Assessment of the fetoplacental complex and hemostasis system status in perinatal care of pregnant women with fetal congenital malformations
Keywords:fetal congenital malformations, antenatal fetal death, placental dysfunction, Dopplerometry, hemostasis, low-frequency piezoelectric thromboelastography
Research objective: to assess the morpho-functional status of the fetoplacental complex and hemostasis system in pregnant women with congenital malformations in the fetus to prevent antenatal fetal death and determine further tactics of management and delivery.
Materials and methods. The state of fetoplacental circulation was studied in 120 pregnant women with fetal congenital malformations in the third trimester by Doppler assessment of blood flow in the umbilical artery (UA) and middle cerebral artery (MCA) in the fetus, with resistance index, pulse index and maximum systolic and terminal diastolic velocities ratio. The functional activity of the hemostasis system was assessed by low-frequency piezoelectric thromboelastography. Morphological examination of the placenta was performed. The control group included 25 pregnant women without fetal congenital malformations.
Results. In case of Doppler flow disturbances in UA and combination of these disturbances with hypercoagulability, the probability of antenatal fetal death if there were congenital malformations ranged from 2–3 to 7–14 days (r = 0.51 and r = 0.55, respectively). A high risk of antenatal fetal death occurred with blood flow disorders in the UA and MCA (r = 0.70), as well as with blood flow disorders in the UA in combination with hypercoagulation and inhibition of fibrinolysis (r = 0.78). The highest risk of antenatal death occurred in case of impaired blood flow in the MCA with hypercoagulation and inhibition of fibrinolysis (r = +0.99).
An urgent delivery within a day is indicated when there are blood flow disorders in the UA or MCA, combined with hypercoagulation and inhibition of fibrinolysis. The respiratory distress syndrome is treated by administering a surfactant at gestational ages up to 34 weeks. Delivery within 2–3 days is indicated in case of impaired blood flow in the UA and hypercoagulation, this allows preventing of respiratory distress syndrome with corticosteroids if the gestational age is less than 34 weeks.
Conclusions. In pregnant women with fetal congenital malformations, significant disturbances in blood flow in the UA (increased resistance index and maximum systolic and final diastolic velocities ratio) and decreased pulse index in the MCA were revealed, which indicates intrauterine hypoxia and centralization of blood flow. The functional activity of the hemostasis system was characterized by an increase in the blood coagulation potential in the vascular-platelet, a coagulation unit, which was accompanied by morphological and functional changes in the placenta in response to hypoxia.
Implementation of the proposed algorithm for perinatal support of pregnant women with fetal congenital malformations and placental dysfunction helps to optimize pregnancy management and delivery, reduce perinatal morbidity and mortality.
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