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RISK FACTORS FOR PREGNANCY AND CHILD IN PRINCIPAL WOMEN
OF OLDER REPRODUCTIVE AGE
Haydarova Firuza Abdumalikovna
Asian International University, Bukhara, Uzbekistan
https://doi.org/10.5281/zenodo.17214966
Introduction.
In all countries, there is a growing number of women who are 35 years of
age or older at the time of their first birth. [1,4]. According to the literature data, there is the fact
that the age of a woman during the first pregnancy and childbirth is directly related to the
influence of extragenital pathology on the course of the gestational process, delivery [5]. The
negative impact of extragenital diseases on the course of pregnancy is manifested by
characteristic complications of pregnancy and childbirth, and also affects perinatal morbidity
and mortality [2,3].
Key words:
perinatal morbidity, pregnancy, perinatal outcomes, epidemiological case-
control, reproductive period.
ФАКТОРЫ РИСКА БЕРЕМЕННОСТИ И РОЖДЕНИЯ РЕБЕНКА У ОСНОВНЫХ
ЖЕНЩИН СТАРШЕГО РЕПРОДУКТИВНОГО ВОЗРАСТА
Введение.
Во всех странах мира отмечается рост числа женщин, достигших на
момент первых родов возраста 35 лет и старше [1,4]. Согласно данным литературы,
возраст женщины при первой беременности и родах напрямую связан с влиянием
экстрагенитальной патологии на течение гестационного процесса и родов [5].
Негативное влияние экстрагенитальных заболеваний на течение беременности
проявляется характерными осложнениями беременности и родов, а также влияет на
перинатальную заболеваемость и смертность [2,3].
Ключевые слова:
перинатальная заболеваемость, беременность, перинатальные
исходы, эпидемиологический случай
-
контроль, репродуктивный период.
Therefore, the issue of planning pregnancy after 35 years must be taken very seriously, it
is necessary to undergo thorough examinations, including all kinds of genetic studies, consult a
geneticist and be ready for constant medical supervision throughout pregnancy.
Mandatory passage of all special tests and analyzes in order to identify fetal pathologies
and ultrasound diagnostics of fetal development [4]. No studies have been conducted that
determine a significant correlation between the age of the primipara, the degree of perinatal risk
and the frequency of perinatal morbidity, therefore, there are no clear age limits at which a
pregnant woman can be reliably attributed to a high-risk group.
Despite the huge interest in the course of pregnancy and childbirth, as well as perinatal
outcomes in primiparas older than 35 years, the problem is far from being understood and
resolved. The foregoing determined the relevance of this article.
Purpose of the study.
To study the anamnesis, the course of pregnancy and childbirth
and identify risk factors in nulliparous older reproductive age.
Materials and methods.
The study was conducted on the basis of the city perinatal
center. The city perinatal center is a large medical institution with an annual number of births of
more than 3500. For the study, the method of a retrospective clinical and epidemiological case-
control study was chosen (analysis of archival materials for 2015-2019). Statistical data
processing was carried out using the integrated system of complex statistical analysis and data
processing "SPSS-23 version".
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A retrospective analysis of the history of pregnancy, childbirth and individual cards of
newborns from a woman of the late reproductive period over the age of 35 years (n=100), a
comparison group (n=80) of pregnant women of a favorable reproductive age (20-25 years) was
carried out. The criteria for inclusion of patients were indicators such as residence in the city of
Shymkent, voluntary informed consent. Anamnestic data were studied; the levels of physical and
sexual development of adolescents, as well as the course of pregnancy, somatic and
gynecological health of patients were assessed.
Results of the study and their discussion.
Marital status of the majority of age
primiparas: “married” (73%). Most of them were working. Their age was 35.5 ± 1.87 years, in
group II: 24.1 ± 1.27 years. According to our data, the average age of menarche for group I is
14.02 ± 1.23 years for group III and 13.9 ± 1.52 years for group II. The average age at the
beginning of sexual activity: in the group of girls 20-
25 years old (II) = 18.9±1.1 years, in the
group of women 35 years and older (I)=18.9±1.26 years. Alas, 73.3% of age
-related primiparas
had a history of extragenital pathology. A quarter of all women were infertile, and 85% of
women still conceived naturally, and only 15% of them had to resort to assisted reproductive
technology programs. A high percentage of gynecological diseases was also noted - 73%. At the
same time, cervical ectopia was more common in 34%, uterine fibroids in 15%, various types of
inflammatory diseases - in 27%, ovarian cysts were in 8% of women.
