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Section 6. Medical science
Among the patients of the second group (cervical length 2130 mm) birth vaginally occurred in 90%. At the same time 35% of the generic activities developed spontaneously. Caesarean section was urgently conducted in 4 (3,4%) patients after use as a preparation for childbirth laminaria and easy-glandinovogo gel. The indications for cesarean section were clinically narrow pelvis [4,2-4], chronic fetal hypoxia [3, 1-2].
In the group of patients in whom transvaginal ultrasound cervical length was 31-40 mm, the cesarean rate was significantly higher than in the second group, and reached 27.5%. At the same time of 11 caesarean sections were performed in 10 urgently order in connection with a clinically narrow pelvis, uterine inertia, chronic fetal hypoxia. Generic activities in all patients, delivery by surgery, developed on the background of the use of prostaglandin gel.
The highest incidence was observed among cesarean patient fourth group for which the length of the cervix according transvaginal ultrasound exceed 40 mm (44%). For this group of patients was characterized by the same frequency planning and urgently abdominal delivery. Planned indications for cesarean section was 42 weeks gestational age or more and lack of preparation of the birth canal. The indications for emergency caesarean section was the weakness of labor activity.
Conclusions:
1. Length cervix at prolonged largely reflects the willingness of pregnant women for childbirth.
2. State cervical uteri using transvaginal sonography, should be considered when determining the obstetric tactics in women with post-term pregnancy.
References:
1. Strizhakov A. N., Davydov A. I., Belotserkovtseva L. D. Clinical lectures on obstetrics and gynecology. - M., 2004. - 621 p.
2. Kravchenko E. N. Prevention intrapartum fetal damage in complicated childbirth: Author. Dr. med. Sciences: 14.00.01. - Omsk, 2009.
3. Gorelov P. P. Condition offetoplacental complex in the prolonged pregnancy//Actual problems of obstetrics. - SPb., 1996. - P. 16-17.
4. Larsen L. G., Clausen H. V., Andersen B. et al. A serologic study of postmature placentas fixed by dual perfusion//Am. J. Obstet. Gynecol. - 1995. - Vol. 172. - 489 p.
5. Halperin R., Peller S.et al. Placental apoptosis in normal and abnormal pregnancies//Gynecol.Obstet. investing. - 2000. Vol. 50, № 2.
Mamadazimova Dilorom Fayzymamatovna, Senior Research Scientist of the Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute Karimova Feruza Dzhavdatovna, Professor, Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute E-mail: [email protected]
Some features of hemodynamics in prolonged pregnancy according to doppler
Abstract: The study of the functional state of fetoplacental complex and fetus at term pregnancy allows to develop the forecast for the next delivery.
Keywords: fetoplacental complex, fruit, prolonged pregnancy.
Increased vascular resistance of the fetus due to their spasm, is one of the compensatory mechanisms — centralization of circulation with the primary blood supply to vital organs at increasing hypoxia and metabolic disorders. The growth of fetal hypoxia is accompanied by a decrease in resistance vessels of the brain, providing it with adequate oxygenation. The preferential blood flow to the brain of the fetus in terms of progression of placental insufficience (PI) has been called «brain-sparing effect» [3, 2-4; 1, 1-2].
Objective: to study the functional state of fetoplacental complex and fetus at term pregnancy.
Material and Methods: group 1, the main-18 womens with post-term pregnancy 2-group- control 14 womens with normal gestation.
Results and discussion
Analysis of the Doppler study in a group of pregnant women with post-term pregnancy revealed significant differences between hemodynamic parameters in the mother-placenta-fetus as compared with those of a control group which included pregnant women with gestational age 39-40 weeks.
In the study group (prolonged pregnancy 42 weeks) in 14 patients (46,67 ± 9,11%) of pregnant women there was a significant violation of utero-placental blood flow.
When comparing the FRC (flow rate curve) in utero-placental blood flow was determined by a significant increase in the ADR (average diastolic ratio) (2,90 ± 0,08), PI (pulse index) (1,643 ± 0,06) and RI (resistance index) (0,67 ± 0,03) in comparison with indicators comparison group and the control group (p <0.001).
Thus, detection of pathological changes of hemodynamic parameters in the uterine arteries in the study group reveal a violation of the process of ensuring adequate oxygenation and nutrition of the developing fetus at term pregnancy.
When Doppler study of fruit-placental and fetal hemody-namics in the study group were isolated from pregnant unaltered fruit-placental blood flow and cerebral blood flow: — Fetal hemodynamics without pathological changes — 12 (40,00 ± 8,94%) observations;
— Changes in hemodynamics fruit — 18 (60,00 ± 8,94%) cases.
In 12 (40,00 ± 8,94%) observations in the analysis features of fetal hemodynamics was no significant difference from those of its parameters in the control group, in fruits and placental blood flow was normal.
