FEATURES OF THE COURSE OF THR POSTPARTUM PERIOD IN PATIENTS WHO SUFFERED A NEW CORONAVIRUS INFECTION DURING PREGNANCY


Cite item

Abstract

Resume. Since the appearance of the new coronavirus infection COVID-19, the question of the impact of the transmitted infection on the human body has become relevant. It is known that NCI is characterized by changes in the functioning of the hemostasis system with the development of adverse thromboembolic complications. Even more relevant is the question of the effect of the NCI on the course of pregnancy, childbirth and the postpartum period. The purpose of the study: to evaluate the features of the course of the postpartum period in women in labor who underwent NCI during pregnancy. Materials and methods. A retrospective analysis of the birth histories of patients who underwent NCI during pregnancy and delivered in the Clinic of Obstetrics and Gynecology of the Military Medical Academy named after S.M. Kirov in the period 2021-2022 was carried out. A total of 30 patients were included in the study, 15 of whom underwent NCI during pregnancy - the main group. The control group included patients with no indication of a transferred NCI.

The results of the study:

Total blood loss in the main group was 378.53±57.92 ml, in the control group 264.60±95 ml (p=0.04). According to ultrasound data immediately after delivery, the uterine body dimensions in the main group of maternity women were 152.00±24.00 mm, 88.00± 11.00 mm, 110.00±15.00 mm in the main group, in the control group - 107.50±33.00 mm(p=0.03), 75.00±18.00 mm(p=0.04), 97.00±19.00 mm(p=0.02). The width of the uterine cavity in the mothers of the main group was 31.00 ± 1.22 mm, in the control group - 8 ± 2.85 mm (p ≤0.5). At the same time, 72 hours after delivery, no statistically significant differences were found between the parameters of pelvic ultrasound in patients of both study groups.

Conclusion:

Thus, it was found that in maternity women who underwent NCI during pregnancy in mild form, there is a statistically significant increase in the size of the body and the uterine cavity, as well as increased total blood loss, regardless of the parity of labor. At the same time, 72 hours after delivery, there were no changes detected immediately after delivery. Since there were no postpartum hemorrhages in these cases, it can be argued that the prophylactic administration of oxytocin solution is sufficient to compensate for the detected changes.

Full Text

Resume

. The causative agent of NKI is an RNA-containing virus of the Coronaviridae family. The virus is stable in the external environment and has a high contagiousness, which causes an increase in morbidity rates. The course of NCI is characterized by a change in the functioning of the hemostasis system and the development of adverse thromboembolic events[1]. An important issue is the effect of NCI on the course of pregnancy and the postpartum period, since pregnancy itself is a state of physiological hypercoagulation aimed at minimizing blood loss during childbirth. Hypercoagulation changes persist in the postpartum period [2]. It has been found that NCI increases the frequency of preterm labor, preeclampsia, premature rupture of fetal membranes and fetal growth retardation. Publications concerning the course of the postpartum period in women who have undergone NCI are limited [1, 3]. Currently, ultrasound is one of the most accessible and informative methods of changes.In the postpartum period, ultrasound is performed on the 3rd day to assess the degree of involution of the uterus. At the same time, the most important parameters evaluated on ultrasound are: the size of the uterus and its cavity, the structural characteristics of the organ, the presence of pathological formations [5]. It should be noted that the interpretation of data in the event of postpartum complications, such as postpartum bleeding, often remains a difficult task to solve [6]. Since data on the course of the postpartum period in patients who underwent NCI during pregnancy are limited, this prompted us to conduct a study.

The purpose of the study: to evaluate the features of the course of the postpartum period in maternity women who underwent NCI during pregnancy.

Materials and methods: A retrospective analysis of the birth histories of patients who underwent NCI during pregnancy and delivered in the conditions of the Clinic of Obstetrics and Gynecology of the Military Medical Academy named after S.M.Kirov in the period 2021-2022 was carried out. A total of 30 patients were included in the study,15- of whom underwent NCI during pregnancy - the main group. The control group included patients with no indication of a transferred NCI. Exclusion criteria from the study: multiple pregnancy; the presence of a scar on the uterus. The average age of patients in both groups was 32.00± 5.0 years (p=0.08), the gestation period at the time of delivery was 40.00±1.00 weeks in the main and 39.75±0.79 weeks (p=0.05) in the control group. 40% (6/15) of the patients of the main group and 60% (9/15) of the comparison group were primiparous. All patients underwent a standard clinical and laboratory examination regulated by the clinical guidelines "Clinical recommendations. Single-child labor, spontaneous delivery in occipital presentation (normal labor)." Also, upon admission, all patients had material taken from the nasopharynx for the presence of RNA-SARS-CoV-2 by PCR. In the postpartum period, the patients underwent ultrasound of the pelvic organs on the ultrasound device My Sono U6 (Korea) with a convexic sensor with a frequency of 3-5.0 MHz immediately after the birth of the afterbirth and on the 3rd day of the postpartum period. At the same time, the size of the uterine body was assessed: length, width, height, width of the uterine cavity, the presence of contents in the uterine cavity and its nature. The patients of the main group underwent mild NCI in the third trimester of gestation. Drugs affecting the patient's hemostasis system were not received. Medical preparation of the cervix for childbirth, labor arousal and stimulation of labor activity were not carried out in both groups of the study. Statistical processing of the obtained data was carried out using the Microsoft Excel 2019 program, STATISTICA 6.0., methods of variational statistics for parametric data with the calculation of average values of indicators (M), standard deviation errors (m). The difference between the compared values was recognized as statistically significant with an error probability of p <0.05.

