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42УДК: 618.1.56-006.1.2
A MODERN APPROACH TO THE PREVENTION OF EARLY POSTPARTUM HEMORRHAGE
KHAMIDOVA NIGORA RUSTAMOVNA
Doctoral candidate of the Department of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute named after Abu Ali ibn Sino, Uzbekistan, Bukhara. ORCID ID 0000-0002-2125-5251
TUKSANOVA DILBARISMATOVNA Bukhara State Medical Institute named after Abu Ali Ibn Sino, Head of the Department of Obstetrics and Gynecology, Dsc, Bukhara, Republic of Uzbekistan. ORCID ID 0000-0002-7626-0410 NEGMATULLAEVA MASTURA NURULLAEVNA Bukhara State Medical Institute named after Abu Ali Ibn Sino, professor of the Department of Obstetrics and Gynecology, Dsc, Bukhara, Republic of Uzbekistan. ORCID ID 0000-0001-7698-0533
AKHMEDOV FARHOD KAHRAMONOVICH Bukhara State Medical Institute named after Abu Ali Ibn Sino, Senior Lecturer, Department of Obstetrics and Gynecology, PhD, Bukhara, Republic of Uzbekistan. ORCID ID 0000-0003-0104-4980
ABSTRACT
The aim of our study is to evaluate the effectiveness of tranexanoic acid for the prevention of bleeding is the early postpartum period. We have analyzed 100 cases of childbirth in puerperas, at risk for postpartum hemorrhage. Cases were devided into 2 groups (50 people each), depending on the therapy carried out in childbirth: 1 - study group, 2 -control group. Tranexamic acid refers to antifibrinolytic agents. It has local and systemic haemostatic effects in bleeding associated with increased fibrinolysis, as well as anti-inflammatory, anti-allergic, anti-infectious and anti-tumor effects due to the suppression of the formation of kinins and other peptides involved in allergic and inflammatory reactions.
Электронный научный журнал «Биология и интегративная медицина» №3 - май-июнь (43) 2020
Keywords: Obstetric hemorrhage, hemotacritis, acid trexaxamic.
СОВРЕМЕННЫЙ ПОДХОД К ПРОФИЛАКТИКЕ РАННИХ ПОСЛЕРОДОВЫХ КРОВОТЕЧЕНИЙ
ХАМИДОВА НИГОРА РУСТАМОВНА
Доктарант кафедры акушерства и гинекологии №2 Бухарского Государственного медицинского института имени Абу Али ибн Сино, Узбекистан, г.Бухара
ORCID ID 0000-0002-2125-5251 ТУКСАНОВА ДИЛБАР ИСМАТОВНА Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, заведующая кафедрой «Акушерство и гинекологии», Dsc, город Бухара Республика Узбекистан.
ORCID ID 0000-0002-7626-0410 НЕГМАТУЛЛАЕВА МАСТУРА НУРУЛЛАЕВНА Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, профессор кафедры акушерство и гинекологии, Dsc, город Бухара Республика Узбекистан.
ORCID ID 0000-0001-7698-0533 АХМЕДОВ ФАРХОД КАХРАМОНОВИЧ Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, старший преподаватель кафедры акушерство и гинекологии, PhD, город Бухара Республика Узбекистан.
ORCID ID 0000-0003-0104-4980 АННОТАЦИЯ
Целью нашего исследования оценить эффективности применения транексановой кислоты для профилактики кровотечения в раннем послеродовом периоде. Нами был проведен анализ 100 случаев родов у родильниц, имеющих на риск на послеродовые кровотечения. Случаи были разделены на 2 группы (по 50 чел.) в
Электронный научный журнал «Биология и интегративная медицина» №3 - май-июнь (43) 2020
зависимости от проводимой терапии в родах: 1- исследуемая группа, 2- контрольная группа. Транексамовая кислота относится к антифибринолитическим средствам. Обладает местным и системным гемо статическим действием при кровотечениях, связанных средствам с повышением фибринолиза, а также противовоспалительным, противоаллергическим, противоинфек-ционным и противоопухолевым действием за счет подавления образования кининов и других пептидов, участвующих в аллергических и воспалительных реакциях.
