Prediction of placental insufficiency in pregnant women with different somatotypes

2020 ◽  
Vol 69 (4) ◽  
pp. 23-28
Author(s):  
Kristina G. Tomayeva

Hypothesis/aims of study. Poor placental vascularization can lead to placental insufficiency, due to which the metabolism of nutrients and microelements between the maternal and fetal blood circulations subsequently decreases. Due to poor perfusion of placental vessels, placental dysfunction occurs. Chronic fetal hypoxia causes fetal growth retardation. The aim of this study was to assess the frequency of placental insufficiency in women with different somatotypes and to develop a model for predicting the risk of this pathology. Study design, materials and methods. A total of 390 women were examined, of whom 110 were macrosomatic, 173 mesosomatic, and 107 microsomatic. Somatometry was performed according to R.N. Dorokhov for women in the early stages of pregnancy (up to 9-10 weeks). Placental insufficiency markers (VEGF, PlGF, IL-6, and endocan-1) were determined spectrophotometrically in blood serum at the gestational age of 1213 and 2223 weeks using ELISA methods. Results. Placental insufficiency was significantly more prevalent among the women of the macro- and microsomatic body type compared with those of mesosomatotypes (p 0.05). In pregnant women with subsequent placental insufficiency, VEGF and PlGF serum levels at 1213 weeks were lower, when compared to those in patients who did not develop pathology (p 0.05), and the levels of serum endocan-1 and IL-6 were higher in comparison with those in individuals who did not develop pathology (p 0.05). Using multiple regression analysis, we obtained the regression equation (formula), which predicts the development of placental insufficiency in women of different somatotypes. Conclusion. The resulting formula allows us to accurately predict the development of placental insufficiency and to form high-risk groups among women for the development of this disease. This will contribute to the effective implementation of therapeutic and preventive measures to avert the development of this pathology.

2019 ◽  
Vol 6 (2) ◽  
pp. 94-97
Author(s):  
E. V Timokhina ◽  
Mariam G. Saakyan ◽  
N. V Zafiridi ◽  
I. M Bogomazova

The aim of the study was to assess the course of pregnancy and childbirth in patients with varying degrees of obesity.Material and methods of research. A retrospective study of pregnant women with different body mass index (BMI), the delivery of which occurred in the period 01.01.2018-06.30.2018, was conducted. The results of the study. In the study, the largest proportion - 53% were pregnant women with a BMI above 30 kg/m2, the proportion of women with premorbid obesity - 47%. The incidence of diseases that complicate the course of pregnancy (chronic hypertension, gestational hypertension and preeclampsia) was highest in women with a BMI higher than 30 kg/m2. In the study groups, gestational arterial hypertension was the most common - 14%. Pregnancy complications, namely, fetal growth retardation/placental insufficiency, occurred with a frequency of 8% in the group with premorbid obesity. In pregnant women with a BMI of more than 30 kg/m2, acute/chronic fetal hypoxia was observed, the frequency of which in total was 10%. Complications of the fetus in the studied women showed that the risk of fetal hypoxia in pregnant women with a BMI above 30 kg/m2 is very high. Large fruit was found in 15% of cases of the total number of women studied, in groups with a BMI of more than 30 kg/m2, with a frequency equal to 10% of the total number. The number of births through the birth canal in women with a BMI of more than 30 kg/m2 was 28%, and the frequency of cesarean section operations was 24%. Conclusion. Women with a BMI above 30 kg/m2 have a high frequency of pregnancy complications (gestational arterial hypertension, preeclampsia, chronic arterial hypertension). A high frequency of perinatal pathology was revealed - acute/chronic fetal hypoxia, placental insufficiency, fetal growth retardation, macrosomia. Pregnant women with a high BMI should be closely monitored by an obstetrician-gynecologist, observe proper nutrition, monitor weight gain, and timely treat chronic diseases, in particular hypertension.


2019 ◽  
Vol 10 (1) ◽  
pp. 37-41
Author(s):  
Sergey N. Gaidukov ◽  
Kristina G. Tomaeva ◽  
Elena N. Komissarova

The aim of the study was to study the frequency of postpartum hemorrhage in women with different somatotypes and to develop a method for predicting the risk of this pathology. Materials and methods. 390 women were examined, 110 were mаcrosomatotype, 173 – mesosomatotype, and 107 – microsomatotype. Somatometry was performed according to R.N. Dorokhov for women in early pregnancy (before 9-10 weeks of gestation). Results. It was found that postpartum hemorrhage was significantly more prevalent among the women of macro-and microsomatic body type compared with women with mesosomatotypes (p < 0.05). In the course of multiple regression analysis, we obtained a regression equation (formula) for predictive models, which predicts the development of postpartum hemorrhage in women of different somatotypes. The calculations according to the presented formula, allows to predict with high accuracy the prognosis of postpartum bleeding, and also allows to form among patients a high-risk group for the development of this disease in the first trimester of pregnancy when the pregnant woman is registered in the women’s consultation, long before delivery, which will contribute to more effective implementation of therapeutic and preventive measures to prevent the development of postpartum bleeding.


