Analysis of the results of severe oligohydroamnions in pregnant women in the perinatal center of Pavlodar for 2018 year Текст научной статьи по специальности «Клиническая медицина»

¿y SMT ]65 Original article

^ SF.MRY MEDICAL UNIVERSITY

Received: 24 March 2019 / Accepted: 19 June 2019 / Published online: 30 June 2019

UDC 618.3:615.07 (574.25)

ANALYSIS OF THE RESULTS OF SEVERE OLIGOHYDROAMNIONS IN PREGNANT WOMEN IN THE PERINATAL CENTER OF PAVLODAR FOR 2018 YEAR

Aizhan Zh. Alipanova 1, http: //orcid.org/0000-0003-4592-0014 Zhansulu E. Akylzhanova 1, https://orcid.org/0000-0001-6855-127X Tatiana M. Dernova 1, https://orcid.org/0000-0001-7609-1568 Oksana I. Shalbaeva 1, https://orcid.org/0000-0002-9646-1981

1 Department of Emergency Medicine, Obstetrics and Gynecology course Pavlodar branch of the NCJSC "Semey Medical University" Pavlodar c., Republic of Kazakhstan

Summary

Relevance: One of the insufficiently studied sections in the perinatal obstetrics is the pathology of amnion, particularly oligohydramnios, characterized by reducing the amount of amniotic fluid in the second half of pregnancy, decline the vertical depth of the pocket - 2 cm or less or amniotic fluid index of less than 5 cm. Estimation of the volume of amniotic fluid is an integral part of antenatal care. Physiological fluid volume increases with gestational age up to 36-37 weeks. The relationship of oligohydramnios with high rates of perinatal mortality in the modern obstetrics determines the relevance of the study.

Objective: to identify the risk factors of severe oligohydramnios, examine the condition of the fetus during pregnancy, the methods of delivery and perinatal outcomes at the oligohydramnios.

Materials and methods: Study design - retrospective study. For the period 01.01 to 09/31/2018y was 3036 labors, out of which labors with oligohydramnios amounted 222 labors 7.3%. The analysis of the work consisted in comparing 2 groups of women with moderate and severe oligohydramnios. The main group consisted of 24 pregnant women with severe oligohydramnios. The control group included 29 pregnant women with oligohydramnios of moderate severity. The formation of a database of research and calculation of statistical indicators has been produced with the help of a licensed program SPSS 20.0 (IBM Ireland Product Distribution Limited, Ireland). For the statistical results using Student's t-test.

Results and discussion. At the studying medical records, both groups did not undergo pregravid preparation before pregnancy. In the study of anamnesis and complications during pregnancy found that acute respiratory, infectious disease during pregnancy in the main group is - 5(20.8%), in the control group - 4(10.3%). Gestational diabetes mellitus during pregnancy was diagnosed in the main group of 1(4.1%), in the control group 5(17.2%). Pre-eclampsia was complicated by labor in the main group 9(37.5%), and 5(17.2%) in the control group. In the study of somatic anamnesis, there is a high frequency of anemia of any degree in the main group 9(37.5%), in the control group 7(24.1%), a violation of fat metabolism in the main group 3(10.3%), in the control group 3(12.5%). 7(29.1%) of the main group had in anamnesis abortions and miscarriages, and in the control group 7(24.1%).

There is a large percentage of prenatal complications at severe oligohydramnios, associated with the fetus. Violation of fetal-placental circulation in the main group is 5(20,8%), in the control group - 4(10,3%.). Developmental delay syndrome of fetus in the main group is 8(33,3%), while in control group - 6(20,6%). In the intranatal period were noted such complications as: passage of meconium into the amniotic fluid in the main group - 2(8.3%) and in the control group - 1(3.4%); life-threatening conditions of fetus according to cardiotocography assessment - 12(50%) in the main group and 6 (20.6%) in the control group, respectively; weakness of labor activity was observed in women with severe oligohydramnios 1 (2.4%). In oligohydramnios, the number of operative labor is 2 times higher. In the main group, vaginal delivery in -13( 54%), operative delivery in - 11(46%). The control group had 12(41%) births through the birth canal, operative delivery in 17(59%). The perinatal outcomes of our analysis were rated on the Apgar scale: up to 5 points, in the main group -5(20.8%), and to the control group -2(6.8%), up to 7 points, in the main group is 10(41.6%) and in the control group -3(10.3%); and more than 7 points 9(37.6%) in main group and in the control group is 24(82.9%). This fact again shows that severe oligohydramnios affects the condition of the newborn. All newborns who born in serious condition were transferred to the neonatal intensive care unit.

