Ultrasound Fetometry Research Articles

BIOMEDICAL RISK FACTORS FOR THE DEVELOPMENT OF PREECLAMPSIA OF VARYING SEVERITY IN PREGNANT WOMEN

The aim of this study was to identify biomedical risk factors for the development of preeclampsia of varying severity in the group of examined pregnant women. Material and methods. 70 women whose pregnancy was complicated by the development of preeclampsia were under observation. The first group included 46 (65.7%) patients with moderate preeclampsia; the second group included 24 (34.2%) women with severe preeclampsia. The diagnosis was established on the basis of the patient's complaints, clinical examination, somatic, obstetric and gynecological anamnesis, analysis of the course of the present pregnancy, ultrasound fetometry and Dopplerometry findings. The patients who participated in the study had an assessment of clinical and anamnestic parameters, somatic status, obstetric and gynecological anamnesis. Data from 45 pregnant women with an unencumbered obstetric and gynecological history and a physiologically occurring pregnancy were used as control values. Results. The prognostic risk factors for the development of moderate and severe preeclampsia were analyzed based on the calculation of relative risk indicators (RR) and 95% confidence interval (95% CI). In the group of pregnant women with both severe and moderate preeclampsia, strong prognostic risk factors were: place of residence in the regions, extragenital pathology in the anamnesis, gynecological diseases in the anamnesis, the number of pregnancies in the anamnesis, birth parity, and arterial hypertension. The early identification of risk factors for moderate and severe preeclampsia enables timely preventive measures, thereby improving patient outcomes and prognosis. Conclusion. The analysis revealed that preeclampsia was more prevalent among pregnant women with a history of various extragenital diseases, a complicated obstetric and gynecological history, and concomitant hypertension.

Correction of placental dysfunction in the first trimester of pregnancy as a method of preventing fetal growth retardation

Objective: to study the effectiveness of complex therapy of placental dysfunction (PD) as a method of prevention of fetal growth retardation syndrome in pregnant women with miscarriage in the 1st trimester of pregnancy.Materials and methods. 100 pregnant women with verified PD on the background of miscarriage in the first trimester of pregnancy took part in the study.Verification criteria for PD were: a decrease in the volume of the chorion and its vascularization index by more than 15%, an increase of the resistance index in the uterine and spiral arteries during dopplerometric examination at the end of the first trimester of pregnancy.The patients were divided into groups: group I (main) – 36 pregnant women with PD who received complex treatment, group II (comparative) – 32 pregnant women with PD who were prescribed only hormonal support, III group (control) – 32 patients with the physiological course of the first trimester of pregnancy. Complex therapy in the group I included hormonal agents, venotonic drug Normoven, the drug Magnicum, and the drug Artihol.Clinical data, ultrasound fetometry, dopplerometric study of utero-fetal blood flow were used to assess the effectiveness of treatment.Results. Already in the 22–24th week of gestation there was no significant difference in the resistance index in the spiral and uterine arteries between the main and control groups (p > 0.05). Ultrasound fetometry at 32–34 weeks of gestation showed that in the first group there were 8.3% (3) fetuses small for gestational age, 15.6% (5) in the second group and 3.1% (1) in the control. The average body weight of newborns in the main group and in the comparison group differed significantly and was 2810 ± 267 and 2610 ± 175 g respectively (р < 0.05) and 3295 ± 295 g in the control group.Conclusions. Complex, pathogenetically justified, long-term treatment of PD from the early stages of pregnancy makes it possible to avoid progression of compensated and development of subcompensated stages of placental disorders. Complex therapy of PD, which includes micronized progesterone, Normoven, Artichol and Magnicum, Complex PD therapy, which includes micronized progesterone, Normoven, Artihol and Magnicum, normalizes blood flow in the mother-placenta-fetus system, normal growth and fetus development and is an effective way of preventing fetal growth retardation.

