Nagornaya V.F., Tatarova A.M., Gura L.N.
State Medical University of Odessa,
Pregnancy and childbirth is a great emotional factor that significantly influences psychosomatic organization of a woman [1, 2]. It is known, that certain changes of psychoemotional state occur even in healthy women in the time of physiological pregnancy process . Certain psychological disorders appear in healthy pregnant women but they are physiological and provide adaptation of a woman to pregnancy. In case of different complications development, including risk of miscarriage, psychological changes that appear could be referred as pathological because they cause desadaptation development, support and result in pathological processes progressing in the body of pregnant women [1, 4, 5].
In spite of these facts, at present time during examination of patients with miscarriage methods of psychoemotional state evaluation of pregnant women with such pathology as a result of stress and methods of the following adequate impact on such disorders with evaluation of treatment results are not introduced to applied public health.
Pharmacotherapy of miscarriage that is aimed at hormonal disorders correction, inflammatory processes elimination in the system mother ï¿½ placenta ï¿½ fetus, causes polypragmasia that is not indifferent to the pregnant woman, fetus and neonate, and not always is effective enough. At present time, there is no enough information for evaluation of adequacy of impact on CNS during application of standard approaches of miscarriage treatment. At the same time, it is known, that CNS is one of the main components of adaptation system.
Given circumstances dictate necessity of development of approaches of examination of patients with miscarriage that are aimed at their psychoemotional state evaluation as an indicator of existing stress level as well as at adequate, preferably non-drug correction of psychoemotional state of pregnant women, methods usage.
Purpose of our research is to improve an effectiveness of treatment of patients with risk of miscarriage on the basis of psychoemotional state research and its complex correction with the help of transcutaneous dynamic electroneurostimulation (DENS) application.
Level of health of mother ï¿½ placenta ï¿½ fetus system was evaluated in 64 patients with miscarriage during the period from 8 to 22 weeks and in the age range from 17 to 42 years old. There were 38 (59.4%) of primigravidas, 26 (40.6%) women with consecutive pregnancy. 11 (42.9%) patients with repeated pregnancies had labor as a result of previous pregnancies, 13 (50%) had therapeutic abortion and 2 (7.1%) had spontaneous abortion. From the anamnesis it became known that average age of menarche was 12.8 +_ 1.2 years old. 34 (53.1%) of pregnant women had extragenital pathologies, and 22 (34.4%) of patients had gynecological disorders.
Miscarriage diagnosis was confirmed with complaints on pain in lower part of the abdomen in 64 (100%) of pregnant and blood-tinged discharge from genital tracts in 17 (26.6%) of pregnant. Uterus tone increase was confirmed with bimanual examination data; uterus hypertone in 23 patients (35.9%) was confirmed with ultrasonic examination, 11 patients (17.2%) had detachment of placenta, retrochorionic hematoma, 4 patients (6.25%) had fetus developmental lagging from gestation periods, 17 patients (26.6%) had reduced caryopyknotic index.
Psychoemotional state was evaluated according to clinical questionnaire , which consists out of 68 questions. For each woman the score was determined that characterized her adaptability and stress resistance according to 6 scales: anxiety scale (AS), neurotic depression scale (NDS), scale of asthenia (SA), hysterical reaction type scale (HRTS), obsessive-phobic disorder scale (OPDS), vegetative disorder scale (VDS).
A graph was drawn for diagnostic coefficients results interpretation for each of 6 scales. The state that satisfied an interval of indices from + 1.28 to ï¿½ 1.28 was considered to be a wellbeing. Index over + 1.28 indicates high adaptive ability in certain symptom complex; index lower than ï¿½ 1.28 indicates abnormal character of detected disorders (desadaptation state).
DiaDENS-DT apparatus was applied in a ï¿½Testï¿½ mode at a minimal energy range and in a ï¿½Therapyï¿½ mode at 77 Hz frequency rate at a comfortable energy level. An application was carried out in the projection of trigeminal nerve branches output on a face for 2 minutes on each of 6 points. Course made up to 7 procedures.
All the studies of pregnant women were carried out and evaluated in dynamics before and after the treatment course. All the patients under observation were divided into 2 groups. Comparison group that consisted of 34 people received standard therapy (spasmolytics, sedative medications, gestagens, b-mimetics if needed).
DENS-therapy with general course of 5-7 procedures was carried out daily according to described method in the basic group of 30 patients along with standard treatment which was limited only to spasmolytics intake and sometimes gestagens intake.
Analysis of data received during the examination of pregnant women revealed presence of variety stress-factors both psychic and emotional (low and medium intensity) in lives of those patients which permanently affect these women and frequently add one to another. An accomplished research gave an opportunity to understand that the majority of patients unsufficiently estimate their condition and do not realize that that their psychoemotional stress is increased.
