Определение степени перинатального риска по результатам антенатальных эхографических мониторингов

Abstract

The purpose of the study was the development of perinatal risk graduations according to antenatal ultrasonographic monitoring results to optimize antenatal surveillance protocols and validation of perinatal prognosis. Patients and methods. Аntenatal ultrasound examinations were performred in 1448 fetuses with a high perinatal risk. The studies included ultrasound fetometry and estimated fetal weight calculation with the definition of gestational weight percentile as well as visual assessment of fetal ultrasound anatomy and Doppler assessment of placental and fetal cardiovascular profile. Pregnancy outcomes and neonatal status were studied. Postnatal results were classified as adverse general postnatal outcome which meant perinatal or infant death and adverse clinical postnatal outcome which meant perinatal acidemia, Apgar score of 0–4 points, persistent pathological condition of the newborn. All the fetuses of the studied cohort were divided into two clinical groups: 638 fetuses with poor general postnatal outcome and/or clinical postnatal outcome (I group) and 810 fetuses with favorable clinical postnatal outcome catamnesis (II group). Results. Significant differences between groups were at fetometry with calculated fetal weight below the 10th percentile after 34 GW and before 28 GW (p<0.01). The most significant differences occurred at comparing the frequency of registration ductus venosus a-reverse wave, p<0.01. When oligohydramnios, maternal arterial hypertension and umbilical artery absent/reverse diastolic flow were registered adverse general postnatal outcome and/or clinical postnatal outcome prevailed (p<0.05). The increased cardio-thoracic ratio occurred in fetuses of group 19 times more frequent than in group II. The cerebro-placental ratio reduction occurred 18 times, the prevalence of reverse flow component of the fetal aortic isthmus 6.2 times and the deepening of ductus venosus myocardial isovolumetric relaxation phase in the group I were registered 21 times more often than in group II (the differences did not have statistical significance due to the small number of observations). Fetal hydrops of any genesis, as well as variable umbilical artery Doppler on the background of maternal arterial hypertension, are factors of uncertain perinatal risk, with the possibility of both normal and adverse perinatal outcome. Antenatal surveillance of these fetuses requires multivascular Doppler monitoring. Ultrasound predictors that had the strongest correlations with adverse general postnatal outcome and/or clinical postnatal outcome have been established. Conclusions. The high risk pregnancy antenatal care protocols need to include an assessment of the cardiovascular profile with monitoring of ductus venosus hemodynamic and fetal cardio-thoracic ratio evaluation as predictors of extremely high risk of adverse perinatal outcome. Results of the study can be used for prenatal counseling and perinatal prediction and for the future development of echographic perinatal risk gradations scale: extremely high or high risk (which require monitoring in perinatal center), or uncertain risk (which requires postnatal follow-up). The development of advanced tools for calculating the degree of perinatal risk as echographic scale and online calculators can improve understanding of different professionals working in the general perinatal space: obstetricians, radiologists and neonatologists. Key words: high'risk pregnancy, ultrasound, perinatal result, perinatal risk scale.