Клинико-анамнестические предикторы развития плацентарной недостаточности

Abstract

Aim: To determine the predictors of placental insufficiency based on clinical and anamnestic data of patients with fetal growth retardation and impaired uteroplacental circulation. Study design: Longitudinal cohort comparative study. Materials and methods. The study included 140 patients with placental insufficiency diagnosed at 28–36 weeks gestation. Pregnant women were divided into three subgroups: 1st — 50 patients whose gestational period was complicated by fetal growth retardation (early and late phenotypes), 2nd — 50 patients with impaired uteroplacental circulation without fetal growth retardation, 3rd — 40 pregnant women with both fetal growth retardation phenotypes (early and late late) in combination with a violation of uteroplacental circulation. The comparison group was represented by 30 pregnant women without placental insufficiency at 28–36 weeks gestation. The data of somatic and obstetric-gynecological anamnesis, antrometric parameters of the examined patients and perinatal outcomes were analyzed. Results. The study of perinatal outcomes showed that newborns of women with placental insufficiency had statistically significantly lower weight and height indicators than in the comparison group, and moderate asphyxia (4–6 points) on the Apgar scale at the 1st and 5th minutes (p < 0.05). Placental insufficiency most often developed in patients with subclinical hypothyroidism (odds ratio (OR) = 6.37; 95% confidence interval (CI) — 2.45–16.6; p < 0.05) and chronic pyelonephritis (in remission) (OR = 4.32; 95% CI — 0.98–19.1; p < 0.05), as well as in women with a history of medical abortions (OR = 3.18; 95% CI — 1.04–9.65; p < 0.05), non-developing pregnancies (OR = 6.69; 95% CI 2.22-20.17; p < 0.05) and abdominal delivery (OR = 3.60; 95% CI 1.03–12.5; p < 0.05). Acute respiratory viral infections were registered more often in patients of the main group than in the comparison group (OR = 0.19; 95% CI — 0.08–0.43; p < 0.05). Conclusion. Burdened somatic status (subclinical hypothyroidism, chronic pyelonephritis) and obstetric and gynecological history (medical abortion, undeveloped pregnancy) are associated with the risk of developing various manifestations of placental insufficiency. Timely prevention of pregnancy complications, correction of endocrine dysfunction and treatment of infectious pathology will improve gestational outcomes and reduce the frequency of perinatal complications. Keywords: placental insufficiency, pregnancy outcome, ultrasound diagnostics.