Features of hemodynamics of pelvic organs in women with tubal-peritoneal infertility

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Despite the constant improvement and improvement of the quality of medical care for the female population, the problem of female infertility continues to be relevant, both in our country and abroad [1, 2, 3]. The frequency of infertile marriages in the Russian Federation ranges from 17% to 20% and does not tend to decrease, and tubal-peritoneal infertility is the main in the structure of female infertility, and is detected in more than 60% of infertile couples [1, 2]. Therefore, overcoming tubal-peritoneal infertility is an important task of modern medicine. To solve it, surgical, medical and combined methods of treatment are used, which are not always effective [3-7], even after IVF [8].
According to available scientific data, the lack of effectiveness of modern methods of treating tubal-peritoneal infertility may be due to persistent hemodynamic disorders of the pelvic organs in patients with this pathology [1, 9-12]. Therefore, the diagnosis of hemodynamic disorders of the pelvic organs and their correction can be an important link in a comprehensive solution to the problems of overcoming tubal-peritoneal infertility. Unresolved problems of tubal-peritoneal infertility allowed us to determine the purpose of the study.
The aim of the study was to identify the features of the hemodynamics of the pelvic organs in women with tubal-peritoneal infertility using the method of computer tetrapolar reopletismography (TPRPG).

Materials and methods.

Features of the hemodynamics of the pelvic organs were studied in 53 women aged 25 to 35 years. Of these, the main group consisted of 33 women with confirmed secondary tubal-peritoneal infertility, the control group - 20 practically healthy women with a history of spontaneous pregnancy and childbirth, no abortions. The average age of patients in the groups did not have significant differences and amounted to 28.3±0.02 years in the main group and 28.8±0.04 years in the control group (p>0.05). All patients had a normal body mass index (BMI). Women with overweight (BMI ≥ 25) and underweight (BMI ≤ 18.5) were not included in the study to level the effect of body weight on study results.
For a comprehensive study of pelvic circulation, the method of computerized tetrapolar reopletismography (TPRPG) was used according to the generally accepted method [13, 14], taking into account modern recommendations [15-17]. The advantage of TPRPG is the ease of implementation, high information content, the absence of harmful effects on the woman's body, the possibility of long-term and repeated studies. Computer registration and processing of TPPG allows you to quickly, in seconds, perform up to 300 measurements of parameters and evaluate the characteristics of rheographic curves, carry out 500 calculations of hemodynamic parameters.
Analysis of TPPH was performed based on the results of assessing 10 indicators characterizing pelvic hemodynamics [13-15, 17]:
1) Specific pulse volume (SPV) is a complex integrated volume indicator that characterizes the number of microliters of blood entering 1 cm3 of the tissues of the area under study per heartbeat.
2) Minute peripheral bloodstream (MPBS) is a complex integrated volume indicator that characterizes the number of microliters of blood entering 1 cm3 of the tissues of the area under study in 1 minute. BMD is a unified indicator that characterizes the quantitative blood flow in the studied tissue segment.
3) Rheographic systolic index (RSI) - characterizes the amount of blood supply to arterial vessels, systolic blood flow to the area under study, the degree of vascular opening and the intensity of blood circulation.
4) Relative volumetric pulse (RVP) - characterizes the pulse increase in blood volume per unit of time, which is directly proportional to the degree of blood filling of arterial vessels.
5) Amplitude-frequency index (AFI) - characterizes both the intensity of blood circulation and vascular tonic tension in the area under study. It decreases with a decrease in the volume of blood entering the studied segment.
6) Inter-amplitude indicator (MAP) - characterizes the degree of predominance of arterial (systolic) blood flow over diastolic (venous) outflow.
7) Peripheral resistance index (PRI) - characterizes peripheral vascular resistance - arteriole tone.
8) Anacrotic-catacrotic index (ACI) - characterizes the state of the tone of the vascular wall, its elasticity, resilience, the ability to return to its original state after the passage of a systolic blood wave through the vessel. The value of AKP decreases with difficulty in venous outflow from the area under study.
9) Filling time index (FTI) - characterizes the state of the tone of large and small arterial vessels in the region under study.
10) Tissue dehydration index (TDI) is a highly informative parameter of peripheral and regional blood flow, which allows diagnosing the initial manifestations of visually hidden tissue edema (with a decrease in TDI) or the onset of dehydration of the body (with an increase in TDI).
Statistical processing of the obtained results was carried out using the computer software package Statistica v. 11 (StatSoft, Inc., USA).

Results and its discussion.

The results of the study of TPRPH in patients of the main and control groups are presented in the table.