ULTRASOUND CHARACTERISTICS OF THE DEVELOPMENT OF THE FETOPLACENTARY COMPLEX IN PREMIER PREGNANCY

The article is devoted to the study of ultrasound changes in the fetoplacental complex in the early gestational period in pregnant womenwith miscarriage. Placental insufficiency (PI) is a syndrome caused by morpho-functional changes and is the result of a complex responseof the fetus and placenta to various pathological conditions of the maternal body [1]. It is based on disorders of compensatory-adaptivemechanisms of the fetoplacental complex (FPC) at the molecular, cellular and tissue levels. Ultrasound fetometry and placentometry are very important methods for diagnosing the state of the fetoplacental complex and can be used from the early term. Many researchers identify a number of prognostically unfavourable ultrasound markers: low chorion attachment, especially with the appearance of areas of detachment, discrepancy between the size of the foetus and gestational age, lack of clear visualization of the embryo, especially its heartbeat. In pregnant women with a history of miscarriage it is important to identify early signs of placental dysfunction from the firsttrimester onwards and to provide adequate correction for this condition. For this situation it is important to create appropriate conditions for the development and growth of the placenta and its adequate functioning. Significant fetal abnormalities occur as early as the first trimester and have a significant impact on the further process of ontogenesis.Aims and objectives of the study. To assess the normal parameters of embryonic and extraembryonic formation and to evaluate theparticular features of the formation and development of the fetoplacental system during pregnancy in women with a history of miscarriage.Materials and Methods. We erformed a comprehensive ultrasonographic examination of 25 somatically healthy women with aphysiological gestational process (control group) between 5 - 40 weeks’ gestation and 25 pregnant women with a history of miscarriage (study group). The SONOACE 8800 GAI MT with a 3.5 to 7.5 MHz convex transducer was used in the study. The data were statistically processed using standard methods of mathematical analysis with the use of Student’s and Fisher’s criteria, standard and specialized computer programs. Paired correlation indices were used to study the nature and degree of correlation between different parameters. The scientific research was positively evaluated by the Bioethics Commission of the Bukovinian State Medical University (Protocol No. 4 of 6.12.2021).Results and their discussion. In the transvaginal examination, uncomplicated pregnancy is characterized by the mandatoryvisualization of the embryo in the fetal cavity with a diameter of 14 mm or more, corresponding to 6 weeks' gestation. From the time of embryo identification in our study, we measured the coccygeal-parietal size (CPS) and compared its values with gestational age. It was found that in 22 (88.0%) cases the embryo size corresponded to the calculated gestational age and the mean inner diameter of the fetal egg. In severe clinical manifestations of threatened miscarriage the most sensitive echographic sign was a decrease in the volume of the foetus, which is a marker of further adverse pregnancy course and outcome. However, when there was an isolated increase in myometrial tone in the absence of clinical manifestations of threatened abortion, there was predominantly an isolated reduction in amniotic cavityvolume, easily corrected by the administration of conventional antispasmodic therapy.The ultrasonic criteria for alterations in pregnancy were developed, including delay in embryo CTR by 2 weeks or more on ultrasound examination up to 9 weeks' gestation; bradycardia at 90 bpm or less up to 8-12 weeks' gestation; chorionic detachment withretrochorial hematoma formation (over 25 ml); tachycardia at over 200 bpm with clinical manifestations of spontaneous miscarriage; marked progressive decrease of amniotic cavity volume; severe polyhydramnios with a thick echopositive suspension in the amniotic cavity. The risk of spontaneous miscarriage and formation of placental insufficiency increases with the simultaneous detection of 2 or more echographic markers.Conclusions. On the basis of the above, it is possible to conclude on the need to conduct an ultrasound examination with an assessment of the echographic parameters of the formation and development of the embryo and extraembryonic structures in the first trimester in pregnant women with a history of miscarriage and a risk of developing placental insufficiency in the history in order toidentify markers of a complicated course of gestation and the and the subsequent choice of rational tactics of pregnancy management.

The Role of High Concentrations of Homocysteine for the Development of Fetal Growth Restriction.

To assess homocysteine (Hcy) levels in the three trimesters of pregnancy in women with fetal growth restriction (FGR) and to evaluate the role of Hcy as a possible predictor of FGR. A total of 315 singleton pregnant women were included in the present prospective cohort study and were monitored since the 1st trimester of pregnancy before delivery. Newborns were monitored for the first 7 days of life. Patients who had risk factors for FGR were excluded. Fetal growth restriction was defined according to uterine fundal height (< 10 percentile), ultrasound fetometry (< 5 percentile), and anthropometry of newborns (< 5 percentile). The concentrations of Hcy were detected at between 10 and 14, between 20 and 24, and between 30 and 34 weeks of pregnancy by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristics (ROC) curve test and diagnostic odds ratio (DOR) were performed to evaluate the results of ELISA. The concentration of Hcy in patients with FGR was 19.65 umol/L at between 10 and 14 weeks, compared with 9.28 umol/L in patients with normal fetal growth (p < 0.0001). The optimal cut-off level for Hcy in the 1st trimester of pregnancy was > 13.9 umol/L with AUC 0.788, sensitivity of 75%, specificity of 83.6%, and DOR of 15.2. Assessment of serum Hcy concentration may be used as a predictor of FGR, with the highest diagnostic utility in the 1st trimester of pregnancy.

Prediction of perinatal outcomes in pregnant women with fetal growth retardation

Introduction. An important problem of modern obstetrics is the development and improvement of methods for predicting fetal growth retardation (FGR) and pregnancy outcomes in this pathology, since there are no proven effective treatments for FGR. Purpose of the study — to develop prediction criteria for newborn hypotrophy and cumulative adverse perinatal outcome in pregnant women with FGR. Objective. To identify key predictive factors for adverse perinatal outcomes in pregnancy complicated by FGR. Material and methods. A case-control, cohort-based study was conducted that included 155 pregnant women with FGR, who were divided into two groups after delivery: Group 1 included 90 patients with neonatal hypotrophy and Group 2 included 65 patients without neonatal hypotrophy. A comprehensive analysis of clinical and anamnestic, laboratory and instrumental data, peculiarities of the course of pregnancy and perinatal outcomes was performed. FGR was determined on the basis of ultrasound fetometry. Results. Factors associated with neonatal hypotrophy and unfavorable perinatal outcome were: impaired blood flow in the uterine arteries and/or umbilical artery, early preeclampsia and scarcity of water. Protective factors were antibacterial therapy for intrauterine infection, administration of low-molecular-weight heparin in the first trimester, and acetylsalicylic acid starting from the 12th to 16th weeks of gestation. Conclusion. The most promising measures in the prevention of FGR and adverse perinatal outcomes in this pathology may be timely prescription of antithrombotic correction and treatment of genital infections.

