Method of diagnostics of physiological course of pregnancy and chronic fetoplacental deficiency

FIELD: medicine; obstetrics.

SUBSTANCE: fetal cardiac rhythm is registered. Additionally cardiointervalography is performed with determination of spectral power density of maternal and fetal cardiac rhythm waves and selection of very low frequency VLF, low frequency LF and high frequency HF levels, regulator system tension index TI, cortizol and adrenaline level in maternal and fetal blood. Physiological pregnancy course is defined at adrenaline level of 28 ng/mol, cortizol level of 360 ng/ml, indices of VLF=120 relative units, LF=40 r.u., HF=20 r.u., TI=70 r.u., for the mother and at indices of VLF=25 r.u., LF=2 r.u., HF=1 r.u., TI=250 r.u. for the fetus; compensated form of chronic fetoplacental deficiency is detected at the adrenaline level of 46 ng/ml, cortizol level of 695 ng/ml, VLF=180 r.u., LF=50 r.u., HF=100 r.u., TI=160 r.u. for the mother and at VLF=45 r.u., LF=5 r.u., HF=1 r.u., TI=400 r.u. for the fetus; and decompensated form of chronic fetoplacental deficiency is detected at the adrenaline level of 2 ng/ml, cortizol level of 1003 ng/ml, VLF=900 r.u., LF=25 r.u., HF=10 r.u., TI=30 r.u. for the mother and at VLF=3 r.u., LF=1 r.u., HF=0 r.u., TI=700 r.u. for the fetus.

EFFECT: improved accuracy and information capacity of diagnostics of physiological pregnancy course and chronic fetoplacental deficiency forms.

1 dwg, 9 tbl

 

The invention relates to the field of medicine, obstetrics and Perinatology, and can be used for the diagnosis of physiological pregnancy and chronic placental insufficiency (hfpn).

In chronic placental insufficiency (hfpn) are circulatorio-metabolic disorders in the area of the placental barrier, which are accompanied by a relative (offset) or absolute (decompensated) failure of the regulatory and adaptive mechanisms in the system mother-placenta-fetus [1, 2].

Closest to the present invention is a method for the diagnosis of hfpn by conducting cardiotocographic (CTG) study of the fetus, and evaluation of CTG 8-10 points testified normal (no hfpn), 6-7 points on the offset form hfpn (initial violation intrauterine fetal condition), 4-5 points - subcompensated form hfpn,3 points and below - about decompensated form of NEF (there are serious changes in the life of the fetus [3]. However, this method has the following disadvantages:

1. The method is tedious and relies on a large number of indicators (time, complexity, requires a qualified doctor). Interpretation of results is difficult for doctors who do not have the necessary is specialisatie.

2. There is no possibility the most accurate prediction of perinatal complications and, as a consequence, the solution of the question of the choice - whether further prolongation of pregnancy on a background of treatment or early delivery in the interests of the fetus.

3. When conducting CTG cardiac activity of the fetus are registered structural contractions of cardiomyocytes, which determines the structural activity of the cardiac activity of the fetus, therefore, the known method only indirectly indicates the nature of the pathological processes occurring in the fetoplacental complex and the degree of preservation of compensatory-adaptive mechanisms of this system.

4. There is no information about the level of functional activity in the body of the mother, her adaptation reserves.

5. Indicators KTG a fetus cannot be identified with the presence of varying degrees of intrauterine hypoxia. Data CTG reflect only part of the complex pathological changes occurring in the system "mother-placenta-fetus", resulting in the known method is not sufficiently accurate and informative in terms of identifying the degree of NEF.

