scholarly journals Prevention of primary placental dysfunction with low location of the chorion

2020 ◽  
Vol 24 (4 (96)) ◽  
pp. 80-84
Author(s):  
S. Pecheriaha ◽  
I. Marynchyna
Keyword(s):  
Blood Flow ◽  
Pregnant Women ◽  
Gestational Age ◽  
Ginkgo Biloba ◽  
Ginkgo Biloba Extract ◽  
Main Group ◽  
Control Group ◽  
Low Grade ◽  
Doppler Examination ◽  
Placental Dysfunction

Objective is to develop new methods to prevent primary placental dysfunction (PD) in early gestational age with low placentation.Material and methods. We have examined 119 pregnant women with low placentation. This diagnosis was made from 6-7 weeks of gestation on the basis of echographic research. The main group consisted of 64 pregnant women with low chorionic location, which was used to prevent PD from the early gestational age by the complex of medicines developed by us and a control group of 55 women with low placentation that had not undergone PD prophylaxis from early gestational periods. The treatment and prophylactic complex included: Luteina, ginkgo biloba extract, folio and biolectra. In the main and control groups, all pregnant women underwent Doppler examination in the uterine and spiral arteries, as well as determined the volume of the chorion and the volume of blood flow in the chorion.Results. Doppler examination in the main group showed a decrease in all indices of resistance in the uterine and spiral arteries, as well as a significant increase in chorionic volume and vascularization index in three-dimensional ultrasound compared with the control group.Conclusions. The proposed treatment and prophylactic complex agents (Luteina, ginkgo biloba extract, folio and biolectra) helps to normalize uterine-chorionic blood flow, restore effective embryo-chorionic relationships and significantly reduces the frequency of further development of primary placental dysfunction in pregnant women with low-grade pregnancy.

Study of retinal blood flow in pregnant women with diabetes mellitus

2021 ◽  
pp. 117-120
Author(s):  
N.V. Pomytkina ◽  
◽  
E.L. Sorokin ◽  
Y.E. Pashentsev ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Optical Coherence Tomography ◽  
Pregnant Women ◽  
Main Group ◽  
Retinal Blood Flow ◽  
Control Group ◽  
Vascular Density ◽  
Third Trimester ◽  
The Third

Purpose. To investigate changes in retinal blood flow in pregnant women with diabetes mellitus (DM) using optical coherence tomography in angiography (OCTA) mode. Material and methods. 60 pregnant women were examined. The main group consisted of 24 women with DM type 1 and type 2. The control group was represented by 36 healthy women with physiological pregnancy. Women underwent OCTA on an Optovue RTVue XR Avanti device (Optovue Inc., USA) using the HD Angio Retina 6.0 mm scanning protocol. The total vascular density (TVD), foveal vascular density (FVD), and the area of the foveal avascular zone (AFAZ) in the superficial retinal plexus were studied. The survey was carried out in all trimesters of pregnancy in the main group, in the control group – in the third trimester. Results. When conducting a comparative analysis, no significant differences in the values of TDV and AFAZ were found between the main group and the control group. FVD values in pregnant women with diabetes were statistically significantly lower relative to the control group (p=0.001). There were no significant differences in FVD values in the subgroups of pregnant women with diabetic retinopathy (DR) and with diabetes and the absence of DR in the third trimester (p=0.114). However, AFAZ indices in patients with DR were significantly higher (p=0.039), and TDV – significantly lower in comparison with pregnant women with diabetes and no DR (p=0.035). Conclusions. 1. In pregnant women with diabetes in the third trimester, a statistically significant decrease in FPS in the superficial retinal plexus was revealed in comparison with healthy women with physiological pregnancy, in the absence of significant differences in TDV and AFAZ. 2. In pregnant women with DR in the third trimester, a statistically significant expansion of AFAZ with a decrease in TDV in the superficial plexus was revealed in comparison with pregnant women with DM and no DR. Key words: diabetes mellitus, diabetic retinopathy, optical coherence tomography in angiography mode, retinal blood flow.