Table.

Indicators of pelvic hemodynamics in patients of the main and control groups, M±m.

Indicators TPRPG	Research result
	Control group, n=20	Main group, n=33
Pulse, per minute	72,9±0,03	73,0±0,06
SPV, мкл/см3	0,67±0,001	0,55±0,003*
MPBS, мкл/см3/мин	44,3±0,33	43,9±0,21
RSI, условных единиц	0,19±0,001	0,15±0,001*
RVP, условных единиц	1,07±0,09	1,05±0,007
AFI, условных единиц	0,22±0,001	0,15±0,002*
MAP, условных единиц	2,7±0,33	2,3±0,26
PRI, условных единиц	0,34±0,005	0,27±0,008*
ACI, условных единиц	0,23±0,002	0,24±0,001
FTI, условных единиц	0,58±0,003	0,51±0,001*
TDI, условных единиц	0,05±0,004	0,04±0,002*

Note: n is the number of women in groups; * - statistically significant differences compared to control (t-test), p<0.05.

In patients with tubal-peritoneal infertility, significant circulatory disorders in the vascular basin of the small pelvis were revealed, according to TPRPG. Thus, in women of the main group, there was a significant decrease in volumetric indicators of pelvic blood flow, the differences are significant compared with the control group in terms of SPV and AFI (p<0.05). A significant decrease in systolic blood flow to the pelvic organs and blood circulation intensity was recorded, the differences are significant in terms of RSI compared with the control (p<0.05). There was also a decrease in regional vascular resistance in the pelvic basin due to a decrease in the tone of arterioles, the differences are significant compared with the control group in terms of PRI (p<0.05). This contributed to a decrease in the tonic tension of the walls of blood vessels and their tone, the differences are significant compared with the control group in terms of FTI (p<0.05).
The results obtained do not contradict the available scientific data. Thus, studies by El-Mazny A. and co-authors (2016), who used ultrasound with 3D power Doppler, also revealed an adverse effect of tubal-peritoneal infertility on the hemodynamics of the uterus and ovaries in women [12]. According to Savasi V. (2015) and Shcherbakova L. N. (2020) et al., the insufficient effectiveness of laparoscopic correction of tubal-peritoneal infertility may be due to a persistent hemodynamic disorder of the pelvic organs [5, 8]. At the same time, the results of studies by Khudoyarova D. R. (2020), Amerkhanova Kh. aimed at improving the hemodynamics of the pelvic organs [9-11].

Conclusion.

The results of a comprehensive study of the hemodynamics of the pelvic organs in patients with tubal-peritoneal infertility, conducted using computer tetrapolar reopletismography, revealed significant changes in arterial inflow and a decrease in the tonic tension of the capillary network, as well as significant changes in venous blood flow in the pelvic organs. The results obtained indicate the presence of circulatory problems in the pelvic organs in women with tubal-peritoneal infertility, which can be regarded as an unfavorable factor that must be taken into account when choosing treatment tactics. Therefore, one of the main components in the complex treatment of tubal-peritoneal infertility should be medication and efferent methods aimed at normalizing the hemodynamics of the organs of the female reproductive system.

About the authors

Ol’ga N. Kharkevich

Military Medical Academy

Author for correspondence.
Email: Kharkevich.olga@mail.ru
ORCID iD: 0000-0002-1663-7263
SPIN-code: 7591-5730
Scopus Author ID: 37034214500
ResearcherId: U-2332-2017

M.D., D.Sc. (Medicine), Professor, Professor of the Obstetrics and Gynecology Department

Russian Federation, 6, Akademika Lebedeva str., Saint Petersburg, 194044

Alexander I. Mirov

Ryazan State Medical University named after academician I.P. Pavlov; City Clinical Hospital No. 8

Email: mirov8gb@gmail.com
ORCID iD: 0000-0001-8466-4258
SPIN-code: 7847-6988

M.D., Ph.D. (Medicine), Assistant of the Obstetrics and Gynecology Department, Faculty of Medicine, chief physician

Russian Federation, Ryazan; Ryazan

Irina G. Golofast

City Clinical Hospital No. 8

Email: golofast.ig@gmail.com

M.D., obstetrician-gynecologist

Russian Federation, Ryazan

Irina B. Kaplun

Military Medical Academy

Email: irina.kaplun20@gmail.com
SPIN-code: 9926-5999
ResearcherId: 1122641

M.D., Ph.D. (Medicine), Associate Professor, Obstetrics and Gynecology Department

Russian Federation, Saint Petersburg

References

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