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10УДК: 618-053.6-06:618.174-084
DIAGNOSIS OF REPRODUCTIVE HEALTH DISORDERS IN GIRLS OF
EARLY REPRODUCTIVE AGE
KHOLOVA NODIRA FAZLIDDINOVNA
Director of the Regional Reproductive Health Center of the population. The city of Bukhara, Uzbekistan.
ORCID ID 0000-0001-7677-9311 KHAMDAMOVA MUHKHAYOHON TUKHTASINOVNA DSc, docent of department of obstetrics and gynecology 2 of the Bukhara medical Institute. Uzbekistan. ORCID ID 0000-0003-3128-6120.
ABSTRACT
The review article is devoted to the reproductive health of girls. It is directly related to the health of children and, consequently, to the future of the state, health and preservation of the gene pool of the people of our Republic of Uzbekistan.
Keywords: girls, reproductive health, somatic disease, geno fund.
ДИАГНОСТИКА НАРУШЕНИЙ РЕПРОДУКТИВНЫЙ СИСТЕМЫ У ДЕВУШЕК РАННЕГО РЕПРОДУКТИВНОГО ВОЗРАСТА
ХОЛОВА НОДИРА ФАЗЛИДДИНОВНА
Директор областного репродуктивного центра здоровья населения. Город Бухара, Узбекистон.
ORCID ID 0000-0001-7677-9311 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА DSc, доцент кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика Узбекистан.
ORCID ID 0000-0003-3128-6120 АННОТАЦИЯ
Обзорная статья посвящена на репродуктивное здоровье
девушек. Оно напрямую связано со здоровьем детей, а, следовательно, с будущим государства, здоровьем и сохранением генофонда народа нашей Республики Узбекистан.
Ключевые слова: девушек, репродуктивное здоровье, соматические заболевание, генофонд.
РЕПРОДУКТИВ ЁШДАГИ КИЗЛАРДА РЕПРОДУКТИВ ТИЗИМДАГИ УЗГАРИШЛАРНИ ЭРТА ДИАГНОСТИКАСИ
ХОЛОВА НОДИРА ФАЗЛИДДИНОВНА
Бухоро вилоят ацоли репродуктив саломатлик маркази директори. Бухоро ша^ри, Узбекистон Республикаси.
ORCID ID 0000-0001-7677-9311 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА DSc, акушерлик ва гинекология кафедраси доценти, Бухоро давлат тиббиёт институти, Бухоро шацри, Узбекистон Республикаси. ORCID ID 0000-0003-3128-6120.
АННОТАЦИЯ
Тадцицот циз болалар репродуктив саломатлигига багиш-ланган. ^изларнинг репродуктив саломатлиги бевосита болалар саломатлиги, демакки давлат келажаги, Узбекистон Республикаси халцининг саломатлиги ва генофондини сацлаш билан богликдир.
Калит сузлар: цизлар, репродуктив саломатлик, соматик касаллик, генофонд.
Reproductive health, as defined by the World Health Organization (WHO), denotes a given period - a state of physical and mental and social well-being in all areas related to the reproductive system, its functions and processes, including reproduction and harmony in psychosocial relations in the family [UN, Cairo , 1994]. According to WHO, adolescence is the period of growth and development of a person, which follows until reaching
adulthood, that is, from 10 to 19 years. Reproductive health care is defined as a collection of methods, techniques, technologies and services that promote reproductive health and well-being by preventing and addressing reproductive problems - [1, 3].
Preservation of the reproductive health of adolescents and young people is of great social importance. The state of reproductive health of today's children and adolescents entering fertile age will directly affect the demographic processes of the next 10-15 years. The demographic situation largely depends on the reproductive attitudes of modern adolescents - [2, 6, 11]. The pathological course of this period in the future may have an adverse effect on the reproductive e function of a woman, depending to a large extent on the state of her he al thin child hood and adolescence - [1, 4].
The main areas of work in the field of reproductive health of children and adolescents should be recognized as conducting preventive examinations at a qualitatively new level for the timely detection of diseases of the reproductive system, providing a range of medical and sanitary services in special medical institutions, disseminating information about reproductive health, improving educational work to increase in maintaining their reproductive health - [7, 9].
The search for predictive markers of reproductive disorders for early diagnosis of pathology, the choice of differentiated therapy and prevention is today an urgent problem for doctors and scientific researchers in the field of obstetrics and gynecology, as well as endocrinology.
Timely identification of high-risk groups for impaired formation of puberty, as well as menstrual function, is the key to normal physical, sexual, mental health, and therefore, "healthy motherhood". Recently, many authors have been working on the problem of identifying risk factors leading to a violation of the formation of the reproductive system, as well
as creating prognostic programs and maps to assess the possible risks of the formation of this system in girls - [8, 10].
Annually, according to the drawn up plan and schedule, it is necessary to conduct a preventive examination of girls 9-11 years old to predict the upcoming development of menstrual function. Such possibilities were opened by the method proposed by G.A. Ushakova (1993) and the further implementation of this method was continued in the works of S.I. Elgina - [1, 2, 3]. According to him, the following disorders are predicted: early age of menarche, late age of menarche, long period of formation of the rhythm of menstruation, dysmenorrhea, abnormal uterine bleeding during puberty.