Исходы беременности при преждевременном излитии околоплодных вод в зависимости от длительности ее пролонгирования

Aim. Evaluation of pregnancy outcomes depending on the duration of its prolongation in preterm rupture of amniotic membranes at 22 to 34 weeks gestation period. Material and Methods. Outcomes of pregnancy were studied in 196 patients of the contingent of O. Gudushauri National Medical Center with prenatal rupture of amniotic membranes at gestational age of 22 to 34 weeks, who underwent treatment aimed at prolongation of pregnancy in 2016-2018. All the patients were divided into 2 groups. Group 1 included pregnant women in whom it was possible to prolong the pregnancy for 14 days or more; group 2 included women in whom pregnancy could not be prolonged or duration of prolongation was less than 14 days. The patients who were clinically stable, after examination and observation for 48 hours, were discharged from hospital and, subsequently, were observed and treated on an outpatient basis. In order to identify contraindications for prolongation of pregnancy on the part of the mother, a routine clinical and laboratory examination was carried out: complete blood count, biochemical blood test, coagulogram, general urine analysis, bacterioscopy of a vaginal smear, bacteriological examination of the vaginal secretion. Diagnostics of the fetal condition included ultrasound fetometry with daily assessment of the amniotic fluid index using Voluson e8 Expert ultrasound device, daily cardiotocography (CTG) using Sonicaid Team Cape device, as well as Doppler study of blood flow in the umbilical cord artery, fetal aorta, and uterine arteries. Results. In premature rupture of amniotic membranes, a significantly higher incidence of premature birth was revealed in pregnant women of group 2 with prolongation of pregnancy for less than 14 days: 76 (100%), compared with group 1 with prolongation for 14 days or more: 40 (33.33%) (p&lt;0.0001). The average gestational age at which childbirth took place was significantly greater in group 1 than in group 2: 35.92±3.65 weeks and 29.97±3.02 weeks, respectively (t=-12.38, p&lt;0.0001). The same can be said about the average weight of the fetus at birth: 2660.33±876.55 g in group 1 and 1488.68±61.94 g in group 2 (t=-10.17, p&lt;0.0001). In the group without prolongation, compared with patients in group 1, there was an increase in the comparative risk of such complications of the newborn as patent ductus arteriosus, RR=2.50 (95% CI: 1.84 to 3.39); chronic hypoxia, RR=5.00 (95% CI: 3.23to 7.72); retinopathy, RR=2.939 (95% CI: 2.108 to 4.097); hemolytic disease, RR=5.16 (95% CI: 2.80 to 9.50); infections, RR=6.54 (95% CI: 4.04 to 10.61); respiratory distress syndrome, RR = 2.88 (95% CI: 2.29 to 3.61); intraventricular hemorrhage, RR=7.14 (95% CI: 2.40 to 21.21). Due to the presence of complications, newborns from women of group 2 required antibiotic therapy, RR=3.14 (95% CI: 2.46 to 4.00); installation of surfactant, RR=4.76 (95% CI: 1.49 to 15.19). Conclusion. Prolongation of pregnancy for more than 14 days in case of preterm rupture of amniotic membranes in the period of 22-34 weeks, reduces the risk of unfavorable perinatal outcomes.

FEATURES OF ULTRASOUND IMAGING IN FETAL INTRAUTERINE GROWTH RETARDATION

Fetal growth retardation complicates an average of 10% of all pregnancies. Today, ultrasound examination is used in obstetrics for diagnosis. Therefore, early detection of this complication is the key to adequate treatment and reduction of perinatal consequences. A deeper understanding of the early accompanying ultrasound parameters will allow timely detection or prevention of intrauterine fetal development. The aim of the research was to conduct an ultrasound antenatal examination of women with intrauterine growth retardation. Ultrasound fetometry and placentometry were conducted in women with intrauterine growth retardation (the main group, n-41) and women in the comparison group with the physiological course of pregnancy (n-12). At the initial ultrasound examination, among women in the main group, fetuses below the 10th percentile were probably more common and had a decrease in biparietal head size and abdominal circumference (p = 0.001, p = 0.08). With repeated ultrasound examination, the frequency of detecting decreased indicators of biparietal head size, head circumference, abdominal circumference, femoral shaft length below the 10th percentile among women in the main group increases by 1.5 times, and significantly differs from the indicators of the comparison group. (p = 0.0002, p = 0.001). A decrease in the biophysical profile of the fetus to 6-7 points accompanies 63.4% of pregnancies with intrauterine growth retardation. The amniotic fluid index below the 5th percentile in relation to the gestational age in women at the initial examination was 2.4%, and at the second examination - 7.3%. The placental ultrasound marker of premature maturation by gestational age 21.4%, the presence of petrification in 58.5%. In case of timely detection of the fetometric and placentometric changes, it is possible, from the standpoint of modern obstetrics, to start etiopathogenetic therapy and prevention of this complication of pregnancy.