Complex therapy of placental dysfunction in pregnant women with oligohydramnios

2017 ◽  
pp. 50-53
Author(s):  
I.E. Basiuga ◽  
Keyword(s):  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Water Shortage ◽  
Main Group ◽  
Control Group ◽  
Compensatory Mechanisms ◽  
Placental Dysfunction ◽  
Trust Relationships ◽  
Personal Anxiety ◽  
Psychological Features

The objective: to improve the treatment of placental dysfunction in pregnant women with oligohydramnios regarding their psychological condition. Patients and methods. Survey was conducted in 120 pregnant women with oligohydramnios the gestational age of 27-29 weeks (main group) and 30 physiologically healthy pregnant women (control group) on the basis of the city clinical hospital of Ivano-Frankivsk. Results. During the study of psychological features we have not yet determined significant differences in the level of personal anxiety with oligohydramnios as compared with pregnant women with physiological gestation. Also, was found the division of examined for low, medium, and high levels of this indicator between the two pregnant groups. In particular, approximately half of the individuals had an average level of personal anxiety – 14 (46.67±9.11%) and 57 healthy pregnant women (47.50±4.56%) with oligohydramnios, third – highest, respectively 11 (36.67±8.80%) and 39 (32.50±4.58%), the lowest level recorded in 5 (16.67±6.80 per cent) and 24 (20.00±3.65%) patients. A comprehensive approach to correction of the condition of water shortage has been applied in women of the main group, which included: psychological support for couples with sessions with a psychologist to control emotions. Establishing emotional contact with a woman, trust relationships, discussion of physical and emotional changes is a part of pregnancy. Conclusion. In the result of the researches, the approach proposed by us to the treatment of pregnancy with oligohydramnios, allowed to reduce the stress of compensatory mechanisms of the fetoplacental unit, which contributed to the reduction of anxiety in pregnant and have improved not only obstetric but also perinatal outcomes in women of the main group. Key words: pregnancy, placental dysfunction, oligohydramnios, Cytoflavin.

Features of pregnancy, childbirth and postpartum period in sexually transmitted infections

2020 ◽  
pp. 63-65
Author(s):  
O.І. Krotik ◽  
Keyword(s):  
Pregnant Women ◽  
Sexually Transmitted Infections ◽  
Premature Birth ◽  
Main Group ◽  
Control Group ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Sexually Transmitted ◽  
Placental Dysfunction ◽  
Group 12

The objective: to identify the features of pregnancy, childbirth, the postpartum period in patients with sexually transmitted infections. Materials and methods. A retrospective analysis of 150 pregnancy and childbirth histories was performed: the main group included 100 pregnant women with a history of sexually transmitted infections (STIs) and episodes of manifestations during this pregnancy and 50 pregnant women in the control group without this pathology. The exclusion criteria were pregnant women with sexually transmitted infections whose pregnancies ended in short-term abortions. Results. The threat of abortion was detected in 46% of the main group, against 26% of the control group. Oligohydramnios 13% in the main group against 8% in the control group. Preeclampsia in the main group 12%, against 5% in the control group. FGR in the main group 10% vs. 6% in the control. Placental dysfunction in the main group of 20% vs. 16% in the control. Bacterial vaginosis was 67% in the main group versus 14% in the control group. The risk of miscarriage, premature birth in the main group is 20% compared with the control group of 4%. Premature rupture of membranes was observed in 33% of women in the main group against 16% in the control group. Conclusions. The threat of abortion occurred in women of the main group (46%), which is 1.7 times more often than in the control group (26%). Oligohydramnios was observed in (13%) of the main group, which is 1.6 times more than in the control group (8%). Preeclampsia occurred 2 times more often in the main group (12%) than in the control group (6%). FGR occurred 1.7 times more often in the main group (10%) than in the control group (6%). Placental dysfunction was 1.25 times more common in the main group (20%) than in the control group (16%). A high percentage of bacterial vaginosis (67%) was observed in patients of the main group, which is 4.8 times higher than in the control group (14%). The risk of miscarriage, premature birth in the main group was higher (20%) and was observed 5 times more often than in the control group (4%). Premature rupture of membranes is observed in (33%) women in the main group, which is 2 times higher than in the control group (16%). Keywords: sexually transmitted infections (STIs), pregnancy, childbirth.

scholarly journals Prevention of pregnancy complications and delivery at low placentation

2021 ◽  
Vol 25 (3 (99)) ◽  
pp. 83-88
Author(s):  
S. Pecheriaha ◽  
I. Marynchyna
Keyword(s):  
Pregnant Women ◽  
Pregnancy Complications ◽  
Uterine Cavity ◽  
Main Group ◽  
Late Gestation ◽  
Lower Percentage ◽  
Control Group ◽  
Early Gestation ◽  
Placental Dysfunction ◽  
Pregnancy And Delivery