The most common pathology in all groups were diseases such as anemia: in group I 58%,
in group II 50%; in groups I and II: kidney disease 38.3% and 28% of cases, respectively;
vegetative-vascular dystonia (VVD) in 25% and 22% of cases, respectively; in group I, the
cardiovascular system prevailed, mainly arterial hypertension 44%, obesity 39%, diseases of the
liver and biliary system 18%.
Among the complications of pregnancy, the threat of abortion in group I was noted in
48% of cases, in group II - 20%, severe preeclampsia in group I - 30%, group II - 6%, placental
insufficiency in 18% and 14% of cases, respectively.
An analysis of the history of childbirth showed that natural childbirth was observed in
40% of pregnant women of older reproductive age (group I), in 54% of cases in pregnant women
of a favorable reproductive age (group II). The frequency of operative delivery is statistically
significantly higher in the group of women of the late reproductive period - 60%, in group II -
46%. One case of antenatal fetal death was recorded.
Children born from age-related primiparas did not quantitatively differ by gender among
women in labor of a favorable reproductive age, so girls were born in 40%, and boys in 60%.
The Apgar score in the majority of children corresponded to the norm and most had more than 7
points at the end of 1 and 5 minutes after birth. About 12% of newborns had an Apgar score of
less than 7 points. As a result, 85% of them were diagnosed with “Newborn”, 12% were born in
asphyxia, 13% had other pathologies in the form of: intrauterine growth retardation,
bronchopulmonary dysplasia, interstitial pneumonia that occurred in the perinatal period,
extreme immaturity of 26 weeks, cysts choroid plexuses of the fetal brain. 83% of full-term
newborns were born with normal div weight and only 2.5% with large birth weight.
Conclusion.
Thus, this study confirms the presence of a high incidence of obstetric and
perinatal complications in pregnant women of older reproductive age. The course of pregnancy
and childbirth is accompanied by characteristic complications in the form of hypertensive
conditions and placental insufficiency.
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It should be noted that extragenital pathology, which in most cases accompanies
pregnancy at the age of 35 years or more, is predisposing to complications. Optimization of
pregnancy management in age-related primiparas should be based on earlier advisory follow-up
and planned hospitalization for targeted treatment of complications, as well as careful intranatal
risk reassessment.
Literature:
1.
Radzinsky V.E. Ovarian reserve and fertility: Challenges of the 21st century. A rational
approach to preserving the reproductive reserve as a guarantee of fertility and conscious
childbearing. - M.: Status Praesens, 2015. - 54 p.
2.
Reproductive plans: to preserve and increase the potential. Results of the meeting of
Russian doctors with the leadership of the European Society of Gynecologists and the
European Society for Contraception and Reproductive Health (Moscow, March 12
–
13,
2013) / T.S. Ryabinkina, H.Yu. Simonovskaya, S.A. Makletsov. - M .: Editorial staff of the
Status Praesens magazine, 2013. - 24c.
3.
Pregnant XXI century: it is more difficult than ever. Why is it necessary to take care of the
optimal folate status of a pregnant woman? Newsletter / T.V. Galina, T.A. Dobretsova; ed.
V.E. Radzinsky. - M.: Editorial staff of Status Praesens, 2015. - 20 p.
4.
Older reproductive age: contraception and more. Rational contraception of older women:
contraceptive and non-contraceptive aspects. Newsletter / T.S. Ryabinkina, H.Yu.
Simonovskaya, O.D. Rudnev; ed. V.E. Radzinsky. - M .: Editorial staff of Status Praesens,
2014. - 16 p.
5.
Contraception in older reproductive age. Newsletter / I.V. Kuznetsova, I.I. Ipastova; ed.
V.E. Radzinsky. - M .: Editorial staff of Status Praesens, 2016. - 24 p.
