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UDC 613.99:616-053.32
REPRODUCTIVE PICTURE OF ADOLESCENT GIRLS BORN PREMATURELY
Kemerovo State Medical University, Kemerovo S.I. Yelgina, Ye.N. Nikulina
The aim of the study was to assess the reproductive system of adolescent girls born prematurely at the gestational age of 28-32 weeks and full-term ones (their somatic health, physical, sexual development, menstrual function, pelvic size, basic ultrasound parameters of the uterus and appendages were assessed). The object of the study was 200 teenage girls (15-16 years of age) who were born prematurely at the gestational age of 28-32 weeks and full-term ones, examined by general clinical, gynecological, instrumental, ultrasound, and statistical methods. There were established statistically significant differences in the main indicators characterizing the reproductive system in adolescent prematurely born girls to full-term born girls, namely, the difference in sexual development, menstrual function, pelvic size, ultrasound parameters of the uterus and appendages. The miscarriage of pregnancy makes a change in the formation of the reproductive system in the postnatal period and contributes to the emergence of its pathology.
Key words: adolescent girls born prematurely full-term ones, indicators of the reproductive system.
During the period of fetal development there is formed the basis of human reproductive health, and often - ill health. The "perinatal trace" of reproductive system pathology, apparently, takes place more often than we imagine. It is connected with the fact that the realization of pathology is postponed until puberty or even later [1, 2]. The problem of pregnancy miscarriage is one of the topical issues of obstetrics. Numerous researches implying morphological material show that by miscarriage organometric parameters and histological structure of reproductive organs are exposed to changes [3, 4, 5, 6]. In this regard, the study of the reproductive health adolescent girls born prematurely is important.
Research objective: to determine the basic parameters of the reproductive system of adolescent girls born prematurely at the gestational age of 2832 weeks and full-term ones (physical, sexual development, menstrual function, pelvic size, basic ultrasound parameters of the uterus and appendages).
Materials and methods
The study was performed by the informed consent of adolescent girls on the basis of Regional Children Clinical Hospital, Kemerovo. The research was approved by the Ethics and medical investigation evidence committee of FSBEI HE KemSMU of the Ministry of Health of the Russian Federation and corresponded to the ethical standards of the bioethical committee elaborated in accordance with the WHO Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects amended in 2013 and in accordance with the Rules for clinical practice in Russian Federation approved by the Decree of the Ministry of Health of Russia of 19.06.2013 № 266. All adolescent girls provided written informed consent to participate in the study.
Research design: retrospective analytical study "case-control". The study included 200 adolescent girls of 15-16 years. I group - 100 adolescent girls born prematurely at the gestational age of 28-32 weeks. II group - 100 adolescent girls born full-term. Criteria of inclusion into group I - adolescent girls born prematurely at the gestational age of 28-32 weeks by practically health mothers without somatic diseases or being at the stage of compensation by the time of delivery residing in Kemerovo Oblast. Criteria of exclusion from group I: adolescent girls born full-term by mothers with somatic pathology at the stage of decompensation by the time of delivery, non resident. Criteria of inclusion into group II: adolescent girls born full-term by practically health mothers without somatic diseases or being at the stage of compensation by the time of delivery residing in Kemerovo Oblast. Criteria of exclusion from group II: adolescent girls born full-term by mothers with somatic pathology at the stage of decompensation by the time of delivery, non resident.
The group were comparable by the age of women-mothers, the average age was 26,21±5,31 and 26,81±4,72 years respectively (p=0,9201). However, the pregnancy of mothers of adolescent girls born prematurely was more often first (p=0,0388), was threatened miscarriage (p=0,0002). The duration of gestation of prematurely born adolescent girls was determined according to the anamnestic data and also data of medical records (maternal discharge summary). There were studied the basic parameters of the reproductive system state: somatic health, physical, sexual development, menstrual function, pelvic size, basic ultrasound parameters of the uterus and appendages. The analysis of the health state was performed on the basis of incidence of outpatient visits, periodic health examination, periodic and ad hoc examinations
of specialists: pediatrician, ENT specialist, neurologist, ophthalmologist, surgeon, gynecologist. The overall medical report on the girl's health was made by the pediatrician.
