Characteristics of somatic dysfunctions in pregnant women with chronic pyelonephritis

Introduction. Chronic pyelonephritis occupies one of the fi rst places in the structure of extragenital pathologies of pregnant women. The approach to the treatment of pyelonephritis in pregnancy consists in the use of both pharmacological and non-pharmacological methods of treatment. One of the non-medicamentous methods is osteopathic correction of somatic dysfunctions. However, the structure of these functional disorders is virtually unexplored.

Goal of research — to describe somatic dysfunctions (SDs) in pregnant women with chronic pyelonephritis before and after osteopathic correction, as well as to defi ne its effect on the intensity of subjective indices.

Materials and methods. A simple longitudinal randomized study conducted in 2016–2018 on the clinical basis of the St. Petersburg Institute of Osteopathy — LLC «Mokhov Institute of Osteopathy» included 120 pregnant women aged 25–45 years with a gestation period of 13–27 weeks. All pregnant women with chronic pyelonephritis were divided into two groups with the use of random number generator. The two groups of 30 people each were comparable in age, parity, presence of concomitant pathology and the duration of the disease. The main group received pharmacological and osteopathic treatment, the control group received only pharmacological treatment. In a similar way, a comparison group of women comparable in age and parity was formed. It included 60 pregnant women in the second trimester of pregnancy without clinical, instrumental and laboratory data of chronic kidney diseases; the patients of this group underwent dynamic observation. All patients were subjected to clinical obstetrical and osteopathic examination. The severity of the pain syndrome was assessed with the use of the visual analogue scale.

Results. In the course of osteopathic diagnostics, the following dominant SDs have been revealed: in patients with chronic pyelonephritis, a global rhythmogenic disorder of the development of the cranial rhythmic impulse (GRD (C)) — 26,7 %, a global neurodynamic disorder (psycho-viscero-somatic) — 25 %, regional SDs: the lumbar region — 33,3 %, the pelvic region — 6,7 %, and the thoracic region — 5 %; in healthy pregnant women, GRD (C) — 6,7 %, GNDD (PVS) — 6,7 %, and regional SDs: the pelvic region — 28,3 %, the thoracic region — 23,3 % and the duramatral region — 26,7 %. As a result of osteopathic correction of SDs in patients with chronic pyelonephritis, there was a decrease in the total number of SDs (from 174 to 30) and a change in their structure (global before the treatment and local after the treatment). The severity of the pain syndrome in accordance with the VAS has also decreased from 29±3,16 to 11±0,79 points in the main group, whereas in the control group it has increased from 20±1,78 to 26±1,53.

Conclusion. In pregnant women with chronic pyelonephritis, the majority of SDs manifest themselves at the global level, whereas in healthy pregnant women, most dysfunctions are regional. Osteopathic correction of SDs in complex therapy of pregnant women with chronic pyelonephritis signifi cantly contributes to the reduction of the pain syndrome according to the VAS compared with isolated traditional pharmacological therapy.

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