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12УДК: 618.146- 611.9
FEATURES OF ANTHROPOMETRIC INDICATORS OF FETAL DEVELOPMENT IN WOMEN OF DIFFERENT SOMATOTYPES
RABIEV SANJAR NASRITDINOVICH
Independent doctoral student of department of obstetrics and gynecology 2 of the Bukhara medical Institute.
ORCID ID 0000-0001-8618-0791 TESHAEV SHUKHRA T JUMAEVICH Professor, department of anatomy and clinical anatomy of the Bukhara medical Institute. ORCID ID 0000-0002-2089-5492 KHAMDAMOVA MUHKHAYOHON TUKHTASINOVNA DSc, docent of department of obstetrics and gynecology 2 of the Bukhara medical Institute. ORCID ID 0000-0003-3128-6120
HARIBOVA ELENA ALEXANDROVNA PhD, docent of department of morphology of the Moscow medical and dental University named after A. I. Evdokimov (MGMSU), Moscow.
ORCID ID 0000-0001-6166-3594 ABSTRACT
Differences in the size of the fetal head appear at an earlier time, which can be explained by the development of the fetus along the cranio-caudal gradient. The circumference of the abdomen and the length of the femur begin to clearly characterize the somatotypic differences of fetuses in the late stages of pregnancy, closer to its end. The division of pregnant women into growth groups allows us to catch the fetometric differences in their fetuses. A number of signs of individual anatomical variability begin to appear already at the stage of perinatal ontogenesis.
Keywords: somatotype, anthropometry, fetus, ultrasound fetometry, placenta, constitution.
ОСОБЕННОСТИ АНТРОПОМЕТРИЧЕСКИХ ПОКАЗАТЕЛЕЙ РАЗВИТИЕ ПЛОДА У ЖЕНЩИН РАЗНЫХ СОМАТОТИПОВ
РАБИЕВ САНЖАР НАСРИДДИНОВИЧ
Докторант кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ОИСЮ Ю 0000-0001-8618-0791 ТЕШАЕВ ШУХРАТЖУМАЕВИЧ доктор медицинских наук, профессор кафедры анатомии и клинической анатомии. Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика
Узбекистан. ORCID Ю 0000-0002-2089-5492 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА ЮБо, доцент кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ОИСЮ Ю 0000-0003-3128-6120 ХАРИБОВА ЕЛЕНА АЛЕКСАНДРОВНА РЬЮ, доцент кафедры морфологии Московского государственного медицинского и стоматологического университета имени А.И.Евдокимова (МГМСУ), Россия Москва.
ОИСЮ Ю 0000-0001-6166-3594 АННОТАЦИЯ
Различия в размерах головы плодов проявляются в более ранние сроки, что можно объяснить развитием плода по кранио-каудальному градиенту. Окружность живота и длина бедренной кости начинают четко характеризовать соматотипические различия плодов на поздних сроках беременности, ближе к её окончанию. Деление беременных по ростовым группам позволяют уловить фетометрические различия и у их плодов. Ряд признаков
индивидуальной анатомической изменчивости начинает проявляться уже на этапе перинатального онтогенеза.
Ключевые слова: соматотип, антропометрия, плод, ультразвуковая фетометрия, плацента, конституция.
ТУРЛИ СОМАТОТИПЛИ АЁЛЛАРДА ХОМИЛА РИВОЖЛАНИШИНИНГ АНТРОПОМЕТРИК КУРСАТКИЧЛАРИ
ХУСУСИЯТЛАРИ
РАБИЕВ САНЖАР НАСРИДДИНОВИЧ
Акушерлик ва гинекология кафедраси докторанти, Бухоро давлат тиббиёт институти, Бухоро шахри, Узбекистон Республикаси.