The assessment of physiological development was conducted according to the unified methods using anthropometric measurements: height and body weight. The menstrual function was evaluated according to the age at menarche, establishment and duration of menstrual cycle, duration and painfulness of menstruation. The examination of sexual development was based on the basic pelvic measurements, dynamics of appearance and degree of manifestation of secondary sexual characteristics. The level of sexual development was studied by the rate of development of mammary glands (Ma0-Ma3), pubic pilosis (P0-P3), auxiliary pilosis (Ax0-Ax3), state of menstrual function (Me0-Me3). The rate of development of secondary sexual characteristics was integrated into the sexual formula (Ma, P, Ax, Me) [7]. The pelvic inlet was characterized according to the measurements of its basic sizes d. spinarum, d. cristarum, d. tro-chanterica, c. еxterna. The ultrasound parameters of uterus and appendages were assessed by means of «Aloka 630» (Japan) using a transabdominal detector. There was carried a comparative analysis in the parallel groups of adolescent girls born prematurely and full-term.
The statistical data analysis was conducted by means of Microsoft Office Excel 2003 (license 74017-640-0000106-57177) and StatSoftStatistica 6.1 (license BXXR006D092218FAN11). The charac-
ter of data distribution was evaluated by means of Shapiro-Wilk test. Depending on the type of distribution there were used various algorithms of statistical analysis. Qualitative characteristics were presented by relative indicators (rates, %). Quantitative data were presented by central central tendencies and dispersion: mean value (M) and standard deviation (s) of characteristics having approximately normal distribution, median (Me) and interquartile range (25th and 75th percentiles) in case of value distribution different from the normal one.
The comparison of two independent groups by one or several characteristics having nonnormal distribution at least in one of the groups or if the type distribution was not analyzed, was conducted by means of testing of statistical hypothesis for the equality of mean ranks by means of Mann-Whitney U-test. The difference of relative values was assessed by the analysis of contingency table (x2). By frequencies under 5, there was used Fisher exact test p. The comparison of relative frequencies in both groups was performed by comparing 95% CI of relative frequencies. If CI are not covered, the differences of frequencies can be considered statistically significant (by significance level 0,05). If intervals are covered, differences are not statistically significant.
Results and discussion
The somatic health of adolescent girls born prematurely and full-term is presented in Table 1.
Indicator adolescent girls P
born prematurely (n=100) born full-term (n=100)
case number case number
Urinary system diseases 25 24 0,0911
Respiratory system diseases (bronchial asthma) 13 12 0,8515
Respiratory system diseases (chronic bronchitis) 32 22 0,1214
Cardio-vascular diseases (mitral valve prolapse) 19 5 0,0025
Endocrine system diseases (thyroid gland diseases) 35 30 0,8515
Endocrine system diseases (adiposis) 4 11 0,0653
Nervous system diseases (hypertensive type vegetovascular dysfunction) 13 16 0,5279
Nervous system diseases (hypotensive type vegeto-vascular dysfunction) 25 25 0,9676
Nervous system diseases (asthenoneurotic syndrome) 31 21 0,1166
Gastrointestinal diseases (chronic gastritis) 24 31 0,2498
Ophthalmological diseases (myopia) 31 8 0,0000
Musculoskeletal disorders (scoliosis) 25 12 0,0440
Table 1
Somatic health of adolescent girls born prematurely and full-term
Note: p - reached level of significance of differences between the indicators of adolescent girls born prematurely and full-time.
The somatic health of adolescent girls born prematurely and full-term did not have statistically significant differences in basic diseases: urinary, respiratory, gastro-intestinal, endocrine and nervous systems. However, adolescent girls born prematurely more often had mitral valve pro-
lapse (p=0,0025), scoliosis (p=0,0440) and myopia (p=0,0000).
Anthropometric parameters of adolescent girls born prematurely and full-term are shown in Table 2.
