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Effect of varicose veins on pregnancy

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https://www.eduzhai.net American Journal of Medicine and Medical Sciences 2021, 11(9): 615-617 DOI: 10.5923/j.ajmms.20211109.02 Influence of Varicose Disease on Pregnancy Orzimurod Shomurodovich Yusupov, Dildora Rakhimovna Khudoyarova* Department of Obstetrics and Gynecology No. 1, Faculty of General Medicine, Samarkand State Medical Institute, Samarkand, Uzbekistan Abstract Varicose veins are one of the most common vascular pathologies, the most important risk factor for which is the female sex. The reasons for this epidemiological phenomenon are cyclical changes in hormonal levels and pregnancy [1,3,4]. The etiological factors in the development of chronic venous insufficiency during pregnancy are considered to be the weakness of the vascular wall, dysfunction of the endothelium of the veins, damage to the venous valves, compression of the inferior vena cava and iliac veins by the growing uterus. An important point is also an increase in the concentration of progesterone in the dynamics of pregnancy and an increase in the coagulation potential of the blood in combination with congenital anomalies of the hemostasis system [2,5]. The study of the effect of this disease on pregnancy and its outcomes is becoming increasingly important as the number of complications increases. The aim of the study was to assess the effect of varicose veins of the small pelvis and extremities on the course and outcomes of pregnancy. The study was carried out in the first perinatal center of the city of Samarkand, retrospectively, a comparative analysis of the course of pregnancy was carried out in 30 patients with a diagnosis of varicose veins (main group) and 20 healthy patients (control group). Both groups were comparable in terms of age and gestational age. The average age of women in both groups was 24.5 ± 2.7 years. Combined varicose enlargement of the great saphenous vein and its tributaries, the veins of the vulva and vagina was observed in 56.7% of patients, isolated expansion of the trunk of the great saphenous vein and its tributaries in 26.7%, and the syndrome of pelvic venous congestion, expansion of the great saphenous vein and external veins genitals in 16.7% of cases. The study showed that at the end of the second trimester, 13 (43.3%) patients of the main group had dysuric disorders, while in the control group, these phenomena occurred only in 2 (10%) cases. The frequency of placental insufficiency in patients of the main group was higher than in the control group. The threat of termination of pregnancy in the main group was registered in 16 (53.3%) cases, in the control group only in 1 (5%) patient (p> 0.05). Delayed intrauterine development of the fetus was observed in 4 (13.3%) pregnant women from the main group. In the main group, polyhydramnios was present in 3 (10%) patients, while in pregnant women in the control group it occurred only in 1 (5%) case (p> 0.05). In 4 (13.3%) patients of both groups, there was an edematous variant of toxicosis, with a significant difference: in 3 (12.5%) patients of the main group and in 1 (4.2%) of the control groups. Summing up, we can say that varicose veins leads to an increase in the development of various severe complications of pregnancy and childbirth, which requires complex correction, and most importantly, prevention of complications by observing innovative treatment approaches. Keywords Varicose veins, Varicose veins of the small pelvis and extremities, Pregnancy, Bleeding, Dysuria, Placental insufficiency 1. Introduction Varicose veins are one of the most common vascular pathologies, the most important risk factor for which is the female sex. The reasons for this epidemiological phenomenon are cyclical changes in hormonal levels and pregnancy [1,3,4]. The etiological factors in the development of chronic venous insufficiency during pregnancy are considered to be the weakness of the vascular wall, dysfunction of the endothelium of the veins, damage to the venous valves, compression of the inferior vena cava and * Corresponding author: 0007.hp@mail.ru (Dildora Rakhimovna Khudoyarova) Received: Aug. 26, 2021; Accepted: Sep. 10, 2021; Published: Sep. 15, 2021 Published online at https://www.eduzhai.net iliac veins by the growing uterus. An important point is also an increase in the concentration of progesterone in the dynamics of pregnancy and an increase in the coagulation potential of the blood in combination with congenital anomalies of the hemostasis system [2,5]. The problem of pregnancy with varicose veins is still quite relevant. It