CC BY
2MODERN ASPECTS OF DIAGNOSING GESTATIONAL
PYELONEPHRITIS
Shopulotova Zarina Abdumuminovna1, Kobilova Zarina Khamzaevna2, Bazarova Fariza
Ravshanovna3
1Samarkand State Medical University, assistant of department Obstetrics and gynecology №1 2Samarkand state medical university, student of 621 group 3Samarkand state medical university, student of 506 group https://doi.org/10.5281/zenodo.10395745
Abstract. In pyelonephritis, the pathogenic factor that affects the chronic stage of inflammation loses its leading role, the processes affecting the change in the rheological properties of blood and microcirculation play an important role, which leads to the development of a chronic condition. comes - the causes of this disease are a risk factor for the mother and the fetus, leading to perinatal losses.
Patients with acute pyelonephritis have significant changes in the hemostasis system, clinical and laboratory parameters. The above changes increase during the transition from the serous stage to the purulent stage of kidney inflammation.
Keywords: ultrasound, statistical studies, nephrostoma, retrospective analysis, Nechiporenko test, Zimnitsky test.
Relevance. Patients with acute pyelonephritis have significant changes in the hemostasis system, clinical and laboratory parameters. The above changes increase during the transition from the serous stage to the purulent stage of kidney inflammation.
The study of the interaction between this pathology and pregnancy is important due to the high percentage of obstetric complications, negative perinatal consequences and serious diseases in newborns, which emphasize the medical and socio-economic importance of the problem (V.V. Iremashvili, 2007; L.E. Nicolle, 2008; K. Shea et al., 2008; A. J. Schaeffer et al., 2010). In chronic pyelonephritis, pregnancy is complicated by iron deficiency anemia (35-70%), premature termination of pregnancy at various times (15-20%), chronic placental insufficiency (30-35%), preeclampsia (35-70%). 30-40% causes complications such as chronic hypoxia of the uterus (3040%), fetal infection (20-30%) and growth retardation (12-15%) (I.G. Nikolskaya et al., 2007). In the background of chronic pyelonephritis, the adaptation ability of newborns is significantly impaired and the risk of early neonatal death increases (L.E. Nicolle, 2008; K. Shea et al., 2008).
Aim of the study. Identify modern aspects of diagnosing gestational pyelonephritis.
Materials and methods. In order to achieve the set goal and fulfill the tasks, the data of 55 pregnant women and their newborns, who applied to the perinatal center of Samarkand city on the basis of the Department of Obstetrics and Gynecology No 1 of SamSMU, were studied during 2020-2022. The women studied during the study were divided into 2 groups: the main group - 35 pregnant women with gestational pyelonephritis (GP) and the control group - 20 conditionally healthy pregnant women.
Examination of pregnant women includes the following: determination of clinical and anamnestic features of the pregnancy process, laboratory diagnosis of inflammatory pathology of the kidneys, examination of the kidneys and small pelvic organs, as well as the state of the fetus and feto-placental system using instrumental methods. Renal function: the amount of urea and
creatinine in the blood serum (nitrogen excreting activity of the kidneys), glomerular filtration rate (according to endogenous creatinine clearance), concentrating ability (Zimnitsky test), kidneys and urinary tract (Nechiporenko test), and inflammation in the blood evaluated by the presence of the process.
The criteria for inclusion of patients in the examined groups were the absence of organic pathology of the urinary system, absence of acute infectious pathology, specific infection and sexually transmitted infection. The cases of patients with inflammatory pathology in the acute phase or chronic extragenital foci during the period of illness were excluded from the study.
All studied pregnant women were of active reproductive age, that is, from 18 to 38 years old (Chart 1). The average age was 29.2±1.8. 16
14
12
10
8
6
4
2
0
■ main group ■control group
Results and discussion. General blood analysis indicators were counted automatically in hematological analyzers such as "CELL-DYN 1700" and "CELL-DYN 400" ABBOTT DIAGNOSTICS (USA), the sedimentation rate of individual erythrocytes was determined in 1 hour using 5% 0.25 sodium nitrate solution.
Biochemical blood tests were performed on the following devices: "EXPRESS PLUS" device developed by "BAYER" (Germany), "LIVID" by "CORMAY" and "AVARENESS TECHNOLOGI INC." by "STAT FAX-1904 PLUS" (USA) devices. General and indirect bilirubin, blood sugar, urea, creatinine was determined. Blood electrolytes were monitored as indicated, with blood electrolytes Medica Corp. It was carried out in the "Easy Lyte" ion-selective analyzer of the (USA) company. The study of the general analysis of urine included microscopic examination of the sediment, which revealed the presence of leukocytes, erythrocytes, bacteria, salt crystals, cylinders, epithelial cells; the presence of protein was carried out with a 3 or 15% solution of sulfalicylic acid.
The analysis of research results showed that during pregnancy (8-12 weeks) pregnant women with OGP do not significantly deteriorate the nitrogen excretion function of the kidneys, which is confirmed by the absence of significant changes compared to healthy kidneys.