ОРСЮ Ю 0000-0001-8618-0791 ТЕШАЕВ ШУХРАТ ЖУМАЕВИЧ Т.ф.д., анатомия ва клиник анатомия кафедраси профессори, Бухоро давлат тиббиёт институти, Бухоро шахри, Узбекистон Республикаси. ORCID Ю 0000-0002-2089-5492 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА DSc, акушерлик ва гинекология кафедраси доценти, Бухоро давлат тиббиёт институти, Бухоро шахри, Узбекистон Республикаси.
ОРСЮ Ю 0000-0003-3128-6120 ХАРИБОВА ЕЛЕНА АЛЕКСАНДРОВНА PhD, морфология кафедраси доценти, А.И.Евдокимов номидаги Москва давлат тиббиёт ва стоматология университети,
Москва, Россия. ORCID Ю 0000-0001-6166-3594 АННОТАЦИЯ
Хомила бошининг катталигидаги фарклар цомиладорликнинг эрта муддатларида пайдо булади, бу хомиланинг кранио-каудал градиент буйлаб ривожланиши билан изоцланиши мумкин. 1^орин айланаси ва соннинг узунлиги хомиладорликнинг сунги босцич-ларида хомиланинг соматотипик фаркларини аник, белгилай олади.
Хомиладорларнинг буй улчамлари буйича булиниши уларнинг хомиласи фетометрик фарцларини аницлашга имкон беради. Индивидуал анатомик узгарувчанликнинг бир цатор белгилари перинатал онтогенез босцичида пайдо була бошлайди.
Калит сузлар: соматотип, антропометрия, томила, ультратовушли фетометрия, йулдош, конституция.
A modern component of this process is screening ultrasound fetometry - [1, 3, 6]. To correctly assess the indicators of these ultrasound studies and reduce diagnostic errors, it is necessary to use the standards of fetometric indicators developed for a specific region. The development of personalized medicine, the formation of individual approaches to assessing the physical condition of the mother and fetus and their adaptive potential forces us to pay attention to the constitutional features of mothers, which undoubtedly have an impact on the process of fetal development - [5, 7]. The mother-fetus system is a combination of two independent organisms united by a common goal, a common end result-ensuring the normal development of the fetus. The main link between the mother and the fetus is the placenta. The placenta plays the role of a specific executive organ of the mother and fetus, a reflexogenic zone of their organisms, providing an adequate response of the relationship between mother and fetus - [2, 4]. Therefore, to predict and diagnose the features of intrauterine fetal development and possible complications, it is important to study the effects of placental and maternal factors.
Providing long-term prognosis in the form in which there is an urgent need for perinatal obstetrics is possible only if an individual approach is taken to each pregnant woman. This approach is provided by modern clinical anthropology - [1, 6, 7].
Evaluation of fetal development is the most important task of obstetricians at the stages of pregnancy and childbirth. According to the
order of the Ministry of Health of the UZR of May 18, 2012. No. 137 "On the organization and provision of antenatal care and medical care for pregnant women in primary health care institutions" examination of pregnant women includes a mandatory three-time screening ultrasound examination: during 11-14 weeks of pregnancy, when a comprehensive prenatal diagnosis of fetal development disorders is carried out, including ultrasound examination and determination of maternal serum markers (pregnancy-related plasma protein A and free beta-subunit of chorionic gonadotropin), followed by a comprehensive calculation of the individual risk of giving birth to a child with a chromosomal pathology; at 18-21 weeks, ultrasound is performed to detect late-manifesting congenital anomalies of the fetus; ultrasound at 30-34 weeks is performed for the purpose of functional assessment of the fetus.
Monitoring fetal development has become commonplace in modern clinical practice. Evaluation of the development of a complex of fetometric parameters (fetal head size, abdominal circumference, femoral length) is included in the protocol of management of pregnant women. At the same time, we have not found any studies devoted to the study of the peculiarities of changes in the somatometric parameters of the fetus in pregnant women, depending on their height and physique - [1, 6, 7].
Purpose of the study the aim of the study was to study the dynamics of the dimensional somatometric characteristics of fetuses obtained at the stages of screening ultrasound scanning in women of different physiques and height.
