Мать и дитя в Кузбассе (Feb 2022)
FEATURES OF UTERINE BLOOD FLOW WITH AN ABNORMAL LOCATION OF THE PLACENTA AGAINST THE BACKGROUND OF CORRECTION OF THE CERVIX WITH A DOME-SHAPED PESSARY ARABIN
Abstract
Anomalies in the location (ARP) and attachment of the placenta (APP) remain an important problem in obstetrics. The detection of ARP is based on ultrasound, but the diagnosis of placental rotation has not yet been standardized. Up to 2/3 of cases of APP remain undetected during pregnancy, therefore, the main direction of research is aimed at finding markers of APP. The aim of the research. Study of the features of uterine blood flow with an abnormal location of the placenta against the background of correction of the cervix with the arabin pessary. Materials and methods. 120 pregnant women with ARP were examined: main group A (n = 60) and comparison group B (n = 60). The main group received micronized progesterone vaginally 200 mg per day and an obstetric pessary was inserted at 18-20 weeks. In the comparison group, drug support was not provided. Ultrasound was performed at 18, 24, 28 and 33 weeks with Doppler examination of IR in the uterine arteries and in the arcuate arteries over the placentation area. Results. In patients with placental migration after the installation of an obstetric pessary, there was a decrease in IR in the arcuate arteries of the placentation area, which indicated an improvement in blood circulation in this area; in subgroups without placental migration, IR increased in the uterine and arcuate arteries; «Migration» of the placenta was observed 2.1 times more often in the group using an integrated approach; in subgroups with ams, IR levels were maximal. Conclusion. The process of migration of the placenta is carried out against the background of low-resistance blood flow; the use of an integrated approach to the management of pregnancy with ARP, allows you to influence the blood flow in the arcuate arteries of the placental region and, to a lesser extent, on the resistance of the uterine arteries; APP occurs against the background of high-resistance blood flow in both arcuate and uterine arteries, while the method of pregnancy does not significantly affect the process of placental rotation.
