THE EFFECT OF POSTPARTUM PHYSICAL THERAPY ON AUTONOMIC SYMPTOMS OF POST-COVID-19 SYNDROME IN WOMEN AFTER CAESAREAN SECTION WHO EXPERIENCED CORONAVIRUS DISEASE DURING PREGNANCY
Purpose: to determine the effectiveness of restoring the state of women health with post-COVID-19 syndrome who underwent cesarean section, based on the dynamics of parameters of the autonomic nervous system.
Methods. 44 women were examined at the beginning of the late postpartum period. The control group consisted of 15 women who gave birth vaginally and did not suffer from COVID-19 during pregnancy and observation. The comparison group consisted of 15 women after cesarean section who suffered from COVID-19 during pregnancy, recovered during pregnancy and the postpartum period according to general recommendations for the rehabilitation of patients with coronavirus infection. The main group consisted of 14 women after caesarean section, suffered from COVID-19 during pregnancy, performed a proven program of physical therapy for 2 months using breathing therapeutic exercises, therapeutic exercises with elements of yoga for the muscles of the back, abdomen, upper and lower limbs, taking into account movement limitations due to a scar of the anterior abdominal wall; massage of the chest, back, abdomen; aromatherapy sessions; autogenic training sessions. They tried to restore the state of women through a balance between the sympathetic and parasympathetic departments due to the normalizing effect of the applied agents on the hormonal background and psycho-emotional state, reducing the feeling of bodily discomfort, general strengthening of the body, accelerating the recovery of the organs of the abdominal cavity and pelvis, accelerating adaptation to changes in habitual activity due to a violation daily routine and childcare needs. The condition of the women was assessed by the results of the test with isometric load, the Kerdo index, the dynamics of 24-hour heart rate variability monitoring (power in the range of low LF frequencies and high HF frequencies, LF/HF ratio, Baevsky tension index).
Research results. During the first examination, an imbalance between the activity of the sympathetic and parasympathetic links of the autonomic nervous system towards sympathicotonia was detected in all women, which was most pronounced in women with post-COVID-19 syndrome in all parameters. During re-examination, the best result in terms of all studied parameters was found by women of the control group, who demonstrated the dynamics of the normal course of the postpartum period after vaginal delivery and increased activity of the parasympathetic department against the background of suppression of the sympathetic department. The results of the women of the main group according to the Kerdo index, tests with isometric tension, the results of daily blood pressure monitoring, which were determined, were statistically significantly better than those of the women of the comparison group, testifying to the reduction of the imbalance of the links of the autonomic nervous system and the advantages of the rehabilitation program for the correction of the autonomic signs of post-COVID-19 syndrome, which was created taking into account the physical and psychoemotional state of women after cesarean section, in comparison with the general rehabilitation program.
Conclusions. The use of physical therapy, taking into account the imbalance of the links of the autonomic nervous system (sympatheticotonia), is pathogenetically and practically justified in the process of physical therapy of women with post-COVID-19 syndrome in the postpartum period after abdominal delivery.
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