Изменения в системе гемостаза у беременных с задержкой роста плода

Введение: Задержка роста плода (ЗРП) занимает второе место в структуре причин перинатальной смертности, а ее наличие имеет длительное неблагоприятное влияние на здоровье ребенка. Оценка степени активации системы гемостаза при ЗРП в сопоставлении с клиническими исходами имеет важное значение в понимании патогенеза, улучшении прогнозирования и профилактики этого патологического состояния. Цель исследования: оценить состояние гемостаза у беременных с ЗРП в сравнении с женщинами с физиологическим течением беременности. Материалы и методы: Тип исследования: поперечный срез на базе когортного. В исследование включено 52 беременных. Основная группа — 32 пациентки с ЗРП, выявленной при ультразвуковой фетометрии; контрольная группа — 20 практически здоровых женщин без отягощенного акушерско-гинекологического анамнеза, с физиологически протекавшей беременностью, завершившейся неосложненными родами. Оценку состояния системы гемостаза проводили на сроке 24-32 нед гестации. Результаты: Среди факторов тромботического риска у беременных с ЗРП чаще выявлялось табакокурение во время беременности. Наличие ЗРП было значимо связано с маловодием, генитальной и внутриматочной инфекцией, преэклампсией, нарушениями маточно-плацентарно-плодового кровотока. У женщин с ЗРП обнаружен более высокий уровень фибриногена, а также повышение скорости роста сгустка, больший размер сгустка, более частое формирование спонтанных сгустков в сравнении с контрольной группой. Заключение: У беременных с ЗРП имеется протромботическая готовность плазмы, что может служить основанием для дальнейшей разработки антитромботической коррекции с целью улучшения перинатальных исходов. Background: Fetal growth retardation (FGR) is the second leading cause of perinatal mortality, has a long-term adverse effect on child health. Assessment of hemostasis activation in FGR in comparison with clinical outcomes is important for understanding pathogenesis, improving the prognosis and prevention of this pathological state. Objectives: to assess hemostasis state in pregnant women with FGR compared to women with physiological pregnancy. Patients/Methods: Type of study: crosssectional based on cohort. The study included 52 pregnant women. The main group consisted of 32 patients with FGR diagnosed by ultrasound fetometry; the control group consisted of 20 practically healthy women without burdened obstetric-gynecological history, with physiological pregnancy that ended in uncomplicated childbirth. Hemostasis assessment was carried out at 24-32 weeks of gestation. Results: Smoking during pregnancy as a factor of thrombotic risk was more common in pregnant women with FGR. FGR was significantly associated with oligohydramnios, genital and intrauterine infection, preeclampsia, and placental insufficiency. Women with FGR showed a higher level of fibrinogen, as well as an increased rate of clot growth, clot larger size, and more frequent formation of spontaneous clots in comparison with the control group. Conclusions: Pregnant women with FGR are characterized by prothrombotic state that may be the basis for further development of antithrombotic correction for improving perinatal outcomes.

Melatonin Levels Decrease in the Umbilical Cord in Case of Intrauterine Growth Restriction.

Intrauterine growth restriction (IUGR) is a common reason for perinatal morbidity and mortality. Also, it is often complicated with fetal distress. Melatonin is widely known as an anti-oxidant agent, and it might decrease the damage of tissues caused by hypoxia. It is also known that levels of pro- and anti-inflammatory cytokines are changed during pregnancy. Placental growth factor (PlGF) is responsible for the angiogenesis in the placenta. We aimed to investigate whether the level of melatonin, cytokines, and PlGF in umbilical blood after birth is different in the case of IUGR compared to normal fetuses. Fourteen women whose pregnancies were complicated with IUGR were included in the study group. The presence of IUGR was confirmed by ultrasound fetometry in the third pregnancy trimester, 30-36 weeks of gestation. All patients delivered their children vaginally after 37 weeks of pregnancy. The cases of severe fetal distress that required a caesarian section, obstetrical forceps, or vacuum extraction of the fetus were excluded from the study. We found that the concentrations of cytokines did not differ significantly between the groups. Also, no significant difference in the daytime of delivery was found between the groups. The concentrations of melatonin and PlGF in the umbilical blood at labor were significantly lowered in the case of IUGR compared to normal pregnancies. This fact, as we consider, is caused by altered production of melatonin and PlGF by the placenta. Therefore, the protective action of these two factors for the fetus at labor is decreased in IUGR.

Ultrasonic predictors of macrosomia in gestational diabetes mellitus

BACKGROUND: The basis of early ultrasound (US) diagnosis of diabetic fetopathy (DF) in pregnant with gestational diabetes mellitus (GDM) is the forehanded detection of macrosomia, especially its asymmetric forms. In pregnant with GDM on a diet therapy, the detection of macrosomia may be an indication for starting the insulin therapy. In pregnant with hyperglycemia due to mutation in the glucokinase gene (GCK), US fetal growth dynamics helps to assume the fetal genotype, as well as to stratify the risks of insulin therapy.&#x0D; AIM: To determine the prognostic significance of asymmetric form of macrosomia and the value of the coefficients of proportionality for the diagnosis of DF in pregnant with GDM, including hyperglycemia due to mutation in the GCK gene.&#x0D; MATERIALS AND METHODS: US fetometry was performed in 95 pregnant with GDM (including 22 pregnant with hyperglycemia caused by mutation in the GCK gene) (main group) and 427 healthy pregnant women (control group). Estimated fetal weight, standard fetometric indicators and coefficients of proportionality were evaluated. Retrospective analysis of US predictors of macrosomia was carried out after evaluating the weight of the newborn and clarifying the signs of DF.&#x0D; RESULTS: In the group with GDM, 51 (53.7%) pregnant had children with phenotypic symptoms of DF, including macrosomia 66,7% (34 children). We found statistically significant differences in fetal weight between the control group and the main group who gave birth to children with DF starting from 32 weeks. The coefficients of proportionality (femur length/abdominal circumference and the head circumference/abdominal circumference), characterizing the formation of the asymmetric macrosomia were significantly from 34 weeks (Р0,05).&#x0D; CONCLUSION: The most effective predictive fetometric indicators for the diagnosis of fetal macrosomia are the dimensions of fetal abdomen and fetal weight 90 percentile for gestational age. A specific sign of DF in pregnant with GDM is the asymmetric macrosomia. In pregnant with a mutation in the GCK gene, the tendency to macrosomia was revealed only in the absence of a mutation in the fetus, but insulin therapy in the presence of a similar mutation in fetus did not lead to a significant decrease in its percentile ranges.