The results of psychoemotional state of patients are given according to different scales.
Anxiety scale (AS). Basic data: 14.7% of patients remained within the norm interval; 47.8% of pregnant women had high adaptive ability (hyperadaptation state); 38.2% of women were not adapted to anxiety (that is they were in anxiety state). After the treatment in comparison group an anxiety state of 50% of patients did not change, anxiety worsened for 16.7 %, adaptation for anxiety increased in 33% of pregnant.
Reduction of adaptive abilities of the body to anxiety was not observed in the basic group. 50% of patients stayed in the same condition, 50% of patients showed significant improvement of adaptation.
Neurotic depression scale (NDS). Basic data: 29.4% of patients remained within the norm interval, 17.6% of patients had neurotic depression, 52.9% of women had hyperadaptation to neurotic depression. After the treatment in a comparison group 75% of pregnant did not show any changes in condition, 4.3% showed worsening of neurotic depression resistance, 20.8% of patients demonstrated increase of adaptation to given parameter. In the basic group 20% of patients did not show any changes in their condition, 50% of patients demonstrated increase of adaptive abilities of the body to neurotic depression, and 30% of women had aggravation of their condition.
Asthenia (SA). Basic data: 23.5% of patients remained within the norm interval, 35.3% of patients were in the asthenic state, 41.2% of patients had an increased adaptation to this parameter. After the treatment course in a comparison group indices were divided in the following way: 58.3% did not have any changes in their condition, 16.7% demonstrated an increase in adaptive abilities of the body, 25% of patients showed worsening of the condition. In the basic group 60% of patients did not have any changes in their condition, 20% of patients showed worsening of reactivity of the body to asthenia, 20% demonstrated an increase in adaptive abilities of the body.
Hysterical reaction type scale (HRTS). Before the treatment 20.6% of patients remained within the norm interval, 29.4% of patients belonged to hysterical type of reaction, 50% of pregnant demonstrated an increased adaptation to this criteria. After the treatment in a comparison group 54.1% did not change their hysterical reaction type, 16.7% demonstrated worsening of the results, 29.2% of patients showed stabilization of indicated parameter. In the basic group 10% of patients demonstrated worsening of their condition, increase of resistance to indicated criteria was observed in 50% of cases, 40% of pregnant did not show any change of condition.
Obsessive-phobic disorder scale (OPDS). Basic data: 20.6% of patients with obsessive-phobic disorders remained within the norm interval, 55.9% of patients had an increased resistance to indicated factor, 23.5% of patients had dysfunctions.
After the standard treatment 16.6% of patients demonstrated worsening of their condition, 66.6% of patients did not show any changes in their condition, 16.8% of patients had their condition improved. 40% of patients did not have any change in their condition or their condition became worse, 20% of patients demonstrated an improvement of their state after complex treatment with the help of DENS was carried out.
Vegetative disorders scale (VDS). Only 8.8% of women under study remained within the norm interval at the time of vegetative disorders research, 50% of patients were in the state of adaptation, 38.2% of pregnant had some dysfunctions. After the treatment course in a comparison group 66.6% of patients had the same indices, 16.7% of patients demonstrated worsening of the state, 16.7% demonstrated improvement of their condition. 60% of patients did not show any condition change, 40% of pregnant had their indices improved in the basic group after complex treatment with DENS application was carried out. Worsening of the condition was not registered.
Diagram 1. Dynamic of patientsï¿½ health after standard treatment (comparison group). Here, AS is anxiety scale, NDS is neurotic depression scale, SA is scale of asthenia, HRTS is hysterical reaction type scale, OPDS is obsessive-phobic disorders scale, VDS is vegetative disorders scale.
ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Diagram 2. Dynamic of patientsï¿½ health after complex treatment with DENS application (basic group). Here, AS is anxiety scale, NDS is neurotic depression scale, SA is scale of asthenia, HRTS is hysterical reaction type scale, OPDS is obsessive-phobic disorders scale, VDS is vegetative disorders scale.
ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ The accomplished research revealed that patients with miscarriages had great number of stress-factors, both acute and chronic. All the factors that had been received were considered according to 3 groups: norm, desadaptation and group with increased adaptive reaction. Significant changes in psychoemotional sphere normalization were not registered after the standard treatment, worsening of condition regarding to some scales was observed. DENS-therapy application along with complex treatment caused characteristics improvement in great number of patients.
ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Thus, the results that were received allow to say that DENS method ï¿½ non-medicamental correction method ï¿½ makes it possible to improve psychoemotional status of pregnant women, gives a possibility to prolong pregnancy. According to recommendations of psychologists, data received is required to be analyzed over period of time for therapy consequences to be taken into consideration.
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