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Assessment of fetoplacental system and its correction at term pregnancy
Nazhmetdinova Dilfuza Farhatovna, Senior Research Scientist — researcher, State Medical Institute Abu Ali Ibn Sina, Department of Obstetrics and Gynecology, Ministry of Health of the Republic of Uzbekistan Bukhara E-mail: [email protected]
Assessment of fetoplacental system and its correction at term pregnancy
Abstract: Based on the results of US studies conducted before delivery, reducing the severity of the functional activity of the fetus, as well as the data monitoring BFN in integrated antenatal therapy to evaluate its effectiveness, it is possible to predict complications during childbirth, its outcome for the fetus and the basis on which to develop a rational obstetric tactics.
Keywords: Prolonged pregnancy, placental insufficiency, hofitol.
Prolonged pregnancy (PB) is a problem of great scientific and practical interest in obstetrics. The urgency is due to its large number of complications in childbirth, a high percentage of childbirth operations, high prenatal mortality
[1; 2; 4; 6].
Some importance in the etiology of PB has a state of the placenta and fetus. A disturbance in the placental system is one of the reasons for the late emergence of labor and its anomalies. Placental insufficiency at Prolonged pregnancy occurs in one in three women and 70% of the fruit to endure chronic hypoxia [4; 6; 7; 8].
Pathology of the uterine-placental circulation is characterized by three important points: violation of blood flow in the intervillous space (IMP), obstruction of outflow of blood from him and changes of rheological and coagulation properties of the mother’s blood. In parallel, there is a change in the circulation of the fruit of the placenta. Slow blood flow in utero-placental pool leads to a hypercoagulable state in microvascular chorionic due to increased blood flow entering the tissue thromboplastin and increased aggregation ofblood cells resulting in growing ICE syndrome [2; 4; 6; 8].
So a number of studies found that when true Prolonged pregnancy placenta decrease in glycogen content of lipids, RNA, the activity of a number of redox enzymes, accumulation in some parts of acid mucopolysaccharides, activation of alkaline phosphates’ (CHF) [6; 7; 8]. Reduction of lipids in the tissues of the placenta is accompanied by a simultaneous decrease in lipid peroxidation (LPO). Formed during lipid peroxidation toxic radicals have a damaging effect not only on lipids and proteins in the cell membrane, thereby contributing to the development of enzymatic and hormonal placental insufficiency. In addition, the violation of lipid and protein metabolism significantly alters the immune response, synthesis of hormones and prostaglandins.
Neonatal morbidity at PB reaches 29%, and prenatal mortality — 19%o, which is much higher than in full-term pregnancy. This is connected with low resistance to hypoxia fetus due to the greater maturity of the brain and with decreasing oxygen admission thereto due to morphological changes in the placenta in PB.
Objective: Evaluating the effectiveness of treatment of placental insufficiency in prolonged pregnancy.
Materials and methods
A total of 200 women studied. Group I consisted of 50 pregnant women with physiological pregnancy. Group II 75 patients with gestational age over 41 weeks and Group III 75 pregnancies of more than 42 weeks of gestation.
All pregnant women who were present before birth in the hospital conducted clinical and laboratory research. Assessment of fetoplacental complex (FPC) carried out on the basis of echo graphic research and unstressed test proposed IS Sidirovoy (2000), Which is a five-point scale of the studied traits. Total index of 5 points indicates the absence of signs of FPN. 4-points of a sign compensated FPI, 3 points — sub compensated, decompensate 2 points, 1 point — the presence of a critical form of FPN.
Results and discussion.
In determining the fetal biophysical profile, we paid attention to the following information:
— Feto metric;
— Fetal heart rate;
— Respiratory fetal movement;
— The motor activity of the fetus;
— The tone of the fetus;
— The volume of amniotic fluid.
Functional assessment of the FPS carried out in 150 pregnant women at 41-42 weeks of gestation or more. A marked increase of the relationship between gestational age and an increase in the number of observations with echo graphic signs of violations morph functional fetoplacental system. In the study of fetal biophysical profile was revealed significant violations of the status of the fetus at term pregnancy.
