PLACENTAL DYSFUNCTION IN PREGNANT WOMEN WITH DIABETES. MODERN APPROACHES TO CHILDBIRTH

Abstract

Diabetes mellitus is a common chronic disease in the women of reproductive age. Pregnant women with this disease often have placental dysfunction, which manifests itself in fetal growth retardation, dehydration and requires delivery by a cesarean section. To evaluate the effect of antiprogesterone use on cervical maturation and optimization of delivery in pregnant women with placental dysfunction resulted from diabetes, 120 women were examined according to generally accepted norms. Ultrasound examination with Doppler velocimetry of the fetoplacental complex vessels and measurement of the uterus neck, hormonal examination to determine the level of hormones (progesterone, oxytocin, prostaglandin E2) by enzyme−linked immunosorbent assay, endothelial dysfunction factors (VEGF, endothelin, еNOS), assessment of uterus neck according to Bishops' score and the course of childbirth by cardiotocography and partogram, the newborn condition on the Apgar scores, newborn weight, glycometric condition of the mother. Preparation of pregnant women for childbirth was carried out by intracervical injection of prostaglandins of group E2 (dinoprostone); Foley catheter; antiprogesterone drug (mifepristone). The research has found that diabetes complicates the course of pregnancy with placental dysfunction in almost every second pregnant woman due to endothelial dysfunction, especially in the fetoplacental complex, which can be determined at an earlier stage of pregnancy by studying endothelial factors. The need for initiating the premature birth in pregnant women with diabetes is stipulated by the impairments in mother and fetus (placental dysfunction, diabetic fetopathy, distress), which requires preparation of the cervix for the labor induction. The most effective pre−induction of pregnant women with diabetes was the pathogenetic method of intracervical administration of antiprogesterone, which did not have a negative effect on the body of mother and child. Key words: diabetes mellitus, placental dysfunction, pregnant women, antiprogesterone.