Table 2
Anthropometric parameters of adolescent girls born prematurely and full-term
adolescent girls
Indicator born prematurely (n=100) born full-term (n=100) P
Height, sm 160,0 [156,0-163,0] 160,0 [156,0-163,0] 0,7766
Weight, kg 56,0 [56,0-60,0] 56,0 [52,0-58,5] 0,7507
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
The characteristic of menstrual function of ado-
Anthropometric parameters of adolescent girls born prematurely and full-term did not have statistically significant differences.
lescent girls born prematurely and full-term is presented in Table 3.
Table 3
Menstrual function of adolescent girls born prematurely and full-term
adolescent girls
Indicator born prema- born full-term n
turely (n=100) (n=100) r
case number case number
Menstrual cycle established at once 24 76 0,0000
Duration of menstrual cycle:
28 days 17 28 0,0033
from 29 to 35 days 36 47 0,0033
over 35 days 48 25 0.0033
Duration of menstruation:
3-4 days 40 18 0,0000
5-7 days 30 76 0,0000
8 and more 31 6 0,0000
Painful menstruations 52 26 0,0002
T
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
The age of menarche in adolescent girls born prematurely and full-term did not have statistically significant differences 12,6±0,15 and 12,47±0,06 (p=0,9201).
However, adolescent girls born prematurely more often than the ones born full-term had irregular (p=0,0000) and prolonged (over 35 days) menstrual cycle (p=0,0033), duration of menstruation over 8 days (p=0,0000), dysmenorrhea (p=0,0002).
Sexual development of adolescent girls born prematurely and full-term also differed. The sexual formula of adolescent girls born prematurely was Ma2, P3, Ax3, Me2; adolescent girls born full-term
- Ma3, P3, Ax3, Me3. Differences were statistically significant for the development of mammary glands (p=0,0041) and menstrual function (p=0,0015).
The pelvic measurements of adolescent girls born prematurely and full-term are presented in Table 4.
Pelvic measurements of adolescent girls born prematurely and full-term had statistically significant differences in all cross parameters. Pelvic measurements of adolescent girls born prematurely are smaller than of full-term born girls.
Ultrasound parameters of uterus and appendages are shown in Tables 5, 6, 7.
Table 4
Pelvic measurements of adolescent girls born prematurely and full-term
adolescent girls
Indicator born prematurely (n=100) born full-term (n=100) P
d. spinarum, sm 22,0 [21,0-22,0] 23,0 [22,0-23,0] 0,0000
d. cristarum, sm 24.0 [23,0-25,0] 26,0 [26,0-27,0] 0,0000
d. trochanterica, sm 27,0 [26,0-28,0] 28,0 [27,0-29,0] 0,0000
c externa, sm 18,0 [17,0-19,0] 18,0 [17,0-18,0] 0,3032
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
Table 5
Ultrasound parameters of uterus of adolescent girls born prematurely and full-term
adolescent girls
Indicator born prematurely (n=100) born full-term (n=100) P
Cervical length, mm 22,0 [21,0-23,0] 19,0 [16,0-22,0] 0,0001
Endometrial thickness, mm 7,0 [5,0-8,0] 7,0 [6,0-8,0] 0,4598
Midline echo, mm 6,0 [6,0-7,0] 9,0 [7,0-10,0] 0,0000
Length of uterus, mm 40,0 [39,0-42,0] 44,0 [42,0-45,0] 0,0000
Width of uterus, mm 39,0 [38,0-40,0] 41,0 [40,0-42,0] 0,0000
Thickness of uterus, mm 30,0 [29,0-31,0] 32,0 [31,0-32,9] 0,0000
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
Table 6
Ultrasound parameters of the right ovary of adolescent girls born prematurely and full-term
Indicator adolescent girls P
born prematurely (n=100) born full-term (n=100)
Length of ovary, mm 30,0 [29,0-31,0] 31,0 [30,0-32,0] 0,0015
Thickness of ovary, mm 21,0 [20,0-23,0] 22,0 [21,0-23,0] 0,0168
Width of ovary, mm 22,0 [21,0-24,0] 23,0 [21,0-24,0] 0,6190
Follicle size in ovary, mm 5,0 [4,0-6,0] 6,0 [5,0-7,0] 0,0000
Follicle number in ovary 5 [4-5] 5 [5-6] 0,0039
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
Table 7
Ultrasound parameters of the left ovary of adolescent girls born prematurely and full-term
adolescent girls
Indicator born prematurely (n=100) born full-term (n=100) P
Length of ovary, mm 31,0 [30,0-31,0] 32,0 [31,0-33,5] 0,0000
Thickness of ovary, mm 21,0 [20,0-22,0] 20,0 [19,0-21,0] 0,0003
Width of ovary, mm 22,0 [20,0-23,0] 22,0 [19,0-24,0] 0,4528
Follicle size in ovary, mm 5,0 [5,0-6,0] 5,5 [5,0-6,0] 0,0698
Follicle number in ovary 5 [4-5] 8 [7-9,0] 0,0000
Note: p - reached level of significance of differences between indicators of adolescent girls born prematurely and full-term.
