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ASPECTS OF DELIVERY DURING THE PRENATAL DISCHARGE OF
AMNIOTIC FLUID
KHATAMOVA MATLYUBA TILAVOVNA
Associate Professor of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute named after Abu Ali ibn Sino, Uzbekistan, Bukhara ORCID ID 0000-0002-0279-0240 BURKHANOVA MASTURA ELDOROVNA Assistant of the Department of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute named after Abu Ali ibn Sino, Uzbekistan, Bukhara. ORCID 0000-0002-1504-8547 FAYZULLOEVA NAFOSATSHOKIROVNA Assistant of the Department of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute named after Abu Ali ibn Sino, Uzbekistan, Bukhara. ORCID 0000-0003-2286-4523 ABSTRACT
Prenatal outflow of amniotic fluid combination with infectious diseases is a serious problem of modern obstetrics. The article presents modern views on the etiology and pathogenesis of premature and antenatal rupture of amniotic fluid. The pathological, genetic and microbiological aspects of this pathology are considered. Further solutions to the problems associated with premature and antenatal rupture of amniotic fluid are outlined. The causes of prenatal outflow of amniotic fluid, despite numerous studies, are not completely established, although the leading factor in this complication is considered to be infection.
Key words: full-term pregnancy, induction of labor, prenatal outflow of amniotic fluid
АСПЕКТЫ ВЕДЕНИЯ РОДОВ ПРИ ДОРОДОВОМ ИЗЛИТИИ
ОКОЛОПЛОДНЫХ ВОД
ХАТАМОВА МАТЛЮБА ТИЛАВОВНА
Доцент кафедры акушерства и гинекологии №2 Бухарского Государственного медицинского института имени Абу Али ибн Сино, Узбекистан, г. Бухара ОНОЮ Ю 0000-0002-0279-0240
БУРХАНОВА МАСТУРА ЭЛДОРОВНА ассистент кафедры акушерства и гинекологии №2 Бухарского Государственного медицинского института имени Абу Али ибн Сино, Узбекистан, г. Бухара.
ОНОЮ 0000-0002-1504-8547 ФАЙЗУЛЛОЕВА НАФОСАТШОКИРОВНА ассистент кафедры акушерства и гинекологии №2 Бухарского Государственного медицинского института имени Абу Али ибн Сино, Узбекистан, г. Бухара.
ОНОЮ 0000-0003-2286-4523 АННОТАЦИЯ
Дородовое и преждевременное излитие околоплодных вод сочетание с инфекционных заболеваний является серьезной проблемой современного акушерства. В статье представлены современные взгляды на этиологию и патогенез преждевременного и дородового излития околоплодных вод. Рассмотрены патоморфологические, генетические и микробиологические аспекты данной патологии. Намечены дальнейшие пути решения проблем, связанных с преждевременным дородовым излитием околоплодных вод. Причины дородового и преждевременного излития околоплодных вод, несмотря на многочисленные исследования, окончательно не установлены, хотя ведущим фактором данного осложнения считают инфицирование.
