Медицинские науки/ 1. Акушерство и гинекология

Medical sciences / 1. Obstetrics and Gynecology

Zharkih A.V., Syusyuka V.G., Plotnik V.A.

Zaporozhye State Medical University, Zaporozhye

THE STATE OF NEUROHUMORAL REGULATION MECHANISMS IN PREGNANT WOMEN WITH MISCARRIAGE

Miscarriage is one of the most common pregnancy complications. Its frequency at different terms of gestation has reached steady annual indicators [1]. Currently, the frequency of miscarriage ranges from 10 to 25%. In the first trimester, it can reach 50%, in the II trimester – 20%, in the third trimester – 30%. There are from 40% to 80% of all spontaneous abortions during early pregnancy (6-8 weeks) [2]. Frequency of spontaneous abortion in Ukraine is 15-23% of all reported pregnancies [3], thus over 80 – 92% of them going up to 12 weeks of gestation [3, 4].

Objectives. To evaluate the state of the systems involved in the implementation of adaptation mechanisms in pregnant women with miscarriage by assessing the autonomic nervous system, the hormonal and psychological profiles.

Materials and methods. 67 pregnant women at the gestational age of 7-14 weeks with a singleton pregnancy were examined. The main group consisted of 35 women with threatened abortion clinic who were treated at the gynecological department of the maternity hospital №9 in Zaporozhye. The inclusion criteria were complaints of pulling pain in lower abdomen and poor or moderate bleeding from the genital tract on the background of intrauterine pregnancy. 32 women without clinical manifestations of threatened abortion made the control group. The group of an exception included women with hyperandrogenism, polycystic ovary syndrome, menstrual irregularities, abnormal development of reproductive organs, recurrent pregnancy loss, malformations of the fetus, and pregnant with heavy bleeding from the genital tract.

Assessment of the level of anxiety was carried out by testing according to the C. D. Spielberg method modified by Y. L. Hanin. Quantification of cortisol and insulin levels was studied in blood serum by ELISA. The autonomic nervous system was studied with the help of cardiointervalography method. Statistical processing of the results of the study was investigated by the program for statistical analysis "Statistica" (Version 6.0, Stat Soft INS, USA, license number is AXXR712D833214FAN5) using parametric (descriptive statistics, two-sample t-test with equal variances) and non-parametric statistical methods (Mann–Whitney U test, Kolmogorov-Smirnov test).

Results. All the women were randomized by age and social status.

In the study of anxiety we found that pregnant women with clinical manifestations of threatening abortion had increasing of reactive anxiety: the average value of reactive anxiety in the main group was 43.88±1.61 points and was significantly more than the control group had – 32.34±0.97 points (p≤0.01). That may be due to emotional reactions to a stressful situation and evidence about psycho-emotional dysadaptation. Considering that more than half (51.4%) of pregnant women with miscarriage had high level of personal anxiety, unlike the control group, where the level was 9.38%, which is a stable individual characteristic, reflecting the predispositions of the subject to anxiety, this fact should be considered as a risk factor for this disease.

After examination of the autonomic nervous system was found the significantly presence of sympathicotonia in the background of parasympathetic failure in pregnant women with miscarriage (p≤0.01), which evidence of the violation compensatory-adaptive reactions of the body and tension of adaptive mechanisms in the context of a stressful situation, which threatening abortion is, because one of features of the system regulation of the autonomic nervous system during the normal pregnancy is the expressed advantage of parasympathetic tone in the first, and until the middle of the second trimester. However, in case of a pathological pregnancy development there is noticed an inversion of regulatory reactions [5].

The study of the hormonal profile established a violation of hormonal balance in women with miscarriage. The average level of cortisol was significantly more than the same level of the control group – in the main group it was 356±19.01 ng/ml and in the control group it was 269.31±25 ng/ml (p≤0.01). The same data were observed with the cortisol/insulin index levels – cortisol/insulin index was significantly higher and were respectively in the main and control group as 56,7±12,60 and 29,8±5,05 points (p≤0.05). Such changes can be caused by psychoemotional dysadaptation of pregnant women with miscarriage, as the emotional reaction to a stressful situation.

Conclusion. The study was found the violations of the psycho-emotional state, vegetative and hormonal balance in women with clinic of threatened abortion, as well as their impact on the realization of adaptive mechanisms.

References

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2. R. J. Yuldasheva, S. N. Urkumbaeva, T. A. Iskakova, E. А. Zhakupbekova, O. N. Musabaeva, K. U. Kulbaeva (2016) IPPP kak prichina nevynashivaniya beremennosti [Sexually transmitted infections as causes of miscarriage]. Vestnik KazNMU, no. 1, pp. 8-12.

3. Zhuk S. I., Kalinka Ya., Sidelnikova V. M. (2007) Nevynashivanie beremennosti: novyy vzglyad na staruyu problemu [Miscarriage: a new look at an old problem]. Zdorov'ja Ukrajiny, no. 5/1, pp. 3-5.

4. E. K. Aylamazyan, V. I. Kulakov, V. Ye. Radzinskiy, G. M. Saveleva (ed.) (2007) Akusherstvo. Natsionalnoe rukovodstvo [Obstetrics. National guidance]. Moscow: GEOTAR-Media. (in Russian)

5. S. A. Kleshchenogov, A. N. Fleyshman (2006) Prognozirovanie oslozhneniy beremennosti na osnove izucheniya variabelnosti ritma serdtsa materi [Prediction of pregnancy complications on the basis of a study of heart rate variability of the mother]. Byulleten Sibirskogo otdeleniya Rossiyskoy akademii meditsinskikh nauk, no. 3, pp. 52-59.