Ключевые слова: Акушерские кровотечение, гемотокрит, тренаксамовая кислота
ТУГРУКДАН КЕЙИНГИ ЭРТА КОН КЕТИШЛАРНИНГ ПРОФИЛАКТИКАСИГА ЗАМОНАВИЙ ЁНДАШУВ
ХАМИДОВА НИГОРА РУСТАМОВНА
Акушерлик ва гинекология №2 кафедраси докторанти, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон
ORCID ID 0000-0002-2125-5251 ТУКСАНОВА ДИЛБАР ИСМАТОВНА Dsc, Акушерлик ва гинекология №2 кафедраси мудири, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон
ORCID ID 0000-0002-7626-0410 НЕГМАТУЛЛАЕВА МАСТУРА НУРУЛЛАЕВНА Dsc, Акушерлик ва гинекология №2 кафедраси профессори, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон
ORCID ID 0000-0001-7698-0533 АХМЕДОВ ФАРХОД КАХРАМОНОВИЧ PhD, Акушерлик ва гинекология №2 кафедраси катта уцитувчиси, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон. ORCID ID 0000-0003-0104-4980
АННОТАЦИЯ
Тадкикотимизнинг максади транексам кислотасининг тугруфан кейинги эрта кон кетишларнинг профилактикасида самарадорлигини аниклашдан иборат. Биз тугруфан кейин кон кетиш хавфи булган 100 та аёлни текширдик. Аёллар олиб борилган даво чорасига караб 50 кишидан 2 гурухга ажратилди. 1 -текширилаётган гурух, 2 - назорат гурухи. Транексам кислотаси антифибринолитик дорилар гурухига киради. У фибринолиз кучайиши билан боглик кон кетишларда махаллий ва тизимли гемостатик таъсирга эга, шунингдек, аллергик ва яллигланиш реакцияларида иштирок этувчи кинин ва бошка пептидларни блоклаши хисобига яллигланиш, аллергия ва усмага карши хусусиятларга эга.
Калит сузлар: акушерлик кон кетишлар, гемотакрит, транексам кислотаси
The main objective of the demographic policy of the Republic of Uzbekistan: the continuation of depopulation, the reduction of maternal and infant mortality, not less than 2 times. Obviously, an essential condition for achieving these goals is to maintain women's health, including reproductive health [8,9].
To achieve these goals, a set of measures has been directed that has been implemented within the framework of a priority national project in the field of healthcare in our Republic since 1998, especially aimed at increasing the availability and high quality of preventive medical care for mothers and children. Improving the material and technical base in this area through the implementation of national projects, funds from the state reserve fund, as well as regional target programs has significantly expanded the possibilities of timely early diagnosis of pregnancy
complications and prevent the development of terminal conditions in childbirth - [4, 5].
Bleeding, the most dramatic complication of obstetric practice, remains one of the main causes of maternal mortality worldwide in the 21st century. According to WHO, obstetric hemorrhages cause 25-30% of all maternal deaths [1,3]. The risk of death from bleeding associated with pregnancy and childbirth in developed countries corresponds to 1: 100000, in developing countries it reaches 1: 1000 births - [6, 9].
The early postpartum hemorrhages that occur in the first 24 hours after birth account for a quarter of all maternal deaths worldwide, also in our Republic of Uzbekistan [8.9]. The frequency of bleeding in the early postpartum period ranges from 8- to 18%.
The swiftness of the increase in the volume of blood loss, combined with the urgent need for a high-quality implementation of the algorithm of actions aimed both at stopping bleeding, replacing blood loss, and providing anesthetic benefits, determine the outcome of pregnancy and childbirth for the mother and her offspring.
To reduce the volume of blood loss after childbirth, protocols for their treatment and prevention standards have been developed to date. One of the preventive therapy for bleeding in the early postpartum period is the use of methods of active management of the third stage of labor, management of uterotonics immediately after the birth of a newborn - [8, 10].