Objective is to evaluate the effectiveness of the developed method of preventing pregnancy complications with low placentation from early gestation.Material and methods. We have examined 119 pregnant women with low placentation. This diagnosis was made at 6-7 weeks of gestation on the basis of echographic research. The main group consisted of 64 pregnant women with low chorionic location who underwent prevention from pregnancy complications in early gestation by the complex of medicines developed by us and a control group -55 women with low placentation who had not undergone complications prophylaxis from early gestational periods. The prophylactic complex included Luteina, ginkgo biloba extract, folio and biolectra. To assess the effectiveness of the therapy in the study groups, we analyzed the course of pregnancy in early and late gestation, as well as complications of pregnancy and delivery.Results. The frequency of pregnancy pathologies in the main group, where the prevention of pregnancy complications from early gestation with low placentation, was significantly lower than in the control group. According to the study, the risk of abortion with bleeding and without bleeding in the first and second trimesters significantly decreased in the main group of pregnant women (p<0.05). In the third trimester of gestation in the group where the prevention of pregnancy complications was significantly reduced, the incidence of preterm birth, premature detachment of the low-lying placenta, fetoplacental dysfunction, fetal developmental delay syndrome and fetal distress during pregnancy (p<0.05). Also, in the main group there was a lower percentage of premature births and births that ended by cesarean section.Conclusions. 1. The place of attachment of the placenta in the uterine cavity is closely related to its function, the development of placental dysfunction, pregnancy and delivery. 2. Studies have shown the effectiveness of our proposed comprehensive drug prevention of complications of pregnancy with low placentation, which in turn has led to improved pregnancy and delivery and has become an effective means of preventing placental dysfunction.

scholarly journals PECULIARITIES OF THE FUNCTIONAL STATE OF THE MOTHER-PLACENTA–FETUS SYSTEM IN PREGNANT WOMEN WITH PLACENTAL DYSFUNCTION

2018 ◽  
Vol 17 (3) ◽  
pp. 24-28
Author(s):  
L. M. Yuryeva
Keyword(s):  
Blood Flow ◽  
Pregnant Women ◽  
Vascular Resistance ◽  
Functional State ◽  
Newborn Infants ◽  
Mean Value ◽  
Control Group ◽  
Fetal Blood ◽  
Peripheral Vascular ◽  
Placental Dysfunction

Among the causes that lead to antenatal affliction of the fetus, namely its hypoxia, hypotrophy, ante- and intranatal distress, is placental dysfunction (PD). Perinatal mortality in PDs is 10.3‰ in newborn infants, 49 ‰ – in preterm infants. Perinatal morbidity with PD reaches 70‰, and mortality rate – 20%. Objective. To investigate the functional state of the fetoplacental complex (FPС) in pregnant women with PD. Material and methods. The functional status of the FPC in 104 patients with PD (main group) and in 136 women with uncomplicated pregnancy and delivery (control group) using ultrasound placentalography, Dopplerometry was examined. Research results. The ultrasound characteristics of the placental dysfunction were the following: discrepancy between the degree of maturity of the placenta of the gestation period, true thickening of the placenta, its hypoplasia, reduction of echogenicity of the placenta, oligohydramnios. Dopplerometric signs of disorder of the utero-placental blood flow were high peripheral vascular resistance, both in dominant and in subdominant UA, asymmetry of blood flow in UA. Hemodynamics of fetal-placental circulation against the ground of PD was characterized by a decrease in the final diastolic blood flow velocity, which was manifested by an increase resistance in the peripheral vascular of the fetal part of the placenta,  decrease in placental coefficient. The peculiarity of fetal blood flow in pregnant women with PD was the decrease in the mean value of vascular resistance indices in the middle cerebral artery of the fetus and a significant decrease in the cerebral-umbilical index. Conclusions. In pregnant women with placental dysfunction hemodynamic changes in the utero-placental complex are associated with decrease in the intensity of placental-fetal blood flow and in 16.3% of cases by centralization of the fetal circulation. Timely Dopplerometry is important both in the diagnosis of the compensatory capabilities of the FPK, and during determination of reasonable suggested obstetrical tactics.

scholarly journals New Approaches to Treatment of Severe Intrauterine Growth Restriction

2014 ◽  
Vol 3 ◽  
Author(s):  
Zhanar Kurmangali
Keyword(s):  
Blood Flow ◽  
Pregnant Women ◽  
Gestational Age ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Control Group ◽  
Intrauterine Growth ◽  
New Approaches ◽  
Port System