Conclusions: Thus, the combination of pregnancy with extragenital pathology increases the risk of developing placental dysfunction and fetal hypoxia, which can affect the change in the quantity of amniotic fluid, next oligohydramnios significantly worsens the prognosis for the fetus and newborn. In the presence of severe oligohydramnios, placental insufficiency, threatened fetus condition, oligohydramnios should be considered as an aggravating factor of high perinatal risk, which is justified, expands the indications for emergency delivery in the interests of the fetus.

Key words: oligohydramnios, placental insufficiency, caesarean section, newborn.

' ' SF.MFY MFDK'AI. UNIVFRS1TY

Резюме

АНАЛИЗ РЕЗУЛЬТАТОВ ТЯЖЕЛЫХ МАЛОВОДИЙ У БЕРЕМЕННЫХ ЖЕНЩИН ПО ПЕРИНАТАЛЬНОМУ ЦЕНТРУ ГОРОДА ПАВЛОДАР ЗА 2018 ГОД

Айжан Ж. Алипанова 1, http://orcid.org/0000-0003-4592-0014 Жансулу Е. Акылжанова 1, https://orcid.org/0000-0001-6855-127X Татьяна М. Дернова 1, https://orcid.org/0000-0001-7609-1568 Оксана И. Шалбаева 1, https://orcid.org/0000-0002-9646-1981

Кафедра неотложной медицины, курс акушерства и гинекологии Павлодарский филиал НАО «Медицинский университет Семей», г. Павлодар, Республика Казахстан.

Актуальность: Одним из недостаточно изученных участков в перинатальном акушерстве является патология амниона, особенно маловодие, характеризующаяся уменьшением количества околоплодных вод во второй половине беременности, уменьшением вертикальной глубины кармана - на 2 см или более или индекс амниотической жидкости менее 5 см. Оценка объема околоплодных вод является неотъемлемой частью дородового наблюдения. Объем физиологической жидкости увеличивается с гестационным возрастом до 36-37 недель. Связь маловодия с высокими показателями перинатальной смертности в современном акушерстве определяет актуальность исследования.

Цель: выявить факторы риска развития тяжелых маловодии, изучить состояние плода во время беременности, методы родов и перинатальные исходы маловодии.

Материалы и методы: Ретроспективное исследование проведено в Павлодарском областном перинатальном центре. За период с 01.01.22018 г. по 09.31.2018 г. было 3036 родов, из которых роды с маловодием составили - 222 родов (7,3%). Был проведен анализ 2 групп женщин с маловодием средней и тяжелой степени тяжести. Основную группу составили 24 беременных с тяжелой формой маловодие. Контрольную группу составили 29 беременных с маловодием средней степени тяжести. Формирование базы данных исследований и расчета статистических показателей было произведено с помощью лицензионной программы SPSS 20.0. Для статистического результата использовали критерий Т-критерий Стьюдента.

Результаты и обсуждение. При изучении медицинских карт обе группы не проходили прегравидарную подготовку до беременности. При исследовании анамнеза и осложнений во время беременности установлено, что острые респираторные, инфекционные заболевания во время беременности в основной группе составляют -5(20,8%), в контрольной группе - 4(10,3%). Гестационный сахарный диабет во время беременности был диагностирован в основной группе - 1(4,1%), в контрольной группе - 5(17,2%). Преэклампсия осложнила роды в основной группе - 9(37,5%), а в контрольной группе - 5(17,2%). При исследовании соматического анамнеза наблюдается высокая частота анемии любой степени в основной группе - 9(37,5%), в контрольной группе - 7(24,1%), нарушение жирового обмена в основной группе - 3(12,5%,) в контрольной группе - 3(10,3%). 7(29,1%) основной группы имели в анамнезе аборты и выкидыши, а в контрольной группе -7 (24,1%).