Materials and methods: 205 primiparous women with normal single - child pregnancy and childbirth were examined on the basis of the "Bukhara regional Perinatal Center" (chief physician - N. R. Bahronova) In addition to general clinical methods of examination, the following somatometric indicators were determined for each woman at admission: height, weight (initial, before pregnancy), distantia spinarum, distantia
cristarum, distantia trochanterica, external straight pelvic size, pelvic width indices and the weight-weight index of the Yarcho-Kaupe according to generally accepted methods - [1, 5]. Based on the data obtained, groups of women with brachial, dolicho-and mesomorphic body shapes were identified. Since the indices do not take into account the size of the body length of the subjects, and for persons of different height, the values of the norm of these indices will be different - [8], all pregnant women were divided into three groups - 151-160 cm ("short"), 161-170 cm ("medium-sized"), 171-180 cm ("tall").
Ultrasound examinations were performed using the MINDRAY DC-60 Quik Guide device and a 2-61C/50/72 convex sensor. The measurements were carried out in the period of 21-22 weeks and 30-31 weeks. Somatometric parameters such as biparietal size, frontal-occipital size, head circumference, abdominal circumference, and femoral length were studied. The size of the fetal head was determined by transverse scanning at the level of the transparent septum cavity, visual tubercles and brain legs. The biparietal dimension was measured from the outer to the inner surface of the parietal bone contour perpendicular to the M-echo. The frontal-occipital size was determined on the same section as the biparietal one, between the midpoints of the outer contours of the frontal and occipital bones. To level out the influence of fetal head shape on these measurements, the ratio of biparietal size /frontal-occipital size was determined. The circumference of the head was measured at the same level as the biparietal size of the head. The head circumference was measured either by computer planimetry or by the formula: head drcumference=3.14*(biparietal size +frontal-occipital size)/2. The maximum longitudinal size of the calcified diaphysis of this bone was taken as the length of the femur. The circumference of the abdomen was determined in a plane perpendicular to the longitudinal axis of the fetal trunk. The sensor was positioned so that the gas bubble of the stomach
and the middle part of the hepatic vein were visible on the screen (without capturing the area where the hepatic vein flows into the umbilical). The circumference was measured by the length of the external contour of the fetal torso in the cross-section area. The cranial index was calculated as the ratio of the width of the skull to its length, multiplied by 100. The intensity of the increase in indicators at the stages of the screening examination was calculated using the formula: (Sokolov V. V., Chaplygina E. V., Sokolova N. G., 2015) [5]: IR=(D2-D1)/0.5(D1+D2)x100 %, determining by what amount (as a percentage) from the average value, the studied value (D) changed over the period of time of interest (in this case, two weeks). The obtained data were processed using the Microsoft Excel package for Windows 7.0. Quantitative features were expressed as X±Sx, where X is the sample mean, and Sx is the standard error of the mean. The critical significance level (p) for testing statistical hypotheses in this study was assumed to be 0.05.
Results and discussion. This article provides information about standard fetometric measurements at the stages of screening examination of pregnant women. Earlier studies indicate that there are differences in the values of a number of physiological constants in pregnant fetuses of different physiques - [6, 7]. The introduction of the growth differences of pregnant women into the studied indicators allowed us to catch the somatometric features of their fetuses. These differences became especially noticeable at the stage of the third screening examination (3031 weeks). Thus, if the size of the fetal head (and the brain is one of the most mature systems at birth) at 21-22 weeks significantly (p<0.05) differed in biparietal size in "low" and "tall" pregnant women within the group of pregnant dolicho and mesomorphic body types, then at 30-31 weeks it was observed within all constitutional groups. At the same time, it was noted that at 21-22 weeks there were significant (p<0.05) differences in the biparietal size of fetuses in "short" dolichomorphic
(51.3±0.4 mm) and "'tall" mesomorphic (53.4±0.9 mm) and "'medium-sized" brachymorphic (53.1±0.6 mm) pregnant women; the frontal-occipital size was the smallest in "short" brachymorphic (66.9±0.3 mm) fetuses and the largest in "tall" dolicho (67.5±0.5 mm) and mesomorphic (70.3±1.2 mm) pregnant women. The head circumference was significantly smaller (p<0.001) in the fruits of "'short" dolichomorphic pregnant women (187±0.5 mm) than in the fruits of "tall" brachy - (192.1±0.9 mm) and mesomorphic (192.5±0.5 mm) pregnant women (Table 1).