The majority of ultrasound parameters of uterus and appendages of adolescent girls born prematurely and full-term had statistically significant differences. Adolescent girls born prematurely were characterized by a longer cervix, smaller midline echo, length, thickness and width of uterus, ovaries (length and thickness) and smaller number of follicles.
Conclusion
Consequently, there was conducted the evaluation of reproductive system of adolescent girls born prematurely and full-term. Pregnancy miscarriage changes the process of establishment of reproductive system during postnatal period.
The structure of gynecological pathology of adolescent girls in the Russian Federation is leaded by disorders of menstrual function which constitute 4925,2 per 100 000 girls. The frequency and structure of gynecological diseases of adolescent girls have regional peculiarities [8, 9]. In Kemerovo Oblast gynecological morbidity of adolescent girls in 2016 constituted 18,1%. The structure of overall gynecological morbidity is prevailed by inflammatory diseases of external genital organs (41,3%), disorders of menstruation (34,0%), cystic ovaries (3,5%), disorders of sexual development (2,1%). According to the preventive examinations, disorders of menstrual function constitutes 38,3% [10].
One of the important criteria of reproductive function preservation in adolescent girls is the reduction of gynecological incidences by means of modern technologies in early diagnosis, treatment and prevention [8, 11]. On the basis of introduction of modern technologies into diagnostic and treatment process there were obtained new data on etiology and pathogenesis of neuroendocrine disorders in adolescent age, chromosomal and congenital defects [12, 13].
The formation of main elements of reproductive system of adolescent girls begins in the early fetal period. Diseases of perinatal period are risk factors for the disorders of reproductive system during the period of its establishment [14, 15, 16].
In recent years, great attention in medical literature is given to medical and social factors of reproductive health formation of adolescent girls as future mothers [17, 18, 19, 20, 21].
Pregnancy miscarriage is a topical problem of obstetrics and perinatology. Frequency of pregnancy miscarriage constitutes 10-25% of all pregnancies, 6-10% - premature delivery. In spite of its medical and social importance the state of reproductive health of adolescent girls born prematurely is studied insufficiently.
The basic researches of reproductive system of adolescent girls born full-time were the data on physical development, menstrual function, pelvic measurements, ultrasound parameters of uterus and appendages.
There were determined statistically significant differences of basic parameters characterizing reproductive system of adolescent girls born prematurely in relation to full-time born ones. Adolescent girls born prematurely more often than the ones born full-term had irregular and prolonged (over 35 days) menstrual cycle, dysmenorrhea. Pelvic measurements of adolescent girls born prematurely are smaller than of full-term born girls. Ultrasound parameters of uterus and appendages also differ. Adolescent girls born prematurely were characterized by a longer cervix, smaller midline echo, length, thickness and width of uterus, ovaries (length and thickness) and smaller number of follicles. All this indicates the existence of dismaturity and diminished function of reproductive organs in adolescent girls born prematurely.
References
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Contacts:
Corresponding author - Yelgina Svetlana Ivanov-na, Doctor of Medical Sciences, Professor of the Department of obstetrics and gynecology №1 of Kemerovo State Medical University, Kemerovo. 650056, Kemerovo, Voroshilova Ulitsa, 22a. Tel.: (3842) 734856. Email: [email protected]
