Роль оцінювання провізорних органів у діагностуванні патології плода

Abstract

Aim - to evaluate the potential of using data on provisional organs’ changes and fetal growth restriction (FGR) for the diagnosis of fetal pathology, including severe/sublethal pathology - multiple malformations and chromosomal abnormalities (CA). Materials and methods. The results of complex prenatal examinations of 2954 high-risk pregnant women performed in 2020-2022 were analyzed. The rate of FGR, placenta, umbilical cord and amniotic fluid changes were compared depending on the presence of fetal pathology by Chi-Square (χ2) test and odds ratio (OR) calculation. Results. 853 cases of fetal pathology (28.9%) were diagnosed, including cases of 658 anatomical malformations and 195 CA. 264 observations of multiple malformations and CA were allocated to the subgroup of severe pathology. The rates of provisional organs’ changes were significantly higher in presence of fetal pathology: FGR in the control group 2.0%, in the group of fetal pathology 19.5%, in the group of severe pathology 36.7%; single umbilical artery in 1.1%, 9.3% and 14.8%, respectively, velamentous/marginal cord insertion in 1.95%, 7.4% and 8.3%, respectively. OR of fetal pathology in presence of FGR was 11.6, in presence of single umbilical artery 9.2, in presence of FGR combined with polyhydramnios 97.9; for single umbilical artery combined with polyhydramnios 30, combined with oligohydramnios, combined with FGR 13.6. OR of severe pathology in presence of FGR was 27.8, for combination of FGR and polyhydramnios 172.1; in presence of single umbilical artery 15.7, its combination with polyhydramnios 57.2, with FGR 35.5. These markers had low sensitivity, high specificity and accuracy. Conclusions. Early FGR, polyhydramnios, oligohydramnios, single umbilical artery, velamentous/marginal umbilical cord insertion, structural placenta changes are associated with the higher rate of fetal pathology. These findings must prompt women’s referral to tertiary prenatal diagnosis departments and may be an indication for prenatal invasive procedures. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.