CC BY
14
WAYS OF OPTIMIZATION IN THE TREATMENT OF URINARY TRACT INFECTIONS IN PREGNANT WOMEN FOR THE PURPOSE OF PREVENTING SEPTIC COMPLICATIONS
DOI: http://dx.doi.org/10.20534/ESR-17-5.6-31-32
Muminova Nigora Khayritdinovna, The senior lecturer of faculty of Obstetrics and gynecology of Tashkent Institute of improvement of doctors Djuraeva Dilfuza Lutfullaevna, Assistant of the Department of Obstetrics and Gynecology of the Tashkent Institute of improvement of doctors Zakhidova Kamola Shukhatovna, Doctor of Family policlinik № 46 of Tashkent E-mail: [email protected]
WAYS OF OPTIMIZATION IN THE TREATMENT OF URINARY TRACT INFECTIONS IN PREGNANT WOMEN FOR THE PURPOSE OF PREVENTING SEPTIC COMPLICATIONS
Abstract: Infection of the urinary tract (IUT), means the presence of microorganisms in it, with the subsequent development of the inflammatory process. The frequency of IUT in pregnant women is from 4 to 8%. Pregnant women with IUT were treated with an antibacterial drug and phytopreparation, which in all 100 cases gave a clinical and laboratory effect. Keywords: Infection of the urinary system IUT, asymptomatic bacteriuria, cyctit, Urfocin.
Relevnce: Infection of the urinary system IUT, means the presence of microorganisms in it, followed by the likely development of the inflammatory process. The frequency of infections of the urinary system in pregnant women is from 4 to 8% [1; 4; 7]. The presence of only bacteria in the urine without visible clinical manifestations of the disease (asymptomatic bacteriuria) is noted from 2% to 13% of cases.
Causes that affect the predisposition ofwomen to infection are: a short urethra, proximity of the urethra to the rectum and to the external genital organs, changes in the hormonal background. During pregnancy, additional conditions are created for urine stagnation and disturbance of its outflow due to a significant expansion of the kidney pelvis, lengthening of the ureters, decreased tone and contractility of the muscles ofvarious parts of the urinary system as a result of the action of progesterone and kidney displacement. In addition, the outflow of urine from the kidneys worsens due to the mechanical pressure of the pregnant uterus on the ureters. In this connection, V3 of pregnant women have a reverse urine flow from the bladder into the ureters, which promotes the spread of pathogens into the upper parts of the urinary system. Risk factors for the development of urinary tract infection are: failure to comply with the rules of personal and sexual hygiene, previous inflammatory diseases of the genitals (inflammation of the cervix, uterus and uterine appendages), the presence of foci of chronic infection in the body, endocrine pathology (diabetes), the pathology of the urinary system Urolithiasis, chronic cystitis, kidney development anomalies), as well as unsettled sex life and frequent changes in sexual partners.
Objective: treatment of pregnant women with uncomplicated IUT, with getting rid of the pathogen and preventing the recurrence of the infection.
Material and research: This condition was accompanied with dysuric phenomena, in all cases with a rise in temperature above 37C and in 32 women with the threat of miscarriage in different
periods of pregnancy. First-pregnancy was-22, and the rest in the anamnesis had 2-4 births. Twenty-five re-pregnant patients reported a history of IUT in different gestation periods, these were episodes of cystitis, pyelonephritis, and in 17 they were complicated by a febrile condition, with a threatened interruption clinic, and after 30 weeks with an increase in blood pressure to 150/100 mm Hg., In connection with which in 11 pregnant women, the delivery was accelerated prematurely. In the postpartum period, out of 25 women, a picture of the systemic inflammatory response syndrome (SIRS) was diagnosed in 7 puerperas, caused by infection of the urinary tract and exacerbation of chronic endometritis.
On admission, data from a general blood test: leukocytes averaged 11.9 x 10 12, erythrocyte sedimentation rate 30.7 mm/h, creatinine 122 ^mol/L, and urea 8.3 ^mol/L, respectively. The general analysis of urine: a leukocyturia (on the average 19-21 in p.), Bacteriuria was revealed in all analyzes.
Microbiological examination of urine revealed E. coli (69%), klebsiella (19%) of staphylococcus (18%), proteus (7%), and streptococci (13%). Microbial associations were noted in 33%, which coincided with literature data, where acute uncomplicated bacterial cystitis in 80% of cases is caused by E.coli and in 15% by other pathogens: St. Saprophyticus, Klebsiella spp, Proteus spp. [1; 4; 5].
For the treatment of IUT in pregnant women, antibiotics were mandatory given the absence of teratogenic effects. These were preparations of phosphomycin trimethomol (trade name Urfocin). The appointment of an acceptable and safe dose of antibiotic, taking into account the possibility of use during pregnancy, was of no small importance. Taking into account these facts, we appointed Urfocin («Asfarma», Turkey) depending on the severity of the pathological process orally 3g once., With the rise of temperature 38 and higher, 1-3-generation cephalosporins in therapeutic doses.