PECULIARITIES OF LIPID EXCHANGE IN PREGNANT WOMEN WITH OBESITY

The high frequency of obstetric pathology is explained by the violation of adaptive and compensatory-protective mechanisms, the breakdown of the activity of regulatory systems that occur during obesity. Determining the levels and dynamics of changes in lipid metabolism during the gestation period in pregnant women with obesity is of particular interest. The purpose of this study was to evaluate the dynamics of lipid metabolism changes in pregnant women with obesity. The work is based on clinical-anthropometric and clinical-laboratory results of studies of 52 pregnant women with abdominal obesity (the main group). The term of pregnancy was determined by anamnestic data (date of last menstruation, first appearance in a women's consultation) and the results of ultrasound fetometry. The criteria for inclusion of patients in the main group were a BMI value above 25 kg/m2. Waist circumference (FROM) and hip circumference (ABOUT) were also measured. The ratio FROM/TO was calculated. Obesity was regarded as abdominal with a waist circumference of more than 80 cm and an OT/OB ratio of ≥0.85.The control group consisted of 80 healthy pregnant women with a BMI before pregnancy of 18.5-25 kg/m2. The values of the studied indicators obtained in this group were used as a starting point of comparison as physiologically normal values. The state of fat metabolism was assessed according to lipidogram data. The study was conducted three times during pregnancy - at 8-12, 18-20 and 34-36 weeks of gestation. Blood samples were taken from the ulnar vein in the morning on an empty stomach 12-14 hours after eating. High- and low-density lipoproteins were determined by the homogeneous method, total cholesterol and triglycerides were determined by the enzymatic colorimetric method. It was found that the increasing imbalance of lipidogram parameters was accompanied by an increase in BMI: OH (r=0.251; p=0.001), TG (r=0.401; p=0.002), VLDL (r=0.365; p=0.033), HDL (r=-0.318; p=0.002). The development of pregnancy was accompanied by an increase in fat metabolism in the main group at 18-20 and 34-36 weeks of gestation, respectively: OH - by 16.5% and 22.1%, LDL - by 6.3% and 13.0%, TG - by 13.6% and 28.4%, VLDL - by 14.3% and 28.5%. We have revealed the inverse dependence of HDL levels on the duration of pregnancy. So, if the HDL level at the gestation periods of 8-12 and 18-20 weeks did not have a significant difference (p>0.05) with the level of the control group, then by the end of gestation its significant decrease was observed. A decrease in HDL values - by 3.3% and 17.6% during gestation led to a pronounced increase in the atherogenicity coefficient by 32.1% and 76.4% during pregnancy at 18-20 weeks and 34-36 weeks, respectively. This coefficient indicates the distribution of OH between HDL and atherogenic lipoprotein fractions. Anti-atherogenic ratio of HDL/LDL decreased slightly in the dynamics of pregnancy in obese women - by 7.5% and 27.2%, respectively. Thus, the results of the study indicate a significant increase in the group of obese pregnant women in the content of total cholesterol, triglycerides, VLDL with their maximum level by the end of gestation in comparison with patients with normal body weight. Despite the fact that the metabolic changes occurring in the body of a pregnant woman are adaptive, they can play a role in the pathophysiological process of the development of pregnancy complications and labor disorders. With the progression of pregnancy, abdominal obesity in women is a risk factor for the development of pathological dyslipidemia.

Порівняльний аналіз перебігу вагітності, пологів і стану новонароджених при двійнях з монохоріальним типом плацентації

