N.A. CHEREPANOVA², R.S. ZAMALEEVA¹, L.I. MALTSEVA¹, A.V. FRIZINA²

¹Kazan State Medical Academy — Branch Campus of RMACPE MH Russia, Kazan

²Volzhsk Central Municipal Hospital, Volzhsk

Contact details:

Cherepanova N.A. — PhD (medicine), Head of Delivery Ward

Address: 46 Sovetskaya Str., Volzhsk, Russian Federation, 425005, tel. (83631) 6-37-73, e-mail: nat26@list.ru

Objective ― to study the doubtful cardiotocograms (CTG) and values of cardiovascular index (CVI) in women with complicated and physiological course of pregnancy, to extinguish the criteria of hypoxia and satisfactory state of fetus.

Material and methods. Comparison was carried out of the course and outcomes of pregnancy in 246 women in the third trimester with doubtful cardiotocograms (CTG) and various values of cardiovascular index ― ratio of mean arterial pressure (AP mean) to heart rate in women. Doubtful CTG was identified by three criteria at a time: FIGO, Fischer and Dowse-Redman. CTG was performed on a General Meditech device.

Results. Combination of a doubtful CTG with CVI increase over 1.3 preceded such complications as fetus hypoxia, asphyxia and morbidity of the newborns 2.2 times more often than with isolated increase of CVI; 4 times more often than with doubtful CTG with CVI increase less than 1.3, and 11 times more often than in the control group of healthy women with normal CTG and CVI parameters.

Conclusions. The criteria of fetus hypoxia is more than 1.3 increase of CVI combined with the increase of basal heart rate of fetus over 160 and up to 180, or absence of acceleration during 40 minutes of recording; and decrease of variability from 6 to 2 per minutes, increase of variability over 25 per minute or decrease of basal heart rate of fetus from 110 to 100 at STW 3-5 ms.

Key words: cardiotocography, cardiovascular index, doubtful CTG, mean AP.

(For citation: Cherepanova N.A., Zamaleeva R.S., Maltseva L.I., Frizina A.V. Contradictions in doubtful CTG in assessment of fetus functional state in the third trimester of pregnancy. Practical medicine. 2019. Vol. 17, no.  4, P. 37-42)

REFERENCES

1. Partsalis E.M. Risk factors for cognitive impairment in children. Novye issledovaniya, 2013, no. 2, pp. 4-22 (in Russ.).
2. Artymuk N.V., Trishkin A.G., Bikmetova E.S. Perinatal outcomes and long-term consequences of fetal growth retardation. Zhurnal akusherstva i zhenskikh bolezney, 2012, no. 6, pp. 68-75 (in Russ.).
3. Kuz’menko G.N. Sostoyanie gemostaza u nedonoshennykh novorozhdennykh s respi-ratornym distress-sindromom [The state of hemostasis in premature infants with respiratory distress syndrome]. Ivanovo, 2016.
4. Rutherford J. N. The primate placenta as an agent of developmental and health trajectories across the life course. In Building Babies: Primate Development in Proximate and Ultimate Perspective. NewYork: Springer, 2013. Pp. 27-53.
5. Putilova N.V., Nesterova E.A., Pestryaeva L.A. Evaluation of the hemocoagulation system in pregnant women with placental insufficiency and their newborns. Rossiyskiy vestnik akushera-ginekologa, 2017, vol. 17, no. 1, pp. 9-13 (in Russ.).
6. Longtine M.S., Nelson D.M. Placental dysfunction and fetal programming: the im-portance of placental size, shape, histopathology, and molecular composition. Semin. Reprod. Med, 2011.
7. Medvedev M.V. Osnovy dopplerometrii v akusherstve. Prakticheskoe posobie dlya vrachey. 4-e izd. [The basics of dopplerometry in obstetrics. Practical guide for doctors. 4th ed.]. Moscow: Real Taym, 2015. 80 p.
8. Akusherstvo: uchebnik, pod red. Radzinskogo V.E. [Obstetrics: a textbook. Ed. Radzinsky V.E.]. Moscow: GEOTAR-Media, 2016.
9. Benirschke K., Burton G.J., Baergen R.N. Pathology of the human placenta. Rim: Springer, 2012. 951 r.
10. Strizhakov A.N., Lipatov I.S., Tezikov Yu.V. Platsentarnaya nedostatochnost’ [Placental insufficiency]. Samara: OOO “Ofort”, 2014. 239 p.
11. Nesterova E.A., Putilova N.V. The role of parent-fetal thrombophilia in the formation of severe forms of placental insufficiency. Akusherstvo i ginekologiya, 2014, no. 2 (in Russ.).
12. Mochalova M.N., Ponomareva Yu.N. Modern methods for diagnosing the intrauterine condition of the fetus. Astrakhanskiy meditsinskiy zhurnal, 2015, pp. 15-26 (in Russ.).
13. Palieva N.V., Botasheva T.L., Linde V.A. et al. Influence of morphological and functional asymmetries of the mother – placenta – fetus system on hemodynamic processes in the uteroplacental complex, depending on the nature of the metabolism in the female body. Vestnik Adygeyskogo gosudarstvennogo universiteta, 2016, no. 2, pp. 108-114. (Ser. “Estestvenno-matematicheskie i tekhnicheskie nauki”) (in Russ.).
14. Ancheva I.A. Clinical characteristics of placental dysfunction with the position of the trends of modern obstetrics (Literature review). Bukovins’kiy medichniy vіsnik, 2016, vol. 20, no. 1 (77), pp. 196-199 (in Russ.).
15. Anokhin P.K. Ocherki po fiziologii funktsional’nykh system [Essays on the physiology of functional systems]. Moscow: Me-ditsina, 1975. 448 p.
16. Intensivnaya terapiya. Natsional’noe rukovodstvo [Intensive care. National leadership]. Moscow: GOETAR-Media, 2011.
17. Drandrov G.L. Funktsional’naya platsentarnaya nedostatochnost’ [Functional placental insufficiency]. Cheboksary: GUZ “Med. inform.-analiticheskiy tsentr” Minzdravsotsrazvitiya Chuvashii, 2007. 262 p.