Placental disfunction for women with retrochorial haematomas in I trimester of pregnancy: diagnostics and management tactics

Abstract

The objective: is a decline of frequency of placenta disfunction and perinatal pathology forwomen with the different forms of retrochorial haematomas on the basis of study clinical-andinstrumentaland laboratory researches, and also improvement of algorithm of diagnostic andtreatment-and-prophylactic measures. Materials and methods. In research which was conducted in 2 stages, it was included 140pregnant in terms from 6 weeks of гестації and to delivery. On a 1 stage by us 3 groupsof women were selected, on the basis of results of clinical inspection and information ofultrasonic research : 60 pregnant of woman with a recurrent retrochorial haematoma (1group); 50 pregnant with a retrochorial haematoma, which appeared only on the early termsof pregnancy (6–12 weeks inclusive) (2 groups) and 30 the prospectively inspected patientswith uncomplicated pregnancy, which do not have meaningful extragenital pathology andburdened factors obstetric-gynaecological to anamnesis (control group). On 2 stages from60 pregnant with a recurrent retrochorial haematoma by us two sub-groups were selected:1.1 and 1.2.To the sub-group 1.1 30 women were included in the terms of gestation 20-40 weeks,pregnancy in which was conducted on the basis of findings complex clinical-and-laboratoryand echographic inspection, with application of approach which personalize, depending onthat which prevails and etiopathogenetic co-factors with obligatory registration of the writteninformed consent of patients. Sub-group 1.2 were 30 pregnant with the relapse of retrochorialhaematoma, also inspected in obedience to a mine-out design with application of all methods, but pregnancy in which was conducted in obedience to recommendations of MOZ of Ukraine. Results. Frequency of placenta disfunction at a recurrent retrochorial haematoma is 70,0%; atprimary – 30,0%; a level of early forms (to 32 weeks) of delay of development of fetus is 65,0% with the considerable level of II-III of degree – 23,3%. The premature ripening of placenta ata recurrent retrochorial haematoma is 33,3%; at primary – 16,0%. Echo-sign of mesenchymaldysplasia and heterogeneity placenta according to 11,7% and 4,0%.At a recurrent retrochorial haematoma frequency of shortage of water is 16,7% against 4,0%– at primary; violations of blood stream are diagnosed in 23,3% and 6,0%; in the structureof all violations of blood stream in 63,3% – make in an uterine artery and in 30,0% – it isconnected with violation of umbilical cord blood stream. In 5,0% only at a recurrent retrochorialhaematoma there is decompensated placenta disfunction with development of acute fetaldistress. Conclusions. The use of the algorithm of diagnostic and treatment-and-prophylactic measuresimproved by us allows to reduce frequency of relapse of retrochorial haematoma at 4,7 time; itlarge volume – at 3,9 time; level of premature births – in 2 times; frequency of placenta disfunctionand delay of development of fetus – at 6,5 time, to decrease perinatal losses at 5,1 time and warnthe decompensated form of placenta disfunction.