Существует большой процент внутриутробных осложнений при тяжелых маловодиях, связанных с плодом. Нарушение плода-плацентарного кровообращения в основной группе составляет 5 (20,8%), в контрольной группе -3(10,3%). Синдром задержки развития плода в основной группе составляет 8 (33,3%), а в контрольной группе -6(20,6%). В интранатальном периоде были отмечены такие осложнения, как: прохождение мекония в околоплодные воды в основной группе - 2(8,3%) и в контрольной группе - 1(3,4%); опасные для жизни состояния плода по данным кардиотокографической оценки - 12(50%) в основной группе и 6(20,6%) в контрольной группе соответственно; слабость родовой деятельности наблюдалась у женщин с тяжелой формой маловодия - 1(2,4%). При тяжелом маловодии количество оперативных родов в 2 раза выше. В основной группе вагинальные роды в 13(54%), оперативные роды в - 11(46%). Контрольная группа имела 12(41%) родов через родовой канал, оперативные роды в 17(59%). Перинатальные результаты нашего анализа оценивались по шкале Апгар: до 5 баллов, в основной группе -5 (20,8%), в контрольной группе - 2(6,8%), до 7 баллов, в основной группе -10(41,6%), а в контрольной группе -3(0,3%); и более 7 баллов 9 (37,6%) в основной группе и в контрольной группе - 24(82,9%). Этот факт еще раз показывает, что тяжелое маловодие влияет на состояние новорожденного. Все новорожденные, которые родились в тяжелом состоянии, были переведены в отделение интенсивной терапии новорожденных.

Выводы: Таким образом, сочетание беременности с экстрагенитальной патологией повышает риск развития плацентарной дисфункции и гипоксии плода, что может повлиять на изменение количества околоплодных вод. Маловодие значительно ухудшает прогноз для плода и новорожденного. При наличии тяжелых маловодии, плацентарной недостаточности, угрожающего состояния плода, маловодие следует рассматривать как отягчающий фактор высокого перинатального риска, что оправдано, расширяет показания к экстренному родоразрешению путем оперативных абдоминальных родов в интересах плода.

Ключевые слова: маловодие, плацентарная недостаточность, кесарево сечение, новорожденный.

Л SMI lS3 Original article

^ SF.MRY MEDICAL UNIVERSITY

ТYЙiндеме

2018 Ж ПАВЛОДАР КАЛАСЫНЫН ПЕРИНАТАЛДЫК ОРТАЛЫГЫ БОЙЫНША ЖУКТ1 9ИЕЛДЕРДЕП АУЫР СУАЗДЫГЫНЫН

Н9ТИЖЕЛЕР1Н ТАЛДАУ

Айжан Ж. Алипанова 1, http://orcid.org/0000-0003-4592-0014 Жансулу Е. Акылжанова 1, https://orcid.org/0000-0001-6855-127X Татьяна М. Дернова 1, https://orcid.org/0000-0001-7609-1568 Оксана И. Шалбаева 1, https://orcid.org/0000-0002-9646-1981

1 Жедел медицина кафедрасы, акушерия мен гинекология курсы «Семей медицина университет» КеАК, Павлодар филиалы Павлодар каласы, Казахстан Республикасы

©зектiлiгi: Перинаталды акушериядагы толык зерттелмеген тараулардыщ бiрi каганак суы патологиясы, оныщ iшiнде жYктiлiктщ екiншi жартысындагы каганак суыныщ азаюымен,вертикальды капшыктыщ - 2см жэне одан темен немесе амниотикалык суйыктык индешнщ 5 см темендеуiмен сипаталатын жYктiлердщ суаздыгы. Амнионды суйыктыкты багалау босануга дейiнгi бакылаудыщ ажырамас белiгi болып табылады. Суйыктыктыщ физиологиялык келемi жYктiлiктщ мерзiмiмен бiрге 36-37 аптага дейЫ улгаяды. ^рп замангы акушерияныщ перинаталды багытындагы суаздыктыщ перинаталды елiмнiн жогары керсеткiшерiмен байланысы еткiзiлгелi отырган зерттеудщ езектiлiгiн д8лелдейдi.

Зерттеудщ максаты: суаздыктьщ ауыр д8режесЫщ кауiп факторларын аныктау, суаздык жавдайындагы жYктiлiк кезiнде урык жавдайын, босандыру 8дiстерiн ж8не перинаталды н8тижелердi зерттеу.

