Ультразвукові параметри і стан гемодинаміки матки у жінок, які мали порушення менструальної функції у пубертатний період

Abstract

Studying the hemodynamic features of the pelvic organs in women is of great clinical importance, since it makes it possible to assess the degree of restoration of endometrial regeneration after menstruation, the possibility of implanting a fertilized egg and developing the placenta. In women with menstrual dysfunction in the puberty, determining the qualitative and quantitative parameters of uterine hemodynamics may be useful in choosing treatment tactics, evaluating its effectiveness, and will also help significantly in predicting the prospects for the restoration of their reproductive health. The objective: using ultrasound and dopplerometry to study the uterine hemodynamics and assess the ability of the endometrium to implant in women with menstrual dysfunction in the pubertal period. Materials and methods. To achieve this goal, 120 women of reproductive age from 19 to 32 years old were studied. According to the nature of the violations, the main group of women (n=90) with pathology of menstrual function in the puberty was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with late age menarche, the third – with puberty bleeding. The control group included women (n=30) with the correct rhythm of menstruation in puberty. Results. Based on a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual irregularities in the puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that in the middle stage of endometrial secretion, the uterus is 1,2 times smaller in women the main group (p<0.05) due to the width of the uterus (p<0.001). The ratio between the length of the body and cervix in the examined groups did not significantly differ. The thickness of the front wall of the uterus is less than the control values in women with late menarche (p<0.05) and puberty bleeding (p<0.01), which served as a predictor of the absence of combined uterine pathology. An echographic study of the thickness of the endometrium in the late stage of the proliferation phase in the group of women examined did not establish any significant differences with the control group. In the middle stage of the secretion phase, the endometrial thickness was less in women with menstrual dysfunction in puberty – 9.50±0.27 mm compared to 11.38±0.48 mm in the group with the correct rhythm of menstruation (p<0.001), but remained within the limits of reference values. To assess the functional activity and the possibility of secretory transformation of the endometrium, dopplerometry of the uterine arteries was performed, which did not reveal significant differences in women of the main and control groups. Conclusion. An analysis of the relationship between body and cervical lengths proves the absence of signs of genital infantilism in patients with menstrual dysfunction in the pubertal period. Dopplerometric studies of hemodynamics in the arteries of the uterus in this group of women in different phases of the menstrual cycle indicate an adequate blood supply to the uterus. And although as a result of the inferior phase of endometrial proliferation, its thickness in the middle stage of secretion remained insufficient (9.52±0.42 mm; p<0.01), normal blood flow in the radial and basal arteries of the uterus contributed to the successful implantation of a blastocyst. Keywords: menarche, oligomenorrhea, pubertal bleeding, uterine hemodynamics, endometrial proliferation, dopplerometry.