Ключевые слова: доношенный срок, индукция родов, дородовое излитие околоплодных вод, преждевременное излитие околоплодных вод
ТУГРУКДАН ОЛДИН КОГОНОК СУВЛАРИ КЕТГАНДА ТУГРУКНИ ОЛИБ БОРИШНИНГ ХУСУСИЯТЛАРИ
ХАТАМОВА МАТЛЮБА ТИЛАВОВНА
Акушерлик ва гинекология №2 кафедраси доценти, Бухоро, Узбекистон. ОНСЮ Ю 0000-0002-0279-0240 БУРХАНОВА МАСТУРА ЭЛДОРОВНА Акушерлик ва гинекология №2 кафедраси ассистенти, Бухоро, Узбекистон. ОИСЮ 0000-0002-1504-8547 ФАЙЗУЛЛОЕВА НАФОСАТШОКИРОВНА Акушерлик ва гинекология №2 кафедраси ассистенти, Бухоро, Узбекистон. ОНОЮ 0000-0003-2286-4523 АННОТАЦИЯ
Муддатидан ва тугруцдан олдин цогоноц сувларининг кетиши-нинг инфекция билан бирга келиши замонавий акушерликнинг долзарб муаммоларидан бири саналади. Мацолада муддатидан ва тугруфан олдин цогоноц сувларининг кетишининг этиологияси ва патогенези келтирилган. Ушбу патологиянинг патоморфологик, генетик ва микробиологик хусусиятлари келтирилган. Муаммони кейинги ечими тугрисида фикрлар келтирилган. Муддатидан ва тугруцдан олдин цогоноц сувларининг кетишининг жуда куп сабаблари урганилган булсада, бирламчиси %али аницланмаган, лекин цозиргача инфекция асосий омил сифатида царалмоцда.
Калит сузлар: етилган томила, тугруц индукцияси, цогоноц сувларининг вацтидан олдин кетиши
Urgency. One of the most common complications of pregnancy is premature and prenatal discharge of amniotic fluid. There is no single point of view regarding the cause of premature rupture of the membranes. In the literature to date, the role and nature of changes in the structure of the membranes in the prenatal and premature discharge of amniotic fluid is discussed. There is an assumption that the clinical variants of premature discharge of water, as well as the features of the histological structure of the membranes can determine the differences in the degree of infection of mother and child - [12, 14].
The study of the histological structure of the fetal membranes showed that they are metabolically active tissue and consist of amniotic epithelium, basal membranes, connective tissue, chorionic and decadal membrane - [11, 10, 8, 6, 2]. Connective tissue is built of collagen types 1 and 3, which provide strength of the membranes. The basal membrane is located under the epithelium in the video of the eosinophilia cell-free mass; a compact layer is represented by a homogeneous mass devoid of cells (indicating the strength of the amniotic membrane). The layer of fibroblasts is located in a dense network of collagen and reticular fibers and intercellular substance. The spongiotic layer of the amnion is connected by means of connective tissue fibers and intercellular substance with a smooth chorion - [9, 1, 3, 5, 13]. There are four layers in the chorine: cellular; reticular, containing fibroblasts, and pseudobasal membrane, formed by a layer of trophoblast - [4, 7, 13]. Rupture of membranes before onset of labor is called premature rupture of membranes (PIV). Childbirth, complicated by premature rupture of amniotic fluid in full-term pregnancy, is 15,1- 19.6 % and 5-35 % in premature birth (up to 37 weeks of gestation) and has no tendency to decrease - [14, 12]. Leading obstetricians-gynecologists note that this pathology contributes to the growth of complications in childbirth and in the postpartum period from the mother, fetus and newborn - [14, 16, 9]. It should also be noted that the
prenatal rupture of amniotic fluid tends to re-develop in subsequent births with frequency to 20-32 % - [14]. The factors leading to the prenatal rupture of amniotic fluid remain under discussion until now. Despite the constant attention of scientists to the problem of prenatal rupture ofamniotic fluid, the etiology of this obstetric pathology remains not fully studied, there are no clear ideas about the possible mechanisms of ruptureof the membranes. Ladfors L., Chernukha E.A., Savelyeva G.M., Arias F.it is believed that the premature rupture of amniotic fluid is a polyetiologicalpathology - [11].
Prenatal discharge of amniotic fluid (prenatal rupture of amniotic fluid) is a serious problem of modern obstetrics. Amniotic fluid, or amniotic fluid, being a biologically active environment surrounding the fetus throughout pregnancy, perform a variety of functions, ensuring the normal functioning of the system "mother-placenta-fetus" - [1]. According to - [3], labor on the background of prenatal rupture of fetal membranes is often accompanied by abnormalities of labor, hypotonic and atonic bleeding, high rates of trauma of the soft tissues of the birth canal.