Материалдар мен эдютер: Зерттеу курылымы - ретроспективтi талдау. 2018 жылдыщ 01.01.мен 31.09. аралыгында 3036 босану болды, оныщ шнде суаздыкпен босану 222 - 7,3% курады. Жумыстыщ талдауы суаздыктыщ орташа ж8не ауыр д8режесi бар 8йелдердщ екi тобын салыстыру болып табылады. Непзп топка суаздыктыщ ауыр д8режес бар 24 8йел кiрдi. Бакылау тобын суаздыктыщ ортша д8режесi бар 29 8йел курады. Зерттеудщ м8лiметтер базасын ж8не статистикалык керсеткiшердi санау лицензионды SPSS 20.0 бавдарламасымен жYзеге асырлыды. Статистикалык н8тиже Yшiн Стьюдента критерялары колданылды

Нэтижелер: Медициналык кужаттарды зерттеу барсында екi топта да жYктiлiкке дейiнгi предгравидарлы дайындыктан етпеген. АнамнезЫ ж8не жYктiлiк кезiндегi аскынулар зерделей келе аныкталды: жYктiлiк кеандеп жедел респираторлы, жукпалы аурулар непзп топта -5 (20,8%), бакылау тобында 4(10,3%) кездесй ЖYктiлiк кезiнде гестациялык кантты диабет негiзгi топта - 1( 4,1%), бакылау тобында 5(17,2%). Босану преэклампсиямен аскынды негiзгi топта 9(37,5%), ж8не 5(17,2%) бакылау тобында. Соматикалык анамнезiн зерттеу кезiнде непзп топта анемияныщ кез келген д8режесЫщ жогаргы керсеткiшi аныкталды - 9(37,5%), бакылау тобында 7(24,1%), май алмасу бузылысы непзп топта 3(10,3%), бакылау тобында 3(12,5%). Непзп топтыщ 7(29,1%) анамнезще аборт ж8не тYсiктер болса, ал бакылау тобында 7(24,1%). Суаздыктыщ ауыр д8режесЫде урыктыщ босануга дейЫп аскынуларыныщ жогары пайызы байкалады. ¥рык-плацентарлы канайналым бузылысы негiзгi топта 5(20,8%), бакылау тобында 4(10,3%). ¥рыктыч дамуыныщ кiдiруi синдромы негiзгi топта 8(33,3%), бакылау тобында 6(20,6%). Интранаталды кезечде келесiдей аскынулар байкалды: меконийдщ амнионды суйыктыкка шыгуы негiзгi топта 2 (8,3%), ж8не бакылау тобында - 1(3,4%); кардиотокография багалауымен урыктыщ кау^ жавдайы 12(50%) негiзгi топта ж8не 6(20,6%) бакылау тобында с8йкесiнше; босану кызметЫщ 8лсiздiгi суаздыктыщ ауыр д8режелi 8йелдерде 1(2,4%) аныкталды. Суаздык кезЫде опративтi босандыру жиiлiг 2 есе артык. Негiзгi топта кынаптык босану 13(54%), оперативт босандыру 11(46%). Бакылау тобында 12(41%) босану табиги жолмен, оперативт босану 17(59%). Бiздiи талдауда перинаталды н8тижелер Апгар кестесiмен багаланды, 5 баллга дейiн негiзгi топта 5(20,8%), ал бакылау тобында 2(6,8%), 7 баллга дейЫ негiзгi топта 10(41,6%), бакылау тобында 3(10,3%) ж8не 7 баллдан жогары негiзгi топта 9(37,6%), бакылау тобында 24(82,9%) бул деректер суаздыктыщ ауыр д8режес жа^а туган н8ресте жавдайына 8сер ететУн керсетедi. Ауыр жагдайда туган жа^а тугандар н8рестелер реанимация белiмшесiне ауыстырылды.

Кортынды: Сонымен, экстрагенитальды патологиясы бар жYктiлiк, плацентарлы дисфункция мен урык гипоксиясы даму каупiн жогарылатады, ал ол ез кезепнде каганак суыныщ мелшерЫщ езгерiсiне 8келiп, суаздыктыщ ауыр д8режес урык пен жа^а туган н8рестенщ болжамын киындатады. Суаздыктыщ ауыр д8режеа, плацентарлы жетюпеуштк,урыктыч кауiп жавдайы бар кезде суаздыкты урык жавдайы Yшiн жедел босандыруга керсеткiштердi ке^ейтетЫ, перинаталды жогары кауiпiн ауырлатушы фактор ретЫде карастыру кажет.

Нег'1зг'1 сездер:суаздык, плацентарлы жетюпеушш, кесарь тшЫ, жаца туган нересте.

1 WJ SF.MFY MFDIOM. UNIVI RSITY

Библиографическая ссылка:

Алипанова А.Ж., Акылжанова Ж.Е., Дернова Т.М., Шалбаева О.И. Анализ результатов тяжелых маловодий у беременных женщин по Перинатальному центру города Павлодар за 2018 год // Наука и Здравоохранение. 2019. 3 (Т.21). С. 128-134.