Section 4. Medical science
With recurrent cystitis Urfocin was administered again 3g, 7-10 days later.
In addition to antibacterial preparations, phytopreparation, which have a mild antimicrobial and diuretic action, which were of no small importance in the eradication of the pathogen in IUT.
Wild carrot, which is part of the phytopreparation having a pronounced reparative and litholytic activity, promotes improvement of renal blood flow, restores its acid-base balance. Therefore, the course of therapy with phytopreparation, we counted on a long daily reception, in courses of 3-4 weeks with a weekly break.
Urfocin is easily absorbed and quickly reaches the urinary tract and kidneys with blood, effectively removes attacks of renal colic, causing hyperemia (plethora), thereby improving their blood supply, thereby enhancing urinary excretion [3; 4]. The experience of using Urfocin in large scientific and clinical institutions, in the countries of the commonwealth and at the Department of Urology Tashkent Institute of improvement of doctors in pregnant women with renal pathology showed high efficacy of the drug in kidney diseases, as well as an undoubted therapeutic and preventive effect in the development of hypertension in patients of the study groups [2; 3; 4].
Pregnant with IUT and obstetric complications (threat interrupt or hypertension) were treated in a hospital, and the rest were treated in the clinic antibacterial and fitopreparation to 3 days.
Results of the study: After 48-72 hours, the laboratory parameters were analyzed: where the leukocytosis decreased to 7.9 x 1012, while in healthy individuals this index was 7.2 x 1012, the ESR decreased by 9.5 mm/hour (in healthy subjects it was 19.7 mm/hour), urea and creatinine level was closer to the lower limit of normal and the number of leukocytes in urine assays exceed 3-4 In the field ofvision and in 43 samples of bacteria have been identified.
These changes clinic in the direction of improvement suggests Urfocin multilateral action both urinary as well as the activities of other organs and system, that in common with those of other authors [3; 4].
Further observations of the pregnant women gave the following results: relapse of the IUT was again detected in 37-45 days only in 6 pregnant women, who indicated that the phytopreparation was not taken regularly. With the threat of abortion, only 5 women were re-admitted, which was caused not by infection, but by stress and physical stress. Births in 43 pregnant women occurred in terms of 38-42 weeks, without infectious complications. In 4 parturient women, the birth was complicated by a premature discharge of amniotic fluid, the cause of which was inadequate induction of labor, the 3-period in 1 woman was complicated by uterine hypotonia, which resulted in a radical operation.
The course of the postpartum period in 2 puerperas out of 47 was complicated by cystitis, which was stopped by the appointment of phosphomycin trimetamol with phytopreparation.
In conclusion, I would like to note that the timely and comprehensive treatment of IUT in the early stages of its development in pregnant women with a short course of antibacterial therapy, new helps reduce not only the inflammatory processes of the urinary, but also obstetric, such as the threat of abortion and premature birth, The cause ofwhich is infection, thereby in childbirth and the postpartum period leads to a reduction in the incidence of infectious complications to 87.3%, which coincide with the data of foreign studies [6; 7]. This preventive approach, where antibacterial therapy is carried out with long-term support of phytopreparations, reduces the infectious and inflammatory diseases of the urinary tract, suppressing the development of purulent-septic conditions in childbirth and in the postpartum period, and improves maternal and perinatal morbidity and infant mortality.
References:
1. Abramchenko V. V., Kostyuchek D. F., Khadzhieva E. D. Purulent-septic infection in obstetrics and gynecology. - Pb., - 2005. - 460 p.
2. Avdoshin V. P., Morozov S. G., Sobolev V. A. Evaluation of the effectiveness and treatment of acute gestational pyelonephritis // Akush. And the gynecologist. - 2005. - No. 3. - P. 23-26.
3. Antonova V. E., Martov A. G., Danilkov A.P. Efferent therapy in the complex treatment of acute purulent pyelonephritis in the early postoperative period. Urology. - 2007. - No. 4. - P. 94-99.
4. Baranova I. N., Fedorovsky N. M. And Fedotov PA Immunodiagnostics and principles of immunocorrection in patients with purulent-septic diseases of the abdominal cavity // Westpik int. Ter. - 2000. - No. 3. - P. 29-32.
5. Enkin M., Keirs M., Neilson D. Guidance on effective assistance to pregnancy and childbirth. - 2000. - P. 158-159.
6. Urogenital infections / Internation consultation on urogenital infections / ad. K. Naber, A. J. Schaeffer, Ch. F. Heyns, T. Matsumoto, D. A. Shoskes, Truls E. Bjerklund Sohansen. - 2010, European Association of Urology. - 1800 p.
7. Wullt B., Bergsten G., Fischer H. et al. The host response to urinary tract infection. Infect Dis Clin North Am - 2003. 17: 279-301.
