OPTIMIZATION OF METHODS FOR DIAGNOSTIC PLACENTAL DYSFUNCTION IN PREGNANT WOMEN

O. Khlibovska, A. Boychuk, Y. Yakymchuk, V. G. Dzhyvak
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Abstract

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.  
孕妇胎盘功能障碍诊断方法的优化
本研究的目的是:寻找有效可靠的胎盘功能障碍早期诊断的预测指标。材料和方法。为了解决这个问题,我们对60名胎盘功能障碍孕妇(主要组)进行了研究。对照组为30例有生理妊娠过程的孕妇,根据妊娠期生育有体重和生长特征的足月活儿。通过对胎胎盘复合体的激素水平(ppap - a、b -绒毛膜促性腺激素(B-hCG)、黄体酮、胎盘乳原)的研究,探讨了胎胎盘复合体的状态。胎儿生物物理状态(BPP)。在胎儿子宫动脉、脐动脉和大脑中动脉盆区记录血流谱,研究子宫胎盘和胎儿胎盘的血液循环。计算各血管脉搏指数(PI)、阻力指数(IR)和收缩期-舒张比(S/D)。结果和讨论。本文通过对胎盘功能障碍孕妇的记忆资料分析,重点阐述了提示胎盘功能障碍病理发展的因素。通过寻找胎盘功能障碍早期诊断的预测因子并评价其有效性的研究发现,与对照组和胎盘乳原的减少相比,10-11周时人绒毛膜促性腺激素水平下降了1.3倍,血清孕酮水平下降了1.2倍。因此,CTG的这些体征,如振荡幅度下降小于3次/分,没有加速,出现减速,表明胎儿缺氧的明显迹象,需要及时治疗和解决分娩问题。子宫动脉、脐动脉和静脉的多普勒血流发现,子宫动脉血流速度曲线违逆的一个特征性征象是舒张期早期舒张成分降低,出现二向征切迹。结论。作为分析的结果,胎盘功能障碍的早期预测指标是人绒毛膜促性腺激素、PAPP-A、黄体酮和胎盘乳原水平的降低。对于子宫-胎盘疾病的诊断,建议动态记录心动、超声胎儿和胎盘测量,并评估子宫血管和脐动脉的多普勒测量。正是这些指标的组合具有较高的预测价值,不仅可以预测胎盘功能障碍,而且可以及时、充分地诊断胎盘功能障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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