A new technical challenge - improving the accuracy and informative way. To solve the problem in the method for the diagnosis of physiological pregnancy and fo what we chronic placental insufficiency (hfpn) by recording the heart rate of the fetus, additionally spend cardiointervalography (CIG) to determine a value of the spectral power density waves of the heart rate (SPM) maternal and fetal emitting very low frequency VLF, LF LF HF HF levels, the index of tension of regulatory systems IN and determine the level of cortisol and adrenaline in the blood of the mother and the level of adrenaline 28 ng/mol, cortisol 360 ng/ml value and VLF=120$, LF=40$, HF=20 $ IN= $ 70, my mother and VLF=25$, LF= $ 2, HF=1 $ IN=250 cu in the fetus, determine the physiological course of pregnancy, when levels of adrenaline 46 ng/ml, cortisol 695 ng/ml, VLF=180$, LF=50$, HF= $ 100 IN=160 USD, the mother, and when VLF=45$, LF=5$, HF=1$, IN=400 $ fetus, determine the offset, and when the level of adrenaline 2 ng/ml, cortisol 1003 ng/ml, VLF=900$, LF=25 cu, HF=10 $ IN= $ 30 the mother and VLF=3$, LF=1$, HF=0 $ IN= $ 700 fetus define decompensated form of chronic placental insufficiency.

The method is as follows. Produce CIG mother and fetus and determine FSH cortisol and adrenaline mother. Define the hormones in maternal serum. The blood produced from the cubital vein at the end of the third trimester of pregnancy.

The blood is centrifuged for 5 minutes at room temperature in a laboratory centrifuge. The resulting serum is poured into the aliquot is, sealed, frozen and stored in a freezer at a temperature of 18-20°before the time of holding a single hormone research. To determine the functional state of the autonomic nervous system and the condition of the adrenal glands was investigated adrenaline and cortisol.

The study of the above hormones produced by the method of enzyme immunoassay with the use of test systems by ELISA (Germany).

Phonographic research carried out by the modified method of kardiointervalografii (CIG), based on analysis of spectral power density (MTA) of wave processes emitting very low (Very Low Frequency - VLF), low frequency (Low Frequency - LF) and high frequency (High Frequency - HF) levels, which have a certain relationship with the mechanism of hormonal and autonomic regulation of heart rate[3, 4, 5, 6, 7, 10, 12]. The mother of a study conducted by the method Bersenev (1989) [8]; Antileishmania (1994) [4, 1]. To record heart rate using the software package "Spectr" (Tsirulnikov NI, 2001) [9], for processing the recording of heart rate of the fetus used the computer program "Fetal" [11], testifying to registration No. 2005613111 from 29.11.2005. These programs allow data entry in real time, to calculate the spectrum of heart rate, to determine the value of the peaks of the frequency ranges to calculate the statistical the settings and to store the information for further processing. In use, the conversion of pulse waves into electrical impulses that are then sent for processing on a personal computer and at the level of adrenaline g/mol, cortisol 360 ng/ml value and VLF=120$, LF=40$, HF=20 $ IN= $ 70, my mother and VLF=25$, LF= $ 2, HF=1$, IN=250 cu in the fetus, determine the physiological course of pregnancy, when levels of adrenaline 46 ng/ml, cortisol 695 ng/ml, VLF=180 c.u., LF=50$, HF= $ 100 IN=160 USD, the mother, and when VLF=45$, LF=5$, HF=1$, IN=400 $ fetus, determine the offset, and when the level of adrenaline 2 ng/ml, cortisol 1003 ng/ml, VLF=900$, LF=25$, HF=10 $ IN= $ 30 the mother and VLF=3$, LF=1$, HF=0$, JN=700 $ fetus define decompensated form of chronic placental insufficiency.

To explain how examples of its implementation and data tables 1-6 (Application).

In table 1

Example 1 (physiological pregnancy):

Patient I., 23 years. Diagnosis: Pregnancy 36 weeks first. From the anamnesis: The mother in the clinical course of the pregnancy was uneventful.

According to the results of the survey:

according to kardiograficheskoe research (CTG) condition corresponds 8/8 points, i.e. a "satisfactory"

- when carrying out kardiointervalografii (TG) of the mother: in the initial state and when conducting stress-loads - VLF=120$, F=40$, HF=20 $ IN= $ 70, which was interpreted as the Central component voltage regulation with activation baroreceptor link, indicating the increased regulatory activity in the area of microcirculation (during pregnancy this area is the uteroplacental and fetoplacental blood flow). The provision of adaptive mechanisms was sufficient (Table 4)

When conducting kardiointervalografii (CIG) in the fetus: in the initial state and during stress load (hyperventilation mother) - VLF=25$, LF= $ 2, HF=1$, INS= $ 250 - fetal condition corresponded to a satisfactory pre-Natal existence, i.e. the mother's body was fully compensated by the fetus for its provision of adaptive mechanisms (Table 4).

