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УДК 613.888:618.17
Mamazhonova S.O. department of obstetrics and gynecology No. 2 Andijan State Medical Institute
THE IMPACT OF CONTRACEPTIVE METHODS ON WOMEN'S
REPRODUCTIVE HEALTH
Resume: Contraception as a family planning method can also be considered a way to prevent abortion and related complications, and thus has not only medical but also social significance. In order to preserve and enhance women's reproductive health one needs individuality and thoroughness of method of contraception choosing, as well as greater awareness of women about prevention methods.
Key words: contraception, intrauterine contraception, combined oral contraceptive.
Relevance. Contraception, being a method of family planning, can simultaneously be considered a way to prevent abortion and related complications, therefore, has not only medical, but also social significance. In our country, artificial abortion remains the leading means of birth control, which adversely affects reproductive health.
The main majority of patients in this profile are under the age of 25, are women of reproductive age [2,4,8] and belong to the "reserve of childbirth" group. This determines the second feature of the problem associated with this pathology: a large number of secondary complications leading to impaired reproductive function (infertility, miscarriage, etc.) and, finally, the third important factor is the growth among patients of reproductive age of women suffering from chronic infections of the reproductive system. Unfortunately, we have to state that the number of intrauterine interventions with various purposes (diagnostic, therapeutic and abortive manipulations) in total in this group of women has a steady upward trend.
In the last few decades, approaches to the rational prevention of postoperative complications have been developed in surgery and gynecology[3,5,9]. In many studies, in order to standardize approaches to antibacterial prevention, the risk of developing infectious complications after surgical interventions is distinguished. In addition, there are numerous risk factors that affect the occurrence of infectious and inflammatory diseases after surgical interventions in obstetrics and gynecology. The administration of antibiotics for the prevention of infectious complications implies ensuring effective concentrations of the drug in the tissues until their contamination during and after surgery. At the same time, against the background of prolonged use of antimicrobial agents, the probability of infectious and inflammatory
diseases in the postoperative period not only does not decrease, but also increases somewhat [1,6,8].
It is proved that the development of the infectious process is prevented by the introduction of antibiotics no later than 3 hours after the creation of the wound surface (the entrance gate for bacterial pathogens). On the other hand, prescribing antibiotics more than a day before surgery increases the risk of developing resistance of microorganisms to the drug. Therefore, the optimal regimen of antibiotic prophylaxis is the first administration of the antibiotic perioperatively (or intraoperatively - with caesarean section) and subsequent -within 12-24 hours [5,7].
The purpose of the study. Optimization of reproductive health of women using intrauterine contraception.
Materials and methods of research. To fulfill our task, we selected 85 patients who were diagnosed with IUD and had complications. In them, we conducted a clinical analysis and predicted complications.
In the main group of women whose pregnancy was terminated by medical abortion up to 12 weeks by curettage, there was an exacerbation of chronic adnexitis in 2 patients (6.7%).
In the control group, problems after abortion occurred in 12 women (40%): exacerbation of chronic adnexitis was in 6, metroendometritis - in 3, acute adnexitis - in 2, menstrual cycle disorders in one patient.
The results of the study. The main factors that influenced the choice of the method of contraception (IUD) were the fear of repeated abortions, the psychological unacceptability of hormonal contraception, as well as the high effectiveness of IUD, ease of use, affordable cost, harmlessness to health, duration of action, comfort in the sexual sphere. The majority (65.9%) of the surveyed women have a negative attitude to hormonal contraception, preferring to use IUD until menopause. j
The reproductive behavior of women before the use of IUD was characterized by frequently alternating pregnancies, a large proportion of which were abortions, including almost a third before the first birth. The ratio of the number of abortions to the number of births was 2.1:1 in the group of women with inflammatory diseases of the pelvic organs (VZOMT) on the background of IUD and 1.7:1 - without VZOMT.
Intrauterine contraception, subject to the technology of its use, does not adversely affect the fertility of women, allowing them to carry a pregnancy after using IUD. Among women who wished to become pregnant after timely extraction of IUD, 55.6% became pregnant within six months, the rest — within a year. At the same time, the frequency of complications of pregnancy and childbirth did not exceed the average population indicators.
Violations of vaginal microbiocenosis are detected more often in women with VZOMT and are characterized by a small amount or complete absence of lactobacilli and the presence of opportunistic flora (Staphylococcus aureus,
Enterobacteria, Gardnerella, Candida fungi). All patients underwent a traditional examination before intrauterine manipulations and the degree of vaginal cleanliness was additionally determined.
Risk factors for the development of inflammatory diseases of the organs, small, pelvis against the background of IUD are transferred VZOMT or sexually transmitted infections, multiple sexual partners, insufficient examination or inadequate treatment before the introduction of a contraceptive, as well as the lack of follow-up during the use of this method. Conclusion. Based on the results of the conducted research, it will be possible to improve the complex of therapeutic and preventive measures and put into practice scientifically-based recommendations for the prediction and prevention of complications as a result of the use of IUD. The necessity of a thorough examination of patients before the appointment of intrauterine contraception and further dynamic monitoring is substantiated.
An assessment of the role of factors influencing the prevalence of this method of contraception will determine the priority areas of work on the introduction of modern methods of preventing unwanted pregnancy.
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