Table 1
Average values of biparietal size, frontal-occipital size, head circumference (X±S x mm) and cranial index ( % ) in the period of 21-22
weeks
Fetal head dimensions Body ty pe of a pregnant woman
Dolichomorphic Mesomorphic Brachymorphic
The group with a height of 151-160 (n=121)
biparietal diameter 51,3±0,4* 51,5±0,8 50,0±0,5**
frontal-occipital size head 68,14±0,59 67,6±0,66 66,9±0,3
circumference 187±0,5 189±0,96 188±0,85
Cranial index 75,2 75,6 73,7
The group with a height of 161 -170 (n=21)
biparietal diameter 53,4±0,6 52,0±0,74 53,14±0,63
frontal-occipital size head 66,5±0,5 68,3±0,81 67,28±0,52
circumference 192±0,87 191,8±0,75 192,3±0,49
cranial index 78,2 76,1 79
The group with a height of 171-180 (n=7)
biparietal diameter 53,1±0,6* 53,3±0,9 52,5±0,4**
frontal-occipital size head 68,4±0,5 70,3±1,2 69,3±0,7
circumference 191,5±1,3 192,5±0,5 192,1±0,9
cranial index 77,4 76,2 75,7
Note: * * * - in the compared pairs, p<0.05.
As for the values of the cranial index, we were not able to establish any regularities at this stage of ontogenesis. The study of these fetal head sizes at 30-31 weeks showed that the growth rate of all indicators in all groups did not differ statistically, that is, the growth of the fetal head was uniform in all groups (Table 2).
Table 2
Average values of biparietal size, frontal-occipital size, head circumference (X±S x mm) and cranial index (%) in the period of 30-31
weeks
Fetal head Body type of a pregnant woman
dimensions Dolichomorphic Mesomorphic Brachymorphic
The group with a height of 151-160 (n=121)
biparietal diameter 78,6±0,3* 79,4±0,7" 79,2±0,8**
IR biparietal size 42% 44% 46%
frontal-occipital size 103,8±0,7 100,8±0,9 101,8±0,6
IR frontal-occipital size head 42% 40% 40%
circumference 288,7±0,8 289,4±0,6 288,3±0,9
IR head 43% 42% 43%
circumference
cranial index 76 79 78
The group with a height of 161 -170 (n=21)
biparietal size growth 80,3±0,7 80,3±0,9 80,6±0,8
rate biparietal size 41% 43% 41%
frontal-occipital size growth 100,6±0,6 102±0,5 101,0±0,4
intensity frontal-occipital size head 38% 39% 40%
circumference growth 289,4±0,6 290,4±0,8 290±0,7
intensity head circumference 40% 41% 40%
cranial index 80 79 80
The group with a height of 171-180 (n=7)
biparietal size growth 82,5±0,5* 83,1±0,6" 82,6±0,5**
rate biparietal size 43% 43% 44%
frontal-occipital size growth 102,3±0,7 103,4±0,5Л 103,4±0,9
intensity frontal-occipital size head 40% 38% 40%
circumference growth 292,7±0,9 294±1,1 293,6±0,5
intensity head circumference 42% 42% 41%
cranial index 81 81 80
Note: * * * " - in the compared pairs p<0.05.
