PATHOGENETIC SUBSTANTIATION OF ETIOTROPIC PREVENTION OF FETAL DISTRESS IN PREGNANT WOMEN WITH A HISTORY OF PERINATAL LOSSES

Abstract

The purpose of the study: to establish the features of fetal distress pathogenesis in pregnant women with a history of perinatal losses. Object and methods. We examined 200 women with perinatal losses in previous pregnancies. Cardiointervalography was performed to determine heart rate variability in order to assess the state of the autonomic nervous system. The condition of the mother-placenta-fetus system was examined using ultrasound with Doppler and determination of placental hormonal function. The levels of cortisol, adrenaline and norepinephrine were found. Results. The cardiointervalography analysis indicates a decrease of the ANS total tone in patients with a history of perinatal losses (decrease of SDNN), hypersympathotonia (increase of AM and LF) against a decrease of the parasympathetic tone (pNN50). In patients of the main group a violation of the placental hormonal function (decreased levels of progesterone, estradiol and placental lactogen) and increased stress hormones (cortisol, adrenaline and norepinephrine) revealed during study. Ultrasound manifest a structural changes of placenta in 48.5% of women in the main group. IUGR I was determined 4.8 times more often, IUGR II – 4 times more often in women with perinatal losses than in patients of the control group. IUGR III was diagnosed only in women with complicated obstetric history. IA-B and II degrees hemodynamic disorders in the «mother-placenta-fetus» system were diagnosed in these women almost 4 times more often than in the control group, III degree – only in women of the main group (3.5%). Cardiotocography showed signs of fetal cardiac reactivity of 5-7 points by Fisher’s scale in 16.0%, less than 5 points was determined in 3.5% of women in main group. Conclusion. In patients with a history of perinatal losses there is a decrease in overall ANS tone on the background of hyperactivity of the sympathetic division and a decrease in the parasympathetic tone. Women with a history of perinatal losses are at risk for placental dysfunction, as evidenced by ultrasound and Doppler signs, impaired placental hormonal function on the background of increased stress hormones.

Keywords

• perinatal losses
• fetal distress
• cardiointervalography
• autonomic nervous system
• placental dysfunction.