In a study conducted using the Nechiporenko method in pregnant women with GP, a high level of leukocytes was 4.8-5.1*103 per 1 ml, proteinuria - 0.23-0.25 g / l, bacteriuria - 50 per 1
ml from 100 to more than a thousand bacteria have been identified. The presence of an inflammatory process in the kidneys is confirmed by positive data according to the Nechiporenko test. The causative agent of GP was mainly conditionally pathogenic microorganisms.
Table 1
Kidney function parameters in pregnant women with GP (M±m)
Indicators Control group (n=20) Main group (n=35)
SK in blood, mmol/l 270,3±16,20 381,6±10,40
Excretion of SK, mg/day 480,4±17,95 357,4±15,54
Creatinine in blood, mmol/l 67,8±4,10 112,5±3,81
Creatinine clearance, mmol/l 115,6±8,72 72,8±3,35
Relative density of urine 1014,0±1,03 1013,0±1,02
CFT, ml/min 153,8±8,85 78,8±5,68
Proteinuria, g/l 0,01±0,01 0,19±0,11*
Leukocyturia, >25 103 ml-1 1,0±0,01 12,8±0,40*
Bacteriuria - 35 (100%)
All women underwent USD and dopplerometry. In this, the state of the pelvic organs and the fetus, as well as the state of the kidneys, were evaluated. The homogeneity of the renal parenchyma was evaluated during the ultrasound examination of the kidneys, the presence or absence of hyperechoic and hypoechoic structures of the kidneys was measured by the transverse dimension of the pelvis. It is the size of the pelvic cavity that was chosen as an objective criterion for statistical processing, since this parameter reflects the degree of urodynamic disturbance. The largest size was considered.
Table 2
Ultrasound data
Diagnosis Main group (n=35) Control group (n=20)
Abs % abs %
Pyelonephritis 35 100% 0 0%
Chronic salpingo-oophoritis 8 22,9% 1 5,0%
Ovarian cyst 4 11,4% 1 5,0%
Varicose dilatation of small pelvic veins 6 17,1% 0 0,0%
Hydronephrosis 35 100% 2 10,0%
Conclusion. According to the ultrasound data, hydronephrosis cases were found in 100% in the main group, because we selected women with complicated gestational pyelonephritis for the study. The 1st degree of hydronephrosis was found in 22.8%, the 2nd degree in 62.8%, and the 3rd degree in 14.3%.
When the condition of the fetus was examined, complications such as increased uterine tone (100%), fetal growth retardation (25.7%), and fetoplacental insufficiency (34.3%) were detected in the main group of women who were in the 2nd-3rd trimester of pregnancy. Summarizing the results of the study of the importance of clinical signs in diagnosing the severity of the inflammatory process in pyelonephritis of pregnancy, we can conclude that the most valuable criteria that determine the severity of the inflammatory process are the percentage of lymphocytes and neutrophils in the peripheral blood. The composition of erythrocytes, the level of glycemia and proteinuria may play a slightly smaller role. Parameters such as platelet count, potassium, urea and creatinine, pyuria and hematuria have the least diagnostic value. Finally, parameters such as temperature reaction, total leukocyte count and protein content in the blood do not play any role in diagnosing the severity of the patient's condition. From subjective symptoms, pain syndrome plays a certain role in diagnosing the severity of the inflammatory process in pregnancy pyelonephritis. USD is the most convenient and non-invasive method for assessing the state of the kidneys and fetus, and is currently widely used. US can be used to evaluate the condition of the kidney parenchyma and the level of hydronephrosis, and at the same time, it can be considered as a criterion with a special place in the assessment of the severity of GP.
REFERENCES
1. Khudoyarova D. R., Shopulotova Z. A., Solieva Z. M. PREVENTION OF COMPLICATIONS IN PREGNANT WOMEN WITH CHRONIC PYELONEPHRITIS //Бюллетень студентов нового Узбекистана. - 2023. - Т. 1. - №. 5. - С. 25-29.
2. Айламазян Э.К. и др. Морфофункциональная оценка нижнего сегмента матки в конце физиологической беременности и у беременных с рубцом // Журн. акушерства и женских болезней. - 2006. - Т. 55, №4. - С. 11-18.
3. Буянова С.Н., Щукина Н.А., Чечнева М.А., Мгелиашвили М.В., Титченко Ю.П., Пучкова Н.В., Барто Р.А. Современные методы диагностики несостоятельности швов или рубца на матке после кесарева сечения // Российский вестник акушера-гинеколога. - 2013. -№1. - С. 73-77.
4. Густоварова Т. А. Беременность и роды у женщин с рубцом на матке: клинико-морфологические и диагностические аспекты: автореф. дис. д-ра. мед. наук / Т. А. Густоварова. - М., 2007. - 49 c.
5. Густоварова Т. А., Иванян А. Н. Беременность и роды у женщин с рубцом на матке после кесарева сечения. — Смоленск, 2007. — 196 с.
