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5ANEMIA IN PREGNANT WOMEN WITH VARICOSE DISEASE
Khudoyarova D.R.1, Yusupov O.Sh.2, Shopulotova Z.A.3
1Samarkand State Medical University, DcS, professor of department Obstetrics and gynecology
№1
2Samarkand State Medical University, available applicant of department Obstetrics and
gynecology №1
3Samarkand State Medical University, assistant of department Obstetrics and gynecology №1
https://doi.org/10.5281/zenodo.10398866
Abstract. Determine the level of anemia in pregnant women with varicose veins. The study was conducted on 100 pregnant women with a history of varicose veins who were treated in the maternity complex of the Samarkand regional perinatal center during 2022-2023. The study used general clinical, laboratory (hematological, biochemical), instrumental and statistical research methods. All pregnant women with VV from the main group were diagnosed with anemia of various forms and degrees, which is characterized by a relationship between the duration, activity and manifestations of the disease.
Keywords: ferritin, anemia of chronic diseases, iron deficiency anemia, varicose veins (VV), anemia.
Relevance. Varicose veins (VV) usually begin in the reproductive years for many women, but it can also appear in childhood and adolescence. In addition, in recent years, in developing countries, there is a tendency for women to plan pregnancy at a later age, which makes it necessary to discuss the problem of pregnancy in this disease. The first symptoms of VV are more common between the ages of 25-35, but these symptoms can also be seen in other age groups [6,20]. The long-term inflammatory process inside the vessels almost always leads to structural and anatomical tissue damage and deterioration of the quality of life of patients [17,20]. Due to VV, labor activity is limited in people of the most working age. Economic losses caused by this disease can be compared with cardiovascular disease [9,18]. Even with standard therapy, 60-90% of patients lose their ability to work 20 years after the onset of the disease, and one-third of them become completely disabled [7,25].
Varicose veins (VV) is one of the most serious human diseases, and its prevalence ranges from 25% to 45% according to various reports [1,2,8]. Without effective therapy, VV increases the risk of thromboembolism [5,19,22].
Considering the increasing incidence of varicose veins women who want to have children in the future, it is also an urgent problem to consider alternative methods of drug treatment and to conduct research on possible side effects. It is worth noting that among women, this disease leads to the development of pregnancy pathologies. Especially now, there are many cases of thrombosis and embolism as the cause of maternal death.
Varicose veins, cardiovascular diseases, etc. are often accompanied by anemia. At the same time, the fact that the body of a pregnant woman now serves two people also causes extragenital diseases and disrupts the balance of the body. As a result, many secondary diseases occur.
Aim: determination of the value of the level of anemia in pregnant women with varicose
veins.
Materials and methods. The study was conducted on 100 pregnant women with a history of varicose veins who were treated in the maternity complex of the Samarkand regional perinatal center during 2022-2023. Pregnant women were also monitored by phlebologists and hematologists. The average duration of the disease in the studied women was 5.2±1.5 years.
All VV-infected pregnant women were divided into 2 groups based on hematological parameters: 20 (20%) pregnant women without anemia were assigned as a control group; 80 (80%) women who were diagnosed with anemia as a result of hematology examination, these patients formed the main group. Type and degree of anemia in VV patients were classified according to the classification recommended by WHO. According to the results of the blood analysis of the women divided into the main group, 56.25% had anemia caused by chronic diseases, 40% had iron deficiency anemia, and 3 women (3.75%) had both types of anemia.
Examination of patients was carried out using generally accepted and standard clinical, laboratory (hematological, biochemical) and instrumental methods. The degree of development of VV, that is, the assessment of the development of the disease, was evaluated by a phlebologist according to the internationally proposed standards. At the same time, the anamnesis of obstetric and gynecological diseases was carefully analyzed. Special attention was paid to the absence of VV disease and the occurrence or increase in the level of anemia during pregnancy.
Among laboratory methods, a general blood test, biochemical analysis of blood, coagulogram, and a general analysis of urine were performed.
