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TYMIH
Г.А. САТЕНОВА1, Ж.К. САТЕНОВ12, Д.П. НЕТАЛИЕВА2
АКТ9БЕ К. ЖЕДЕЛ МЕДИЦИНАЛЫК К9МЕК БЕКЕТ1 КЫЗМЕТ1НЩ ИННОВАЦИЯЛЫК ТЕХНОЛОГИЯСЫ
Марат Оспанов атында^ Батыс К,азак,стан мемлекетпк медицина университетi1, Ак,тебе, К,азак,стан Ак,тебе к,. жедел кемек бекетР, Ак,тебе, К,азак,стан
Жедел медициналык, кемектщ крлже™дЫпн, сапасы мен тшмдштн арттыру - К,азак,стан Республикасындаfы денсаулык, сак,тауды дамытудыц ец мацызды ба^ггтарыныц 6ipi. Актебе к. жедел медициналык кемек бекет (ЖМКБ) жумысына АДАЖ жэне GPS жYЙелерiн енгiзу сараптамасы жYPгiзiлдi.
Нег'зг'! свздер: жедел медициналык, кемек, инновациялык технологиялар, тшмдМк, шакырулар, автоматтандырылган баскару жуйеа.
I
I
SUMMARY
G.A. SATENOVA1, ZH.K. SATENOV12, D.P. NETALIYEVA2
INNOVATIVE TECHNOLOGIES OF AMBULANCE STATION OF AKTOBE
West Kazakhstan Marat Ospanov State Medical University1, Aktobe, Kazakhstan
Ambulance station of Aktobe city2, Aktobe, Kzakhstan
Increasing of availability, quality, efficiency of emergency medical service is the mainstream of development health care system of the Republic of Kazakhstan. The analysis of implementing ADIS and GPS systems in emergency ward (EW) activity of Aktobe was carried out.
Key words: emergency medical service, innovative technologies, efficiency, calls, automated control system.
UDC: 618.291:611.013
T.S. KOMSHUK
SELECTED FETOMETRICAL INDICATORS OF THE BRAIN IN THE THIRD TRIMESTER OF PREGNANCY
Bukovinian State Medical University,Chernivtsi, Ukraine
Department of human anatomy named after N.G. Turkevich (head of the Department — professor B.G. Makar)
Competitor of the Department of Human Anatomy named after N.G.Turkevich, PhD E-mail: [email protected]
The results of ultrasound examination of physiological pregnant women in the III trimester of gestation living in the Chernivtsi region have been analyzed in the article. Besides normal regional fetometrical indicators of peculiar brain structures dimensions have been calculated. The biparietal diameter, ventricular-hemispheric index, dimensions of anterior and posterior horns and the body of lateral ventricles, the cerebellum, cavity of the septum pellucidum, subarachnoid space and big tank of the brain have been measured.
Key words: fetus, the III trimester of pregnancy, fetometry, brain.
Introduction. The widespread introduction into clinical practice of modern methods of prenatal diagnostic has greatly improved the fetal assessment, optimized obstetric tactics with a view to reduce perinatal morbidity and mortality. Among the numerous methods of fetal assessment nowadays the greatest practical importance has ultrasound examination, which allows to objectively evaluate as anatomical structure and physical development of the fetus throughout the pregnancy as well [3,5].
Various fetometrical indicators were analyzed for prenatal diagnostic of intrauterine growth retardation, which are a compulsory part of a screening and consultative ultrasound examination protocol in the III trimester of pregnancy [7, 8]. For many years of using of echography in obstetrics many standard fetometrical indicators developed by various centers have appeared. Each specialist of prenatal diagnostic inevitably faced a choice of nomogram. Obviously, the concept of a single standard of fetometrical indicators does
not exist. Even fetuses of the same country can have differences associated with ethnic features of nationalities inhabiting the country [1, 2, 4].
Chernivtsi region is divided into 11 districts according to the administrative-territorial division. The regional center — Chernivtsi, consists of three urban areas. The plain (forest steppe) zone of region includes Zastavna, Kitsman, Khotyn, Kelmentsy, Sokyryany and Novoselytsya areas. All parts of the region are poor with zinc and iodine in soil and water.
All this requires the development and use of common standard percentile curves of ultrasonic fetometry in a particular region, as the use of regional nomograms provides a correct estimation of the dynamics of fetus growth and increases the effectiveness of prenatal diagnostic of pathology [6].
Therefore, we needed conduct a study of individual fetometrical indicators of the brain of fetuses in the III trimester of gestation which are authentic for our Chernivtsi region.
ЭКСПЕРИМЕНТАЛЬНЫЕ И КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ
4.44.2014 œ.