6. Кулаков В.И., Чернуха Е. А., Комиссарова Л. М. [и др.] /Результаты кесарева сечения в зависимости от наложения шва на матку и шовного материала // Акушерство и гинекология. - 1997. - № 4. - С. 18-21.
7. Макухина Т.Б. Особенности ультразвуковой диагностики и лечебной тактики при ведении пациенток с беременностью в рубце после кесарева сечения / Т.Б. Макухина, А.В. Поморцев // Рос. электрон. журн. луч. диагностики. - 2012. - Т. 2, № 3.- С. 95-99.
8. Маркарян Н.М. Сравнительный анализ двух методик чревосечения // Вестник РУДН. Серия: Медицина.- 2016. -№ 2. - С. 146.
9. Милованов, А. П. Пути снижения акушерских потерь / А. П. Милованов, Е. Ю. Лебеденко, А. Ф. Михельсон // Акушерство и гинекология. - 2012. -№ 4-1. - С. 74—78.
10. Шопулотов Ш., Абсаматов Ш., Холдоров И. ГИПЕРАКТИВНОСТЬ ДЕТРУЗОРА: СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ТЕРАПИИ //Евразийский журнал медицинских и естественных наук. - 2022. - Т. 2. - №. 6. - С. 409-411.
11. Шопулотова З. А., Худоярова Д. Р. ХРОНИЧЕСКИЙ ПИЕЛОНЕФРИТ И БЕРЕМЕННОСТЬ: ВЛИЯНИЕ КОМОРБИДНОСТИ И ЕГО ПРОЯВЛЕНИЯ //ЖУРНАЛ РЕПРОДУКТИВНОГО ЗДОРОВЬЯ И УРО-НЕФРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ. - 2023. - Т. 4. - №. 4.
12. Худоярова Д. Р., Уктамова Ю. У., Шопулотова З. А. ИННОВАЦИИ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ХРОНИЧЕСКОГО ВОСПАЛЕНИЯ ПРИДАТКОВ МАТКИ //ЖУРНАЛ РЕПРОДУКТИВНОГО ЗДОРОВЬЯ И УРО-НЕФРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ. - 2023. - Т. 4. - №. 4.
13. Akdemir A, Sahin C, Ari SA, Ergenoglu M, Ulukus M, Karadadas N. Determination of Isthmocele Using a Foley Catheter During Laparoscopic Repair of Cesarean Scar Defect. J Minim Invasive Gynecol. 2018 Jan;25(1):21-22. doi: 10.1016/j.jmig.2017.05.017. Epub 2017 Jun 8. PubMed PMID: 28602788.
14. An der Voet LF, Vervoort AJ, Veersema S, BijdeVaate AJ, Brolmann HA, Huirne JA. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG. 2014 Jan;121(2):145-56. doi: 10.1111/14710528.12537. Review. PubMed PMID: 24373589.
15. Burger NF, Darazs B, Boes EG. An echographic evaluation during the early puerperium of the uterine wound after caesarean section. J Clin Ultrasound. 1982 Jul-Aug;10(6):271-4. PubMed PMID: 6811618.
16. Cameron SJ. Gravid Uterus ruptured through the Scar of a Caesarean Section. Proc R Soc Med. 1911;4(Obstet Gynaecol Sect):147-9. PubMed PMID: 19975262; PubMed Central PMCID: PMC2005117.
17. Chan B.C.P., Lam H. S.W., Yuen J.H.F. et al. Conservative management of placenta previa with accreta // Hong Kong Med. J. — 2008. - Vol. 14 - P. 479-484.
18. Shopulotov S., Isroilov O. GIPERAKTIV QOVUQ SINDROMINI DAVOLASH BO'YICHA YANGI IMKONIYATLAR //Бюллетень студентов нового Узбекистана. -2023. - Т. 1. - №. 6 Part 2. - С. 106-109.
19. Shopulotov S. et al. SIYDIK TUTOLMASLIK MUAMMOSI //Центральноазиатский журнал образования и инноваций. - 2023. - Т. 1. - №. 6 Part 6. - С. 44-48.
20. Shopulotova Z. COMPARATIVE ANALYSIS OF CLINICAL CASES OF EXACERBATION OF CHRONIC PYELONEPHRITIS IN PREGNANT WOMEN //International Bulletin of Medical Sciences and Clinical Research. - 2023. - Т. 3. - №. 8. -С. 22-25.
21. Shamatov I., Shopulotova Z. ADVANNAGES OF PALATE LASER THERAPY IN COMPLEX TREATMENT OF LARINGITIS //International Bulletin of Medical Sciences and Clinical Research. - 2023. - Т. 3. - №. 9. - С. 104-107.
22. Shernazarov Farrukh ORGANIZATION OF DIGITALIZED MEDICINE AND HEALTH ACADEMY AND ITS SIGNIFICANCE IN MEDICINE // SAI. 2023. №Special Issue 8. URL: https://cyberleninka.ru/article/n/organization-of-digitalized-medicine-and-health-academy-and-its-significance-in-medicine (дата обращения: 20.11.2023).