is known that it is one of the diseases that increase the risk of thrombophlebitis complications during pregnancy [4]. With varicose veins in pregnant women, there is a generalized dysfunction of all endothelial functions, which is accompanied by dysregulation of vascular tone, an increase in procoagulant, proaggregant, antifibrinolytic and anti-inflammatory activity of the endothelium [5]. This indicates the danger of this disease not only for the mother, but also for the fetus, since it affects the mother-placenta-fetus system. Chronic placental 616 Orzimurod Shomurodovich Yusupov and Dildora Rakhimovna Khudoyarova: Influence of Varicose Disease on Pregnancy insufficiency is a more common pathology observed in approximately every third pregnant group at high risk of perinatal pathology. Perinatal mortality in this group reaches 60%. CRF is a long-term dysfunction of the placenta, often with a compensatory increase in its mass, pathological immaturity of villi, focal or diffuse sclerosis of their stroma, hemorrhages and extensive heart attacks [6,8,12,15]. Aim of the research is to assess the influence of varicose veins of the small pelvis and extremities on the course and outcomes of pregnancy. study, ultrasound examination of the uterus and organs of the reproductive system, fetus and Doppler ultrasonography of the pelvic veins, as well as extremities were used. The mother-placenta-fetus system was studied in detail to identify vascular changes. Statistical data processing was carried out using the program "Statistic 6.0", in the form of the mean (M) and standard deviation (m). Values at the p <0.05 level were calculated as statistically significant. 2. Materials and Methods The study was conducted in the first perinatal center of the city of Samarkand, at the Department of Obstetrics and Gynecology No. 1 of the Medical Faculty of the Samarkand Medical Institute for the period 2019-2021. A retrospective comparative analysis of the course of pregnancy was carried out in 30 patients with a diagnosis of varicose veins (main group) and 20 healthy patients (control group). Both groups were comparable in terms of age and gestational age. The average age of women in both groups was 24.5 ± 2.7 years. The second and third trimester of pregnancy, as well as childbirth and the early postpartum period, were studied. The average age of women in both groups was 24.5 ± 2.7 years. Combined varicose enlargement of the great saphenous vein and its tributaries, the veins of the vulva and vagina was observed in 56.7% of patients, isolated expansion of the trunk of the great saphenous vein and its tributaries in 26.7%, and the syndrome of pelvic venous congestion, expansion of the great saphenous vein and external veins genitals in 16.7% of cases. Women of both groups were examined by general clinical, gynecological and angiological methods. As an additional 3. Results Fertile history showed that there were 8 (26.6%) and 11 (55%) primary pregnant women in groups I and II, respectively; re-pregnant - 22 (73.4%), 9 (45%), respectively. Among gynecological diseases, inflammatory diseases of various origins were more often noted. In general, a burdened obstetric-gynecological history was recorded in 6 (20%) and 4 (20%) pregnant women in groups I and II. The study of the nature of the course of pregnancies (both previous and current) showed that all examined groups had pathology of the gestational process. The most frequent complications were mild to moderate anemia, toxicosis, threatened abortion, abortion, bleeding during childbirth and the early postpartum period. Patients complained of pain and heaviness in the legs, a third of the patients had telangiectasias on the limbs, and 43.33% of women had dysuric disorders. In the main group, polyhydramnios was present in 3 (10%) patients, while in pregnant women in the control group it occurred only in 1 (5%) case (p> 0.05). In 4 (13.3%) patients of both groups, there was an edematous variant of toxicosis, with a significant difference: in 3 (12.5%) patients of the main group and in 1 (4.2%) of the control groups. Table 1. Violation of hemodynamics in the uterine-placental-fetal system Main Group Control Group 16.70% 5% 20% 0 16.70% 5% IA DEGREE IB DEGREE COMBINED LESION American Journal of Medicine and Medical Sciences 2021, 11(9): 615-617 617 As can be seen from the diagram, the frequency of placental insufficiency in the patients of the main group was higher than in the control group. Before the start of treatment, all women in the main group had hemodynamic disturbances in the uteroplacental-fetal system. Isolated lesion of the uterine arteries (grade IA) was detected in 5 (16.7%) patients and