Alipanova A.Zh., Akylzhanova Zh.E., Dernova T.M., Shalbaeva O.I. Analysis of the results of severe oligohydroamnions in pregnant women in the Perinatal center of Pavlodar for 2018 year. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 3, pp. 128-134.

Алипанова А.Ж., Акылжанова Ж.Е., Дернова Т.М., Шалбаева О.И. 2018 ж Павлодар каласыньщ Перинаталдьщ орталыгы бойынша жYктi эиелдердеп ауыр суаздыгыньщ нэтижелерЫ талдау // Гылым жэне Денсаульщ са^тау. 2019. 3 (Т.21). Б. 128-134.

Relevance

One of the insufficiently studied sections in the perinatal obstetrics is the pathology of amnion, particularly oligohydramnios, characterized by reducing the amount of amniotic fluid in the second half of pregnancy, decline the vertical depth of the pocket - 2 cm or less or amniotic fluid index of less than 5 cm. Estimation of the volume of amniotic fluid is an integral part of antenatal care. Physiological fluid volume increases with gestational age up to 36-37 weeks. Amniotic fluid performs several functions, including protecting the fetus from injury and infection, promote lung development and facilitate the development and movement of limbs and other skeletal parts. At the same time, in spite of the diversity and importance of the amnion medium functions, remains relatively limited number of studies devoted to this problem, in particular, oligohydramnios.

Violations of the amniotic fluid volume can contribute to the development of pregnancy complications and even fetal death. Amniotic fluid reduction may carry to increasing risk of complications during parturition at a high-risk pregnancy [6]. In severe oligohydramnios perinatal mortality rises 13 times [6]. In this regard, the amount of amniotic fluid and its composition are considered markers for prenatal risk evaluation [6]. The main reasons of the oligohydramnios are considered congenital anomalies, mainly urinary system (kidney agenesis, polycystic, urinary tract obstruction) and lungs (tracheal atresia, disorders of the pulmonary fluid production), placental insufficiency, post-term pregnancy, premature rupture of fetal membranes [7]. Complications of pregnancy and adverse effects for the fetus, caused by oligohydramnios, associated with lower fetal weight, staining of the amniotic veins with meconium, aspiration with meconium, lowering of umbilical cord pH, lower values of the Apgar scores, development of respiratory distress syndrome [8, 9].

The relationship of oligohydramnios with high rates of perinatal mortality in the modern obstetrics determines the relevance of the study.

Objective: to identify the risk factors of oligohydramnios, examine the condition of the fetus during pregnancy, the methods of delivery and perinatal outcomes at the oligohydramnios.

Study design: Retrospective study.

Materials and methods: The study was conducted on the basis of Pavlodar regional perinatal center, where for the period 01.01.2018 to 09.31/2018 y. was 3036 labors, out of which labors with oligohydramnios amounted 222 (7.3%.) labors At the study are provided retrospective analysis of the course of pregnancy and labors was carried

out in 222 patients with singleton pregnancies, without a scar on the uterus and whole fetal bladder. We have been studied and analyzed the primary medical documentation: individual cards of pregnant women, labors history, neonatal history, ultrasound diagnostic protocols. Oligohydramnios fact confirmed in all groups by ultrasound protocol in terms of diagnosing oligohydramnios, the Ministry of Health of the Republic of Kazakhstan from the 27th of December 2017. Depending on the number of IAF, pregnant women divided into 3 groups: 1-group 5-4 cm, 2-group 3.9-2.1 cm, 3-groups 2-1 cm and less this is the main group. The analysis of the work consisted in comparing 2 groups of women with moderate and severe oligohydramnios. In the course of the study of pregnancy during the surveyed women, it was established that from 222 labors, mild oligohydramnios occurred in 171 (77%), moderate 29 (12.2%), severe in 24 (10.8%) pregnant women.

The main group consisted of 24 pregnant women with severe oligohydramnios. The control group included 29 pregnant women with oligohydramnios of moderate severity.

The amount of water was determined by P.F. Chamberlain (ultrasonic measurement of the height of the free water "pocket") and J.P. Phelani (calculation of the amniotic fluid index by summing the height of the water column in 4 quadrants of the uterus) [14]. For all newborns evaluated their physical development. The perinatal state of the newborn was determined on the basis of Apgar's score at birth.

Access to the history of childbirth was agreed with the leadership of the medical institution.

