OPTIMIZATION OF METHODS FOR DIAGNOSTIC PLACENTAL DYSFUNCTION IN PREGNANT WOMEN
DOI:
https://doi.org/10.11603/24116-4944.2022.1.13219Keywords:
fetus, fetal growth retardation, placental dysfunction, placental hormonesAbstract
The aim of the study: to find effective and reliable predictors of early diagnosis of placental dysfunction.
Materials and methods. To solve the tasks, we conducted a study of 60 pregnant women (the main group) with placental dysfunction. The control group consisted of 30 pregnant women with a physiological course of pregnancy, who gave birth to live full-term children with weight and growth characteristics according to the gestation period. The state of the fetoplacental complex was studied based on the study of the levels of hormones (PAPP-A, B-chorionic gonadotropin (B-hCG), progesterone, placental lactogen). biophysical state of the fetus (BPP). To study the uteroplacental and fetoplacental hemocirculation, blood flow spectra were recorded in the uterine arteries, umbilical arteries, and the basin of the middle cerebral artery (MCA) of the fetus. For each vessel, the pulse index (PI), resistance index (IR) and systole were calculated -diastolic ratio (S/D).
Results and discussion. Based on the analysis of anamnestic data of pregnant women with placental dysfunction, the factors that indicate the development of the pathology are highlighted. As a result of the conducted research on the search for predictors of early diagnosis of placental dysfunction and evaluation of their effectiveness, it was established that the level of human chorionic gonadotropin decreased by 1.3 times, and progesterone in the blood serum at 10-11 weeks decreased by 1.2 times, compared to control and reduction of placental lactogen. Therefore, such signs of CTG, such as a decrease in the amplitude of oscillations less than 3 beats/min, the absence of accelerations, the appearance of decelerations, indicate pronounced signs of fetal hypoxia and require timely treatment and a solution to the issue of childbirth. With Doppler blood flow in the uterine arteries, umbilical arteries and veins, it was found that a characteristic sign of a violation of the blood flow velocity curve in the uterine arteries is a decrease in the diastolic component and the appearance of a dicrotic notch in the early diastole phase.
Conclusions. As a result of the analysis, early predictors of placental dysfunction are a decrease in the level of human chorionic gonadotropin, PAPP-A, progesterone, and placental lactogen. For the diagnosis of utero-placental disorders, it is advisable to conduct a dynamic recording of cardiotocography, ultrasound fetometry and placentometry, and to evaluate dopplerometry in the uterine vessels and umbilical artery. It is the complex of these markers that has a high predictive value and makes it possible not only to predict placental dysfunction, but also to diagnose it in a timely and adequate manner.
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