ANALYSIS OF THE RESULTS OF SEVERE OLIGOHYDROAMNIONS IN PREGNANT WOMEN IN THE PERINATAL CENTER OF PAVLODAR FOR 2018 YEAR
Relevance: One of the insufficiently studied sections in the perinatal obstetrics is the pathology of amnion, particularly oligohydramnios, characterized by reducing the amount of amniotic fluid in the second half of pregnancy, decline the vertical depth of the pocket - 2 cm or less or amniotic fluid index of less than 5 cm. Estimation of the volume of amniotic fluid is an integral part of antenatal care. Physiological fluid volume increases with gestational age up to 36-37 weeks. The relationship of oligohydramnios with high rates of perinatal mortality in the modern obstetrics determines the relevance of the study.
Objective: to identify the risk factors of severe oligohydramnios, examine the condition of the fetus during pregnancy, the methods of delivery and perinatal outcomes at the oligohydramnios.
Materials and methods: Study design - retrospective study. For the period 01.01 to 09/31/2018y was 3036 labors, out of which labors with oligohydramnios amounted 222 labors 7.3%. The analysis of the work consisted in comparing 2 groups of women with moderate and severe oligohydramnios. The main group consisted of 24 pregnant women with severe oligohydramnios. The control group included 29 pregnant women with oligohydramnios of moderate severity. The formation of a database of research and calculation of statistical indicators has been produced with the help of a licensed program SPSS 20.0 (IBM Ireland Product Distribution Limited, Ireland). For the statistical results using Student's t-test.
Results and discussion. At the studying medical records, both groups did not undergo pregravid preparation before pregnancy. In the study of anamnesis and complications during pregnancy found that acute respiratory, infectious disease during pregnancy in the main group is - 5(20.8%), in the control group - 4(10.3%). Gestational diabetes mellitus during pregnancy was diagnosed in the main group of 1(4.1%), in the control group 5(17.2%). Pre-eclampsia was complicated by labor in the main group 9(37.5%), and 5(17.2%) in the control group. In the study of somatic anamnesis, there is a high frequency of anemia of any degree in the main group 9(37.5%), in the control group 7(24.1%), a violation of fat metabolism in the main group 3(10.3%), in the control group 3(12.5%). 7(29.1%) of the main group had in anamnesis abortions and miscarriages, and in the control group 7(24.1%).
There is a large percentage of prenatal complications at severe oligohydramnios, associated with the fetus. Violation of fetal-placental circulation in the main group is 5(20,8%), in the control group - 4(10,3%.). Developmental delay syndrome of fetus in the main group is 8(33,3%), while in control group - 6(20,6%). In the intranatal period were noted such complications as: passage of meconium into the amniotic fluid in the main group – 2(8.3%) and in the control group - 1(3.4%); life-threatening conditions of fetus according to cardiotocography assessment – 12(50%) in the main group and 6 (20.6%) in the control group, respectively; weakness of labor activity was observed in women with severe oligohydramnios 1 (2.4%). In oligohydramnios, the number of operative labor is 2 times higher. In the main group, vaginal delivery in -13( 54%), operative delivery in – 11(46%). The control group had 12(41%) births through the birth canal, operative delivery in 17(59%). The perinatal outcomes of our analysis were rated on the Apgar scale: up to 5 points, in the main group -5(20.8%), and to the control group -2(6.8%), up to 7 points, in the main group is 10(41.6%) and in the control group -3(10.3%); and more than 7 points 9(37.6%) in main group and in the control group is 24(82.9%). This fact again shows that severe oligohydramnios affects the condition of the newborn. All newborns who born in serious condition were transferred to the neonatal intensive care unit.
Conclusions: Thus, the combination of pregnancy with extragenital pathology increases the risk of developing placental dysfunction and fetal hypoxia, which can affect the change in the quantity of amniotic fluid, next oligohydramnios significantly worsens the prognosis for the fetus and newborn. In the presence of severe oligohydramnios, placental insufficiency, threatened fetus condition, oligohydramnios should be considered as an aggravating factor of high perinatal risk, which is justified, expands the indications for emergency delivery in the interests of the fetus.
Aizhan Zh. Alipanova 1, http: //orcid.org/0000-0003-4592-0014
Zhansulu E. Akylzhanova 1, https://orcid.org/0000-0001-6855-127X
Tatiana M. Dernova 1, https://orcid.org/0000-0001-7609-1568
Oksana I. Shalbaeva 1, https://orcid.org/0000-0002-9646-1981
1 Department of Emergency Medicine, Obstetrics and Gynecology course
Pavlodar branch of the NCJSC "Semey Medical University"
Pavlodar c., Republic of Kazakhstan
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