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Symptoms of disease - violation of the fetal blood flow

The Doppler effect is based on the change in the frequency of the sound waves depending on the speed of the observed radiator. In our case the change in frequency of the reflected ultrasonic signal from non-uniformly moving medium - blood in the vessels. Change the frequency of the reflected signals are recorded in the form of curves of speeds of blood flow (CIC).

Hemodynamic disorders in the functional system of the "mother-placenta-fetus" is the leading pathogenetic mechanism of violation of the state and development of the foetus in the various complications of pregnancy. In the vast majority of observations hemodynamic disorders are characterized by versatility and uniformity changes regardless of the status of the fetus and etiopathogenetic factor.

Changing the normal parameters KSK - there is a specific manifestation of many pathological conditions of the fetus, and in many cases, preceding the appearance of clinical symptoms, it is important that this applies to the main pathological conditions in pregnancy - FGRS, hypoxia of the fetus, gestosis, etc. During the period from 18-19 to 25-26 weeks. Doppler - the method of choice, because fetal biophysical profile is informative to 26 weeks, and cardiotocography still not significant.

Methodology dopplerometry involves getting curves speed of blood flow in the vessels of the utero-placental-fetal blood flow, the calculation of indices vascular resistance (ISS), the analysis of the obtained results.

Which diseases there is violation of the fetal blood flow

Classification of violations of the fetal blood flow

1 DEGREE - violation of the Feto-placental blood flow, not reaching the critical values and the satisfactory condition of fetal hemodynamics (impaired blood flow only in the arteries of the umbilical cord). The SDS in the thoracic aorta - 5,52 ± 0,14, in the internal carotid artery - 3,50 to + 1.3. Is compensatory decline in the index of diastolic function of both ventricles of the heart of the fetus in 58,3% of the cases, increase the maximum speed of the blood flow through all the valves of the heart in 33.3%.

2 DEGREE - compensated violation of the fetal blood flow (violation of the fact of fetal hemodynamics). Centralization of blood circulation of a fetus. Reducing the maximum speed of the blood flow through all the valves of the heart of the fetus in 50% of cases, to the left of the departments, to a lesser extent. Further reduction of the index of diastolic function of the ventricles (E/A). Remains the domination of the right-wing departments of the fetal heart. Pathological spectrum of blood flow in aorta and/or internal carotid artery of the fetus. The aorta is a violation of the circulatory system by type of violations in the arteries of the umbilical cord. In the internal carotid artery increase the level of diastolic blood flow resistance reduction microvascular channel hemispheres of the brain of the fetus. In 100% of cases of violation of blood circulation in the vessels of the secondary with respect to changes in the arteries of the umbilical cord. The secondary character of changes in the internal carotid artery to changes in the aorta of the fetus is not installed. The initial change of circulation of the blood vessels of the brain occurs much less frequently (neplatsentarny type of fetal hypoxia). 2 degree not long, quickly passes in 3 degree.

stage 3 is the critical condition of fetal blood flow. The dominance of the functional relation of the left-heart on the right - the more profound restructuring of the intracardiac hemodynamics associated with the centralization of blood circulation. Strengthening of fetal hypoxia - reduction of through the valve blood flow to 10.3% for the valves of the left departments and by 23.3% - to the right-wing. Functional insufficiency of tricuspid valve in 66,7% of cases (flows regurgitation). The aorta is decrease in diastolic blood flow to his absence (69,6%). Decrease of the resistance of the internal carotid artery in the 57,1% of cases. The combination of the simultaneous violations in the aorta and in the internal carotid artery more often, than in 2 extent of the violation (14.3% and 42.3%, respectively).

Stages of violations of the fetal blood flow

1 the degree of the second goes in an average of 3 weeks; 2 to 3 through 1,3 weeks. Possible compensation for violations of the fetal blood flow in different stages, more than in the first stage, less - in the second. In the 3rd stage of decompensation fruit hemodynamics.

