Choice influence of delivery tactics on perinatal outcomes in pregnant women with preeclamps
M.I. Gracheva, N.E. Kan, A.E. Donnikov, V.L. Tyutyunnik
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow
Aim: to identify a dependence of perinatal outcomes on the choice of obstetric tactics for managing pregnant women with preeclampsia (PE) and intrauterine fetal state and the severity of PE.
Patients and Methods: 181 pregnant women were included in the study. Based on the inclusion criteria, the patients were divided into 2 groups. Group I included 97 pregnant women with the PE experience in the period from 26 weeks to 40 weeks 6 days, group II — 84 conditionally healthy pregnant women without the PE experience. Subsequently, the main group of patients was divided into 2 subgroups.
Results: pregnancy during PE is significantly more likely to be complicated by early toxicosis and threatened miscarriage in the first trimester with a subchorionic hematoma formation, threatened preterm labor and fetal growth retardation in the second and third trimesters. PE is characterized by the most unfavorable perinatal outcomes in the form of lower Apgar score at birth, low mass-growth indices.
In severe PE, perinatal outcomes are worse than during moderate PE, which is associated with preterm delivery periods. However, in severe PE up to 35.5 weeks of gestation, a severity underestimation of the fetus condition may occur, which is manifested with more severe perinatal outcomes during caesarean section for mothers.
Conclusion: since the perinatal outcomes during delivery up to 35.5 weeks for mothers were worse than during delivery for the fetus, it can be assumed that the severity of the fetus condition is underestimated when the state of the pregnant woman worsens. More favorable perinatal outcomes during delivery for the fetus indicate the effectiveness of active obstetric tactics for the prevention of neonatal morbidity.
Key words: preeclampsia, delivery tactics, preterm labor, perinatal outcomes, asphyxia, fetal hypoxia.
For citation: Gracheva M.I., Kan N.E., Donnikov A.E., Tyutyunnik V.L. Choice influence of delivery tactics on perinatal outcomes in pregnant women with preeclampsia // RMJ. Medical Review. 2018. № 8(I). P. 41–44.
References
1. Duley L. The global impact of pre-eclampsia and eclampsia // Semin. Perinatol. 2009. Vol. 33. P.130–137.
2. Spencer-Jones J. Make every mother and child count // S. Afr. Med. J. 2005. Vol. 95. P.382.
3. England, Wales and Northern Ireland. Confidential Enquiry into Maternal and Child Health (CEMACH); CEMACH: London, UK, 2008. [Электронный ресурс]. URL: http://www.publichealth.hscni.net/sites/default/files/Saving%20Mothers%27%20Lives%202003–05%20.pdf (дата обращения: 12.10.2018).
4. Warrington J.P., George E.M., Palei A.C. et al. Recent advances in the understanding of the pathophysiology of pre-eclampsia // Hypertension. 2013. Vol. 62. P.666–673.
5. Irgens H.U., Reisaeter L., Irgens L.M., Lie R.T. Long term mortality of mothers and fathers after pre-eclampsia: Population based cohort study // BMJ. 2001. Vol. 323. P.1213–1217.
6. Yu C.K., Khouri O., Onwudiwe N. et al. Fetal Medicine Foundation Second-Trimester Screening Group. Prediction of pre-eclampsia by uterine artery Doppler imaging: Relationship to gestational age at delivery and small-for-gestational age // Ultrasound Obstet. Gynecol. 2008. Vol. 31. P.310–313.
7. Witlin A.G., Saade G.R., Mattar F., Sibai B.M. Predictors of neonatal outcome in women with severe pre-eclampsia or eclampsia between 24 and 33 weeks’ gestation // Am. J. Obstet. Gynecol. 2000. Vol. 182. P.607–611.
8. Киселевич М.Ф., Главнова Е.С., Мелехина Э.Д. и др. Частота и особенности течения беременности и родов у женщин с асфиксией новорожденного // Белгородский государственный национально-исследовательский университет: сб. трудов конференции. 2018. С. 235–239 [Kiselevich M.F., Glavnova E.S., Melehina Je.D. i dr. Chastota i osobennosti techenija beremennosti i rodov u zhenshhin s asfiksiej novorozhdennogo // Belgorodskij gosudarstvennyj nacional’no issledovatel’skij universitet: sb. trudov konferencii. 2018. S.235–239 (in Russian)].
9. Постнов А.С., Баева Е.А. Предикторы риска формирования тяжелой асфиксии новорожденных, Современные технологии в педиатрической практике // Сб. материалов науч.-практ. конференции. 2015. С.166–167 [Postnov A.S., Baeva E.A. Prediktory riska formirovanija tjazheloj asfiksii novorozhdennyh, Sovremennye tehnologii v pediatricheskoj praktike // Sb. materialov nauch.-prakt. konferencii. 2015. S.166–167 (in Russain)].
10. Батман Ю.А. Прогнозирование развития дезадаптационного синдрома и асфиксии у новорожденных // Донецкий государственный медицинский университет им. М. Горького. 2007. № 4 (7). С.51–57 [Batman Ju.A. Prognozirovanie razvitija dezadaptacionnogo sindroma i asfiksii u novorozhdennyh // Doneckij gosudarstvennyj medicinskij universitet im. M. Gor’kogo. 2007. № 4 (7). S.51–57 (in Russain)].
11. Викторов В.В., Фатыхова А.И., Богданова Р.З., Куватов С.С. Факторы риска и прогноз развития пневмонии у новорожденных // Медицинский вестник Башкортостана. 2013. Т.8. № 3. С.62–67 [Viktorov V.V., Fatyhova A.I., Bogdanova R.Z., Kuvatov S.S. Faktory riska i prognoz razvitija pnevmonii u novorozhdennyh // Medicinskij vestnik Bashkortostana. 2013. T.8. № 3. S.62–67 (in Russain)].
12. Shwarzman P., Waintraub A.Y., Frieger M. et al. Third-trimester abnormal uterine artery Doppler findings are associated with adverse pregnancy outcomes // J. Ultrasound Med. 2013. Vol. 32 (12). P 2107–2113.
13. Pretorius T., van Rensburg G., Dyer R.A., Biccard B.M. The influence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis // Int. J. Obstet. Anesth. 2018. Vol. 34. P.85–95.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