Processing of the obtained data was analyzed with the help of Microsoft Excel software package and "STATISTICA 6.0" software package. Descriptive statistics methods included arithmetic mean (M), mean error (p) and mean squared deviation (s) of markers with normal distribution.
Results: Level I disease activity was observed in 23 patients. II degree of VV was detected in 47 patients, III degree of the disease in 30 patients. So, among the examined patients, VV II and III activity was observed in almost 77% of women.
The duration of the disease in patients in the observation groups was 5.2 ± 1.5 years, ranging from 1 to 10 years. Only 35 (35%) of VV patients in the study had disease duration up to 2 years, 2 to 5 years - 42%, and more than 5 years -23% of women. Along with symptoms of varicose veins, patients under observation had complaints such as general weakness (88%), irritability, sleep and attention disorders (37%), agitation (19%), fear (6%). According to our data, anemia was the leading symptom except for VV. Anemia was observed in 80 patients (80%).
When we analyzed comorbidities, they were identified in 78% of patients, and comorbidities were not identified in 22% of women.
Anemia of various forms and degrees was found in 80 (80%) RA patients. Therefore, we divided all patients into 2 groups: patients without anemia (control group) consisted of 20 women, the main group - 80 pregnant women with different degrees of anemia. In particular, 1st degree of anemia was observed in 29 (36.25%) patients, 2nd degree in 33 (41.25%), 3rd degree - 15 (18.75%) and 4th degree - 3 (3.75 %) was determined in patients.
When we analyzed acute inflammatory proteins in blood serum, we observed that their amount increased. Biochemical analysis of blood serum in VV patients showed that all indicators were not different from normal indicators.
The general analysis of urine showed the presence of protein, leukocytes and epithelial cells in urine in only 18% of 100 patients. The frequency of proteinuria was 22%. It was observed in the form of VV with anemia and indicated the presence of other pathologies.
Based on the obtained results, we analyzed the effect of VV passage on pregnancy in the control and main groups. The obtained results showed that anemia on the background of VV is characteristic of most patients and was reflected in fetal growth retardation, changes in the placenta and changes in the blood system of the fetus in women of the main groups.
It is worth saying that according to the degree of anemia, the changes in hematological parameters deepened. Hemoglobin content is 1.21 (R<0.05) compared to standard indicators; 1.41 (R<0.001); 1.65 (R<0.001) and 2.21 (R<0.001) times, erythrocyte count MCV 1.25 (R<0.05); 1.37 (R<0.001); 1.6 (R<0.001) and 1.88 (R<0.001) times, hematocrit indicator - 1.15 (R<0.05); 1.21 (R<0.05); A statistically significant decrease of 1.35 (R<0.01) and 1.49 (R<0.001) times. MCV indicator 1.14 (R<0.05); 1.20 (R<0.05); 1.3 (R<0.05) and 1.42 (R<0.001) times, MSN - 1.19 (R<0.05); 1.3 (R<0.05); 1.4 (R<0.001) and 1.64 (R<0.001) times, MSNS indicator - 1.17 (R<0.05) (R<0.05); 1.23 (R<0.01); We observed a decrease of 1.34 (R<0.001) and 1.55 (R<0.001) times. although the number of leukocytes did not change, the EC was statistically reliable - 3.04 (R<0.001); 3.81 (R<0.001); 4.37 (R<0.001) and 3.67 (R<0.001) times increase was observed.
Conclusion. All pregnant women with varicose veins in the main group were diagnosed with anemia of various forms and degrees, characterized by the relationship between the duration and activity of the disease. The phenotypic characteristics of the body of VV patients determine the tendency to develop anemia, and allow predicting the type of anemia that may develop.
The 1st degree of anemia was found in 36.25%, the 2nd degree in 41.25%, the 3rd degree in -18.75% and the 4th degree in -3.75% of patients and was consistent with the high level of inflammatory processes in the joints. In most of them, anemia caused by chronic diseases was found in 56.25%, iron deficiency anemia in 40% and mixed type (3.1%).
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