Perinatal loss: 1 the degree of violations of the fruit of hemodynamics of 6.1% of cases, 2 degree - 26.7%, of 3 degree - 39,3%.

Intensive therapy of newborns: 1 degree - 35,5%, 2 degree - 45.5%, and in 3 degree - 88,2%.

Conclusions:

1. Increase of DLS (peripheral resistance) is a factor of high risk of complications in the neonatal period.
2. The most frequent reason for the rise of the SDS - intrauterine infection.
3. Long spasm of the cerebral vessels plays an important role in the reduction of compensatory abilities, which leads to violation of the adaptation processes in the early neonatal period.

The average value of the IR uterine artery in 22-41 week of pregnancy.
1. Infants born in the normal state - 0,482± 0,052.
2. Infants born with initial signs of hypoxia in the early neonatal period - 0,623±0,042.
3. Newborns are born in a state of medium gravity 0,662± 0,048.
4. Infants born in the grave and extremely grave condition; death in the early neonatal period - 0,750±0,072.

After 29 weeks threshold DLS (at least on one side) - 2,4, IR - 0,583.
In case of arterial hypotonia in 88% of cases, reduction in BMD of the small minute volume of blood.
Decline of unions and the IPC with a high probability indicates the possibility of the development of complications in infants in the early neonatal period, at the same time, the lack of reduction is not a reliable diagnostic criterion of placental insufficiency of blood circulation, which is a cause of chronic intrauterine suffering of the fetus in 45-60% of cases.
The main cause of malnutrition - a violation of the utero-placental blood flow.

Forecasting FGRS:

At infringement of blood circulation 1A extent syndrome FGRS develops in 93.2% of cases; on the one hand - in 66,7% of cases, with the two sides -95,7%. In violation of the circulatory system 1B degree FGRS develops in 81.6% of cases. While reducing the IPC and the FPK - in 100% of cases.

Under the influence of therapy may improve hemodynamics in the light degree of preeclampsia. The violation of blood circulation in the utero-placental link is less positive than in the Feto-placental unit, which can be explained by the development of morphological changes in the blood vessels of the uterus due to preeclampsia. At the same time, the normalization of blood flow in 40% of cases in the arteries of the umbilical cord is intended functional nature of the changes fetoplacental hemodynamics. However, with severe preeclampsia fetoplacental hemodynamics after treatment did not change significantly. The emergence of a "zero" or retrograde blood flow in the arteries of the umbilical cord, showing the extreme degree of the suffering of the fruit that dictates the necessity to reject the therapy in favor of an emergency delivery.
The diagnostic significance of dopplerometry MA and AP is true only when the violation of blood circulation, when the abnormal colposcopy. However Doppler MA and AP in the event of discrepancy size of the fetus gestation of the pregnancy (in case of suspicion on the symmetrical form of malnutrition) may be used for differential diagnosis with a healthy underweight fruit. The presence of the normal blood flow in a small-sized fruit in the majority of cases will be talking about a healthy LBW the fetus.

Still conclusions:

1. Doppler a fairly reliable method of diagnostics of the condition of the fetus.
2. The normal values of FPK and the IPC, cerebral blood flow are not reliable diagnostic criteria of absence of violation of the condition of the fetus.
3. Reduction in placental blood flow in the majority of cases is accompanied by the fetus hypotrophy.

There is a clear dependence between the character of the blood flow in the uterine arteries and the severity of the clinical picture of preeclampsia (the violation of 59.5%).

In preeclampsia violation of blood circulation occurs in only one of the arteries in the 80,9% of the cases (19.1% in 2 uterine arteries). In connection with this, the blood should be measured in both uterine arteries.

In preeclampsia fetal-placental blood flow violated almost half of pregnant women; when FGRS in 84.4% of cases.

The dependence between the frequency of violations of the blood flow in the arteries of the umbilical cord and the clinical picture of preeclampsia is not revealed.

Impaired blood flow in aorta fruit is accompanied by expressed by the FNV, clinically manifest FGRS 2 and 3 degrees.

