PERINATAL RISKS AT THE TIME OF GLOBAL CIVILIZATIONAL CHALLENGES: OBSERVATIONS IN THE ANTENATAL PERIOD
DOI:
https://doi.org/10.11603/24116-4944.2022.2.13449Keywords:
perinatal risks, observation in the antenatal period, pregnancy, complications, dopplerometry, uteroplacental blood circulationAbstract
The aim of the study – to find prognostic criteria for the development of placental dysfunction in the conditions of global civilizational challenges by determining the characteristics of the dynamics of dopplerometry indicators in the process of antenatal fetal development.
Materials and Methods. An examination of 32 pregnant women with a singleton pregnancy and established placental dysfunction, who were internally displaced persons becausre of military actions in the east and south of Ukraine, was conducted. The control group consisted of 27 healthy pregnant women. The intrauterine fetal condition was assessed according to the data of cardiotocography and ultrasound examination, where fetal biometric indicators, placentometry, and the biophysical profile of the fetus were determined at 25–28, 29–32, and 33–36 weeks of pregnancy using the "Toshiba Applio MX SSA-780A" ultrasound machine. (Japan).
Results and Discussion. In most cases, during the second half of pregnancy, the primary link in the development of placental dysfunction and IUGR was a violation of uteroplacental blood flow. In general, the analysis of Doppler parameters in the vessels of the "mother-placenta-fetus" system revealed a violation of blood flow in the main clinical group of pregnant women, which was most often manifested by an initial increase in peripheral resistance indices in the studied vessels. The study of blood flow in the umbilical cord and brain vessels of the fetus acquires great diagnostic and prognostic value only after the 22–24th week of pregnancy. Changes in blood flow in the umbilical cord of the fetus, which are characterized by a decrease in the diastolic component of the blood flow, and, accordingly, an increase in the pulsative index and resistance index, reflect the degree of fetal hemodynamic disturbance. That is, pathological changes in indicators of the diastolic component of blood flow, systolic-diastolic ratio, resistance index and pulsation index are the earliest sign of blood flow disturbance in the fetoplacental system. And a decrease in the cerebro-placental index less than 1 indicates a redistribution of blood flow and a violation of placental blood circulation. In general, dopplerometric assessment of blood flow in the arteries of the feto-placental complex allows non-invasively and quickly to determine the degree of impairment of the functional state of the feto-placental system of the fetus in its pathological conditions (chronic hypoxia, retardation of growth, placental dysfunction, etc.), to assess the degree of its impairment and to carry out timely correction.
Conclusions. In the conditions of global influences on the development of pregnancy (under the influence of stress, nutritional disorders, regime, energy and environmental deficits), pregnant women experience early disorders of the uterine-placental-fetal blood flow, manifested by feto-placental dysfunction. Dopplerometric assessment of blood flow in the arteries of the utero-placental complex and the middle cerebral artery of the fetus allows to quickly and qualitatively assess the degree of impairment of the functional state of the feto-placental system of the fetus in its pathological conditions by evaluating resistance indices and their ratio.
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