The objective: to analyze the peculiarities of pregnancy, labour and condition of newborn twins with monochorionic type of placentation. Materials and methods. A comparative analysis of pregnancy, labour and perinatal consequences in 110 cases in monochorionic twins pregnancies (MT) was conducted. The I group consisted of 92 patients who did have obstetric complications specific for multiple pregnancy during pregnancy; in group II 18 pregnant women with specific complications during multiple pregnancy were included. Additionaly, ultrasound fetometry, placentalography, doplerometry, cardiotocography were used. Results. Pregnancy with monochorionic twins is a risk factor for the development of pregnancy complications, and specific complications due to this type of placentation are extremely unfavorable in relation to perinatal outcomes. Even with pathogenetic treatment, there is a high risk of pregnancy loss, premature birth, and the development of pathology in newborns. Analysis of perinatal outcomes showed that in the absence of specific complications of MC type of placentation in 49.0% cases normotrophic children were born, according exceeds the percentage of patients whose children were born with hypotrophy varying severity - 51.0% respectively. In both subgroups pregnancies were characterized by high risk of abortion (61.4% and 67.1% respectively), preeclampsia various severity in 33.3% and 44.6%, gestational anemia in 43.4%, and 39.8%, premature birth, which occurred in 66.7% and 46.8% respectively. This explains the high incidence of operative delivery 44.4% and 52.1% respectively, while the incidence of planned abdominal delivery in subgroup 1b was 3.3 times higher than in subgroup 1a. Perinatal loss in patients with MC twins in subgroups were 4.4% and 5.3% respectively. Conclusion. Pregnancy and delivery of monochorionic twins with specific complications has a higher risk for fetus and newborn, which lead to higher rates of perinatal mortality and morbidity in this group of infants. So searching for effective methods of prevention and treatment of these complications is required. The results should be considered during making algorithm of diagnostic and preventive measures in multiple pregnancies. Key words: monochorionic twins, labour, perinatal consequences.

Определение степени перинатального риска по результатам антенатальных эхографических мониторингов

The purpose of the study was the development of perinatal risk graduations according to antenatal ultrasonographic monitoring results to optimize antenatal surveillance protocols and validation of perinatal prognosis. Patients and methods. Аntenatal ultrasound examinations were performred in 1448 fetuses with a high perinatal risk. The studies included ultrasound fetometry and estimated fetal weight calculation with the definition of gestational weight percentile as well as visual assessment of fetal ultrasound anatomy and Doppler assessment of placental and fetal cardiovascular profile. Pregnancy outcomes and neonatal status were studied. Postnatal results were classified as adverse general postnatal outcome which meant perinatal or infant death and adverse clinical postnatal outcome which meant perinatal acidemia, Apgar score of 0–4 points, persistent pathological condition of the newborn. All the fetuses of the studied cohort were divided into two clinical groups: 638 fetuses with poor general postnatal outcome and/or clinical postnatal outcome (I group) and 810 fetuses with favorable clinical postnatal outcome catamnesis (II group). Results. Significant differences between groups were at fetometry with calculated fetal weight below the 10th percentile after 34 GW and before 28 GW (p<0.01). The most significant differences occurred at comparing the frequency of registration ductus venosus a-reverse wave, p<0.01. When oligohydramnios, maternal arterial hypertension and umbilical artery absent/reverse diastolic flow were registered adverse general postnatal outcome and/or clinical postnatal outcome prevailed (p<0.05). The increased cardio-thoracic ratio occurred in fetuses of group 19 times more frequent than in group II. The cerebro-placental ratio reduction occurred 18 times, the prevalence of reverse flow component of the fetal aortic isthmus 6.2 times and the deepening of ductus venosus myocardial isovolumetric relaxation phase in the group I were registered 21 times more often than in group II (the differences did not have statistical significance due to the small number of observations). Fetal hydrops of any genesis, as well as variable umbilical artery Doppler on the background of maternal arterial hypertension, are factors of uncertain perinatal risk, with the possibility of both normal and adverse perinatal outcome. Antenatal surveillance of these fetuses requires multivascular Doppler monitoring. Ultrasound predictors that had the strongest correlations with adverse general postnatal outcome and/or clinical postnatal outcome have been established. Conclusions. The high risk pregnancy antenatal care protocols need to include an assessment of the cardiovascular profile with monitoring of ductus venosus hemodynamic and fetal cardio-thoracic ratio evaluation as predictors of extremely high risk of adverse perinatal outcome. Results of the study can be used for prenatal counseling and perinatal prediction and for the future development of echographic perinatal risk gradations scale: extremely high or high risk (which require monitoring in perinatal center), or uncertain risk (which requires postnatal follow-up). The development of advanced tools for calculating the degree of perinatal risk as echographic scale and online calculators can improve understanding of different professionals working in the general perinatal space: obstetricians, radiologists and neonatologists. Key words: high'risk pregnancy, ultrasound, perinatal result, perinatal risk scale.

Ian M.Symonds, SabaratnamArulkumaran, E.Malcolm Symonds, editors. Essential Obstetrics &amp; Gynaecology, 5th edn. Churchill Livingstone/Elsevier, http://www.elsevier.com/books. Print Book ISBN 9780702030680, eBook ISBN 9780702054754. Price: € 41.99

Every chapter starts with a colored box displaying the intended learning objectives. The text is accompanied by plenty of very good illustrations but also boxes for extra guidance and/or advice. Also, the reader is provided with a key message at the end of every chapter to draw attention to the most important points. The balance in depth between the chapters is somewhat inconsistent. The book applies mainly to students in the UK and we have noticed some routines and practices that differ between countries. A few examples to be mentioned are: vasa previa diagnosis is described only by using color Doppler ultrasound during fetometry. There is no mention of the vasa previa test when diagnosing fetal blood when assessing vaginal hemorrhage during delivery. The two-fold risk of postpartum hemorrhage with SSRI drug use is not mentioned. Other routines that differ between countries are fetal growth assessment by ultrasound fetometry with customized growth charts and biophysical profile, both of which are used in the UK. Admission CTG is not recommended for low-risk women, which is a matter of debate in the Nordic countries. Obstetrics and gynecology is a large and difficult area, and hard to cover in one book. Still, we feel that the forthcoming editions of the book would benefit by including chapters regarding immunization in pregnancy, violence against women and female genital mutilation. In addition, the text regarding the intrauterine contraceptive device, termination of pregnancy and preterm labor need to be updated. To conclude, this book is a good first guide to the magic world of obstetrics and gynecology. The text is easily read and the facts and information are easy to understand. We would recommend it to students and young colleagues as an introductory textbook. It may also be useful to more experienced colleagues that want to refresh their foundation of knowledge.