Hormonal profile was: mother - adrenaline 28 ng/ml, cortisol 360 ng/ml.

Slice after ligation of the umbilical cord of the fetus (the pulsating blood of the fetus) - adrenaline 27 ng/ml, cortisol - 95 ng/ml (Table 6).

Medical therapy was not required. Delivery occurred at 40 weeks, the fruit weight of 3500 grams, length 52 cm, with rating on a scale of Apgar 7/8 points. According to the TG of the newborn state was assessed as satisfactory with sufficient allowance compensatory mechanisms that have survived from the prenatal period. Clinically, early neonatal period was uneventful.

After genus is evaluated qualitative and quantitative parameters of the placenta. Morphological picture was consistent with involutional processes characteristic of uncomplicated third trimester of pregnancy and childbirth.

Parameters kortiko-catecholamine hormones, in comparison with morphometric indices placenta, indicators of vegetative regulation of heart rate of the mother, fetus and newborn on the results of TG - testified about the physiological course of pregnancy that is confirmed is uncomplicated pregnancy, childbirth, the postpartum period, as well as the birth of a healthy newborn.

Thus, in this case, the method CIG mother and fetus, the indicators of adrenaline and cortisol mother, and later the newborn, in comparison with the state of the placenta confirmed the prognostic significance conducted functional and laboratory studies that have identified the provision of adaptation of the mother and fetus during pregnancy, the possibility of a positive, further, to transfer the generic stress that it is not possible to predict one method machine (CTG). Hormone profile within normal parameters conducted correlation allowed to say about hormonal and regulatory informative method CIG mother and fetus.

Example 2 (offset subcompensated placental h is sufficient, we determined the staging process)

Patient F., 30 years, Pregnancy 36 weeks, the second.

Diagnosis: Chronic fetoplacental insufficiency, offset subcompensated form. Chronic hypoxia. The threat of premature birth. Urgent delivery.

Clinical manifestations of complicated pregnancy was manifested in the presence of a pulling pain in the abdomen, increased motor activity of the fetus.

Data machine (CTG) was 6-7 points, indicating that hypoxia. By ultrasound on photometric indices fruit behind in its development at 1-2 weeks and corresponded 34-35 weeks of gestation. Diagnosed structural changes in the placenta. When diplomaticheskii the study of blood vessels in the uterus and the umbilical cord pathology was revealed.

About this complication was treated with the following drugs: magnesium therapy, sedative (diazepam), antispasmodics (driverin).

A survey was conducted using the proposed method according to the claims.

According to KEITH mother: VLF=180$, LF=50$, HF= $ 100 IN=160 USD, which was interpreted as a deficit condition, the decreased activity of sympathoadrenal system and had an even more pronounced worsening in patients receiving this therapy, so the AK these drugs themselves inhibit the sympathetic regulation and appropriate only in case of high activity of sympathoadrenal system. In this case, the system mother-placenta-fetus supported their livelihood due to the activity baroreceptor (peripheral) component of heart rate regulation. The level of compensatory-adaptive mechanisms was tense that was aggravated during placental insufficiency (Table 4).

According to the TG of the fetus: in the initial state and during stress load (hyperventilation mother) - VLF=45$, LF=5$, HF=1 $ IN= $ 400 - indices testified expressed the voltage of sympathoadrenal and baroreceptors systems of regulation of fetal heart rate of the body, and the voltage of compensatory-adaptive mechanisms (Table 4).

Values hormonal profile mother: adrenaline - 46 ng/ml, cortisol 695 ng/ml (Table 6).

In this case, based on the indicators of TG, was canceled applied therapy. Further correction of regulatory violations were aimed at strengthening the processes of the energy (concentrated solution of glucose, vitamin therapy, metabolic therapy), the restoration of cell membranes (Actovegin).