At the same time, it was revealed that at 30-31 weeks, the fruits of tall women are brachycephalic, and in short women - mesocephalic. The size characteristics of the fetal heads were large in tall women. The biparietal size and head circumference were significantly larger (p<0.05) in the fetuses of tall brachymorphic pregnant women compared to short dolichomorphic ones, and the frontal-occipital size in this group did not significantly differ.
The biparietal size was the smallest in the fetuses of dolichomorphic pregnant women (in all growth groups), the frontal-occipital size of the fetal head was the largest in short dolichomorphic mothers. The maximum circumference of the head was observed in the fetuses of tall brachymorphic pregnant women, the smallest - in the fetuses of short brachymorphic and dolichomorphic mothers.
When analyzing the dimensional somatometric characteristics, it was found that in the period of 21-22 weeks, all indicators in all groups did not differ statistically (Table.3).
Table 3
Mean values (X±Shmm) abdominal circumference and femoral length in
the period of 21-22 weeks
Fetal head dimensions Body type of a pregnant woman
Dolichomorphic Mesomorphic Brachymorphic
The group with a height of 151-160 (n=121)
circumference of the abdomen 170,5±1,5 169,7±1,8 170,4±1,3
length of the femur 37,4±0,7 37,2±0,7 37±0,8
The group with a height of 161 -170 (n=21)
circumference of the abdomen 171±1,5 169,4±1,4 169,2±0,6
length of the femur 37,8±0,6 37,3±0,6 38,3±0,7
The group with a height of 171-180 (n=7)
circumference of the abdomen 169,2±1,9 171,4±0,7 169,5±0,7
length of the femur 38,1±0,6 38,8±0,6 38±0,4
The picture of fetuses aged 31-32 weeks significantly changed. It was found that the growth intensity of the abdominal circumference was maximum in fetuses from brachymorphic mothers, and the growth intensity of the femoral length in dolichomorphic mothers, although the difference in values was no more than 5 %. Both the circumference of the abdomen and the length of the femur were significantly larger than tall pregnant women of all body types. The circumference of the abdomen of the fetuses was minimal in dolichomorphic pregnant women and maximal in brachymorphic ones, and in all growth groups. The length of the femur was greater in the fetuses of dolichomorphic mothers in all growth groups (Table 4).
Table 4
Mean values (X±Sx Mm) abdominal circumference and femoral length at
30-31 weeks
Fetal head dimensions Body type of a pregnant womanё
Dolichomorphic Mesomorphic Brachymorphic
Group with a height of 151 -160 (n=71)
abdominal circumference 273±1,7 280,4±1,9 285,3±1,4
growth rate abdominal 46% 49% 50%
circumference femoral 61±0,6** 59,3±0,5° 58,6±0,3''
length growth rate femoral length 48% 47% 46%
The group with a height of 161-170 (n=71)
abdominal circumference 272,3±1,7 280,6±1,1 283,7±1,3
growth rate abdominal 45% 45% 49%
circumference femoral 62,7±0,6 61,7±0,5 60,7±0,9
length growth rate femoral length 47% 46% 45%
The group with a height of 171-180 (n=7)
abdominal circumference 276,5±1,8 279,8±2,1 284,7±1,9
growth rate abdominal 48% 44% 50%
circumference femoral 63,1±0,4** 62,9±0,5° 61,4±0,8"
length growth rate femoral length 47% 46% 45%
Note: * ° " - in the compared pairs p<0.05.
Thus, summing up the identified changes, it can be noted that the differences in the size of the fetal head appear at an earlier time, which can be explained by the development of the fetus along the cranio-caudal gradient. The circumference of the abdomen and the length of the femur begin to clearly characterize the somatotypic differences of fetuses in the late stages of pregnancy, closer to its end. The division of pregnant women into growth groups allows us to catch the fetometric differences in their fetuses. A number of signs of individual anatomical variability begin to appear already at the stage of prenatal ontogenesis. Our task is to identify such signs and implement these data in clinical practice.
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