2018 ◽  
pp. 67-72
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  

The objective: was to reduce the incidence and severity of the development of «Great Obstetrical Syndromes»: miscarriage of pregnancy, placental insufficiency, fetal growth retardation and / or fetal distress, preeclampsia, premature detachment of a normally located placenta, premature delivery, by developing an algorithm for prophylaxis during pregnancy in women at high risk for their development. Materials and methods. Clinical and statistical analysis of pregnancy in 88 pregnant women with high risk of decompensation of placental insufficiency was conducted. Depending on the method of preventing complications, 2 groups were formed. The I group included 58 pregnant women who were offered the following algorithm: micronized progesterone 200 mg PV from 6 to 20 weeks of gestation; from 21 to 26 weeks of gestation and from 31 to 36 weeks; phleboprotector with ultra-micronized fractions of bioflavonoids (Flego) 15 ml per os; with subsequent appointment from 21 to 26 weeks of gestation; and from 31 to 36 weeks. Group II included 30 pregnant women who had abandoned any proposed prophylactic measures. The control group consisted of 30 healthy pregnant women. Clinical and statistical analysis of pregnancy in the study groups was conducted. During statistical processing, personal computer and software Microsoft Excel XP and Statistica 6.0 Windows, methods of descriptive statistics, correlation analysis were used. The reliability of the difference between the indicators is estimated by the Student-Fisher criterion. Results. The method of prophylaxis of «Great Obstetrical Syndromes» by sequential administration from the early stages of pregnancy of micronized progesterone with the following appointment – from the second trimester of pregnancy – showed a high efficacy of the phleboprotector, which is manifested in a significantly lower number of cases of preeclampsia in the main group of 3.5% (2) versus 50% (15) in the control group, placental insufficiency was 13.8% (8) versus 100% (30); fetal growth retardation was 5.2% (3) versus 56.7% (17); fetal distress was 3.5% (2) versus 43 , 3% (13), preterm labor 1.7% (1) versus 13.3% (4) and in the absence of premature detachment normal but located on the placenta, severe forms of preeclampsia and placental insufficiency. Conclusions. Pregnant of «Great Obstetrical Syndromes» risk groups need timely prophylactic measures to reduce the likelihood of a pathological pregnancy and improve perinatal outcomes. The proposed prophylaxis scheme significantly lowered the incidence of large obstetric syndromes and improved neonatal outcomes. Key words: great obstetrical syndromes, pathological pregnancy, placental dysfunction, phleboprotector.


2021 ◽  
Vol 70 (5) ◽  
pp. 37-48
Author(s):  
Igor S. Lipatov ◽  
Yury V. Tezikov ◽  
Mikhail S. Amosov

BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the endometriosis and pregnancy issue requires close study and specific proposals to optimize pregnancy management. AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters. MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental -1-microglobulin (PAMG-1), tumor necrosis factor (TNF), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests. RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNF 100) and PI II (PAMG-1 / PlGF 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh 100), DI II (HbF / PlGF 100) and DI III (L CD95+ / PAPh 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%). CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.


2021 ◽  
pp. 33-38
Author(s):  
O.V. Kravchenko

Research objective: to evaluate the effectiveness of diagnosis and complex therapy of placental dysfunction (PD) in early stages of gestation.Materials and methods. We examined 110 pregnant women with risk for the primary PD. Exclusion criteria were multiple pregnancies, anomalies of fetal development and internal genital organs of the mother, pregnancy resulting from assisted reproductive technologies.The diagnosis of PD was established in 56 women (group I) based on the assessing the state of extraembryonic structures and blood flow in the spiral and uterine arteries at 12–13 weeks of gestation. The rest of the patients (54 women) entered the control group without PD (group II).Results. All pregnant women with verified PD at 12–13 weeks were prescribed complex drug treatment, which included micronized progesterone, venotonic Normoven, Magnicum, and Artihol. As a result of treatment, already at 22–24 weeks of gestation, the average value of blood flow (resistance index) in the uterine and spiral arteries did not differ significantly in the groups. There was no significant difference in fetometry and placentometry indices at 35–36 weeks of gestation. Complications of the gestational period in patients in the study groups were also almost the same.Conclusions. History of hormonal disorders and miscarriage, clinical signs of miscarriage in early gestation, abnormal embryo placement, extragenital pathology, and genital tract infections are risk factors for PD. Determination of the state of extraembryonic structures at 7–8 weeks of pregnancy (ovum volume, blood flow in the corpus luteum) and at 12–13 weeks (chorion volume, vascularization index, blood flow in the spiral and uterine arteries) can serve as a verification criterion for the PD development. Complex drug therapy, which began from the early stages of gestation (micronized progesterone, Normoven, Magnicum, Artihol) has established itself as an effective method of treating primary PD in pregnant of risk groups.


