PATHOGENETIC BIOCHEMICAL ASPECTS IN TRUE AND INFECTED POSTPARTUM UTERINE SUBINVOLUTION

The aim of the study was to analyze the activity of cholinesterase, the content of norepinephrine, monoamine oxidase, TNF-α, procalcitonin, highly sensitive CRP in the blood serum of puerperas with various types of postpartum uterine subinvolution. A survey of 111 puerperas (mean age 25.1±2.3) who were hospitalized in the physiological department of the 3rd City Clinical Hospital named after E.V. Klumova, Minsk. All patients were divided into the following groups: 1st – 34 puerperas with infected subinvolution (mean age 22.6±2.0); 2nd – 45 puerperas with true true (mean age 23.0±2.1). The control group consisted of 32 puerperas with a physiological postpartum period (mean age 25.4±1.9). The obtained results demonstrated that an important link in the pathogenesis of postpartum subinvolution of the uterus is a decrease in the content of norepinephrine and an increase in the activity of cholinesterase in the blood serum. The threshold level of HoA concentration was 57.8 ng/ml (ROC-curve area 0.98±0.02; CI 0.95-1.0; p < 0.001), PN was 97.0%, DS 94.0%. The threshold level of ChE activity was 4124 U/l (ROC-curve concentration was 57.8 ng/ml (ROC-curve area 0.98±0.02; CI 0.95-1.0; p < 0.001), PN was 97.0%, DS 94.0%. The threshold level of ChE activity was 4124 U/l (ROC-curve area 0.94±0.03; CI 0.88-1.0; p < 0.001), PM was 93.0%, DS 88.0%. The conducted ROC-analysis allows us to regard the studied parameters as predictors of the development of SCI, which makes it possible to conduct a reliable and timely differential diagnosis of the normal and complicated course of puerperia. A significant increase in the level of C-reactive protein up to 17.4±1.2 mg/l (p = 0.001) and procalcitonin up to 0.8±0.03 mg/l (p = 0.001), as well as an increase in the concentration TNF-α up to 336.0±96.0 (p = 0.007) compared with normal data. Therefore, the treatment of postpartum subinvolution of the uterus, accompanied by hypotension and congestion in the uterine cavity, should be aimed at stimulating the adreno- and cholinergic parts of the ANS.

1. Abramchenko V.V, Kaplenko O.V. Adrenergicheskie sredstva v akusherskoj praktike. – Spb., 2000.

2. Veres, I. A. Analiz klinicheskih proyavlenij poslerodovoj subinvolyucii matki kak predstadii gipotonicheskogo poslerodovogo endometrita / I. A. Veres // Ros. vestn. akushera-ginekologa. – 2020. – T. 20, № 5. – S. 84–90.

3. Kamyshnikov V.S. Spravochnik po kliniko-biohimicheskim issledovaniyam i laboratornoj diagnostike. M., MEDpress-inform. 2009. – 896 s.

4. Persianinov, L.S. Fiziologiya i patologiya sokratitel‘noj deyatel‘nosti matki / L.S. Persianinov, B.I. Zheleznov, N.A. Bogovlyan. – M.: Medicina, 1975. – 360 s.

5. Sidorova I.S. Fiziologiya i patologiya rodovoj deyatel‘nosti. – M.: Medicina, 2000. – 848 s.