On the background of individualized therapy according to the TG of the mother and fetus, in combination with indicators kortiko-catecholamine hormones of the mother, the patients were relieved of symptoms of threatened abortion, placental insufficiency, improving the EN flow in uteroplacental and fetoplacental units of blood circulation, chronic hypoxia has been effective.

To evaluate a correction were re-conducted studies TG in the mother and fetus in the treatment process the following data were obtained: mother - VLF=60$, LF=23 cu, HF=9 $ IN= $ 72 USD; the fruit - VLF=24$, LF=6$, HF=2 $ IN= $ 254

Births occurred in the period 39-40 weeks. Born live, full-term son, weighing 3150 g, length 53 cm, with estimation on Apgar scale 8/8 points.

After ligation of the umbilical cord is defined fetal hormones: adrenaline: increase to 62 ng/ml, cortisol - 145 ng/ml (Table 5).

Conducted qualitative and quantitative study of the placenta, correlation analysis of Spearman between indicators kortiko-catecholamine hormones of the mother, fetus with quantitative parameters of the placenta and indicators CIG mother and fetus.

Revealed a strong correlation between the increase of adrenaline mother and increased vascularization of the chorionic villi - 15,06% (R=0,96). Cortisol mother correlated with increased syncytial knots placenta (R=0,96).

Revealed a strong correlation between the increase of adrenaline fetus and increased vascularization of the chorionic villi - 15,06% (R=0.98). The level of fetal cortisol correlated with increased syncytial knots placenta (3,7%), which are an indicator of respiratory function of the placenta and indirect evidence of respiratory function fruit (R=,89). Indicators CIG fruit was correlated with cortisol levels and increased syncytial knots.

Thus, the increase of adrenaline and cortisol mother has prognostic value in determining the outcome of pregnancy for the fetus and placenta status (increase vascularization of the chorionic villi and syncytial knots that talks about increasing the functional and structural load of the placenta), which was korrelirovala performance CIG and condition of the newborn, with the period of disadaptation in the early neonatal period, due to the transferred birth stress, which were stopped up to 7 days).

These results confirm the literature data. If any pathogenic variants hfpn, including injury-subcompensated stage, characterized by high functional connectivity of the entire spectrum of the CIG with a specific area of syncytial knots, which are the morphological equivalent of the intensity of gas exchange and metabolic processes placental barrier in the third trimester of pregnancy [9].

Indicators CIG in the mother and fetus has allowed to determine the status of the regulatory activity in the system mother-placenta-fetus, individual tactics this pregnant women and to assess the prognosis for pregnancy and birth outcomes for mother and fetus, which does not allow to make m the TOD machine (CTG).

Example 3 (decompensated placental insufficiency)

Patient, 28 years old, first pregnancy.

Burdened gynecological history.

Diagnosis: Chronic fetoplacental insufficiency. Chronic water scarcity. Chronic hypoxia. The intrauterine development of the fetus. Premature prompt delivery.

Data machine (CTG) - amounted to 4-5 points, indicating that severe hypoxia moderate severity.

By ultrasound on photometric indices fruit behind in its development at 3 weeks and corresponded to 30 weeks of gestation. Diagnosed marked oligohydramnios, structural changes in the placenta.

When diplomaticheskii the study of blood vessels in the uterus and the umbilical cord revealed a pronounced increase of the resistance index, indicating structural changes in the vessels and their increased resistance to blood flow.

However, the results of these studies did not allow to determine the functional state of the body of the fetus and the level of compensatory-adaptive reserves of the mother and fetus.

A study was conducted according to the proposed method:

Indicators CIG mother was - VLF=900$, LF=25$, HF=10 $ IN= $ 30 is testified regarding satisfy enom state regulatory mechanisms of heart rate and the average level of compensatory-adaptive mechanisms pregnant (Table. 4).

Indicators CIG fruit was (Table 4): - VLF=3$, LF=1$, HF=0 $ IN= $ 700 - States expressed the energy and the extreme voltage of the Central mechanisms of regulation of heart rate, indicating that an unfavorable outcome in anticipation of a possible failure of compensatory mechanisms. In the interests of the fetus was carried out a delivery by cesarean section in the emergency order.

