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Medical science
Matyakubova S. A., Ruzmetova D. T., Urgench branch of the Tashkent Medical Academy E-mail: mbshakur@mail.ru
RISK FACTORS OF DEVELOPMENT OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES IN PREGNANT WOMEN
Abstract: Preterm premature rupture of fetal membranes (PPROM) occurs in approximately 3% of pregnancies. PPROM is associated with maternal and fetal pathologies, contributing to the birth of premature infants. The longer the time elapsed between rupture and delivery, the greater the chance of infection for both mother and fetus. Risk factors for the development of SRD are various, often combined pathological processes that occur before or during gestation. Births with this obstetric pathology are 2.5 times more likely to require operative delivery, complicated by anomalies of labor, an increase in the incidence in the perinatal period as compared with patients with timely amniotic fluid.
Keywords: pregnancy, premature ruptures of membranes, risk factors.
Premature rupture of membranes (PPROM) is one of the most important problems in obstetric practice. According to some authors, births complicated by RDS in full-term pregnancy range from 8.2% to 19.6%, and for premature births (up to 37 weeks of gestation) range from 5 to 35% [3; 6]. Similarly, different authors note that up to 20-32% of a proSPD has a tendency to re-develop in subsequent births [1; 5]. According to the American College of Obstetricians and Gynecologists, rupture of the membranes during pregnancy up to 37 weeks complicates in 2-4% of pregnancies with one fetus and 7-20% with multiple fetuses [7; 8].
An incorrect diagnosis of premature rupture of the fetal membranes of pregnant women can lead to unreasonable actions (for example, hospitalization or early delivery), and late diagnosis leads to a delayed reaction of obstetricians and the growth of infectious and inflammatory complications. We must not forget that the management of pregnancies complicated by PPROM is very expensive [2; 4].
Objective: to analyze the outcomes of pregnancies complicated by PPROM in 24-37 weeks, depending on the duration of the latent period and the timing of gestation.
Materials and research methods: a clinical and anamnestic analysis of 131 pregnant women with PPROM, fetuses and newborns was conducted, as well as the course of pregnancy and premature labor during the spontaneous development of labor in the 24-37 week of pregnancy (main group). Postnatal outcome of newborns traced to discharge from the hospital. The control group consisted of 30 women with a physiological pregnancy in the period from 37 to 40 weeks.
A comparative analysis of the outcome of pregnancy was carried out depending on the duration of pregnancy at the time of discharge of the amniotic fluid and the length of the
anhydrous period in three intervals: (l) - up to 48 hours, (2) -from 48 hours to 168 hours and (3) - 168 hours or more.
Upon admission, we conducted patients with a comprehensive clinical and laboratory examination, microscopic analysis of the vaginal flora, and bacteriological culture of the contents of the cervical canal to determine sensitivity to antibacterial drugs.
Results of the study: the analysis of social, anamnestic, clinical and laboratory data and the characteristics of the course of this pregnancy allowed us to identify a number of reliable risk factors for PPROM in the middle of the 2nd beginning of the 3rd trimester of pregnancy.
The largest number of pregnant women (49.6%) with premature rupture of the amniotic fluid was between 31 and 35 years old, i.e. in late reproductive age. At the same time, a significant percentage (15.3%) of pregnant women with PPROM is at the age of 16-18 years old, although it is obvious that the frequency of births at this age is much less than in other age groups. Probably, this fact is associated with insufficient adaptation of the body of a pregnant woman to various pathogenic factors and stresses in this age period.
When analyzing the socio-demographic factors, we found that every second woman in the group with OSPA was between the ages of 31 and 40 years (52.3%), which was significantly more frequent than in the group with amniotic fluid amid the birth activity (29, one%). According to our data, the age of mothers up to 18 years and over 30 years is a risk factor in relation to the outpouring of water before the onset of labor.
The risk factors for PPROM should include a high incidence of sheath rupture and preterm labor in history (r = 0.684; p < 0.05).
In the structure of chronic pathology of pregnant women, the overall frequency of which was about 60.3%,
RISK FACTORS OF DEVELOPMENT OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES IN PREGNANT WOMEN
iron deficiency anemia is closely associated with PPROM. Indeed, iron deficiency, which is a cofactor for various enzymes, including metalloproteinase of the fetal membranes, may play an important role in the genesis of their structural degradation and rupture.
Closely associated with inflammatory diseases of the genital tract, in the first place, endometritis in history (84.7%). In pregnant women with PPROM, bacterial vaginitis was significantly more common (69.5%).
An analysis of the course of pregnancy showed that one of the most significant risk factors for CRD should be considered an acute respiratory viral infection in the first trimester of pregnancy, the frequency of which in pregnant women of the main group was 28.2%, whereas in the control group this figure was only 10% (P < 0.05).
Conclusion: our data confirm the predominant importance of genital and respiratory infections in the genesis of the prostate cancer. The analysis of perinatal outcomes with pro-
longed prolongation of pregnancy showed that with PRPT up to 25 weeks of gestation, the perinatal outcome is extremely unfavorable and is not related to the duration of the latent period.
High risk of purulent-septic complications of the mother, low survival rate of newborns, due to the deep morphofunc-tional immaturity of children, as well as severe systemic pathology due to intrauterine infection (IUI), suggest expectant management of pregnancy, complicated by CRCP, under the control of the possible implementation of purulent-septic infection.
Prolonging pregnancy after 25 weeks leads to a significant reduction in early neonatal mortality, primarily due to severe forms of SDR, and a simultaneous increase in antenatal losses associated with unfavorable conditions of fetal development due to intra-amniotic infection and lack ofwater, and the lack of reliable criteria for critical state fetus, adverse perinatal outcome in general, and, as a consequence, untimely delivery.
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