In the pathogenesis of disease in the FPC prolonged pregnancy and the development of labor is one of the leading unit’s takes violations of the structural — functional properties of cell membranes, in particular, changes in the ratio of phospholipids and cholesterol. The accumulation of cholesterol in membranes, disrupting normal packing lipid bilipidnom layer promotes disruption of its permeability to calcium, which leads to an overload of cells and they play a role in the pathogenesis of placental insufficiency.
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Section 8. Medical science
Very low density lipoproteins and low density, as atherogenic substances stimulate the excessive accumulation of lipids in the endothelium with the subsequent change in the lumen ofblood vessels, tissue ischemia. HDL, on the contrary, has a vital role in the elimination of tissue cholesterol. The reduction ofVLDL, belonging to the most active substrates to form lipid peroxides should reduce activity of lipid peroxidation. The results obtained in our studies of lipid metabolism changes, which had a direct correlation with the performance of the index tells of the final signs of varying severity FPN by ultrasound scanning, as criteria for targeted corrective therapy in pregnant women studied groups.
The drug of choice was hofitol that French laboratory developed Rosa-Phytopharma. Hofitol is a purified extract from the juice of fresh leaves of an artichoke field (Cynara geolymus). According to the chemical composition it is a mixture kafeolo-voy and quinic acids, flavonoids, sekviterpenlaktona, inulin tsi-narin and ascorbic acid, vitamin B1, and B12, carotene.
Pharmacologically-sided effects of the drug. Hofitol increases protein synthesis due to the normalization of the thiol-disulfide system and increasing the content of sulfhydryl groups. Due choleretic enhance elimination and reduction of cholesterol synthesis in the liver hofitol helps reduce cholesterol levels in the blood. Due to its unique chemical composition and high content of flavonoids, hofitol has cytopro-tective effect, normalizes vascular permeability, is a powerful antioxidant and antihypoxant, and has a pronounced choler tic effect. These properties Chophytol formed the basis for research on the effectiveness of its application in the post-term pregnancy in order to correct placental insufficiency and improve perinatal outcome in this disease.
In addition to the complex metabolic therapy pregnant test groups received 2.5-5.0 mg of hofitol deaning solution a day for 3-4 days at 41 weeks gestation. In order to evaluate the effectiveness of therapy conducted control tests BFN after inclusion in a comprehensive ongoing drug therapy Chophytol were obtained reliable data indicators that point to improve the final assessment and, accordingly, the functional activity
of the fetus. It increases the number of cases we obtain the final index score 5-4 from 60% to 88% in the second group, and in group 3, the figure rose from 17.3% to 41.2% compared against 28 and 23.9%, respectively.
Sub compensated FPI according to the final index was detected after treatment in group 2 at 8%, and in group 3 in 41.3% of pregnant women, asthma Form 4% in Q2 and 17.3% in group 3, respectively. We have identified the improvement ofblood circulation in the mother-placenta-fetus under the influence of the therapy is undoubtedly a positive factor and is of fundamental importance in the choice of tactics of pregnancy.
Certainly, it affects the strategy of the timing of induction of labor and its outcome. Ultimate tactics of births to women in violation of the FPS is determined individually, taking into account the age of pregnant women during the previous delivery, the severity of obstetric and gynecological history, obstetric pathology, pregnancy and delivery parity, gestational age and obstetric situations arising during the pregnancy and compared with our results study.
Thus, the testimony to the determination of the functional state of fetoplacental complex using echo graphic study is the lack of spontaneous onset of labor at 41 weeks gestation or more, carrying out dynamic control over the ongoing changes of the functional state of the fetus during the treatment and evaluation of the effectiveness of the therapy.
The research allow to recommend for use in corrective therapy Chophytol patients with post-term pregnancy in identifying sub compensated and decompensate forms of placental insufficiency. Turning Hofitol improves the efficiency of treatment in violation of fetoplacental blood flow and utero- platsental and fetal hypoxia.
Based on the results of US studies conducted before delivery, reducing the severity of the functional activity of the fetus, as well as the data obtained in the course of monitoring BFN comprehensive antenatal care to assess its effectiveness, it is possible to predict complications during childbirth, its outcome for the fetus and the basis on which to develop rational obstetric tactics.
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