The formation of a database of research and calculation of statistical indicators has been produced with the help of a licensed program SPSS 20.0 (IBM Ireland Product Distribution Limited, Ireland). For the statistical results using Student's T-test.

Results and discussion.

Pregnant women of the studied groups did not significantly differ in age. Age surveyed ranged from 18 to 44 years. Among surveyed in the main group, pregnant women over 30 years old made up 12 (50%), these women had an additional risk factor by age. When studying medical records, both groups did not undergo pregravid preparation before pregnancy.

In the study of anamnesis and complications during pregnancy found that acute respiratory, infectious disease during pregnancy in the main group is 5(20.8%), in the control group - 4(10.3%). Gestational diabetes mellitus during pregnancy was diagnosed in the main group of

.äsmu 65.

SF.MFY MEDICAL UNIVERSITY

Original article

Science & Healthcare, 2019, 3 (Vol. 21)

1(4.1%), in the control group 5(17.2%). Pre-eclampsia was complicated by labor in the main group 9(37.5%), and 5(17.2%) in the control group. In the study of somatic anamnesis, there is a high frequency of anemia of any degree in the main group 9(37.5%), in the control group 7(24.1%), a violation of fat metabolism in the main group 3 (10.3%), in the control group 3 (12.5%). 7 (29.1%) of the main group had in anamnesis abortions and miscarriages, and in the control group 7 (24.1%). In the main group, most frequently occurred extragenital diseases: urinary system diseases (chronic pyelonephritis, urolithiasis) -8(25%),

cardiovascular diseases (hypertension, vegetovascular dystonia, varicose disease of the lower extremities) -9(37.5%).

The fact of oligohydramnios was confirmed in all women of the main group by means of ultrasound examination, except oligohydramnios, assessed the fetus condition during pregnancy: the presence of fetal malformations, low fetus weight for gestational age, fetal developmental delay syndrome, impaired fetal-placental blood flow, the percentages are shown in diagram 1.

Diagram 1. Assessment of fetal condition during pregnancy by ultrasound diagnosis.

There is a large percentage of prenatal complications at severe oligohydramnios, associated with the fetus. Violation of fetal-placental circulation in the main group is 5(20,8%), in the control group - 4(10,3%). Developmental delay syndrome of fetus in the main group is 8(33,3%), while in control group - 6(20,6%). Small for gestational age fetus in the main group - 1(4,1%), in control group isn't noted. During the evaluation of fetal condition in the main group, small for gestational age fetus composed 1(4,1%). In this group, 5(20.5%) of women during pregnancy were diagnosed with pelvic presentation of the fetus, which may be explained by the restriction of the intrauterine space, as well as by a decrease in the motor activity of the fetus during hypoxia. In 15.4% of cases, the pelvic presentation of the fetus was preserved until delivery. An increase in the frequency of fetal growth retardation syndrome was noted in 8(33.2%) of the main group, and 5(20,6%) in the control

Complications of the intranatal period._

group. In the main group more often observed violation of the fetal-placental blood flow, which composed 5(20.8%), in the control group is 4(0.3%).

In the intranatal period, the fetal condition was assessed according to cardiotocography, signs of fetal suffering (rhythm monotony, decrease in the number and amplitude of accelerations, appearance of decelerations, decrease in heart rate variability, doubtful or reactive nonstress test) and the output of meconium into the amniotic fluid. In the intranatal period were noted such complications as: passage of meconium into the amniotic fluid in the main group - 2 (8.3%) and in the control group - 1 (3.4%); life-threatening conditions of fetus according to cardiotocography assessment - 12 (50%) in the main group and 6 (20.6%) in the control group, respectively; weakness of labor activity was observed in women with severe oligohydramnios 1 (2.4%). Tab. 1.

Table 1.

Main group n . OA Control group n . 9Q

Abs % Abs %

Meconium passage into the amniotic fluid 2 8,3% 1 3,4%

Life-threatening condition of fetus according to CTG assessment 12 50% 6 20,6%

Weakness of labor activity 1 2,4% 0 0

Next, we compared pregnant women with severe oligohydramnios. In diagram 2, it is shown by which method they were more often delivered. Indications for emergency caesarean section were the threatening conditions of the fetus, decompensated form of placental insufficiency, weakness of labor. Indications for a planned cesarean section were determined exclusively in each case,

depending on the clinical situation, and more often were combined: pelvic presentation, fetal growth retardation syndrome. In oligohydramnios, the number of operative labor is 2 times higher. In the main group, vaginal delivery in - 13 (54%), operative delivery in - 11 (46%). The control group had 12 (41%) births through the birth canal, operative delivery in 17 (59%).