Values hormonal profile mother: adrenaline level 2 ng/ml, cortisol 1003 ng/ml (Table 6).

After ligation of the umbilical cord is defined fetal hormones: adrenaline 10 ng/ml, cortisol - 77 ng/ml (Table 5).

Conducted qualitative and quantitative study of the placenta, correlation analysis of Spearman between indicators kortiko-catecholamine hormones of the mother, fetus with quantitative parameters of the placenta and indicators CIG mother and fetus.

Revealed a strong correlation between the reduction of adrenaline, cortisol mother and anemia placenta (R=0,96), by hardening its villi, lack of syncytial knots (decompensated placental insufficiency) (R=0.84).

Similar correlation was determined by hormones the fetus and the placenta.

The reduction of regulatory and metabolic parameters CIG mother and fetus had a strong correlation with a decrease in hormonal activity: the mother of Raag is believed pathological profile all 3 circuit; in the fetus is increased activity of the autonomic regulation of depletion of adrenaline and energy of all loops with a decrease in cortisol.

Born alive preterm fetus, female, weighing 950 grams, length 46 cm, with a score on the Apgar 5/7 points. In the neonatal intensive care unit was taken on artificial lung ventilation (ALV), which was within 2 days. During nursing, the management of early neonatal period was aimed at the correction of prematurity and immaturity, treatment of pulmonary system of the child, and everything was more or less favorably.

Thus, depletion of the levels of adrenaline and cortisol in the mother, had a correlation with reduced spectral payment power CIG mother and fetus, subsequently confirmed decompensated stage of placental insufficiency. These indicators are reflected in the clinical outcome of pregnancy for the newborn and the depletion of its adrenal - asphyxia due to previous intrauterine hypoxia, the development of the syndrome disadaptation CNS, giovanbattista, and disadaptation cardiovascular : sinus tachycardia, systolic murmur with prevalebit bypass.

Thus, in this example, the method of kardiointervalografii (TG) of the fetus is allowed to determine the level of functional activity of the fetal body, is the lack of reserve its compensatory-adaptive mechanisms, inexpediency of further pregnancy and to decide on early operative delivery in the interests of the fetus. This pregnancy was dissociative between the body of the mother, placental unit and the body of the fetus. Informative in terms of the prediction of outcome of pregnancy in decompensation were the parameters of the hormonal profile of a mother CIG fruit that gave the opportunity to make sure that the only method KTG a fetus is no accurate predictive capability, especially in functional relation to a unified system mother-placenta-fetus.

The adrenal glands of the fetus are directly related to the development of compensatory-adaptive reactions in the placenta that can be used for indirect retrospective assessment of the level of secretion of corticosteroid and catecholamine hormones. In connection with pathological verification decompensated hfpn, combined with clinical signs of intrauterine fetal hypoxia, it is necessary to consider the possibility of adrenal insufficiency of the newborn in terms of prognosis health and adaptation to extrauterine life. The data obtained on the direct functional relationship of cardiac activity of the newborn with the structural features of the placenta in line with modern ideas about cardioblate the tarn circle of blood, each of the components of which are equally involved in compensatory reactions in chronic placental insufficiency [4].

Justification of the method are the data of the research literature, according to which a substantial impact on the state gravidarum homeostasis have the hormones of the adrenal glands of the fetus. During the prenatal period in the adrenal cortex is also active special endocrine structure (inner fetal zone), which is about 80% of the total volume of the adrenal glands and is fully reduced in the neonatal period. The remainder in the outer definitive (adult) area, which formed a permanent adrenal cortex of the adult person. It is established that fetal zone produces androgenic hormone dehydroepiandrosterone sulfate (DHEAS), and in the definitive zone is formed of the glucocorticoid hormone cortisol. DHEAS is the main precursor of estrogens in the placenta since the completion of the process of placentation at 14-15 weeks of pregnancy. In contrast, the content of cortisol in the blood of the fetus, with a variety of regulatory properties, increases in the last weeks of pregnancy, documenting structural and functional maturity definitive adrenal cortex.

