CLINICAL AND MORPHOLOGICAL PARALLELS IN PREGNANCY COMPLICATED BY POLYHYDRAMNIOS

Аннотация

Despite the significant breakthrough of obstetric science and practice in the second half of the 20th century and the beginning of the 21st century, the introduction of innovative methods, the rapid development of the pharmacological industry, the problem of obstetric bleeding remains one of the most urgent problems of obstetrics [2,5,7]. Of the 550-600 thousand maternal deaths, about 200,000 die from obstetric bleeding. Bleeding is in the leading positions among the so-called "big five" causes of maternal mortality [1,3,9,10] At the same time, 125 thousand women die due to massive obstetric bleeding, almost half die from uterine hypotension. The main reasons for the development of hypo and atonic bleeding may be the insufficiency of myometrial retraction and thrombosis in the vessels of the placental site, which has from 150 to 200 spiral arteries [4,5] Keywords: pregnancy, polyhydramnios, postpartum hypotonic bleeding, myometrium, edema and hemorrhage. I. INTRODUCTION Intensive retraction of the uterine muscle fibers after the birth of a child contributes to the compression, twisting and retraction of the spiral uterine arteries into the thickness of the muscle, along with which the process of thrombosis begins. The formation of dense, elastic blood clots provides reliable hemostasis. Violations of the coagulation properties of blood, as well as a decrease in the contractility of the myometrium in combination with each other, play a crucial role in the development of postpartum bleeding [7, 10]. Another reason for uterine hypotension may also be connective tissue dysplasia. In connective tissue dysplasia, the frequency of AK is 1.7 times higher than in the general population. Maslyakova G. N. [1,6], in histological studies of queens removed due to hypotonic postpartum bleeding of unclear genesis, showed that the uterus is not able to contract sufficiently with tumors, overgrowth due to multiple births, polyhydramnios, a large fetus. It is believed that the violation of the contractile function of the uterus is associated with overgrowth and "exhaustion" of the contractile ability of the myometrium, with infection, as well as with anatomical/functional features of the uterus, with the delay of parts of the afterbirth or blood clots in the uterine cavity [8,10,11]. One of the causes of reproductive losses is polyhydramnios during pregnancy. The frequency of this complication, according to foreign and domestic authors, ranges from 0.12 to 8.4%. Among the causes leading to polyhydramnios, there are: diabetes mellitus, acute and recurrent chronic infectious diseases, isosensitization by the Rh factor, fetal malformations. An excessive amount of fluid is determined indirectly by ultrasound criteria, usually with the help of IAZH (AFI). AFI is the sum of the vertical depth of the fluid column measured in each quadrant of the uterus. Normally, the AFI is from 5 to 24 cm; valu≥e s2 o4f cm indicate polyhydramnios. www.turkjphysiotherrehabil.org 4137 Turkish Journal of Physiotherapy and Rehabilitation; 32(2) ISSN 2651-4451 | e-ISSN 2651-446X Chronic hydramnion is more common, when excess amniotic fluid accumulates gradually [12] In the acute form, the volume of amniotic fluid increases sharply (in a few hours or days). An important role in the development of hypotonic postpartum bleeding is played by the rate of accumulation of amniotic fluid and their volume. Morphological changes in fruit shells, detected during morphological and electron microscopic studies, are very interesting from a scientific point of view. Morphostructural changes of the amnion were revealed, indicating the predominance of the processes of amniotic fluid resorption over the processes of reabsorption, which is a pathogenetic mechanism of excessive accumulation of amniotic fluid [5,7] . At the same time, morphostructural changes occurring in the uterine wall during polyhydramnios remain insufficiently studied. The purpose of this study was to study the features of the clinic and the morphological structure of the uterine wall in polyhydramnios of varying severity. II. MATERIALS AND METHODS OF RESEARCH The peculiarities of the course of pregnancy and childbirth were studied in 49 women who developed polyhydramnios at 32-40 weeks. All the observed patients underwent a full clinical examination in the conditions of the city maternity complex No. 2 of the city of Samarkand for the period 2018 - 2019. The control was the indicators of 40 women of the control group with the physiological course of gestation of the same age and parity. Histological studies of myometrial tissues obtained during cesarean section surgery were performed in 23 patients of the main and 10 patients operated on as planned due to the presence of a scar on the uterus. Clinical (obstetric), laboratory (general clinical and biochemical studies of blood, urine, secretions, coagulogram), functional (ECG, dopplerometry, ultrasound). Special morphological studies were also used. Fra