Effect of osteopathic correction on the outcome of pregnancy and childbirth in women with chronic pyelonephritis

Introduction. The course of pregnancy against the background of chronic pyelonephritis is associated with a high risk of complications both on the part of the expectant mother and the fetus. The peculiarities of intrauterine development of the child in pregnancy complicated by chronic pyelonephritis (delayed intrauterine development and chronic fetal hypoxia against the background of placental insufficiency due to infectious process, gestosis, anemia, etc.), as well as the non-physiological course of the birth act have a negative impact on the adaptation of newborn children in the postnatal period, leading to neonatal morbidity and early childhood disability. The complicated course of pregnancy and labor in women suffering from chronic pyelonephritis, which has a negative impact on the development of the fetus and the health of the newborn child, necessitates the search and inclusion in the dispensary monitoring of this contingent of women of new non-medicamentous ways to reduce perinatal risks in order to preserve the health of mother and child.
The aim of the study: evaluate the effect of osteopathic correction on the outcome of pregnancy and childbirth in women with chronic pyelonephritis.
Materials and methods. In a prospective controlled randomized study conducted from January 2018 to January 2025g on the basis of the medical clinic LLC «Institute of Osteopathy Mokhov» were included 180 pregnant women with chronic pyelonephritis without renal failure at the age of 25–45 years. A comparison group of 60 healthy pregnant women was also formed. All pregnant women with chronic pyelonephritis, depending on the correction method used, were divided by simple randomization using a random number generator into three groups: the main group (60 people) and two control groups of 60 people each. Patients of the main group received standard drug therapy according to the approved clinical recommendations and osteopathic correction of somatic dysfunctions (3 procedures with an interval of 10–14 days). Patients in the first control group received standard drug therapy. Patients of the second control group, along with drug therapy, used physical exercises 2 times a week for 1,5 months, as prescribed by a physician of therapeutic physical training (LPK). Healthy pregnant women were dynamically monitored. In all women, the term and method of delivery, the body weight of the newborn child, and Apgar scale scores at 1 and 5 minutes after birth were assessed (using data extracted from medical records).
Results. Osteopathic correction in the complex therapy of chronic pyelonephritis in pregnant women in comparison with isolated standard drug therapy and with the use of exercises of physical therapy in combination with standard drug therapy statistically significantly (p<0,01) promotes timely delivery of premature newborns with normal body weight without signs of asphyxia, and also statistically significantly (p<0,05) reduces the frequency of operative delivery, including emergency delivery, which is comparable with the corresponding indicators in healthy pregnant women.
Conclusion. The course of pregnancy in the background of chronic pyelonephritis is associated with a high risk of developing perinatal pathology. The inclusion of osteopathic correction in the complex treatment of chronic pyelonephritis allows to statistically significantly reduce the frequency of operative delivery, including emergency delivery, and also leads to timely delivery of full-term newborns with normal body weight without signs of asphyxia.

1. Shekhtman M. M. Guide to extragenital pathology in pregnant women. M.: Triada-Kh; 2013: 896 p. (in russ.).

2. Dobrokhotova Yu. E., Borovkova E. I. Antenatal care for pregnant women with extragenital diseases. M.: GEOTAR-Media; 2020: 384 p. (in russ.).

3. Lazareva N. V. State of reproductive health of women and children in conditions of perinatal infection. Med. almanakh. 2018; 6: 38–41 (in russ.).

4. Gordovskaya N. B., Korotchaeva Yu. V. Urinary tract infection in pregnant women: focus on asymptomatic bacteriuria. Nefrologiya. 2018; 22 (2): 81–87. https://doi.org/10.24884/1561-6274-2018-22-2-81-87 (in russ.).

5. Tetelutina F. K., Chernenkova M. L. Obstetric complications in chronic pyelonephritis // V sb. nauch. statey. Izhevsk: Izhevskaia GMA; 2023; 136–137 (in russ.).

6. Prokopenko E. I., Nikolskaia I. G., Vatazin A. V., Vetchinnikova O. N. Chronic kidney disease and pregnancy. M.: Buki Vedi; 2018: 200 p. (in russ.).