Introduction. Intrauterine growth restriction (IUGR) is a leading cause of perinatal morbidity and mortality due to placental insufficiency. Currently, one of the new approaches to treating this disease is the injection of nutrients to the fetus through intravascular port-systems (catheters).Objective. To assess the impact of nutrient injections as treatment to fetuses with severe growth retardation.Materials and methods. Pregnant women with IUGR (abdominal circumference (AC) < 5th percentile) with the absence of diastolic flow in the umbilical artery and a fetal gestational age of less than 30 weeks were randomly divided into two groups. The treatment group included six pregnant women who had an intravascular port-system for the infusion of nutrients (amino acids and glucose) in the umbilical vein of the fetus for 14 ± 3 days. The control group consisted of eight patients who received only traditional dynamic monitoring and delivery at the optimum time of pregnancy. Fetal status was assessed using ultrasound equipment Accuvix V20 (Medison, South Korea) by examining indicators of biometry and Doppler study of blood flow in utero, umbilical arteries, middle cerebral artery, and ductus venosus with fetal vascular resistance index calculation - pulsatility index (PI). Criteria for blood flow disturbances in the vessels were considered PI values above normal values for their gestational age, which were defined as absence or reverse blood flow in a diastole in the umbilical artery.Results. In a comparative analysis of the two groups, the treatment led to a 44.7% increase in AC of the fetus (121.0 ± 11.5 mm and 219.3 ± 18.3 mm, respectively, p ˂ 0.001). In all cases, the profile of blood flow in the umbilical artery had a positive diastolic component. As a result, there was a 45.3% decrease in PI in the umbilical artery (2.14 ± 0.54 and 1.17 ± 0.15, respectively, p < 0.05). Average fetal weight in the study group was not significantly higher than the control group (1,120.3 ± 213.6 g and 909.6 ± 131.4 g, p > 0.05).Conclusion. Thus, injection of nutrients to the fetuses through intravascular port-system improved placental perfusion and metabolism, which has the potential for improved fetal growth. This, in turn, promoted full-term pregnancy and improved perinatal outcomes in fetal pathology.

scholarly journals MODERN DIAGNOSIS OF PLACENTAL DYSFUNCTION AND ITS COMPLICATIONS

2021 ◽  
Vol 8 (3) ◽  
pp. 182-187
Author(s):  
V.V. Lazurenko ◽  
I.B. Borzenko ◽  
O.A. Lyashchenko ◽  
O.B. Ovcharenko ◽  
D.Yu. Tertyshnyk
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Main Group ◽  
Control Group ◽  
Prospective Clinical Study ◽  
Fetal Growth Retardation ◽  
Clinical Algorithm ◽  
Vascular Growth ◽  
Placental Dysfunction

The aim of the study was to improve the modern diagnosis of placental dysfunction and its complications. Materials and methods. The study involved a prospective survey of 70 pregnant women divided into the main group (pregnant women with placental dysfunction) (n = 50) and the control group (n = 20). The main group was divided into subgroups of pregnant women with placental dysfunction and fetal growth retardation (n = 30) and pregnant women with placental dysfunction without fetal growth retardation (n = 20). The control group comprised 20 pregnant women with physiological gestation. Apart from history taking, the study comprised obstetric and general clinical examination, evaluation of endothelium- dependent vasodilation, serum concentrations of soluble forms of vascular and platelet- endothelial molecules of cell adhesion 1, indicators of athrombogenicity of the vascular growth wall, uterine-placental-fetal blood circulation, pathomorphological and histometric examination of the placenta. Results. Based on the obtained clinical-morphological and endotheliotropic criteria, a personalized clinical algorithm for managing pregnant women with placental dysfunction was developed and implemented. Conclusions. Assessment of pregnancy results in a prospective clinical study showed that the proposed algorithm for personalization of the risk of perinatal abnormalities not only helped to avoid antenatal mortality, but also to prevent intranatal and early neonatal losses in patients with placental dysfunction and fetal growth retardation.

