- Is it possible the prediction of placental dysfunction?
Is it possible the prediction of placental dysfunction?
HEALTH OF WOMAN.2016.7(113):23–27; doi 10.15574/HW.2016.113.23
Is it possible the prediction of placental dysfunction?
Zhuk S. I., Melnik Yu. M., Pehnio N. V.
National Medical Academy of Postgraduate Education P. L. Shupyk, Kiev
Kiev city center of reproductive and perinatal medicine
The purpose of the study: the study of the initiating mechanisms of development of violations of the fetal-placental relationship to develop prognostic criteria, tactics of pregnancy and delivery in women at high risk.
Materials and methods. In the period from 2013 to 2015 a comprehensive examination of 334 pregnant women, which depending on the peculiarities of pregnancy and childbirth were divided into groups. The control group consisted of 236 pregnant women with uncomplicated gestational period, no morphological signs of placental dysfunction. The main group (OG) included 98 patients with a complicated pregnancy who had revealed violations of the fetal-placental relationship, which was confirmed by morphological examination of the placenta immediate postpartum period. Depending on options of course of gestation period pregnant OG were divided into subgroups: subgroup I – 31 pregnant signs of preeclampsia of different severity; subgroup II – 33 pregnant women with clinical and morphological signs of placental dysfunction, subgroup III – 34 pregnant women with threatened miscarriage and premature birth. In addition, to evaluate the effectiveness of prediction and diagnosis of disorders of fetal-placental relationship was highlighted in the comparison group (GP), which included 32 pregnant women with risk factors for placental dysfunction, which carried out the monitoring of the pregnancy by the proposed algorithm.
Results. Due to the datas of high-frequency dopplerometry was determined that decline of cerebro-placental index can be the sign of placental dysfunction (p<0.05). At women with placental insufficiency the reliable increase of endothelin-1 (p<0.05), decline of vascular endothelial growth factor (p<0.05) and placental growth factor (p<0.05), increase of interleukin-1b maintenance (p<0.05) and interleukin-3 reduction (p<0.05) were set. It was proven that during placental dysfunction with an absence of high variableness episodes and STV value less than 4,0 points immediate delivery was necessary.
Conclusion. It was developed the monitoring, that based on the prognostic markers determination and dynamic control of pregnancy and it allowed to predict placental dysfunction and decrease its clinical signs during pregnancy in 2,5 time and unfavorable delivery outcomes in 1,7 times.
Key words: placental dysfunction, prediction, endothelin-1, growth factor, interleukin, dopplerometry, cardiotocography.
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