Особенности центральной гемодинамики, функционального состояния вен нижних конечностей и перинатальные исходы у беременных женщин с начальными формами флебопатий

Abstract

Objective. To study the features of functional status of veins and central hemodynamics in women with early stages of phlebopathy during pregnancy and their role in perinatal outcomes. Patients and methods. Seventy pregnant women with early manifestations of chronic venous disorders were examined. The study group included 30 patients who gave birth to children with signs of ante-, intra-, postnatal hypoxia; the control group included 40 patients with normal physiological birth outcomes for newborns. When assessing the status of venous system, the elasticity index was calculated, and the severity of sludge syndrome was identified. Volumetric compression oscillometry was used to measure several central hemodynamic parameters in the second trimester. The relative gene expression of HIF1α transcription factor was calculated in the second and third trimesters. Morphological examination of the placenta was performed with determining the fetoplacental ratio and placental weight (g). Results. There was a statistically significant increase in the elasticity index during gestation in pregnant women in the study group. The first stage of sludge syndrome in the second trimester was detected in 70% of pregnant women in the study group, and the second stage of sludge syndrome was detected in 16.6% of patients. The relative expression of HIF1α in patients in the study group increased more than 2.5-fold in the second trimester and more than 3.5-fold in the third trimester. Pregnant women in the study group had statistically significant changes in all central hemodynamic parameters as compared with the control group. All women required emergency delivery. Fetal weight in the study group was statistically lower than in the control group. Apgar score at 1 minute of life in the study group was 6.5 (6; 7) and at 5 minutes – 7.5 (7; 8), in the control group it was 8 (8; 8) and 9 (8; 9), respectively (p > 0.001). The revealed changes in the placentas from women in the study group corresponded to hypoxic tissue injuries. Conclusion. Pregnant women with early stages of phlebopathy have specific features of central hemodynamics and venous functional status, which determine perinatal outcomes. Key words: pregnancy, phlebopathy, hemodynamics in pregnant women, placental morphology