Оцінювання впливу комплексної терапії вагітних із затримкою росту плода на акушерські та перинатальні наслідки розродження

Abstract

The objective: estimate efficiency of complex, neuroprotective therapy of pregnant women with fetus growth inhibition and its influence on obstetric and perinatal consequences of delivery. Materials and methods. Complex examination of 95 pregnant women in term 28–34 weeks of gestation were examined. The first group (the main group) includes 32 pregnant women with fetus growth inhibition (FGI). FGI was diagnosed according to data of ultrasonic examination. Pregnant women of this group had prescribed therapy with piracetam and thiotriazolinum (1000 mg and 250 mg consequently in 100 ml of 0.9% saline solution per day, intravenously by drop infusion) in complex with L-arginine hydrochloride (4.2%, 100 ml of solution per day intravenously by drop infusion) during 10 days and further L-arginine aspartate (5 ml, 6 times per day) during 14 days. In complex therapy pregnant women also get Flebodia (diosmin 600 mg per day) during 30 days. The second group (the comparison group) is presented by 33 pregnant women with FGI whose pregnancy follow-up and assistance in labour is provided by valid orders of Ministry of Healthcare of Ukraine. The third group (the control group) comprises 30 pregnant women without FGI. Average age of pregnant women in the first group made 25.9±1.6 years in the second group – 27.7±1.8 years and 25.8±1.0 years in the control group. According to results of anthropometric measurements of pregnant women there was not determined statistically significant difference between examined groups (p>0.05). The severe somatic diseases were exclusion criterion. Variational and statistic processing of results was made using STATISTICA 13 – license standard application program packages for multidimensional statistical analysis. Results. By means of analysis of peculiarities of gestation course in the examined groups there was found that rate of miscarriage in the second group made 39.4% and it was significantly higher than values of the first group (21.8%) and the third group (16.7%). General rate of anemia of pregnant women was also the highest in the second group and made 42.4% and in the first and third groups anemia occurred almost with the same rate (31/3% and 33.3%, correspondingly). Hypertensive disorders during pregnancy and labour were diagnosed only in pregnant women of the first group (6.3%) and the second group (9.1%). In the first group premature labour rate index made 3.1% and it was 6 times lower than the same index in the second group (21.2%). Fetus distress rate in the second group (18.2%) is almost 2 times higher than the same index in the first group (9.4%) and in the third group it made 3.3%. General rate of abdominal delivery was the highest in the second group and made 45.5% and in the first group – 15.6% and 6.7% in the third group. In the second group the rate of cesarean operations under urgent indications is 4 times higher than the same index in the first group (29.5% and 6.8% correspondingly). State of newborns in the examined groups was analyzed under Apgar score. Both at the first and fifth minutes the general index under the certain score was statistically and significantly lower in the second group comparing to indices of the first and thirds groups. By means of characterizing perinatal complications there was found that considerable percentage of neonatal encephalopathy and neonatal jaundice in the second group made 33.3% and 36.4% correspondingly. In the first group their rate made 9.4% and 3.1% correspondingly. In structure of perinatal pathology prematurity had occurred in 21.2% of newborns of the second group that is 6 times higher than the same index of the first group (3.1%). Mentioned complications in the third group were not found. Based on anthropometric measurements of newborns there was revealed that average index of their weight in the second group made 2162.2±105.4 g and was statistically and significantly (р<0.05) lower than the same index in the first group (2785.2±100.2 g) and the third group (2914.3±180.2 g). Conclusions. 1. Results of performed research indicate that obstetric and perinatal consequences of delivery of pregnant women with fetus growth inhibition are characterized by high rate of complications but their rate considerably prevails in the group of women who hadn’t proposed complex neuroprotective therapy. Thus in group of pregnant women with fetus growth inhibition who had proposed therapy there was found the decrease of rate of complications in labour (premature labour and fetus distress) having direct influence on rate of operative delivery under urgent indications. 2. Positive effect of proposed complex neuroprotective therapy for women with fetus growth inhibition was demonstrated by statistically significant (р<0.05) prevalence of both indices under Apgar score with correspondingly adaptation processes and results of anthropometric measurements of newborns and their body mass indices. Perinatal consequences of delivery are characterized by lower level of neonatal encephalopathy rate. Key words: pregnancy, fetus growth inhibition, obstetric and perinatal complications, neuroprotective therapy.