с персистенцией условно
-
патогенных микроорганизмов
и/или вирусов; истмико
-
цервикальная недостаточность
(ИЦН); пороки развития матки; внутриматочные синехии;
антифосфолипидный синдром и другие аутоиммунные
заболевания.
INTRODUCTION
Chlamydia, mycoplasmosis, ureaplasmosis, gardnerellosis, cytomegalovirus, and
herpes virus have become of particular importance in obstetric and gynecological
practice. It can cause infertility, and when pregnancy occurs, it can cause miscarriage;
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Профилактическая медицина и здоровье
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with the progression of pregnancy, it can cause congenital malformations of the fetus and
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, fetoplacental
insufficiency, 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, and 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 is 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 microbiological research 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
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and more
–
in 10. Of the 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, and 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, and 2 women had chronic hypertension. The observed
pregnancy in all proceeded with the phenomena of threatened miscarriage. During an
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, and 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.
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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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Azam AZ, Vial Y, Fawer CL, et al: Prenatal diagnosis of congenital
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