The causes of prenatal amniotic fluid, despite numerous studies, have not been fully established, although the leading factor in this complication is considered to be infection - [4]. Daneshmand et al., (2012) concluded that morpho-functional, physiological and biochemical changes in the genital tract during pregnancy lead to the vaginal microflora becoming more homogeneous, with a pronounced dominance of lactobacilli, which reduces the likelihood of contamination of the fetus by opportunistic microorganisms during its passage through the birth canal. But childbirth leads to significant changes in the qualitative and quantitative composition of the vaginal microflora. Significantly increased the number of non-forming gram-negative strict anaerobes (mainly Bacteroides), Escherichia, and reduced levels of lactobacilli and bifidobacteria. Disorders of the normal vaginal microflora contribute to the
development of such infectious complications as endometritis. One of the mechanisms of maintaining the normal vaginal microflora is associated with the formation of lactobacilli during their metabolism of lactic acid and other organic acids that maintain a low pH of the vaginal environment. Acidification of various media during the growth of lactobacilli inhibits the proliferation of opportunistic microorganisms such as Candida, peptostreptococci, bacteroids, gardnerell and other bacteria released from the vagina of women with dysbiotic disorders. Gram-negative obligate -anaerobic bacteria, some of their species, have pathogenic properties: as part of the cell wall contain lipopolysaccharide, which is an inducer of IL-8, the main cytokine, triggering the inflammatory process. They are able to produce succinic acid, inhibiting the migration of polymorphonuclear neutrophils and their phagocytic ability. Consequently, it increases the possibility of infection of the fetus and mother - [8].
Prenatal outpouring of amniotic fluid and tightening of the anhydrous interval often leads to complications of labor (rapid and rapid childbirth, weakness and discoordination of the uterine contractile activity), which exacerbates the condition of the fetus and in some cases requires operative delivery - [2]
The frequency of prenatal rupture of membranes varies widely: from 5 to 19.8% of cases with full-term pregnancy - [4]. Childbirth in this case does not always end favorably for the fetus and mother. Childbirth and the postpartum period may have: the risk of developing purulent-septic complications in the mother, abnormalities of labor and intrauterine infection of the fetus. In addition, labor excitation may be ineffective, which leads to an increase in the frequency of surgical interventions - [1] Purpose of research:
The study of the aspects of childbirth in prenatal discharge of amniotic fluid, simultaneously studying the role of infection in prenatal rupture of amniotic fluid, to reduce the obstetric and perinatal
complications and development of rational tactics of childbirth in prenatal discharge of amniotic fluid.
Survey materials and methods:
To solve these problems, a comprehensive survey of 72 pregnant women, whose births were complicated with prenatal rupture of amniotic fluid in terms of 37-40 weeks of gestation, received in the Bukhara regional perinatal center for the period of 2017. With the help of anamnestic, clinical, laboratory and instrumental data, the course of pregnancy, childbirth, the postpartum period, the state of the fetus and the newborn were studied. The readiness of the birth canal was assessed on the Bishop scale. According to the National standard management of patients with prenatal rupture of amniotic fluid after 18 hours, anhydrous period of the conducted antibacterial therapy with the purpose of prophylaxis of purulent-septic complications in puerperants. The birth canal of women in parturient woman prenatal rupture of amniotic fluid examined after 24 hours in the absence of labor in order to decide whether the induction of labor. The nature of labor activity was controlled on the basis of partograms. Held: the observation of hemodynamic indicators, record sheet of observation, measurement to - body every 4 hours, laboratory control leukocytes 1 time a day, urinalysis, analysis of vaginal secretions. Conducted ultrasound of the uterus and fetus, cervicodynia, monitoring the rhythm and frequency of heartbeats of the fetus and the overall healthof mothers. Given the high sensitivity to ampicillin of vaginal and cervical bacteria, the Protocol used this antibacterial drug. Fetal status was assessed according to ultrasound and cardiotocography (CTG), and the state of the newborn at birth - on the Apgar scale. Fetalni the intrapartum monitoring is conducted by the device "Corometrics 170".
