Method for predicting fetoplacental insufficiency in pregnant women with thyroid diseases

FIELD: medicine, obstetrics.

SUBSTANCE: except detecting placental lactogen in blood serum one should study the content of alphafetoprotein. At placental lactogen content being below 75% against the norm and content of alphafetoprotein below 70% against the norm it is possible to conclude upon availability of fetoplacental insufficiency.

EFFECT: higher accuracy of detection.

3 ex, 4 tbl

 

The present invention relates to medicine, in particular to obstetrics.

There is a method of assessing the status of the fetus and detection of placental insufficiency on ultrasonic measurement of individual linear parameters of the fruit, the quantity of amniotic fluid, the thickness and structure of the placenta; when comparing with reference values that are characteristic of certain stages of pregnancy in healthy pregnant women were given a conclusion on the presence of placental insufficiency. Demidov, V.N. and other "Using computerized ultrasonic fetometry in the diagnosis of fetal malnutrition". "Ultrasound diagnosis in obstetrics, gynecology and Pediatrics", 1995, No. 2, pp.31-39.

The disadvantage of this method is the relatively low accuracy associated with quantifying only the anatomical and morphological characteristics of the fetus and placenta, which do not allow to estimate the parameters of the functions of fetoplacental complex.

The objective of the invention is to improve the accuracy of the method of determination of placental insufficiency in pregnant women with thyroid disease.

This object is achieved by the method lies in the fact that determine the level of placental lactogenic and alphafetoprotein in the serum and in the content below 75% of normal for placental lactogenic and 70%of normal for alphafetoprotein make a conclusion about the presence of placental insufficiency.

Evaluate the information content of indicators of placental lactogenic and alfafetoprotein as criteria of placental insufficiency in pregnant women with diseases of the thyroid gland was performed in 30 healthy pregnant women and 30 pregnant women with fetoplacental failure with diseases of a thyroid gland (table 1).

Table 1

Indicators of placental lactogenic and alphafetoprotein in healthy pregnant women and pregnant women with placental insufficiency, with diseases of a thyroid gland
Placental lactogenicAlphafetoprotein
IIIIIIIIII
trimestertrimestertrimestertrimester
Healthy pregnant100

(75-125)
100

(75-125)
100

(70-150)
100

(70-150)
Pregnant women with placental insufficiency,67,8*66,4*58,7*46,5*
having thyroid disease(62,5-73)(55,7-76,1)(52,5-79) (39,8-51,2)
* differences in performance in healthy pregnant women and pregnant women with placental insufficiency having thyroid disease, significant (p<0,001).

Note: indicators of placental lactogenic and alfafetoprotein presented in percent of the average normative values taken as 100%.

As follows from the table, fetoplacental insufficiency in pregnant women with thyroid disease is characterized by a decrease in placental lactogenic and alphafetoprotein.

Example 1.

The patient ALG, 36 years.

Diagnosis: Diffuse toxic goiter 2tbsp. at the stage of subcompensation.

In the 3rd trimester revealed fetoplacental insufficiency, an indicator of placental lactogenic amounted to 31.9%of alphafetoprotein of 34.8% from the norm. Rodorazresheniye at 38 weeks caesarean section in a planned manner. Retrieved live girl weighing 1920, length 44 cm, condition assessment on a scale of Apgar scores were 7 and 8 points: there is a fetal hypotrophy of III degree, the syndrome of delayed fetal growth of III degree.

Table 2

Placental lactogenic in% of normalAlphafetoprotein is in% of normal
Healthy pregnant100(75-125)100 (70-150)
The patient ALG31,934,8

As can be seen from the table, the indicators of placental lactogenic and alfafetoprotein has not reached the reference value (75% and 70%, respectively), indicating the presence of placental insufficiency.

Example 2.

The patient LEE, 28 years.

Diagnosis: Diffuse toxic goiter 2tbsp. in the stage of compensation.

In the 3rd trimester revealed fetoplacental insufficiency, an indicator of placental lactogenic amounted to 42.0%, alphafetoprotein of 33.4% from the norm. Rodorazresheniye at 38 weeks caesarean section on an emergency basis. Retrieved live boy weight 2600 g, length 48 cm, condition estimation on Apgar scale amounted to 4 and 7 points: there is a fetal hypotrophy of the II degree, the syndrome of delayed fetal growth, second degree.

Table 3

Placental lactogenic in% of normalAlphafetoprotein in% of normal
Healthy pregnant100

(75-125)
100 (70-150)
The patient ALG42,0the 33.4

As can be seen from the table, the indicators of placental lactogenic and alfafetoprotein has not reached the reference C is acini (75% and 70%, respectively), evidence of placental insufficiency.

Example 3.

The patient AGE, 25 years old with a diagnosis of diffuse toxic goiter 2 tbsp., moderate in the stage of compensation.

In the 3rd trimester indicators of placental lactogenic and alphafetoprotein was 87.7% 104,1%, respectively.

At 38 weeks was an urgent spontaneous labor living boy weighing 3200 g, length 49 cm, condition assessment on a scale of Apgar scores were 8 and 9 points; mass-growth parameters of the child are normal for 38 weeks of gestation.

Table 4

Placental lactogenic in% of normalAlphafetoprotein in% of normal
Healthy pregnant100

(75-125)
100 (70-150)
The patient AGE87,7104,1

As can be seen from the table, the indicators of placental lactogenic and alfafetoprotein exceeded the lower reference value (75% and 70%, respectively), indicating the absence of placental insufficiency by the time of delivery.

This method examined 30 pregnant women with placental insufficiency having thyroid disease and 30 healthy pregnant women, formed the control group. The result is m assessment of the status of the fetus and newborn accuracy of the proposed method was 89,8%.

The method of determination of placental insufficiency in pregnant women with thyroid disease, including the identification of placental lactogenic in serum, characterized in that it further determine alphafetoprotein and when the content of placental lactogenic below 75% of normal and the content below 70% of normal for alphafetoprotein make a conclusion about the presence of placental insufficiency.



 

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