Abstract
Abstract. Reduction and prevention of perinatal losses through their accurate, differentiated forecasting can serve as one of the ways to stabilize the unfavorable demographic situation. To do this, we must use reliable markers of fetal distress that are pathogenetically justified. The most promising for us are trophoblastic β-glycoprotein and cortisol, which make it possible to assess the functional state of the placenta and the degree of tension of the compensatory processes occurring in it. Objective of the study: to conduct a comparative analysis of the content of trophoblastic β-glycoprotein and cortisol in the blood serum of pregnant women with various types of perinatal outcomes and to determine the prognostic weight of their concentration values in assessing the risk of antenatal, intrapartum and early neonatal losses. Materials and research methods. We conducted a retrospective assessment and comparative analysis of the results of quantitative determination of trophoblastic β-glycoprotein and cortisol in the blood serum of pregnant women in the third trimester with subsequent antenatal (n=55), intrapartum (n=33), early neonatal (n=38) losses and a favorable perinatal outcome (n=45) as a control. We determined the prognostic weight of the concentration values of these markers in women with unfavorable antenatal, intranatal and early neonatal outcomes. We used the program "Statistica 10.0" for statistical processing of the obtained data and the Bayes model of prediction with analysis by A. Wald, method of E.V. Gubler and the criterion of S. Kullback. Results. The level of trophoblastic β-glycoprotein was significantly reduced in pregnant women with subsequent unfavorable perinatal outcomes (2.4 times in antenatal, 1.8 times in intranatal and 1.7 times in early neonatal losses) in comparison with the control, and the level of cortisol was significantly increased (1.6 times in antenatal and 1.3 times in intranatal losses). In the third trimester of pregnancy the content of trophoblastic β-glycoprotein was 1.3 times lower in the blood of patients with subsequent antenatal fetal death than in women with intranatal fetal death, on the contrary, the cortisol content was 1.3 times higher. Also, the level of cortisol was 1.5 times higher in antenatal losses than in early neonatal losses. We have calculated prognostic coefficients and indicators of informative values of the concentration of the studied markers in the blood serum of pregnant women with antenatal fetal death, intranatal fetal death and early neonatal death of a newborn. We have determined the concentration levels of these markers that worsen and improve the perinatal prognosis. Conclusion. The conducted study allowed to establish the presence of a statistically significant difference in the content of trophoblastic β-glycoprotein and cortisol in pregnant women with various types of perinatal outcomes. We have determined the prognostic weight of their concentration values in assessing the risk of antenatal, intrapartum and early neonatal losses. The results of the study made it possible to substantiate the expediency of using these markers in differentiated stage-by-stage perinatal prognosis and recommend their inclusion in multifactor prognostic systems for assessing perinatal risk.
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