7. Ailes E. C., Gilboa S. M., Gill S. K. et al. Association between antibiotic use among pregnant women with urinary tract infections in the fi rst trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res. Part A: Clin. Molec. Teratol. 2016; 106 (11): 940–949. https://doi.org/10.1002/bdra.23570

8. Stepankova E. A., Sukhorukova A. O. Pyelonephritis and pregnancy. Trudnyy patsient. 2021; 19 (1): 27–30 https://doi.org/10.24414/2074-1995-2021-1-27-30 (in russ.).

9. Michelim L., Bosi G. R., Comparsi E. Urinary tract infection in pregnancy: Review of clinical management. J. clin. Nephrol. Res. 2016; 3 (1): 1030. https://doi.org/10.47739/2379-0652/1030

10. Tetelutina F. K., Chernenkova M. L. Features of labor in women with chronic pyelonephritis. Praktich. med. 2017; 7: 67–71 (in russ.).

11. Repina M. A. Eclampsiya. Errors in Obstetric Tactics. M.: SIMK; 2014: 248 p. (in russ.).

12. Tetelutina F. K., Chernenkova M. L. Health status of fetus and newborn in women with chronic pyelonephritis who underwent improved preconception preparation. Praktich. med. 2017; 2 (1): 95–99 (in russ.).

13. Order of the Ministry of Health of the Russian Federation dated November 1, 2012 № 572n «On approval of the Procedure for providing medical care in obstetrics and gynecology (excluding assisted reproductive technologies)» (in russ.).

14. Mokhov D. E., Aptekar I. A., Belash V. O., Litvinov I. A., Mogelnitskiy A. S., Potekhina Yu. P., Tarasov N. A., Tarasova V. V., Tregubova E. S., Ustinov A. V. Fundamentals of osteopathy: Textbook / Ed. D. E. Mokhov. M.: GEOTAR-Media; 2020: 400 p. https://doi.org/10.33029/9704-5292-9-OST-2020-1-400 (in russ.).

15. Popov S. N., Valeev N. M., Garaseva T. S. et al. Therapeutic physical culture: Textbook for higher education sudents. M.: Akademiya; 2004: 416 p. (in russ.).

16. Shavyirina S. V., Shevliakov A. I. Therapeutic physical culture for various diseases: Educ. manual. Orel: OGU im. I. S. Turgeneva; 2017: 70 p. (in russ.).

17. Bezrukova V. Yu. Physical exercises and health level correction in pyelonephritis. Intellektualnyy potentsial XXI v.: stupeni poznaniya. 2016; 31 (in russ.).

18. Dukhova G. A. Therapeutic exercise for kidney diseases (exercise complexes): Method. guidelines. M.: MGUPS (MIIT); 2015: 22 p. (in russ.).

19. Puntus V. A., Medvedeva G. I., Nevrorova Yu. S. Therapeutic physical culture for kidney diseases in students: Manual for students. Gomel: GGTU im. P. O. Sukhogo; 2016: 24 p. (in russ.).

20. Mokhov D. E., Belash V. O., Aptekar I. A., Nenashkina E. N., Potekhina Yu. P., Tregubova E. S., Beliaev A. F. Somatic dysfunction: Clinical guidelines. Russ. Osteopath. J. 2023; 2: 8–90. https://doi.org/10.32885/2220-0975-2023-2-8-90 (in russ.).

21. Paendi O. L., Orazmuradov A. A., Kniazev S. A. et al. Features of pregnancy course in some extragenital diseases (anemia, pyelonephritis, hypertension). Vestn. RUDN (seriya «Meditsina»). 2012; 5 (in russ.).

22. Polyanin A. A., Kogan I. Yu. Blood fl ow indicators in uteroplacental and fetoplacental arteries in normally developing pregnancy. Zhurn. akush. i zhen. bol. 2002; 51 (2): 10–12 (in russ.).

23. Kadimova Sh. G. K. Assessment of fetal functional state in mothers with chronic pyelonephritis. Vestn. RAMN. 2013; 12 (in russ.).

24. Potekhina Yu. P., Tregubova E. S., Mokhov D. E. Effects of osteopathic correction and research possibilities. Russ. Osteopath. J. 2022; 4: 8–29. https://doi.org/10.32885/2220-0975-2022-4-8-29 (in russ.).