Анализ течения и исходов родов у пациентов высокого риска по пренатальному скринингу

Abstract

Objective. To study the course and outcome of labor in patients who are at high risk of pre-eclampsia (PE), fetal growth restriction (FGR), preterm birth (PB), and fetal chromosomal abnormalities (CA) according to the results of prenatal screening. Patients and methods. We performed a prospective analysis of the course of labor in 443 women with singleton pregnancy who underwent the first trimester prenatal risk assessment based on the Astraia program. Group 1 (n = 235) included highrisk subgroups for CA – 1A (n = 69); PE – 1B (n = 66); FGR – 1C (n = 48); PB – 1D (n = 52). Risk combinations were excluded, and one of the four assessed outcomes was considered. Group 2 (control group, n = 208) was comprised of lowrisk women. Results. The risk of PB (>34 and <37 weeks) was higher in group 1 than in group 2 (р < 0.05). Full-term birth in both groups had no differences (р > 0.05). Post-term birth was more common in group 2 (р < 0.05). Labor induction prevailed in group 1 and subgroups 1B, 1C (р < 0.05). Labor complications were more common in group 1 (р < 0.05). Prelabor rupture of membranes was more frequent in the subgroups 1B and 1D of group 1 (р < 0.05). Fetal distress and a combination of complications (distress, weak contractions, and rupture of membranes) prevailed in group 1 (p < 0.05). Cesarean section was performed more frequently in group 1 than in group 2 (р < 0.05). Indications in group 1 were placental insufficiency (PI) and PE (р < 0.05). The dif-ference in the frequency of PI between subgroups 1C and 1B was significant relative to 1A, 1D (р < 0.05). Fetal distress was noted in one third of both groups and subgroup 1C (р > 0.05). Conclusion. In the high-risk group based on the results of prenatal screening compared with the control group, there was a significantly higher frequency of prelabor rupture of membranes (in subgroups 1B (PE), 1D (PB)), fetal distress, and a combination of complications, as well as cesareans delivery (subgroups 1B (PE) and 1C (FGR)) (р < 0.05). Key words: fetal distress, labor induction, labor complications, prenatal screening, risk level