Table 1. Regional (Chernivtsi region) standards of brain structures measured in a transthalamic plane
Duration of pregnancy (weeks) BPD (mm) LPD (mm) Septum pellucidum cavity (mm)
29-30 73,5±3,06 92,8±2,74 7,2±0,63
31-32 80,0±2,25 97,21±5,81 7,36±0,84
33-34 82,56±1,67 100,78±3,23 6,89±0,60
35-36 87,91±2,17 105,55±5,84 7,18±0,75
37-38 91,0±1,6 109,0±6,68 7,43±0,97
39-40 93,0±1,41 110,5±7,78 7,50±0,75
Table 2. Regional (Chernivtsi region) standards of brain structures measured in a transcerebellar plane
Duration of pregnancy (weeks) Cerebellum (mm) Subarachnoid space (мм) Large tank (mm)
29-30 35,5±2,88 13,05±1,33 7,50±0,97
31-32 38,64±4,13 14,07±1,96 7,43±0,94
33-34 38,33±2,79 13,67±2,35 8,0±1,22
35-36 41,45±3,56 13,36±2,50 8,36±1,36
37-38 41,57±4,03 14,43±2,64 8,14±0,89
39-40 38,5±0,71 12,04±0,91 8,26±0,13
Table 3. Regional (Chernivtsi region) standards of brain structures measured in a transventricular plane
Duration of pregnancy (weeks) Anterior horns (mm) Posterior horns (mm) Body of lateral ventricle (mm) Ventricular-hemispheric index (VHI)
29-30 7,0±0,67 8,50±0,97 8,5±0,07 0,25±0,05
31-32 7,07±0,83 8,71±0,78 8,71±0,82 0,24±0,05
33-34 6,67±0,66 7,56±0,51 8,44±0,81 0,22±0,04
35-36 6,64±0,36 7,72±0,49 9,09±0,91 0,22±0,05
37-38 7,14±0,21 8,71±0,60 8,71±0,66 0,24±0,03
39-40 7,28±0,05 5,5±0,42 9,5±0,71 0,25±0,04
Purpose of the study - to develop regional indicators of individual fetometri-cal indicators of the brain in the III trimester of physiological pregnancy.
Materials and methods. 53 results of ultrasound examination of pregnant women in the III trimester of physiological gestation who were living in Chernivtsi region have been analyzed. Ultrasound examination has been performed on the base of Medical Genetic Center (MGC) of Chernivtsi Regional Diagnostic Center (ChRDC). Ultrasound diagnostic has been performed using ultrasound machine ECHO «Aloka" - 630, working in real time by using transabdominal, line, sectoral sensor with a frequency 3,5 and 5,0 MHz. A retrospective analysis of 2004-2008 years has been conducted.
Normal fetometrical indicators of the
^ brain dimension were conducted. The bi- ^ ^ parietal diameter, ventricular-hemispheric ^
^ index, dimensions of anterior and posteri- ^ ^ or horns and the body of lateral ventricles, ^ the cerebellum, cavity of the septum pel-lucidum, subarachnoid space and big tank of the brain were measured.
The study was conducted in three ^ standard dimensions: transthalamic, tran- ^
^ scerebellum and transventricular ones. In ^
^ transthalamic plane biparietal size (BPS) ^
^ and fronto-occipital size (FOS) were mea- ^ ^ sured. In transcerebellum plane dimen-
Ii sions of cranial fossa posterior structures ^
^ were evaluated, namely hemispheres of ^
^ cerebellum, cerebellum worm and a large ^ ^ tank. Analysis of structure and size of the ||
S
^ lateral ventricles and their vascular plexus ^
S
has been performed in transventricular plane.
Estimation of mean values and Confidence intervals for mean values has been carried out by standard methods and conventional biometrics for nonparametric small samples using Microsoft Excel 5,0 and Biostat statistical program.
Results and Discussion.
The structures of the fetus brain are clearly differentiated starting from the 16th week of gestation. The study was conducted in three standard planes: transthalamic, transcerebellar and transventricular ones [1, 2].
In the transthalamic plane biparietal diameter (BPD) has been measured, which helps clearly define the term of pregnancy up to 5-10 days, and head circumference. Also in this plane the size of septum pellu-cidum cavity and the dimensions of anterior and posterior horns of lateral ventricles have been measured.
Медицинский журнал Западного Казахстана
35
Dimensions of the posterior fossa ^ 1. to establish morphometry pa- ^ 4. Медведев М.В. Нормальная
structures in transcerebellar plane have ^ rameters of separate structures of ventric- ^ ультразвуковая анатомия плода / М.В.
been evaluated, namely the cerebellar ^ ular system of fetus brain, ^ Медведев, Н.А.Алтынник. - М.: Реал
vermis and hemispheres and the large ^ 2. to determine with sufficient ac- ^ Тайм, 2008. - 152 с.