Intraplacental blood flow in third trimester of placental insufficiency pregnancy

Background. Serious perinatal, most of all, neurological consequences of placental insufficiency condition necessity further search it’s markers for optimal delivery time. Methods. At third term of pregnancy we examined 16 singleton physiological pregnant women (first group) and 27 placental insufficiency patients (second group). We standard obstetrical examined, ultrasound fetometry, basic arteries of functional system mother-placenta-fetus Doppler and three-dimensional power Doppler in central, two paracentral and two periphery placenta areas. We processing images by VOCAL and analyzed vascularisation (VI), flow (FI) and vascularisation-flow indexes (VFI). Results. In placentae correlated groups FI differ in size reliable in central (t=4,03; p&lt;0,001 и U=240,00; p&lt;0,001) and paracentral (t=2,61; p&lt;0,05 и U=348,00; p&lt;0,05) areas. Patients second group indexes were relative on 17% and 8% less than patients first group indexes. Patients second group VFI was on 35% less than patients first group VFI (t=2,08; p&lt;0,05 и U=337,00; p&lt;0,05). We described results of comparison three-dimensional power Doppler intraplacental blood flow indexes from patients second group with different degree hemodynamic disorder. Conclusion. In placental insufficiency presence reduction blood circulation, particular in central placenta area, conditioned by reduction blood flow in initial vessels number. Central placenta area FI may be regarded new additional criterion of placental insufficiency at third term of pregnancy.

Relations between fetal brain‐sparing circulation, oxytocin challenge test, mode of delivery and fetal outcome in growth‐restricted term fetuses

The study was designed as a prospective non-interventional, observational study to elucidate the potential value of fetal middle cerebral artery Doppler velocimetry to identify brain-sparing flow in a surveillance program for suspected intrauterine growth restriction (IUGR). The study was carried out at Skåne University Hospital, Malmö, Sweden. One hundred and twenty-six single pregnancies suspected of IUGR at ≥36 gestational weeks were assessed. The main outcome measures were positive/negative oxytocin challenge test (OCT) and cesarean/vaginal delivery. The pregnancies were managed with ultrasound fetometry, uterine and umbilical artery Doppler flow velocimetry, nonstress test, and an OCT to decide the optimal time and mode of delivery. Cases with a positive OCT were promptly delivered by cesarean section, whereas negative cases were allowed a trial of labor. Middle cerebral artery Doppler flow velocimetry results were blinded to the managing obstetricians. Brain-sparing flow was defined as a middle cerebral artery-to-umbilical artery pulsatility index ratio of <1.08. Nonparametric statistics with significance set at p < 0.05 were used, and Cohen's kappa coefficient was calculated for congruence of brain-sparing flow with OCT and mode of delivery, respectively. The positive predictive value and sensitivity figures of brain-sparing flow to indicate a positive OCT and cesarean delivery were 33-63%. The inter-rater reliability of brain-sparing flow vs. positive OCT showed a kappa coefficient of 0.19, and brain-sparing flow vs. cesarean section among OCT-negative cases a kappa coefficient of 0.23. Fetal brain-sparing flow is a poor predictor of a positive OCT, and of cesarean section in OCT-negative cases.

The effect of birthweight upon insulin resistance and associated cardiovascular risk factors in adolescence is not explained by fetal growth velocity in the third trimester as measured by repeated ultrasound fetometry

Smallness for gestational age (SGA) is associated with increased risk of developing components of the metabolic syndrome. Although SGA can imply intrauterine growth restriction (IUGR), more information is required to link specific fetal growth patterns to adult outcomes. We examined the impact of fetal growth velocity during the third trimester (FGV) vs birthweight for gestational age on early markers of the metabolic syndrome in 123 healthy men and women (mean age 17.5 years) born at term. FGV was determined by ultrasound measurements. After correction for confounders including current BMI, SGA was significantly associated with raised basal plasma insulin (+19% above appropriate for gestational age), homeostasis model assessment of insulin resistance (+21%), cholesterol:HDL-cholesterol ratio (+13%) and systolic BP (+4.8%) (all p < 0.05). Furthermore SGA was associated with increased fat mass (+9.6%) and trunk-fat per cent (+6.8%) and with reduced lean body mass as determined by dual-energy X-ray absorptiometry scans (-4.1% below appropriate for gestational age) (all p < 0.05). In contrast, IUGR in the third trimester was associated only with an elevated cholesterol:HDL-cholesterol ratio (+11% above not-IUGR). In the present study, FGV did not explain the impact of birthweight upon the metabolic phenotype in adolescence. This suggests that fetal growth prior to the third trimester or postnatal catch-up growth plays a more important role.

