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14
Section 2. Medical science
Minavarova Shohsanam Anvarovna, student of medical-pedagogical faculty Tashkent pediatric medical Institute Uzbekistan, Tashkent
Bijanova Asema Bauyrjanovna, student of medical-pedagogical faculty Tashkent pediatric medical Institute Uzbekistan, Tashkent E-mail: [email protected]
ACTUAL PROBLEMS OF INFECTIOUS DISEASES IN OBSTETRICS
Abstract: The urgency of the problem of obstetric and gynecological infections is determined by their high prevalence and pronounced adverse effects on the reproductive function of women, the course and outcome of pregnancy. The article summarizes the data of modern scientific, methodological and normative literature covering various aspects of infectious and inflammatory diseases important in obstetrics and gynecology. The actual epidemiological data are given, the modern ideas of pathogenesis, ways of infection and risk factors, clinical manifestations of infections and their complications, treatment and prevention are stated.
Keywords: infections, reproductive system, etiology, pathogenesis
Infectious diseases of the mother play a leading role in insensitive to broad-spectrum antibiotics. Characteristically,
infertility, miscarriage and miscarriage, and the cause can be both severe systemic infectious diseases and asymptomatic bacterial and viral infections of the genital tract. Premature infants have a high rate of stillbirth, early neonatal mortality and disability [6]. The role of infection in the development of gestosis has been revised and this factor is very important. In fact, the pathogenesis of gestosis is currently considered from the standpoint of systemic inflammatory response with endothelial dysfunction, cytokine cascade, dysfunction of immune cells, vascular system, hemodynamics and the development of multi-organ failure [3].
The problem of inflammatory diseases in gynecology, postpartum inflammatory processes and sepsis remains topical. From year to year, sepsis takes the leading place in the structure of maternal mortality, with post - abortion sepsis-more often than postpartum [7]. Chronic inflammation of the genitals leads to a decrease in the quality of life ofwomen due to the development of chronic pelvic pain syndrome, infertility, miscarriage, ectopic pregnancy and neurotic conditions. Thus, the problems of infections become crucial in obstetrics and gynecology [1].
Currently, the etiological structure of infectious diseases of women, as well as intrauterine infection of the fetus and newborn has changed. These changes relate to both opportunistic and pathogenic flora. Dominant in recent years, gram-negative microbial flora in the inflammatory foci of the sexual sphere was replaced by coccal (which was typical for the 40-50-ies) and this led to an increase in the number of purulent processes. Formed particularly resistant coccal flora,
along with staphylococci, a lot of pathology was to determine strep D Enterococcus that are resistant even to antibiotics of the reserve. Consistently held its position among the etiological factors of inflammatory diseases of the nonspore anaerobes (peptococcus, Peptostreptococcus, Bacteroides, fuzobakterii, veillonella etc.), and their detection remains an insurmountable challenge for health care practice [8].
However, it is in recent years has increased dramatically the role of pathogens of sexually transmitted diseases: chlamydia, Mycoplasma, Ureaplasma, herpes simplex viruses, cytomegalovirus, fungi. Along with the well-known, well-studied representatives of conditionally pathogenic genital bacterial flora, these pathogens, and with them the viruses of rubella, enteroviruses and Toxoplasma, made TORCH-complex - is well known to obstetricians, neonatology and Perinatology. It is a complex of pathogens that can cause intrauterine infection of the fetus. Infections, sexually transmitted infections, an essential part of this list and built him significant linkage [2].
The need for comprehensive treatment of women with urogenital infection during pregnancy to prevent infection of the placenta and fetus became apparent after studying the risk of intrauterine fetal infection in women with specific infection. The examination of 200 infected pregnant women at 22-40 weeks of gestation and 96 newborns [4] revealed that in women with Mycoplasma(Ureaplasma)-chlamydial infection the rate of infection of the placenta is 74.2%, in viral infection - 21.8%, in Mycoplasma-chlamydia-viral Association - 63%, while there is no nonspecific microflora in placental tissue. Pathomorphologi-cal changes in placental tissue, membranes and umbilical cord
ACTUAL PROBLEMS OF INFECTIOUS DISEASES IN OBSTETRICS
in women with specific urogenital infection largely depend on the type of pathogen. Mycoplasma (Ureaplasma) and herpetic infections potentiated the formation of compensatory-adaptive processes in the form of terminal villi hypervascularization in moderately pronounced basal lymphocytic deciduitis.
Alterative and dystrophic reactions were manifested by arteriosclerosis, the formation of calcifications in the placenta and were characteristic of chlamydial and cytomegalovirus infection. Amniotic fluid in the vast majority of women with urogenital infection were sterile, only 0.7% revealed Mycoplasma, 1.4% -cytomegalovirus and herpetic infection. Features of the microelement composition of amniotic fluid in pregnant women with urogenital infection is a high level of strontium, contributing to the development of placental insufficiency, and increased glucose levels, reflecting metabolic disorders in the fetus [9].
According to some authors, the fetus is most often infected with intranatally conditionally pathogenic flora of the lower genital tract (66%), myco - and Ureaplasma (19.7%), chlamydia (10.4%). Antenatal infection occurs much less frequently-viruses in 1.4%, Mycoplasma-in 0.7%, chlamydia-in 2.1% of newborns. The main condition for the infection is an infection of the placenta, Feto-placental insufficiency and infectious pathology of the vagina [5; 7].
Prognostically reliable criteria for the risk of intrauterine infection of the fetus are specific bacterial and viral infection in the mother, the threat of termination of pregnancy, colpitis, pathology of amniotic fluid, fetoplacental insufficiency, the lack of comprehensive treatment during pregnancy.
As data on intrauterine infection accumulate, its Association with women's somatic health becomes apparent. Women
at risk of inflammatory diseases in the postpartum period have gastrointestinal, cardiovascular and respiratory diseases 1.9, 1.7 and 1.6 times more often than healthy puerperas, as well as the threat of abortion, gestosis and anemia 3.3, 3.6 and 1.7 times respectively. Childbirth is 2.7 times more often complicated by abnormal contractile activity of the uterus, 2.2 -premature discharge of amniotic fluid and 2.5 - pathological blood loss. However, a factor determining the development of inflammatory diseases after childbirth, along with the above, is the presence of chronic chlamydial, mycoplasmic [10], urea-plasmic, herpetic and cytomegalovirus urogenital infection combined with activation of urinary tract infection in the first trimester and recurrent colpitis or gestosis in late pregnancy, as well as a combination of chronic specific infection, abnormalities of uterine contractility and gestosis [4].
The high degree of infection of the endometrium and postpartum inflammatory complications are certainly associated with intrauterine infection of newborns, which was detected in 44% of children of women who had postpartum inflammatory complications, and in 32.8% who did not have them.
Implementation of intrauterine infection according to clinical and microbiological data was proved in 4.6% and 2.9% of children, respectively, the rest had a high risk of intrauterine infection. this was manifested by umbilical cord infection in 31.1%, auricle infection in 58%, as well as complications in the early neonatal period - intrauterine growth retardation - in 12.7%, hemorrhagic syndrome - in 21.9%, neurological symptoms - in 37.5%, jaundice syndrome - in 11.5%, which should be regarded as the consequences of placental insufficiency and hypoxic complications[7].
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