CC BY
0IMPROVING DIAGNOSTIC AND THERAPEUTIC APPROACHES IN PREGNANT WOMEN WITH CERVICAL
PATHOLOGY
1Ruziyeva N.H., 2Jurayeva N.A.
1,2Tashkent Pediatric Medical Institute, Faculty of Obstetrics and Gynecology, Department of
Gynecology, Tashkent https://doi.org/10.5281/zenodo.13883664
Abstract. Pregnancy is a very important period of a woman's life. In the body of a pregnant woman, there are changes in all systems and a decrease in the function of the immune system. Against the background of reduced immunity, a pregnant woman is easily accessible to viruses and infections. Various diseases of the cervix reduce the course characteristic of pregnancy, and the risk of infection with papillomavirus infection, including those contained in amniotic fluid, increases. Papillomas (warts, anogenital warts, genital warts) are benign growths caused by the human papillomavirus (HPV). In addition to cosmetic inconveniences, HPV often causes the development of cervical cancer, genital tumors and other equally dangerous ailments.
Keywords: microbiocenosis, cervix, pregnancy, DeflaGyn gel.
Today, HPV is the most common of all sexually transmitted diseases. About 50% of the world's population is infected with the human papillomavirus. Currently, there are about 180 types of HPV, of which 29 types have oncogenic potential. During pregnancy, changes occur in all structures of the uterus. At the beginning of pregnancy, the cervix retains its usual dense consistency. In the future, due to increased blood circulation, stagnant phenomena develop in it, causing edema, and therefore increases and softens. The multilayer squamous epithelium is hyperplassified, a large number of dividing cells appear, often with impaired differentiation. The cells contain a large amount of glycogen, and the concentration of glucosaminoglycans in the composition increases. About 20% of pregnant women have a thickening of the basal layer. The mucous membrane of the cervical canal (endocervix) also thickens (due to an increase in cell size), the cells of the cylindrical epithelium become taller, their nuclei move to the middle of the cell, there is an increase in secretion. The human papillomavirus has a latent course: from infection to the appearance of the first signs of the virus, it can take from three months to a year or more. That is why women planning pregnancy need to check their health in advance and undergo all necessary examinations, even if nothing bothers them. Reserve cells (subprismatic) hyperplasize, while forming polypoid outgrowths in the glands. The inner layer of the cervix is characterized by the presence of numerous glands and vessels. The glandular components increase both in size and quantity, and the glands acquire pronounced tortuosity. Due to an increase in the size of the cervix and changes in its structures, the junction of the epithelium in the second and third trimesters moves towards the exocervix, physiological ectopia (ectopia gravidarum) is visualized. Physiological ectopia during pregnancy is accompanied by severe hypertrophy, edema and vascularization of the papillae, in which convoluted terminal vessels are observed, which simulates malignancy during colposcopy. For a long time, scientists have followed the tactics of monitoring pregnant women with polypoid formations of the cervical canal, considering this to be the absence of their influence on the condition of CMM during gestation and childbirth. Some studies show
that cervical canal polyps during pregnancy lead to changes in the consistency and enzymatic state of cervical mucus, the activity of granulocytes of elastase, which affects the state of local immunity and causes not only the development of cervicitis, but also creates conditions for ascending infection and chorioamnionitis. According to V.I. Krasnopolsky (1997), the tactics of managing pregnant women with cervical canal polyps depends on the size of the polyp, its location, and the nature of the surrounding tissue. One of the indications for polypectomy during pregnancy may be the threat of its termination, resulting from reflex irritation of the cervix.
The probability of infection with HPV in the fetus directly depends on the severity of the infection in the mother during pregnancy and the time of the anhydrous period during childbirth. With a latent course, the virus is transmitted to the fetus in 1% of cases. It is believed that the presence of HPV infection increases the risk of miscarriage. Warts during pregnancy often increase and can reach large sizes, but they often regress after childbirth. Most authors recommend their active treatment, since they represent a focus of infection that increases the risk of infection of the fetus. In addition, large formations can cause obstructive and hemorrhagic complications during childbirth, and children have an increased risk of laryngeal papillomatosis and other organs. The management tactics of patients with diseases caused by papillomaviruses is determined by their high oncogenicity and the ability to be sexually transmitted from mother to fetus. When detecting genital warts of the anal and genital areas, an extended colposcopy and cytological examination of the Pap smear with warts and cervix are a necessary stage of examination.
The composition of the vaginal microbiota influences the progression or regression of malignant diseases in many tissues, trying to identify the molecular mechanisms of carcinogenesis associated with bacteria and viruses. Dysbiotic changes in the vagina are no exception — they, regardless of other risk factors, are associated with cervical neoplasms. Thus, maintaining or restoring the normocenosis of the vagina is a potential tool in the fight against neoplasms of the organs of the reproductive system. In the coming years, we will have many discoveries in the study of the vaginal microbiota — however, the first and probably the most important steps have already been taken. Since vaginitis and dysbiosis can potentially contribute to the development of CIN and even cervical cancer, the restoration of microbiocenosis is advisable not only to combat inflammation and discomfort, but also as a measure to prevent cervical lesions, including malignant ones. The main goals of therapy are to eliminate obligate and reduce the number of conditional pathogens, restore normal pH and increase the number of lactobacilli producing hydrogen peroxide. Of course, the effectiveness of treatment largely depends on whether the problem was correctly diagnosed, the pathogens of the disease were identified and etiotropic therapy was selected.
The most common diagnosis of cervical pathology. To date, the method of liquid cytology has been widely introduced into practice. It allows you to conduct an automated study and save all the collected cells. In the same sample of material, it is possible to determine HPV of high oncogenic risk, and in doubtful cases requiring additional differential diagnosis of cervical dysplasia, immunocytochemical tests can be performed to determine cancer markers. Also, a PCR study with a qualitative and quantitative assessment of the virus helps to predict the development of papillomavirus infection. In each specific case, this allows you to determine the further tactics of patient's management.
In our practice, HPV treatment is widely used in pregnant women, by restoring the microbiota of the vagina, and the risk of infection of the fetus is also reduced. Pregnant women
with HPV virus were divided into two groups. In the second group, in addition to antiviral drugs, we used the drug DeflaGin gel. Vaginal DeflaGin gel is a set for applications. It consists of active substances silicon dioxide, citric acid, sodium selenite, selenium. It suppresses the spread of pathogenic microorganisms and provides antioxidant protection. Finely dispersed micronized particles of silicon dioxide absorb pathogenic factors (bacteria, viruses, cell residues) that cause pathological changes from the surface of the cervix. After that, the components of the vaginal gel bind pathogenic factors and prevent their spread. Absorbed and associated pathogenic factors are neutralized due to the antioxidant properties of biologically active selenium and the patented compound of sodium selenite with citric acid. The release of the cervical epithelium from pathogenic factors contributes to the onset of remission and its restoration. Thus, good results were obtained. In the diagnosis of cervical pathology, samples with three percent acetic acid and Schiller samples with Lugol's solution were performed. Colposcopy reveals signs of cervical lesions that are not always visible to the naked eye. And this showed an improvement in the condition of the cells of the cervix, and reduced the risks of the spread and transmission of the human papillomavirus.
In the world, it is widespread for women aged 21 to 69 years and pregnant women to conduct preventive examinations once a year and cytological examination of a cervical smear and cervical canal with a frequency of once every 3 years. HPV testing is also required for women with identified benign cervical diseases.
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