tank, diameter of which normally does not ^ curacy the gestational age and the period ^ 5. Медведев М.В. Ультразвуковой
exceed 10,0 mm (Table 2). ^ of intensive growth of fetus throughout ^ скрининг / М.В. Медведев, Е.В.Юдина
The large tank of brain is also includ- ^ pregnancy in accordance with the region ^ // Основы пренатальной диагностики. -
ed in the list of protocol of fetal anatomic ^ of residence, that is essential for practical ^ М.: Реальное время, 2002. - 184 с.
structures, subjected to mandatory as- ^ medicine. ^ 6. Ультразвуковая фетометрия:
sessment during screening ultrasound ex- ^ List of literature: ^справочные таблицы и номограммы
amination in the second half of a pregnan- ^ 1. Бондаренко Н.Н. Региональные ^ / Под ред. Медведева М.В. - М.:
cy, because its extension is an echographic ^ нормативы фетометрических ^ Реальное Время, 2002. - С. 80.
marker of chromosomal abnormalities. ^ показателей / Н.Н. Бондаренко //Пре- ^ 7. Pavlova E. Three-dimensional (3D)
Structures and sizes of lateral ven- ^ нат. диагн.- 2003. - Т.2, №1. - С. 7-9. ^ ultrasound in evaluation of fetal brain
tricles and their choroid plexuses in trans- ^ 2. Логвиненко А.В., Демидов В.Н., ^ anatomy / Е. Pavlova, D. Markov, S. Ivan-
ventricular plane were analyzed. ^Демидов С.М. Ультразвуковая биоме- ^ ov// AkushGinekol (Sofia). - 2014. -V. 53,
Also ventricular-hemispheric index ^ трия (справочные таблицы и уравнения) ^ N 2. - P. 11-17.
(VHI) - the ratio of the width of lateral ^ // Клинические лекции по ультразвуко- ^ 8. Three-dimensional ultrasonogra-
ventricle to the width of brain hemisphere ^ вой диагностике в перинатологии / Под ^ phy of the fetal vermis at 18 to 26 weeks'
was measured to match the term of ges- ^ ред. М.В. Медведева, Б.И. Зыкина. - М.: ^ gestation: time of appearance of the pri-
tation, that is used for the diagnostic of | ММА, 1995. - С. 83-93. | mary fissure/Y.Zalel, S.Yagel, R.Achiron [et
ventriculomegaly and hydrocephalus. The ^ 3. Луцай Е.Д. Интенсивность роста ^ al.] //J. Ultrasound. Med. - 2009. - V. 28.
width of lateral ventricles should not ex- ^ соматометрических параметров плода ^ - P. 1-8.
ceed 10,0 mm (Table3). ^ в разные периоды пренатального ^
Conclusions. These data suggest that ^ онтогенеза / Е.Д.Луцай, Л.М. Железнов ^
ultrasound fetometry is a valuable meth- ^ // Астраханский мед. ж. - 2012. - Т.7, № ^
od, which allows: | 4. - С. 168-170. |
TYMIH I РЕЗЮМЕ
Т.С. КОМШУК I Т.е. КОМШУК
ГЕСТАЦИЯНЬЩ III ТРИМЕСТР1НДЕП БАС МИЫНЬЩ | ОТДЕЛЬНЫЕ ФЕТОМЕТРИЧЕСКИЕ ПОКАЗАТЕЛИ ГОЛОВНОГО ЖЕКЕЛЕГЕН ФЕТОМЕТРИКАЛЫК К0РСЕТК1ШТЕР1 | МОЗГА В III ТРИМЕСТРЕ ГЕСТАЦИИ
Буковинский мемлекетпк медицина университетi, Черновцы, | Буковинский государственный медицинский университет, Украина | Черновцы, Украина
Черновицкий облысында туратын эйелдердщ | Проанализированы результаты ультразвукового физиологиялык жYктiлiк Ill триместршщ ультрадыбыстык | исследования Ill триместра физиологических беременностей зерттеу нэтижесi сарапталfан. Бас миынын жекелеген | женщин, проживающих в Черновицкой области. Рассчитаны курылымдарынын мeлшерлерiнiн калыпты аймактык | нормальные региональные фетометрические показатели фетометрикалык кeрсеткiштерi есептелген. Бипариеталды ^ размеров отдельных структур головного мозга. Оценен келем, асказан жарты шарлы индексi, бYЙiрлi карыннын | бипариетальный размер, желудочково-полушарный алдьщ^ы, арткы мYЙiздерi мен денесi, каракус миы, мeлдiр | индекс, размеры передних, задних рогов и тела боковых аралык куысы, субарахноидалды кенiстiк жэне мидын Yлкен | желудочков, мозжечок, полость прозрачной перегородки, куысы баfаланды. ^ субарахноидальное пространство и большая цистерна мозга.
Негiзгi свздер: урыц, жуктлктщ Ill триместр'1, | Ключевые слова: плод, Ill триместр беременности, фетометрия, бас миы. | фетометрия, головной мозг.