Additional hormonal component is ω adrenal glands of the fetus are clusters of chromaffin cells in the Central division, which synthesize noradrenaline and adrenaline. One of the main purposes of the catecholamine hormones during the prenatal period is to ensure full functional activity of the developing heart by emergency increase in blood sugar and direct stimulation of the contractile activity of cardiomyocytes.

Along with hormonal factors regulating cardiac activity of the fetus throughout pregnancy depends on the state of the vascular bed of the placenta. In the long circulatorio-metabolic disorders at the level of terminal villi cardiopulmonary circulation is exposed to certain structural and functional changes with outcome in chronic failure.

The circumstances noted was the basis for mapping morphological features of the placenta with the content of cortisol and adrenaline in the blood of newborns, as well as with indicators fonematicheskogo studies of cardiac activity of the fetus to study the mechanisms of pathogenesis of chronic cardioprotectant failure (hfpn).

The proposed criteria are selected on the basis of analysis of data from clinical and laboratory research.

The total volume of the conducted research was 47 observations donose the Noah pregnancy with natural pregnancy and childbirth. In the first group (the comparison group) was composed of 14 observations of normally developing pregnancy and uncomplicated delivery. In the remaining 33 observations were clinical and morphological signs of chronic placental insufficiency (hfpn) in the stage of compensation (group 2 - 15 observations), subcompensation (group 3 - 11 observations) and decompensation (4 - 7 observations).

All patients during pregnancy, a survey was conducted: the TG of the fetus and the mother, the determination of FSH - cortisol and adrenaline in the mother and also at the time of birth was determined by the same during the umbilical cord of the fetus was performed, also histological examination of the placenta.

The basis for classifying the severity hfpn was put to the ratio of the square of the terminal villi with their size, degree of vascularization and blood [9, 8]. Compensated stage CRF was characterized by hyperplasia, hypertrophy, hypervascularization and hyperemia TWh. As violations of compensatory reactions of the placenta decreased volume of terminal villi (subcompensated stage) in combination with manifestations of apoptosis chorionic epithelium and perepolnennymi sediments fibrinoid (decompensated stage).

Clinically, signs hfpn included various manifestations of gestosis, the severity of which, as a rule, sequencing is up with signs of fetal hypoxia and corresponded to the stages of compensatory reactions of the placenta.

The paper uses a comprehensive diagnostic program that included hormonal, Phonographic, morphometric techniques and thus are allowed to carry out a systematic analysis of hemodynamic activity of the fetal heart, hormonal regulators and structural-functional state of the terminal vascular bed of the placenta.

In accordance with literature data, the development of autonomic and adrenocortical system morphologically and functionally occurs during fetal development, it can be assumed that the markers of their functional state can be the hormones adrenaline and cortisol.

Taking into account the possible dependence of hormone levels in newborns from the endocrine system of the parent body and the placenta, there are methodological difficulties to overcome which can only conducting parallel studies similar hormonal systems of the mother and newborn, determining the correlation between them, and between the hormones of the newborn and placenta.

The object of the research on hormones was the maternal serum and umbilical cord blood. The blood of the mother were taken from the cubital vein at the end of the third trimester of pregnancy, the blood of the newborn after crossing the umbilical cord.

Blood was centrifugals for 5 minutes at room temperature in La is oratorial the centrifuge. The obtained serum was decanted into aliquots, tightly closed, frozen and stored in a freezer at a temperature of 18-20°before the time of holding a single hormone research.

To determine the functional state of the autonomic nervous system and the condition of the adrenal glands was investigated adrenaline and cortisol.

Just taken the 47 samples in newborns and 47 samples of mothers. The total number of hormonal research 188.

The study of the above hormones carried out by the method of enzyme immunoassay with the use of test systems by ELISA (Germany).