2018 ◽  
pp. 14-18
Author(s):  
V.V. Kaminskyi ◽  
◽  
O.I. Zhdanovich ◽  
T.V. Kolomiychenko ◽  
A.D. Derkach ◽  
...  

The endpoint of the negative impact of adverse processes in the mother’s body with influenza is the formation of placental insufficiency, the basis of which is a violation of the uteroplacental blood flow. The objective: to study the features of the course of pregnancy, the state of the fetus and the newborn after the influenza in the first trimester of pregnancy. Materials and methods. 120 women who had the influenza in the first trimester of pregnancy were examined. In 68 (56.7%) pregnant women signs of feto-placental dysfunction were observed, 2 groups were distinguished: the main group - 68 patients with feto-placental dysfunction, the comparison group – 52 pregnant women without signs of feto-placental insufficiency. Results. 3 times more often than women without manifestations of placental insufficiency (42.6% versus 15.4%; p<0.05) a severe course of influenza was observed, it accompanied by a high frequency of clinical manifestations, including in almost all patients (95.6% versus 67.3%; p<0.05), body temperature rose to 38 °C and higher, and in 61.7% of women it stayed for 4–6 days (versus 11.5%; p<0.05). Among the complications of influenza: bronchitis (25.0% versus 9.3%; p<0.05), pneumonia (17.6% versus 5.7%; p<0.05), sinusitis (17.6% versus 7.7%; p<0.05). The threat of abortion was noted in 57.4% of cases, the threat of preterm birth was observed in 39.7% of women. Most often, placental dysfunction was associated with fetal distress (76.5% versus 13.5%; p<0.05) and growth retardation (54.4% versus 3.8%; p<0.05). 32.4% versus 13.5% of women had preeclampsia (p<0.05). The frequency of both polyhydramnios (17.6%) and low water (10.3%) is significantly higher. By cesarean section, 35.3% women were delivered (versus 15.4%, (p<0.05). Delivery was preterm in 17.6% of women versus 7.7% (p<0.05). Premature discharge of amniotic fluid (17.6%) and pathological blood loss during childbirth (16.2%), fetal distress during childbirth (48.5% versus 9.6%; p<0.05) were noted. Maternal placental dysfunction, fetal distress, prematurity (17.6%) and malnutrition (22.1%) led to a high incidence of birth asphyxia (46.5% versus 19.2%, p <0.05). Half (51.5%) of children had disadaptation syndromes, most often neurological disorders (32.4% versus 11.5%; p<0.05) and respiratory disorders (27.9% versus 7.7%; p<0.05). Conclusion. Influenza in early pregnancy with a severe course and a high frequency of complications is associated with a high frequency of feto-placental dysfunction and other obstetric and perinatal complications, which requires a more detailed study to determine risk factors and develop tactics for managing this category of pregnant women. Keywords: pregnancy, influenza, feto-placental dysfunction, obstetric and perinatal complications, newborn.


2011 ◽  
Vol 17 (4) ◽  
pp. 379-383
Author(s):  
V. S. Chulkov ◽  
N. K. Vereina ◽  
S. P. Sinitsin

Objective. To investigate homocysteine ​​levels in pregnant women with chronic hypertension in different terms of pregnancy, and to evaluate the prognostic significance of hyperhomocysteinemia in the development of preeclampsia, placental insufficiency syndrome and fetal growth retardation. Design and methods. It is a cohort prospective study. Pregnant women were divided into 2 groups: group 1 was formed by women with chronic hypertension (n = 80), group 2 consisted of 40 women without hypertension. Results. Pregnant women with chronic hypertension had higher homocysteine ​​levels throughout the pregnancy compared to those without hypertension. Homocysteine ​​level was higher in pregnancy complicated by preeclampsia, placental insufficiency and fetal growth retardation syndrome. Conclusion. Homocysteine ​​levels above 5,8 mmol/l in the III trimester of pregnancy may be used as a prognostic risk factor for preeclampsia development.


