Перинатальні наслідки розродження жінок, які мали порушення менструальної функції в пубертатному періоді
Національна медична академія післядипломної освіти імені П.Л. Шупика
Keywords:puberty, menarche, oligomenorrhea, pregnancy, perinatal outcomes, pubertal bleeding
The issue of preserving the reproductive health of women for many years does not lose its relevance. Fundamental studies of recent decades have made it possible to determine the basic mechanisms of functioning of the female reproductive system, but studies of the characteristics of pregnancy, complications in childbirth and the condition of newborn children in women with menstrual dysfunction in the puberty remain single.
The objective. According to laboratory and instrumental methods of research, to study the characteristics of childbirth and the condition of newborns in women with menstrual dysfunction in the puberty.
Patients and methods. According to the nature of the disorders, the main group of pregnant women (n=120) who had a menstrual pathology in the puberty were divided into 3 subgroups (n=40): the first - pregnant women with primary oligomenorrhea in the anamnesis, the second - with a late age menarche, the third - with puberty bleeding. The control group included pregnant women (n=40) with the correct rhythm of menstruation in puberty.
Results. During the clinical study, significant differences in the biological readiness of the body for childbirth in all subgroups of the main group of pregnant women were noted compared with the control group. In 35 (29,2%) pregnant women with menstrual dysfunction during the puberty, an «unripe» or insufficiently «mature» cervix was observed in the expected period of labor, which was important in the violation of labor activity during spontaneous labor in the occipital presentation and an increase in the frequency of delivery using cesarean section (CS) operation. Caesarean section was performed in 51 (42,5%) pregnant women of the main group: planned CS in 39 (32,5%), urgent delivery in 12 (10,0%). In the group of pregnant women with the correct rhythm of menstruation, spontaneous delivery occurred in 37 (92,5%) women, planned CS due to the narrowed pelvis and large fetus in 2 (5,0%), emergency CS - 1 (2,5%) case. The frequency of complications during childbirth (violation of labor, premature rupture of the membranes, bleeding) in the main group is 4 times higher than in the control group (p˂0,001), in a comparative aspect, the differences between the subgroups are not significant. 95,2% of newborns from mothers with menstrual dysfunction in the puberty were born in a satisfactory condition. The Apgar score is significantly higher in newborns from mothers receiving pregravid preparation. The frequency of individual conditions that occur in the perinatal period is the highest in newborns from mothers with a history of primary oligomenorrhea.
Conclusion. The results of the studies confirm the presence of the biological unpreparedness of the body for the normal course of labor in women with menstrual dysfunction in the puberty, as evidenced by violations of labor, the main predictor of which is placental dysfunction. The frequency of individual conditions that occur in the perinatal period is significantly higher than in newborns from mothers who had the correct rhythm of menstruation. It is possible to reduce the frequency of obstetric and perinatal complications in women with reduced reproductive potential by optimizing the pregravid preparation program and introducing a scientifically based complex of treatment and preventive measures.
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