The prognostic map includes the following factors: age, health, profession of the mother at the time of pregnancy and childbirth, the course of pregnancy, place of birth and residence, as well as the girl's past illnesses with the definition of the health group. Each factor has its own gradation, expressed in a digital predictive coefficient. The results obtained are analyzed on a risk scale and evaluated: minimum, average and maximum. Recommended by the authors of the proposed prognostic map during preventive examinations of girls in order to identify predictors of pathology, the formation of menstrual and reproductive function and carry out preventive measures - [4, 9, 11].
One of the main predictive markers is the assessment of ovarian reserve of the ovaries. Ovarian reserve (follicular reserve) is the number of eggs that are potentially ready for fertilization at a given time and its assessment allows you to determine the patient's ability to conceive. Predicting the risk of decreased ovarian reserve in adolescent girls, based on the determination of laboratory and ultrasound markers, has a high sensitivity and specificity - [5, 8].
One marker of early diagnosis and prediction of reproductive disorders in girls is the determination of the AMK hormone. In a female
fetus, intrauterine synthesis of AMK does not occur, which determines the sex differences in the content of AMK at birth: in boys, these are high levels, in girls, they are practically undetectable. This allows the use of AMK to establish the sex of a child in doubtful cases and to identify the causes of impaired development of the genital organs. The synthesis of AMK in girls begins after birth and continues until menopause, but the activity of this process differs significantly at different age periods. The highest levels are observed during puberty and before the age of 30, then a gradual decline begins - almost to undetectable values during menopause. The intensity of the decline in AMK indicators increases after 38 years. Considering that the main synthesis of the hormone occurs in primordial follicles, AMK is recognized as the most accurate marker of ovarian reserve, the level of which practically does not change during the menstrual cycle, in contrast to traditional markers (FSH, inhibin B, estradiol). In the case of premature sexual development, a high AMK level for the corresponding age is determined. If its low levels are identified, the causes of delayed puberty should be sought - [2, 5, 9 ]. Based on scientific research Elgina S.I. In 2019, a computer program was developed and registered, based on the determination of laboratory and ultrasound markers, to identify a risk group for developing a decrease in ovarian reserve and a more differentiated implementation of preventive measures.
Currently, most researchers recognize that the AMC value of less than 1 ng / ml indicates a low ovarian reserve and the need to address fertility issues using assisted reproductive technologies (ART). It should be noted that AMH is the most sensitive marker of ovarian reserve and its decrease begins long before the change in the levels of traditional markers. The total proportion of correctly predicted values is 94% - [1, 5]. Increasing the ovarian reserve is difficult, and preventing a decline in reproductive potential is not always possible. On the basis of having an ovarian reserve, it is possible to plan the reproductive behavior of a girl,
take preventive or rehabilitative measures, and give recommendations on the implementation of motherhood - [6, 9].
One of the predictive markers of disorders of the central regulation of the reproductive system is the determination of leptin, which is a hormone of adipose tissue and the main mediator of energy homeostasis, regulating carbohydrate metabolism and reproductive function and having a role in the pathogenesis of PCOS. Leptin plays a role in the regulation of carbohydrate metabolism by increasing tissue sensitivity to insulin. In addition, there is evidence of a direct interaction between leptin and insulin and their effect on the reproductive system. At the hypothalamic-pituitary level, leptin is able to directly stimulate the production of luteinizing hormone (LH) and, to a lesser extent, follicle-stimulating hormone (FSH) through the mechanisms of NO-synthesis activation. Receptors to leptin are present in granulosa cells, ovarian theca cells and are regulated cyclically and affect the secretion of ovarian hormones and the maturation of oocytes and their potential - [6, 9]. Vitamin-D binding protein is a marker of the risk of certain abnormalities in the body, also in the reproductive system. LI Gerasimova., MS Denisov 1999 genotyping was carried out and it was proved that the GC2282679 gene is a multifunctional protein and binds to vitamin D and its metabolites in plasma and transports them to tissues. In addition, they determined the C / C or A / C genotypes according to the genetic marker, they may be more predisposed to a low level of vitamin -D due to the reduced ability of vitamin -D transport in the body, and the A / A variation of this gene ensures the physiological metabolism of vitamin D.
Based on the above, we can say that a low content of vitamin D indicates a violation of the menstrual and reproductive function of adolescent girls and is a predictive marker of a decrease in reproductive potential in this category of patients.
The above markers predicting disorders of the reproductive system can help to timely analyze pathological changes in the reproductive system in adolescent girls and young girls and choose the optimal preventive measures and corrective therapy for the benefit of maintaining reproductive health in this contingent.
Thus, the human body is a complex biological system, consisting of organs and tissues. For the body to work as a whole, various organ and tissue systems must have a good direct correlation, including with the endocrine system. The endocrine system coordinates and regulates the activity of all organs and systems and has a significant role in relation to sexual development, which is the main lever for maintaining reproductive health and the formation of its reproductive function.
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