Phonographic studies were submitted by the modified method of kardiointervalografii (CIG), based on analysis of spectral power density (MTA) of wave processes emitting very low (Very Low Frequency - VLF), low frequency (Low Frequency - LF) and high frequency (High Frequency - HF) levels, which have a certain relationship with the mechanism of hormonal and autonomic regulation of heart rate and calculate the index of tension of regulatory systems in arbitrary units according to the formula:

JN=AM/"LW×M

where M is the fashion, the duration of most common values cardiointervals, sec,

AM - mode amplitude, frequency tracemode interval equal to the value of M (in per cent)

DV - range in zmeinyh deviations from a random process in seconds [3, 4, 5, 6, 7, 10, 12]. The mother of a study conducted by the method Bersenev (1989) [8]; Antileishmania (1994) [4, 1]. To record heart rate using the software package "Spectr" (Tsirulnikov NI, 2001) [9]. For processing the recording of heart rate of the fetus used the computer program "Fetal" [11].

Morphometric studies of the placenta was performed on paraffin sections with a thickness of 4-5 μm, stained with hematoxylin and eosin, using the computer program "Videotest". Each observation was determined by the specific area of terminal villi and functioning (filled with erythrocytes) capillaries in parabasal departments of the Central cotyledons placenta. Additionally, we determined the specic area of syncytial knots, reflecting the intensity of formation of sinteticpersona membranes (SCM) [4].

The results sistimaticheski, immunoassay and kardiologicheskij research at various stages hfpn compared with each other by calculating the correlation coefficient (R) using the software package Statistica for Windows 6.0".

Used sistematicheskie indicators allowed us to obtain objective information on morphogenetic processes in the terminal sections Villanova tree and the degree of their functional load in various stages hfpn. In table 7 shows Morphosis ogramme placenta in the observations of ESRD (P± R%), where WPVH - specific area of the terminal villi, PCWH is an indicator of blood villi, the COC - specific area of syncytial knots, (K) is compensated, (C/K) - subcompensated, (l/K) - decompensated chronic kidney disease.

The data obtained indicate that compensatory changes in the placenta are carried out mainly by increasing the capacity of the terminal vascular bed and hyperplasia TWh in combination with the formation of additional sinteticpersona membranes, as evidenced by the increase in the share of syncytial knots. Exhaustion of compensatory allowance documented aggregation and progressive anemia terminal villi with a natural decrease in the number of syncytial knots, which together may be the morphological equivalent of irreversible inhibition circulatorio metabolic processes in peripheral areas cardioprotectornoe circulation with decompensated stage hfpn.

Statistical comparisons of histogramme placenta to the level of the studied hormones in the blood of the fetus were carried out with the unit of observation hfpn to fully or partially offset [CN (K-C/K)] and asthma [CN(K-s/K-d/K)] subgroups (table 8), which presents correlation (R) histogram the s placenta with the content of adrenaline and cortisol in the blood of newborns.

Thus there is a high positive correlation between level of adrenaline with blood villi (PCWH) in compensated (R=0,97), and asthma (R=0.98) variants of CRF. Also noted a statistically significant negative correlation (R= - 0.67) concentration of adrenaline with a specific area of syncytial knots (OOPS).

Correlation of cortisol with histogramme placenta had different structural and functional orientation, as was characterized by high values of correlation coefficient with a specific area of syncytial knots in all forms hfpn (R=0.82 and 0,89) and chorionic villi while maintaining compensatory allowance placenta (R=0,87) (Table 8).

The results of correlation analysis reflect some differences in the regulatory influence of adrenaline and cortisol fruit on the condition of the placenta. Adrenaline is basically doing the "hormone of acute stress", and therefore is sensitive to the degree of blood supply to the terminal capillaries of the villous tree. In contrast, cortisol, which is the "hormone of chronic stress, mainly contributes to the provision of morphogenetic processes in the form of hyperplastic changes TWh and additional sinteticpersona membranes. Differences in the mechanism on istia hormones are confirmed by a logical shift of the graphical orientation of their concentration, the peak of the adrenaline has on the stage of compensation, and cortisol on the stage of subcompensation with subsequent critical reduction in hormone levels in the stage of decompensation hfpn (see drawing, which shows the content of adrenaline (Number 1) and cortisol (Number 2) in chronic placental insufficiency).