Fetal growth and congenital malformations

To ascertain whether the risk for congenital malformations is increased in pregnancies with deviating fetal growth, i.e. in those in which the estimated date of delivery (EDD) was postponed more than 1 week at the second-trimester ultrasound fetometry scan, or those suspected of intrauterine growth restriction at routine ultrasound fetometry in the third trimester. The study period was 1994-2003. We used the Swedish Medical Birth Register to identify pregnancies with appropriate data (n = 605 845). A regional ultrasound database consisting of 73 092 pregnancies was used for more detailed data and analysis of the third-trimester fetal growth. The number of congenital malformations was ascertained from three national health registers. We found a moderately increased risk for any malformation in the group of fetuses in which the EDD was postponed > 1 week. The strongest effect was seen for chromosome anomalies and central nervous system malformations, including neural tube defects. In the third trimester, an increased risk for fetal malformations was found in asymmetrically vs. symmetrically growth-restricted fetuses, perhaps more strongly when adjustment of the EDD had been done at the dating scan. Fetuses in which the EDD differs between that calculated by the last menstrual period and that calculated by second-trimester ultrasound measurement seem to have an increased risk for congenital malformations, including chromosomal anomalies. A targeted ultrasound examination for malformation screening might be recommended for this group. A similar policy might be recommended when intrauterine growth restriction, especially of the asymmetrical type, is suspected later in pregnancy.

Bishop score and ultrasound assessment of the cervix for prediction of time to onset of labor and time to delivery in prolonged pregnancy

To determine the ability of Bishop score and sonographic cervical length to predict time to spontaneous onset of labor and time to delivery in prolonged pregnancy. Ninety-seven women underwent transvaginal ultrasound examination and palpation of the cervix at 291-296 days' gestation according to ultrasound fetometry at 12-20 weeks' gestation. Sonographic cervical length and Bishop score were recorded. Multivariate logistic regression analysis was used to determine which variables were independent predictors of the onset of labor/delivery < or = 24 h, < or = 48 h, and < or = 96 h. Receiver-operating characteristics (ROC) curves were drawn to assess diagnostic performance. In nulliparous women (n = 45), both Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h and < or = 48 h (area under ROC curve for the onset of labor < or = 24 h 0.79 vs. 0.80, P = 0.94; for delivery < or = 24 h 0.81 vs. 0.85, P = 0.64; for the onset of labor < or = 48 h 0.73 vs. 0.74, P = 0.90; for delivery < or = 48 h 0.77 vs. 0.71, P = 0.50). Only Bishop score discriminated between nulliparous women who went into labor/delivered < or = 96 h or > 96 h. A logistic regression model including Bishop score and cervical length was superior to Bishop score alone in predicting delivery < or = 24 h (area under ROC curve 0.93 vs. 0.81, P = 0.03) and superior to Bishop score alone and cervical length alone in predicting the onset of labor < or = 24 h (area under ROC curve 0.90 vs. 0.79, P = 0.06; and 0.90 vs. 0.80, P = 0.06). In parous women (n = 52), Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h (area under ROC curve for the onset of labor 0.75 vs. 0.69, P = 0.49; for delivery 0.74 vs. 0.70, P = 0.62), but only Bishop score discriminated between women who went into labor/delivered < or = 48 h and > 48 h. Three parous women had not gone into labor and six had not given birth at 96 h. In parous women logistic regression models including both Bishop score and cervical length did not substantially improve prediction of the time to onset of labor/delivery. In prolonged pregnancy Bishop score and sonographic cervical length have a similar ability to predict the time to the onset of labor and delivery. In nulliparous women the use of logistic regression models including Bishop score and cervical length is likely to offer better prediction of the onset of labor/delivery < or = 24 h than the use of the Bishop score alone.

Increased risk of perinatal/neonatal death in infants who were smaller than expected at ultrasound fetometry in early pregnancy.

To investigate if there is an association between perinatal/neonatal death and a discrepancy between gestational age by ultrasound fetometry in early pregnancy (GA(U)) and gestational age by last menstrual period (GA(LMP)), and to investigate possible causes for such an association. The Swedish Medical Birth Registry was used to identify singleton pregnancies with information available on GA(LMP) and GA(U) that were delivered in Sweden between 1990 and 2000. A total of 718 011 pregnancies was included and information on the pregnancy and delivery was obtained from the National Board of Health. Infants with a GA(U) at least 7 days less than the GA(LMP) were at increased risk for stillbirth (odds ratio (OR), 1.45; 95% CI, 1.32-1.58), neonatal death within 1 month (OR, 1.87; 95% CI, 1.67-2.09), Apgar score < 7 at 5 min (OR, 1.18; 95% CI, 1.11-1.24), birth weight < 2500 g (OR, 1.48; 95% CI, 1.43-1.52), and preterm birth < 37 weeks (OR, 1.45; 95% CI, 1.42-1.49). The association between a postponed expected date of delivery and perinatal/neonatal death increased with gestational length and was especially pronounced among infants who were born after at least 40 completed weeks of pregnancy (GA(U)). A discrepancy between GA(U) and GA(LMP) may indicate early disturbances in fetal/placental development. Furthermore, it can be speculated that, as the risk significantly increased with gestational duration, at least a part of the increased risk for poor pregnancy outcome in adjusted pregnancies was due to consequences of true post-term pregnancies not being recognized as such.