Gestosis primary disrupted blood flow in the uterine artery, then, as the deepening of the violations in the arteries of the umbilical cord.

Perinatal mortality

Under normal performance of the MPP blood flow and 1 degree of violation cases of perinatal mortality no, a 2-degree - in 13.3%, 3 degrees - in 46.7% of the cases.

Dopplerometric study in women with violation of hemodynamics of 3 degrees in the system of the "mother-placenta-fetus", has allowed to establish the ineffectiveness of the therapy of placental insufficiency. The conservative the conduct of birth perinatal mortality rate was 50%. During delivery by caesarean section perinatal losses was not.

Integrated dopplerometric evaluation of blood flow of the uterine arteries and the arteries of the umbilical cord can be considered as an objective indicator of the severity of gestosis, regardless of its clinical manifestations.

Doppler in the right of the uterine artery is a valuable method in the diagnosis of allowing in the 2nd trimester select group of pregnant with high risk for development of late gestosis (20-24 weeks, the most precise 24-28 weeks). Reliability is 98%. According to the theory of substantial blood supply right uterine artery of the uterus, the frequency of preeclampsia and FGRS above when the location of the placenta at the left wall of the uterus. The deutipara when the location of the placenta from the left fairly often develops FGRS than the primiparous. When the placenta situated on the right there are no distinctions. Probably, this is because postpartum uterine involution leads to a substantial reduction "of the disabled" channel left MA.
Measurement of the ISS in the right MA should be considered as an acceptable method of selection of groups of pregnant for the development of late toxicosis. The forecast should be defined primarily in the 2nd trimester of pregnancy.
Doppler has a high diagnostic and prognostic value if complications of pregnancy: the gang - gestosis, FGRS, fetal hypoxia of the fetus.

This method allows to forecast the complicated course of the early neonatal period and the development of neurological disorders in the newborn.

The outcome of pregnancy and childbirth is defined not so much a nosological accessory, how many degree of hemodynamics in the system mother-placenta-fetus.

Timely correction of management of pregnancy and childbirth, medicamental therapy, carried out with the account of dopplerometry indicators, can reduce perinatal morbidity and mortality, but do not exclude the high risk of severe neurological complications in the early neonatal period.
High diagnostic value of the study of blood flow in the MA at FGRS is explained by the fact that the primary link in the development of this pathology in the majority of cases are violations of the utero-placental blood flow. When you change the KSK in one of the uterine arteries FGRS develops in 63.6% of cases, in 2 - in 100% of cases.

In preeclampsia abnormal colposcopy detected in 75% of cases. In severe forms of gestosis changes are taking place in parallel in the arteries of the umbilical cord. In patients with hypertension the accuracy of the prediction of adverse perinatal outcomes during pregnancy significantly exceeds the accuracy of clinical tests (HELL, the clearance of creatinine, urea, etc.).

With increase of the SDS in the uterine arteries more than 2.6 forecasting of adverse outcomes with a sensitivity of 81%, a specificity of 90%.

If you rely on bisferious notch sensitivity - 87%, specificity of up to 95%.
For the forecast of complications in the 3rd trimester important assessment of the KSK in the 2nd trimester of pregnancy. Pathological KSK in 15 to 26 weeks of pregnancy - reliable prognostic sign of development in the 3rd trimester of preeclampsia and FGRS. Detection of pathological reduction of diastolic blood flow in the uterine artery on 4-16 weeks preceded by the appearance of clinical symptoms of preeclampsia. Study of the KSK in the uterine artery allows to accurately predict otsloicu of the placenta. For the 4 weeks prior to the detachment of the placenta (in 4 out of 7 pregnant) noted pathological decrease in diastolic blood flow, the emergence of dicrotic grooves. When abruption DLS in the arteries of the umbilical cord is increased to 6.0.

Which doctor should I contact if there is a violation of the fetal blood flow

• Obstetrician-gynecologist

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