Neuropsychological and electroencephalographic correlates of damaged and intact hemisphere in left hemisphere insult
Draws attention to the identification in 18 (60,00 ± 8,94%) of the main group of pregnant women to increase vascular resistance in umbilical artery. At the same time an increase in vascular resistance in fruit-placental link to the UA (umbilical artery) was characterized by ADR greater than 3.0, RI — more than 0.67, more than 0.90 UA (umbilical artery).
Patients of the main group there was a significant change in the ADR 3,27 ± 0,20), RI (0,73 ± 0,03) and PI (1,05 ± 0,05). In the comparison group these indicators were: ADR (2,20 ± 0,11), RI (0,53 ± 0,02) and PI (0,75 ± 0,04), (p <0.001).
Analysis of the research showed that when evaluating CSC in fetal umbilical artery in the main group of the most characteristic of all the increase in vascular resistance index.
The increase in RI in the umbilical artery, exceeds the norm, a sign of violations of fruit-placental blood flow dopplerograms. In the comparison group violation fruit-placental blood flow was observed in 10% of cases, while in both cases there was a questionable biophysical profile of the fetus. In 90% of the violations were found (p <0.001).
Comparative analysis of vascular resistance in the UA there is an increase it by 6 times in the intervention group relative to the
comparison group. It should be stressed that this reveals within the placenta combined disturbance of blood flow.
Thus, with prolonged pregnancy fruit hemodynamic changes consistently. Initially, when the fruit unchanged hemodynamic disturbances observed within the placenta blood flow due to the fruit unit (umbilical artery). To further develop the mechanism of centralization of blood circulation: the compensatory decreases resistance in the blood vessels of the brain, there is an isolated change in blood flow in the middle cerebral artery [4, 1-2].
In general, as shown by our study, in the study group increased frequency of adverse perinatal outcomes, which are further compounded by the detection of changes in the Doppler hemodynamics fruit [2, 3-4].
Conclusions: 1. Pregnant with gestational age over 40 weeks, it is necessary to carry out Doppler study of fruit-placental blood flow and the study parameters BFF (biophysical profile of the fetus) for more accurate assessment of the state of the fetus and compensatory possibilities.
2. Timely identify disorders of fetus in prolonged pregnancy will predict the deterioration of the fetus during labor and violation during the neonatal period.
References:
1. Attila C Stepankovo EA Sichinava LG Doppler study of uterine blood flow in the diagnosis of postpartum endometritis//Questions of gynecology, obstetrics and perinatology. - 2002. № 2. - S. 32-35.
2. Bolshakov EE Predicting perinatal outcomes and obstetric tactics in prolonged pregnancy: Author. ... Cand. honey. Sciences: 14.00.01. -M., 1998. - 23 p.
3. Reznichenko GI Differential diagnosis, tactics and prediction of the outcome of labor in post-term and prolonged pregnancy: Author. .Cand. honey. Sciences: 14.00.01. - Kyiv, 1999. - 21 p.
4. Timokhina TF, OR Baev Prolonged pregnancy: diagnosis, tactics and methods of delivery//Questions of gynecology, obstetrics and perinatology. - 2003. - T. 2, № 2. - S. 37-43.
Mamadaliev Akmal,
Department of Neural Diseases of the Andijan medical institute
E-mail: [email protected]
Neuropsychological and electroencephalographic correlates of damaged and intact hemisphere in left hemisphere insult
Abstract: We studied neuropsychological and electroencephalographic correlates of the damaged and intact hemisphere of brain in ishemic insult cases. In dynamics we studied the structure of neuropsychological symptoms of hemispheric insult taking into account the lateralization of the damage focus. We revealed an interrelation between highest cerebral functional disorders and EEG alterations in the damaged and intact hemispheres, we studied inter hemispheric mechanisms of restoration of the damaged cerebral functions.
Keywords: hemispheric insult, neuropsychological syndromes, electroencephalography, hemispheric interrelation, vicari-ate mechanism
The problem of cerebral ischemic insult is one of the actual ones due to the high prevalence, invalidation, and lethality rates. Post insult neuropsychological impairments also serve to be one of the main reasons of invalidation, as the tempus of functional recovery mostly depends on the presence of the last [1, 4, 6]. In case of cerebral insult with hemispheric location there is inter hemispheric reconstruction of the highest cerebral functions (HCF), switching the plasticity mechanism on, accompanied by regress of several neuropsychological impairments [1; 2; 4; 7]. Though, the process of cerebral functions restoration in cerebral insult depends both on the lateralization of the focus, and individual profile of the asymmetry [3].
EEG studies in hemispheric insults performed taking into account hemispheric interrelation provided the chance of a more detailed study of brain intact hemisphere functional status, approach to vicariate mechanism [4-8]. It is necessary to study intact hemisphere dysfunction more thoroughly in hemispheric insults using EEG maping for revealing the vicariate mechanisms and definition of insult rehabilitation prognosis.
Objective of this work is study of neurophysiological and encephalography correlations of the damaged and intact hemispheres of brain in ischemic insults.
Materials and methods of the research. We examined 86 patients with hemispheric ischemic insult along the medial cerebral
