Современные подходы к диагностике раннего маловодия

Abstract

Objective. To compare the methods of oligohydramnios (OHA) diagnosis using 2D- and 3D-ultrasound and to determine clinical significance of OHA in women with intrauterine infection. Patients and methods. We evaluated the amount of amniotic fluid in 130 pregnant women (at weeks 13–21) aged between 17 and 45 years by measuring the largest vertical pocket and calculating the volume of the largest pocket. Seventy patients were found to have reduced amount of amniotic fluid (Group 1). Sixty women comprised the control group (Group 2). Results. The method for measuring the largest vertical diameter of a fluid pocket demonstrated the following performance characteristics: 84% sensitivity, 94% specificity, 87.9% accuracy, and 0.5 AUC. The performance of measurement of the largest pocket volume was as follows: 92.5% sensitivity, 97.3% specificity, 96.1% accuracy, and 0.8 AUC. Perinatal losses were observed only in Group 1 (n = 2; 28.6%). Women in Group 1 were more likely to have fetal hypotrophy than women in Group 2 (54 (77.1%) vs 5 (8.3%)). Hypoxic-ischemic brain injury and intrauterine infections were also more common among patients with OH than in controls (65 (92.8%) vs 4 (6.6%) and 59 (84.3%) vs 7 (11.6%), respectively) (p < 0.001). Conclusion. Early OH is a marker of severe obstetric and perinatal complications in patients with signs of intrauterine infections. Measurement of the largest pocket volume demonstrated better performance characteristics for the detection of early OH than calculation of the largest vertical diameter of a fluid pocket. Key words: intrauterine infection, oligohydramnios, amniotic fluid, three-dimensional ultrasound