The introduction of oxytocin and palliative methods are the main methods of stopping bleeding in the subsequent and early postpartum period. However, in recent years there has been evidence of the need for progestostatic drugs to prevent bleeding along with the above methods.
Purpose of the study: To evaluate the effectiveness of tranexanoic acid for the prevention of bleeding in the early postpartum period.
AKYWEPCW&O M TMWEKPAOTMZ 20
Material and methods.
We have analyzed 100 cases of childbirth in puerperas, which are at risk for postpartum hemorrhage. Cases were divided into 2 groups (50 people each), depending on the therapy carried out in childbirth: 1 - study group, 2 - control group. In the first group, women in the latent phase of labor were infused with tranexanoic acid, 500 ml of sodium chlorine 0.9% + 5 ml (Trenax preparation), intravenous drip. In the 2nd group of patients, childbirth was conducted without the use of the drug. Tranexamic acid refers to antifibrinolytic agents. It has local and systemic haemostatic effects in bleeding associated with increased fibrinolysis, as well as antiinflammatory, anti-allergic, anti-infectious and anti-tumor effects due to the suppression of the formation of kinins and other peptides involved in allergic and inflammatory reactions. The hemostatic effect is realized by specific inhibition of the activation of profibrinolysin (plasminogen) and its conversion to fibrinolysin (plasmin).
Tranexam is prescribed 500 mg 3-4 times a day until the bleeding stops completely. After intravenous administration, it is advisable to switch to the oral administration of the drug.
We studied patients were comparable in age and reproductive history. Of extragenital diseases in the 1st group, the most common were:
- moderate anemia -80%,
- chronic diseases of the genitourinary system-42%
- chronic hepatitis-15, 8%,
- varicose disease - 7%. In the control group:
- moderate anemia of 65%,
- chronic diseases of the genitourinary system - 35%,
- chronic hepatitis-12, 5%,
- varicose veins - 5.8%.
To estimate the volume of blood loss in childbirth, the gravimetric, hematocrit method was used, as well as the formula (0. 36 * initial blood volume / body weight) 0 hematocrit.
Results and discussion A comparison of the data obtained in both groups revealed a statistically significant difference. When using the gravimetric method and calculation by the hematocrit method, the blood loss indicators in the study group were less than in the control group (p <0.05). When calculated according to the Nelson formula, in the 1st group there were more blood losses than in the control group, but the difference was statistically insignificant. In both groups, there were no cases of side effects.
Table number 1
Comparative data on the volume of blood loss (ml) in the studied
groups.
Groups Gravimetric method Hematocrit method Nelson's formula
1- groups 237,7 219.9 338,9
2- groups 328,3 302,9 329,0
From the data of table No. 1 it can be seen that there were differences in the volume of blood loss in comparable groups. According to the gravimetric method, the difference was 90.6 + - 3 ml, according to the hematocrit method 83.0 + - 4 ml.
When calculated by the Nelson formula in the study group, the blood loss was 8.1 ml more compared to the control group, this indicator remained insignificant. When studying hemoglobin indices, its decrease did not have a statistical difference. This was explained by the fact that in the first hours
after blood loss hemodilution has not yet occurred, and the concentration of hemoglobin remains the same, despite a decrease in its absolute value.
Table number 2
Comparative indicators of hemoglobin before and after childbirth
Groups Hb before birth Postpartum Hb
1- groups 94,0+/-1,2 31,3+/-1,02%
2- groups 92,0+/-1,4 30,2+/-1,04%
There were no significant differences in the general analysis of urine in both groups and side effects were noted in the form of nausea, vomiting, diarrhea of thromboembolic complications.
Conclusions
Thus, the efficacy of tranexamic acid in reducing the amount of blood loss in patients with a high risk of bleeding in childbirth and in the early postpartum period has been proved.
The prophylactic use of this drug in pregnant high-risk groups of bleeding reduces the amount of blood loss.
The use of tranexamic acid in obstetric practice does not require a preliminary study of the parameters of the hemostatic system, which significantly reduces the cost and time of preparation for hemostatic therapy. This hemostatic drug can be used as hemostasis in the early postpartum period in the complex therapy of postpartum hemorrhage.
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