The results of the study: The average duration of labor in the main group was 8.35±5.00 h, in the control group - 8.45 ± 3.00 h (p=0.08), the duration of the anhydrous interval in the main group was 5.1 ± 5.00 h and 3.90±3.70 h in the control group (p=0.06). Premature discharge of amniotic fluid occurred in 5 cases (33.3%) in the main group, and in 5 (33.3%) cases in the control group. All patients in the third period were prevented from postpartum bleeding by intravenous drip administration of 5 units of oxytocin solution per 500.0 solution of 0.9% sodium chloride. Total blood loss in the main group was 378.53±57.92 ml, in the control group 264.60±95 ml (p=0.04). The weight of the newborn in the patients of the main group was 3460.00±574.00 g and 3427.00±403.00 (p=0.05) in the control group. The assessment of newborns on the Apgar scale in the main group was 7.73±0.8, 7.92± 0.27 in the control group (p=0.06). According to ultrasound data immediately after delivery, the uterine body dimensions in the main group of maternity women were 152.00±24.00 mm, 88.00± 11.00 mm, 110.00±15.00 mm in the main group, in the control group - 107.50±33.00 mm(p=0.03), 75.00±18.00 mm(p=0.04), 97.00±19.00 mm(p=0.02). The width of the uterine cavity in the mothers of the main group was 31.00 ± 1.22 mm, in the control group - 8±2.85 mm (p=0.03). At the same time, 72 hours after delivery, no statistically significant differences were found between the parameters of pelvic ultrasound in patients of both study groups. There were also no statistically significant differences between the parameters of the clinical blood test in patients of both study groups. There were no cases of thromboembolic complications, postpartum bleeding, purulent-septic complications, maternal mortality in both groups. The discharge of patients was carried out on 3-4 days of the postpartum period.

Discussion: An important mechanism of postpartum hemostasis, in addition to hypercoagulation changes, is the presence of normal contractility of the myometrium [7]. According to published data, the NCI suffered during pregnancy increases the frequency of postpartum bleeding [6]. It should also be noted that in moderate to severe NCI, patients receive low-molecular-weight heparins in therapeutic doses, which in itself increases the risk of bleeding [1]. As a result of the study, it was found that in the early postpartum period, the contractility of the myometrium in maternity women with NCI during pregnancy differs from maternity women who did not have NCI. Also, a statistically significant increase in blood loss during childbirth was noted in the group of patients with a history of NCI. Taking into account the fact that drugs affecting the hemostasis system were not used in the described study, we assume that an increase in blood loss is associated with a change in the contractility of the myometrium. At the same time, it should be noted that on the 3rd day of the postpartum period, there were no statistically significant differences in the rate of uterine involution.

Conclusion: Thus, it was found that in maternity women who underwent NCI during pregnancy in mild form, there is a statistically significant increase in the size of the body and the uterine cavity, as well as increased total blood loss, regardless of the parity of labor. At the same time, 72 hours after delivery, there were no changes detected immediately after delivery.Since there were no postpartum hemorrhages in these cases, it can be argued that the prophylactic administration of oxytocin solution is sufficient to compensate for the detected changes.

 
 
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About the authors

Mikhail Alexandrovich Abramov

S.M. Kirov Military medical academy

Email: misha.abramov86@gmail.com
ORCID iD: 0000-0003-4894-5524

cadet of the 5th year of the faculty of training doctors for the Aerospace Forces

Russian Federation, 194044, Russian Federation, Sankt-Petersburg Akademika Lebedeva str., 6

Alexandra Alexandrovna Polonnikova

S.M. Kirov Military medical academy

Author for correspondence.
Email: alekspol3001@mail.ru
ORCID iD: 0000-0001-7861-4844

5th year student of the Faculty of Training and Improvement of Civil Medical (Pharmaceutical) Specialists

Russian Federation, 194044, Russian Federation Sankt-Petersburg, Akademika Lebedeva str., 6

References

  1. Методические рекомендации. Организация оказания медицинской помощи беременным, роженицам, родильницам и новорожденным при новой коронавирусной инфекции COVID-19// М.: Министерство здравоохранения Российской Федерациию. –2021. –131с.
  2. Макацария А. Д. и др. Тромботический шторм, нарушения гемостаза и тромбовоспаление в условиях COVID-19 //Акушерство, гинекология и репродукция. – 2021. – Т. 15. – №. 5. – С. 499-514.
  3. Jafari, M., Pormohammad, A., Sheikh Neshin, S. A., Ghorbani, S., Bose, D., Alimohammadi, S., et al. Clinical characteristics and outcomes of pregnant women with COVID‐19 and comparison with control patients: A systematic review and meta‐analysis. Reviews in medical virology, 2021:31(5): 1-16.
  4. Смит, Н. Ч. Ультразвуковая диагностика в акушерстве и гинекологии (понятным языком) / Н. Ч. Смит; Норман Ч. Смит, Э. Пэт М. Смит; пер. с англ. под ред. А. И. Гуса. – Москва: Практическая медицина, 2010. – 296 с.
  5. Роды одноплодные, самопроизвольное родоразрешение в затылочном предлежании (нормальные роды). Клинические рекомендации// М.: РОАГ.,2021.–66с.
  6. Al-Bdour, A. N. A., Akasheh, H. F., Al-Husban, N. A. Ultrasonography of the uterus after normal vaginal delivery. Saudi medical journal, 2004; 25(1): 41-44.
  7. Айламазян, Э. К. Акушерство. Национальное руководство. Краткое издание / под ред. Э. К. Айламазяна, В. Н. Серова, В. Е. Радзинского, Г. М. Савельевой. - Москва : ГЭОТАР-Медиа, 2021. - 608 с.

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