ASMUÄ5

1 iw SF.MFY MEDICAL UNIVERSITY

70% 60% 50% 40% 30% 20% 10% 0%

54%

41%

59%

46%

Vaginal delivery Operative delivery

J main group ill control group

Diagram 2. Method of delivery.

Oligohydramnios was often diagnosed at 3rd screenings or after 28 weeks of pregnancy, if there were complaints on disturbed fetal movement according to recommendation of obstetrician-gynecologists. The study of the term of delivery showed a high incidence of preterm

birth up to 33.6 weeks in the main group - 6(25%), in the control group - 4(13.3%). From 34 to 36.6 weeks, in the main group - 8(33.3%), and the control group - 3(10.6%). In term, the birth in the main group - 10(41.7%), in the control group - 22 (76%).

100% 80% 60% 40% 20% 0%

up to 33,6 weeks from 34 to 36,6 weeks from 37 weeks and more

■ main group ■ control group

13,7% 10,3%

76%

25% 33,3%

41,7%

Diagram 3. Term of delivery.

The perinatal outcomes of our analysis were rated on the Apgar scale: up to 5 points, in the main group -5(20.8%), and to the control group - 2(6.8%), up to 7 points, in the main group is 10(41.6%) and in the control group - 3(10.3%); and more than 7 points 9(37.6%) in main group and in the control group is 24(82.9%). This fact again shows that severe oligohydramnios affects the condition of the newborn. Table 2. All newborns who born in serious condition were transferred to the neonatal intensive care unit.

Table 2.

Assessment of the condition of the newborn on the Apgar scale.

Conclusions:

1. Thus, in pregnant women with oligohydramnios significantly more frequent found anemia, severe pre-eclampsia, diseases of the circulatory system, past infectious diseases, miscarriage, abortion in anamnesis.

2. In severe oligohydramnios a significant frequency violation of fetal-placental circulatio is 5(20.8%), developmental delay syndrome of fetus is 8(33.3%), and small for gestational age fetus is 1(4.10%).

3. In severe oligohydramnios often preterm delivery before 33 weeks 6 days is 6(25%), and up to 36.6 weeks -8(33.3%).

4. On the background of severe oligohydramnios, very significant perinatal complications of the newborn: severe degree of newborn asphyxia 6(25%).

Conflict of interest: In conducting the study and writing of articles by the authors there is no conflict of interest.

The authors assure that no part of this work has not been published in other publications.

Authors contribution: Alipanova A.Zh. - a set of materials, data processing, article writing, article design. Akylzhanova Zh.E., Dernova T.M. - scientific leadership.,

Apgar score Main group n 24 Control group n 29

Abs % Abs %

up to 5 points 5 20,8% 2 6,8%

up to 7 points 10 41,6% 3 10,3%

7 and more 9 37,6% 24 82,9%

Л SMI lS3 Original article

^ SF.MRY MEDICAL UNIVERSITY

Literature:

1. Кулавский Е.В. Особенности течения беременности и родов при многоводии: Дис.канд. мед.наук. - Уфа, 2004. - 26 с.

2. Милованов А.П. Патология системы мать, плацента, плод: Руководство для врачей. - М.: Медицина, 1999.- 448 с.

3. Милованов А.П., Радзинский В.Е., Болтовская М.Н. Роль микроокружения в жизнеобеспечении эмбриона человека // Акушерство и гинекология. 2004. № 4. С.15-18.

4. Радзинский В.Е., Кондратьева Е.Н., Милованов А.П. Патология околоплодной среды. -Киев: Здоровье, 1993.- 128 с.

5. Сичинава Л.Г., Горюшина Н.Б., Устинова В.А. Течение беременности и родов при маловодии // Акушерство и гинекология. 2003. № 2. С.25-28.

6. Оценка состояния плодаво время беременност. Европейское региональное бюро ВОЗ. Учебный пакет поэффективной перинатальной помощи. Второе издание, 2015 г. С.39-115.

7. American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 101: Ultrasonography in pregnancy // Obstet Gynecol, 2009. 113, 451-461.

8. Blackwell S.C., Hassan S.S., Berry S.M. Abnormal amniotic fluid volume as a screening test prior to targeted ultrasound // Med. Sci. Monit. 2003. Vol. 9. №11. P.119-122.

