Мать и дитя в Кузбассе (Oct 2019)
THE USE OF PESSARIUM IN PREGNANT WOMEN WITH NO «MIGRATION» OF THE PLACENTA
Abstract
Purpose – to evaluate the influence of obstetric pessary on the blood flow in the area of the placental site in patients with abnormal location of the placenta. Materials and methods. The study included 60 pregnant women with high perinatal risk group (group А), abnormal location of the placenta (ALP). All pregnant women were carried out the installation obstetric pessaries in combination with vaginal micronized form of progesterone. As a result, women were divided into subgroups: the subgroup in which there was a «migration» of the placenta A2 (n = 37) and the subgroup in which the «migration» of the placenta was not observed A1 (n = 23). The stories of pregnant women who did not have placental «migration» (subgroup A1, n = 23) are described in depth. This group of women was divided into subgroups by the presence of placental attachment pathology: A1.x (n = 5) with the rotation of the placenta and A1.0 (n = 18) – without pathological attachment of the placenta. Results. The dynamic dimension of the index Purselo in arcuate arteries in the area of placentation found that it is a gradual build-up throughout pregnancy in the direction of a more highly resistant patients without «migration» of the placenta. At the same time, the increase in blood flow resistance was noted from 18 to 33 weeks by 1.12 times (p = 0.0004). Statistical difference of the index of Purselо identified between the groups without pathological attachment of the placenta (A1.0) and placenta accreta (A1.x) the period of 28 weeks, while patients of subgroup A1.0 indicators of the level of blood flow in arteries arcuate was lower (IR = 0,61 (0,57;0.69)) compared to subgroup A1.x (IR = 0,70 (0,70;0,77)) (p = 0,0073). These changes remained in the period of 33 weeks. Conclusion. In patients with placenta accretа the index resistance in arcuate arteries significantly higher than in normal placentation. The maximum increase in blood flow resistance occurs in terms of 24 to 28 weeks of gestation.
