Women have prognostication and diagnostics of complications of gestation with a high perinatal risk

Abstract

DOI: 10.52705/2788-6190-2025-02.1-05
УДК 618.3/.7-036.8-07-037

The objective: to develop modern algorithm of prognostication and diagnostics of complications of gestation for women with a high perinatal risk.
Materials and methods. Under our supervision by a randomization 404 women were taken from a number those which got up on an account for pregnancies. The criteria of plugging in the program of inspection were early appearance in womanish consultation, singleton pregnancy and consent of pregnant on an inspection during all period of gestation. A control group was made by 50 unpregnant women. An age-old interval of the inspected patients was scope from 17 to 42 years, middle age of pregnant made 25,7 ± 0,3 years, women of control group – 24,8 ± 0,6 years (p>0,05). After completion of pregnancy, depending on the features of its course and result, distributing of women was mine-out on clinical groups. As an analysis of early reproductive losses was not included in the task of research, 8 women were excluded from development as a result of the involuntary breaking of pregnancy and finally formed clinical groups were included by 396 women. I a group was made by 152 women, pregnancy in which flowed with different obstetric complications (by the threat of terminating pregnancy, gestosis, violation of the state of fetus) and completed by an unfavorable perinatal result: by antenatal fetal death, premature births, birth of the worn children with a prenatal hypotrophy and diseases of post-hypoxic genesis. The II group was made by 116 women, pregnancy in which also had complicated course, but completed by birth of the healthy worn children. The III group was made by 128 women with physiology course and result of pregnancy. For all women the analysis of anamnestic data was conducted taking into account somatic and gynaecological morbidity, obstetric anamnesis. The detailed estimation of course of pregnancy and births, presence and character of complications was conducted. The complete was conducted all pregnant clinical-and-laboratory inspection which includes an inspection on the transmitter of infections of TORCH-complex, executed triple ultrasonic research from dopplermetry.
Results. The conducted research rotined that these complications were the weighty factors of perinatal risk: early toxicosis was increased by the risk of unfavorable perinatal result at 2,1 time, threat of terminating pregnancy in I and II trimesters – in 1,6 and 1,7 time respectively, including threat of breaking, which requested the repeated and protracted hospitalizations, – at 2,1 time. Substantially threatenings premature births increased the risk of perinatal complications, even in the cases of successful tocolysis (relative risk = 1,6). The meaningful factor of perinatal risk among complications of pregnancy was a gestosis: relative risk of unfavorable result from the side of fetus and new-born at presence of this complication increased at 1,7 time at the gestosis of easy degree and at 2,5 time at presence of for the patient of gestosis of middle or heavy degree. Pathological changes morpho-functional to the state of fetoplacental complex as a result of ultrasonic diagnostics in the II trimester of pregnancy registered with frequency 19,1% for patients with the unfavorable result of pregnancy for fetus and 21,6% for women with gestational complications which gave healthy children (p > 0,05). In the III trimester of pregnancy frequency of pathological changes was increased to 48,0% and 35,3% respectively (p < 0,05), that informing ultrasonic markers for patients with unfavorable perinatal results for certain more frequent appeared on the stage of clinical manifestation of gestational complications.
Conclusions. On the basis of complex study of fetoplacental homoeostasis a certain algorithm of inspection of women is within the framework of the obstetric monitoring for prognostication of gestational and perinatal complications, optimization of treatment and delivery of pregnant. The conducted research allowed to define informing markers for early diagnostics of violation of the functional state of fetoplacental complex. On the basis of estimation clinically anamnestic information, complemented by informing laboratory tests researches of fetoplacental homoeostasis, formed and inculcated in a practical health protection score-prognostic tables of risk of development of gestational complications (in the early terms of pregnancy) and perinatal to the risk (in 28–32 weeks and at the worn pregnancy).