9. Chamberlain P.F., Manning F.A., Morrison I. et al. Ultra, sound evaluation of amniotic fluid volume. I. The relation, ship of marginal and decreased amniotic fluid volumes to perinatal outcome // Am. J. Obstet. Gynecol. 1984. Vol. 150, № 3. P.245,249.

10. Kemna E.H., Tjalsma H., Willems H. et al. Hepcidin: from discovery to differential diagnosis // Haematologica. 2008; 93: 90-97

11. Locatelli A., Vergani P. Oligohydramnios in uncomplicated term pregnancies // Arch. Gynecol. Obstet. 2004. Vol. 269, № 2. P.130-133.

12. Locatelli A., Vergani P., Toso L., Verderio M, Pezzullo J.C., Ghidini A.Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. 2004 ujl Oligoamnios and Perinatal Outcome // J Obstet Gynecol India. 2017. 2017. № 4. P.45-70.

13. Routine Prenatal Care ICSI Management of Labor Guidelines for hospital-based care. August, 2005, 80 р.

References:

1. Kulavskii E.V. Osobennosti techeniya beremennosti i rodov pri mnogovodii: kand. dis. [Features of the course of pregnancy and childbirth with polyhydramnios] Ufa, 2004. 26 р. [in Russian]

2. Milovanov A.P. Patologiya sistemy: mat', platsenta, plod: Rukovodstvo dlya vrachei [Pathology of the system: mother, placenta, fetus: a guide for physicians]. -M.: Meditsina [M .: Medicine], 1999. 448 p. [in Russian]

3. Milovanov A.P., Radzinskii V.E., Boltovskaya M.N. Rol' mikrookruzheniya v zhizneobespechenii embriona cheloveka [The role of the microenvironment in the life support of the human embryo]. Akusherstvo i ginekologiya [Obstetrics and Gynecology] 2004. № 4. pp.15-18. [in Russian]

4. Radzinskii V.E., Kondrat'eva E.N., Milovanov A.P. Patologiya okoloplodnoi sredy [Pathology of the amniotic environment]. Kiev: Zdorov'e, 1993. 128 p. [in Russian]

5. Sichinava L.G., Goryushina N.B., Ustinova V.A. Techenie beremennosti i rodov pri malovodii [The course of pregnancy and childbirth with oligohydroamnios]. Akusherstvo i ginekologiya [Obstetrics and Gynecology].

2003. № 2. pp.25-28. [in Russian]

6. Otsenka sostoyaniya ploda vo vremya beremennost. Evropeiskoe regional'noe byuro VOZ. Uchebnyi paket effektivnoi perinatal'noi pomoshchi. Vtoroe izdanie [Assessment of the state of the fetus during pregnancy. WHO Regional Office for Europe. Training package for effective perinatal care. The second edition], 2015. P.39-115. [in Russian]

7. American College of Obstetricians and Gynecologists. (2009). ACOG practice bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol, 113, 451461.

8. Blackwell S.C., Hassan S.S., Berry S.M. Abnormal amniotic fluid volume as a screening test prior to targeted ultrasound. Med. Sci. Monit. 2003. Vol. 9. №11. P.119-122.

9. Chamberlain P.F., Manning F.A., Morrison I. et al. Ultra, sound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am. J. Obstet. Gynecol. 1984. Vol. 150, № 3. P.245-249.

10. Kemna E.H., Tjalsma H., Willems H. et al. Hepcidin: from discovery to differential diagnosis. Haematologica. 2008; 93: 90-97

11. Locatelli A., Vergani P. Oligohydramnios in uncomplicated term of pregnancies. Arch. Gynecol. Obstet.

2004. Vol. 269, № 2. P.130-133.

12. Locatelli A., Vergani P., Toso L., Verderio M, Pezzullo J.C., Ghidini A. Perinatal outcome associated with oligohydramnios in uncomplicated term of pregnancies. Oligohydramnios and Perinatal Outcome. J Obstet Gynecol, India. 2017. № 4. P.45-70.

13. Routine Prenatal Care ICSI Management of Labor Guidelines for hospital - based care. August, 2005, 80 p.

Контактная информация:

Акылжанова Жансулу Егизбаевна - и.о. доцента кафедры неотложной медицины НАО «Медицинский университет

Семей», Павлодарский филиал, г. Павлодар, Республика Казахстан.

Почтовый адрес: 0714002, Республика Казахстан, г. Павлодар, улица Торайгырова 72/1.

E-mail: Akilshanova@mail.ru

Телефон: +7 (701)4998464