Thus, the adrenal glands of the fetus are directly related to the development of compensatory-adaptive reactions in the placenta that can be used for indirect retrospective assessment of the level of secretion of corticosteroid and catecholamine hormones. In this regard, when pathomorphological verification decompensated hfpn, combined with clinical signs of intrauterine fetal hypoxia, it is necessary to consider the possibility of adrenal insufficiency newborn.

Marked structural and functional changes of the placenta in the observations hfpn are relevant not only to the hormonal profile, they largely correlate with the hemodynamic features of the fetus, in particular with the figures of the CIG. If any pathogenic variants hfpn, including decompensated stage, characterized by high functional connectivity of the entire spectrum of the CIG with a specific area of syncytial knots, which are the morphological equivalent of the intensity of gas exchange the metabolic processes of the placental barrier in the third trimester of pregnancy [9]. Other components of histogram placenta (OPVH, PCWH) also correlated with some indicators TG, but only within compensated and subcompensated stages hfpn (table), which shows the correlation (R) histogram placenta performance CIG.

The data obtained on the direct functional relationship of cardiac activity of the newborn with the structural features of the placenta in line with modern notions of cardio-placental circulation, each component of which is equally involved in compensatory reactions in chronic placental insufficiency [4].

Conclusions

1. Morphological equivalents compensated stage hfpn are hyperplastic changes TWh, combined with the flushing of the capillary bed and the increase in the area of syncytial knots in connection with the formation of additional sinteticpersona membranes.

2. Reduction of compensatory reactions of the placenta documented progressive anemia microvessels, atrophic changes of chorionic syncytium and aggregation TWh maximally expressed in the decompensated stage hfpn.

3. In the mechanism of compensatory reactions of the placenta participate corticoadrenal adrenal hormones - cortisol and adrenaline, which provide defined the structural changes and blood TWh. In this regard, the pathogenesis of decompensated stage hfpn includes symptoms of chronic adrenal insufficiency newborn.

4. Structural-functional state of the terminal villi at different stages hfpn has a high correlation with the Phonographic rhythms of cardiac activity of the fetus that within cardioprotectornoe circulation plays a leading role in the mechanism of physiological and pathological reactions of the placenta.

Thus the proposed method can accurately diagnose physiological pregnancy and defined in each case the degree hfpn, to determine the nature of the pathological processes occurring in the fetoplacental complex and the degree of preservation of compensatory-adaptive mechanisms of this system, and also allows the most timely manner to resolve the issue of choice - the advisability of further prolongation of pregnancy on a background of treatment or early delivery in the interests of the fetus.

Sources of information

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8. Hlohovec B. I. Pathology of the placenta. / Hlohovec N. - St. Petersburg. 2002. - 447 S.

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11. Testifying to registration No. 2005613111 from 29.11.2005.

12. RF patent №2290861, BI 10.01.2007.

A method for diagnosing a physiological pregnancy and chronic placental insufficiency, by recording the heart rate of the fetus, characterized in that it further conduct cardiointervalography with determining the value of the spectral power density waves of the heart rate of the mother and fetus emitting very low frequency VLF, LF LF HF HF levels, the index of tension of regulatory systems IN, determine the level of cortisol and adrenaline in the blood of the mother and the level of adrenaline 28 ng/mol, cortisol 360 ng/ml, the indicators VLF=120 y.e., LF=40 y.e., HF=20 y.e., JN=70 y.e., the mother and indicators VLF=25 y.e., LF=2 y.e., HF=1 y.e., IN=250 y.e. in the fetus determine the physiological course of pregnancy, when levels of adrenaline 46 ng/ml, cortisol 695 ng/ml, VLF=180 y.e., LF=50 y.e., HF=100 y.e., IN=160 y.e. from his mother, and when VLF=45 y.e., LF=5 y.e., HF=1 y.e., IN=400 y.e. in the fetus, determine the offset, and when the level of adrenaline 2 ng/ml, cortisol 1003 ng/ml, VLF=900 y.e., LF=25 y.e., HF=10 y.e., JN=30 y.e. the mother and VLF=3 y.e., LF=1 y.e., HF=0 y.e., JN=700 y.e. in the fetus define decompensated form of chronic placental insufficiency.



 

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