2019 ◽  
Vol 100 (3) ◽  
pp. 426-433 ◽  
Author(s):  
S D Mayanskaya ◽  
A V Ganeeva ◽  
R I Gabidullina

Aim. To assess the short-term and long-term variability of blood pressure in women, starting from early pregnancy, to predict the development of complications of gestation, including preeclempsia. Methods. In 131 pregnant women, systolic blood pressure, diastolic blood pressure, as well as short-term (intra-visit) and long-term (inter-visit) blood pressure variability were assessed during the gestation period and 6 weeks after delivery. At the end of gestation period, depending on the identified complications, all study participants were divided into four groups: group 1 - control (healthy); group 2 - pregnant with preeclempsia; group 3 - with placental insufficiency; group 4 - with chronic arterial hypertension. In patients with placental insufficiency the indices of fetal growth retardation were also analyzed. Results. In group 4, starting from the second trimester, higher values of short-term blood pressure variability were demonstrated, which increased as pregnancy progressed. Long-term blood pressure variability increased in groups 2 and 4, starting from the second trimester. In pregnant women with fetal growth retardation in the first trimester, blood pressure variability was higher than in pregnant controls and in the second trimester it was higher than in the group with the subsequent development of preeclempsia. Thus, during pregnancy complicated by preeclempsia or placental insufficiency with fetal growth retardation, high long-term blood pressure variability was observed. At the same time, the highest values were observed in the third trimester. Conclusion. The assessment of long-term blood pressure variability from the early gestation seems to be an effective tool for detecting preclinical changes in the body of a pregnant woman, preceding the development of preeclempsia and fetal growth retardation, and in the presence of risk factors of preeclampsia allows narrowing the group of patients for target follow-up and prevention.


2021 ◽  
Vol 6 (2) ◽  
pp. 41-50
Author(s):  
E. N. Kravchenko ◽  
A. A. Goncharova

Aim. To study the features of gestation in women with a combination of antiphospholipid and TORCH syndromes in relation to preconception care.Materials and Methods. We analyzed 137 medical records of women with a past medical history of pregnancy loss and antiphospholipid syndrome (APS), focusing on the presence or absence of plasmapheresis in the preconception period, and further ranking the patients into 2 subgroups (with and without TORCH syndrome). As a control group, we included 28 pregnant women without both syndromes.Results. Gestation in women with combined APS and TORCH syndromes was accompanied by a 10-fold higher risk of threatened abortion in the first trimester and 3-fold higher risk of placental insufficiency as compared to those without both syndromes. Notably, the combination of the syndromes doubled the risk of placental insufficiency in comparison with APS alone. The lack of plasmapheresis in patients with APS and TORCH syndrome was associated with > 2-fold higher risk of threatened abortion. Further, in patients with APS and TORCH syndrome, lack of plasmapheresis increased the likelihood of developing fetal hypoxia by a factor of 2 and 3 in comparison with those diagnosed with APS alone or control patients.Conclusions. TORCH syndrome is a major risk factor of adverse outcome in pregnant women with APS. Inclusion of plasmapheresis into the preconception care in women with APS and TORCH syndrome significantly reduced the development of pregnancy complications. 


2016 ◽  
pp. 82-86
Author(s):  
I.O. Basiuha ◽  

The objective: assess the state of the phetoplacental complex (PPC) in oligohydramnions based on the study echoscopic violations of utero-placental-fruit blood flow, as well as the development and implementation of the algorithm of treatment and preventive measures to reduce adverse perinatal outcomes with the use of different methods of correction. Patients and methods. To solve the goal were examined 65 women in the period of 32-36 weeks of pregnancy with oligohydramnion. In all the pregnant women were observed hemodynamic disturbances in the PPC. The study group included 35 pregnant women with oligohydramnion that the traditional treatment of identified pathology has been added donator NO and Energoprojekt L-arginine, combined with a comprehensive medium for 2 weeks in a pregnancy from 27 to 29 weeks, and 33-34 weeks of gestation. The control group included 30 pregnant women with oligohydramnion who received traditional treatment depending on the identified etiological causes. Results. A clinical-statistical analysis based on the study of the incidence of water shortage, hemodynamic FPC and comparative evaluation of the effectiveness of two methods of correction FPC with water scarcity – the traditional and the proposed (the use of donor of nitric oxide – L-arginine and energoprojekty – inosine). Conclusion. Using Tivortini in complex and comprehensive medicine for the correction of PPC with oligohydramnion, which is one of the few permitted and certified products in obstetrics, will reduce the number of obstetric and perinatal complications. Key words: pregnancy, placenta disfunction, oligohydramnions, tivortini, complex medicine (amber acid, nicotinamide, riboxin, Riboflavin mononucleotide).


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