Results and discussion:
The average age of the observed women was 26.5 years. All women were pregnant against the background of extragenital diseases, and in
most cases a combination of several of them. Anemia of mild and moderate severity (72.2%), thyroid disease (33.3%) and varicose disease (25%) prevailed. Every third woman (32%) suffered from infectious diseases in this pregnancy, mainly in the form of acute respiratory infections, exacerbation of chronic sinusitis, cystitis, pyelonephritis. In 16.7% of pregnant women, acute respiratory infections episodes were repeated many times during pregnancy. Among the gynecological diseases, colpitis of various etiologies was most often diagnosed, which amounted to 43%. 72.2% of women in the history indicated the transferred inflammatory diseases of the genital tract. This is mainly manifested in the form of yeast, Trichomonas and banal colpitis, endometritis and adnexitis. 19.4% of women were treated for cervicitis and cervical erosion. According to previous analyses of vaginal smears in 43% of women had 3 and 4 degree of purity of vaginal smears.
All women with antenatal discharge of amniotic fluid vagina conducted a study to assess the maturity of the cervix on a scale of Bishop. The evaluation was carried out according to 5 criteria. It was revealed that 61.1% of the examined pregnant women had the parameters of disclosure, length, consistency, position of the cervix and the state of the fetal part up to 5 points, which was estimated as "immature neck". And 38.9% of women, vaginal delivery was assessed as "ripe cervix".
Accordingly, the tactics of further conduct was chosen according to the Protocol of the Regional Perinatal Center. In pregnant women with "immature" neck proposed induction of labor Glandine E 2, 3 mg 1 tablet intravaginal after informed consent of the pregnant woman and relatives. A conversation about the possible complications of labor. Fetal heartbeat and uterine activity were monitored during induction. Birth canal reevaluated after 8 hours to clarify the need for continued induction. Pregnant women with "Mature" cervix, the delivery was conducted in a wait and see tactic to cast regular labor or a Council of physicians decided
on induction of labor oxytocin. 58.3% of pregnant women are delivered via natural birth canal. Newborns born to mothers with prenatal rupture of amniotic fluid WERE evaluated on the Apgar scale by an average of 6 points.
Thus, studies have shown that the majority of women in labor with prenatal rupture of the membranes readiness of the cervix was estimated to 5 points, which meant "unpreparedness" of the birth canal to childbirth. Of this number, 58.3 per cent of women in childbirth were given birth after informed consent of the mother and her relatives. 22.2% of mothers had relative or absolute contraindications to induction of labor. The remaining 19.4% of mothers refused to give birth, which as a further tactic of delivery selected cesarean section. The study of the postpartum period showed that 26.4% of women had complications such as lohiometer and hematometer, manifested in the form of subinvolution of the uterus, reasonable clinical data and ultrasound studies. Secondary healing of soft birth canal wounds was observed in 18.1% of women. In 2.8% of women postpartum period was characterized by exacerbation of chronic inflammatory diseases of the genital tract.
Summary:
1.A long anhydrous period is a factor in increasing infection, which leads to an increase in obstetric and perinatal pathology.
2.The long dry period increases the incidence of newborns and postpartum women in the postpartum period.
3.A long anhydrous period increases the contamination of the birth canal of common and opportunistic flora and leads to an increase in the imbalance of the vaginal ecosystem.
These data dictate the need for the use of antibacterial drugs in women in labor with prenatal rupture of amniotic fluid. The appointment of antibacterial therapy after 18 hours of anhydrous interval prevents the development of purulent inflammatory processes in the body of the mother
and fetus, causes colonization resistance and is not a contraindication to operative delivery by cesarean section.
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