Decompensation placental dysfunction: diagnostics and delivery tactics

2017 ◽  
pp. 66-68
Author(s):  
V.I. Boyko ◽  
◽  
S.A. Tkachenko ◽  
Keyword(s):  
Pregnant Women ◽  
Key Words ◽  
Retrospective Analysis ◽  
Control Group ◽  
Present Stage ◽  
Placental Dysfunction ◽  
Perinatal Pathology ◽  
Delivery Times ◽  
Case Rate ◽  
Major Factors

The objective: depression of frequency of perinatal pathology at women with decompensation form of placental dysfunction by improvement of the main diagnostic and treatment-and-prophylactic actions. Patients and methods. 154 pregnant women in gestation term from 22 to 40 weeks were surveyed. Depending on features of course of pregnancy and families of all surveyed it was divided into 4 groups. The group of the retrospective analysis was made by 45 pregnant women with decompensation placental dysfuction, the group of prospective research included 109 pregnant women of whom the main group was made by 38 women with decompensation form of placental dysfunction, the group of comparison included 47 pregnant women with the compensated form of placental dysfunction. The control group was made by 24 pregnant women with the uncomplicated course of pregnancy and labors. The complex of the conducted researches included clinical, ehografical, dopplerometrical, laboratory, morphological and statistical methods. Results. Use of advanced algorithm of diagnostic and treatment-and-prophylactic actions allows to increase efficiency of diagnostics of decompensation form of placental dysfunction for 33.3%, and rational tactics of a delivery leads to depression of perinatal pathology for 22.7%. Conclusion. Decompensation placental dysfuction is one of the main reasons for perinatal mortality and a case rate at the present stage. Use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows major factors of risk of this complication and the indication for change of tactics and delivery times. Key words: decompensation placental dysfunction, diagnostics, delivery tactics.

Optimisation of tactics of conducting pregnancy and labours at women after auxiliary reproductive technologies

2016 ◽  
pp. 160-164
Author(s):  
D.N. Maslo ◽  
Keyword(s):  
Pregnant Women ◽  
Resistance Index ◽  
First Trimester ◽  
Reproductive Technologies ◽  
Premature Delivery ◽  
Control Group ◽  
Uterine Arteries ◽  
Placental Dysfunction ◽  
Placental Blood ◽  
Two Stages

The objective: frequency decrease perinatal pathologies at women after ART on the basis of studying clinical-ehografical, endocrinological, biochemical, dopplerometrical, cardiotokografical and morphological researches, and also improvement of algorithm of diagnostic and treatment-and-prophylactic actions. Patients and methods. The work basis is made spent by us from 2012 on 2015 by complex inspection of 300 pregnant women from which 250 were after ART and 50 – firstlabours which pragnency without ART, and also their newborns. For the decision of an object in view of research spent to two stages. At 1 stage spent prosperctive research which included 150 pregnant women: з them 100 women pregnancy at which has come out ART (1 group) and 50 healthy women (control group). At 2 stage spent prospective randomization in which result of patients after ART have divided on two equal groups by therapy principle: 2 basic group - 75 pregnant women after ART at which used the algorithm improved by us; 3 group of comparison - 75 pregnant women after ART which have been spent on the standard treatment-and-prophylactic actions. Results. The results suggest that women after using ART is a high frequency of reproductive losses in the first trimester (10.0%), 3.0% of spontaneous abortion from 16 to 22 weeks, and 3.0% "early" premature delivery (22 to 28 weeks of pregnancy). The frequency of violations of the functional state of placenta in women after using IVF is 63.0%, which is the main cause of high levels of perinatal losses (40.0 ‰), and delivery by cesarean section (96.0%). Placental dysfunction in women after using ART characterized by retrohorialnyh hematoma (21.0%); size mismatch fruit (30.0%) and hypertonicity of the uterus (73.0%) against changes in fruit-placental blood flow - increased resistance index in umbilical artery and increased vascular resistance in the uterine arteries. Endocrinological and biochemical changes in placental dysfunction in women after using IVF starting from 28 weeks of pregnancy and are in significant reduction in progesterone, placental b1-microglobulin, B2-microglobulin of fertility and trophic в-glycoprotein. Conclusion. The received results: use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows to lower frequency of spontaneous interruption of pregnancy till 22 weeks – from 13.0% to 5.7%; «early» premature birth – from 3.0% to 1.0%; placentary dysfunction from 63.0% to 40.6%; cesarean sections – from 96.0% to 56.5%, and also perinatal losses – from 40.0‰ to 16.2‰. Key words: pregnancy, childbirth, auxiliary reproductive technologies.

scholarly journals Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dong Wang ◽  
Caixia Liu ◽  
Xinyu Liu ◽  
Ying Zhang ◽  
Yu Wang
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Pregnant Women ◽  
Gestational Age ◽  
Speckle Tracking ◽  
Control Group ◽  
Second Trimester ◽  
Cardiac Morphology ◽  
Sphericity Index ◽  
And Function

Abstract Background Due to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW). Methods Fifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable. Results The GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup. Conclusions Fetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

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