Authors
Kamaeva T.А.
Khakass State University named after N.F. Katanova, Abakan
Abstract
Backgraund. The prevalence of placental insufficiency in practical medicine is 29% - 40% of cases, according to researchers: 78% -91% of cases, depending on the timing of pregnancy, the discrepancy proves an unsatisfactory diagnosis. In women who become pregnant after assisted reproductive technologies (ART), pathology is diagnosed 2 times more often. Pathology leads to serious intrauterine and perinatal fetal abnormalities. The problem of pathology is poorly understood, which leads to high rates of stillbirth, morbidity and mortality of newborns.
Aims. To increase the efficiency of diagnosis of placental insufficiency using modern diagnostic methods.
Materials and methods. The study was carried out prospectively in the Kemerovo region of the Russian Federation on the basis of the Road Clinic at the Kemerovo station and the Diagnostic Center in Kemerovo (2014-2017), as well as in the Republic of Khakassia on the basis of the Republican Clinical Perinatal Center of the Republic of Khakassia (2017-2019). The collection of material was carried out from 2014 to 2019. 2019 to 2020 processing of the results was carried out. Completion of the study in 2 regions is associated with a change in the author's place of residence. The subjects of the study are pregnant women. The study consisted of a detailed study of placental blood flow to identify early markers of placental insufficiency. The change in the tactics of pregnancy management consisted in increasing the detail of observation of the fetoplacental complex. An in-depth observation of ultrasound markers of pathology was implemented, followed by histological examination of the placenta in those who became pregnant after ART. When women were registered, anamnesis, laboratory and instrumental examination were carried out.
Results. The study participants were 426 pregnant women, without somatic pathologies and screened. The main group - 290 pregnant women with signs of chronic placental insufficiency. The control group consisted of 136 pregnant women without signs of placental insufficiency. Inclusion criteria: a continuous sample of those who became pregnant after IVF, observed by the author, whose childbirth took place with the participation of the author and histological examination of the placenta. All women participated from start to finish of the study. The outcomes of the study were recorded according to the data of exchange cards. The diagnostic efficiency of the applied methods of radiation research in all clinical groups and the results obtained were evaluated according to the recommendations of the Joint IAEA / WHO Committee of Experts. It was revealed that the main reasons for the development of chronic placental insufficiency of the main group are: preeclampsia (68.4%); the threat of termination of pregnancy (34.7%); burdened obstetric and gynecological history (32.5%); isoserological incompatibility (25.6%); pyelonephritis during pregnancy (14.2%); anemia of a pregnant woman (13.2%). No adverse events were noted during the study.
Conclusions. Visualization of the fetoplacental complex and measurement of peripheral resistance in the umbilical artery during the second trimester of pregnancy are not very informative. To reduce the negative impact of fetoplacental insufficiency and its timely diagnosis, it is necessary to use radiation methods for examining the mother-placenta-fetus system.
Keywords: pregnancy, placental circulation, mother, placenta, fetus, anamnesis.
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