in 1 (5%) from the control group. A change in only fetal placental blood flow (grade IВ) was noted in 6 (20%) cases, a combination of changes in blood flow with premature aging of the placenta was found in 5 (16.7%) patients of the main group. At the same time, oligohydramnios was detected in 10 (33.3%) patients of group I and in 4 (20%) patients in the control group, premature changes in the structure of the placenta in 73.3% (22) cases in pregnant women of the main group. There were no cases of fetal growth retardation syndrome according to the results of fetometry, as well as zero or / and reverse blood flow according to Doppler measurements in the study groups. In a cardiotocographic study, a Fisher score of less than 8 points was found in 5 (16.6%), and changes in the functional state of the fetus were noted only during the first two days after the start of therapy. At the end of the second trimester, 13 (43.3%) patients of the main group had dysuric disorders, while in the control group, these phenomena occurred only in 2 (10%) cases. The threat of termination of pregnancy in the main group was registered in 16 (53.3%) cases, in the control group only in 1 (5%) patient (p> 0.05). Delayed intrauterine development of the fetus was observed in 4 (13.3%) pregnant women from the main group. 4. Conclusions As shown by a study with varicose veins, a violation of the fetoplacental system is present in 53.33% of patients from the main group. The threat of termination of pregnancy was also noted in 16 (53.33%) patients. Varicose veins lead to an increase in the development of various severe complications of pregnancy, which requires complex correction, and most importantly, prevention of complications by observing innovative treatment approaches. features of the gestational period, phlebohemodynamics of the pelvis and lower extremities // Russian Bulletin of Obstetrician-Gynecologist. - 2016. - T. 15. - No. 3. - S. 4-8. [3] Marizoeva Makhina Makhmadulloevna, Nematzoda Okiljon, Sultanov Javli Davronovich, Nazirova Gulnora Obidovna, Ismatova Umiya Subkhonovna, Bobdzhonova Oksana Bobdzhonovna Pregnancy in women with varicose veins // Bulletin of Avicenna. 2017. No. 2. [4] Omarova Kh. M. Features of placental blood circulation in pregnant women with varicose veins // Kazan Medical Journal. - 2008. - T. 89. - No. 4. [5] Kamilova M. Ya., Kasymova Sh. S. Features of the course of pregnancy and perinatal outcomes in women with varicose veins // Bulletin of Avicenna. - 2016. - No. 3 (68). [6] Ivanov EV, Nizamov F. Kh., Mikhailova AV The course of pregnancy and childbirth in women suffering from varicose veins of the lower extremities // Medical science and education of the Urals. - 2012. - T. 13. - No. 3-2. - S. 5-7. [7] Ibragimov B.F., Khudoyarova D.R., Kobilova Z.A. Restoration of fertility in polycystic ovary syndrome // BBK 79. - 2020. - P. 551. [8] Grishchenko O.V., Lancho I.V., Tkachev A.E. The state of the placental complex in women with chronic venous insufficiency: preliminary results. // WOMAN'S REPRODUCTIVE HEALTH # 3 (37) -2008 - P. 138-141. [9] Khudoyarova D. R., Kobilova Z. A., Shopulotov Sh. A. IMPROVEMENT OF METHODS OF NATURAL FERTILITY RESTORATION IN WOMEN WITH INFERTILITY CAUSED BY ENDOMETRIOSIS // Health, demography, ecology of the Finno-Ugric peoples. - 2020. No. 4. - S. 53-55. [10] Budanov PV, Lebedev VA Features of prevention and treatment of varicose veins in pregnant women // Difficult patient. - 2008. - T. 6. - No. 1. [11] Dobrokhotova Yu. E., Li AD, Jobava EM Issues of pathogenesis and therapy of thrombophilic conditions in pregnant women with thrombotic complications and miscarriage // Gynecology. - 2006. - T. 8. - No. 3. - S. 16-23. [12] Medved V. I., Benyuk V. A., Koval S. D. Venous complications in pregnant women // Editorial board. - 2006. -S. 29. [13] Gaidai NV Ways of preventing premature rupture of membranes in pregnant women with varicose veins // Women's health. - 2013. - No. 8. - S. 90-93. REFERENCES [14] Petrov VV, Abashin VG, Novikov KV Management of pregnant women with genital-perineal form of varicose veins // Bulletin of the Russian Military Medical Academy. - 2011. - No. 3. - S. 70-74. [1] Bogachev V. Yu. Varicose veins during and after pregnancy // Gynecology. - 2006. - T. 8. - No. 5. - S. 41-43. [2] Beznoschenko GB et al. Varicose veins in pregnant women: [15] Babadjanova GS et al. CLINICAL ASPECTS OF VARICOSIS DISEASE IN PREGNANT WOMEN // University science: a look into the future. - 2020. -- S. 556-559. Copyright © 2021 The Author(s). Published by Scientific & Academic Publishing This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

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