Наукові праці. Кафедра акушерства та гінекології № 3
Permanent URI for this collectionhttps://repo.knmu.edu.ua/handle/123456789/31733
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Publication EP19.21: Disturbed uterine artery hemodynamics is a possible predictor of fetal autonomic malfunction(John Wiley & Sons Ltd, 2019-09-30) Vasylieva, Iryna; Lakhno, IgorObjectives Since abnormal trophoblastic invasion is known as a reason of great obstetric syndrome the issue is to find out additional markers for the detection of fetal compromise. A chronic placental insufficiency is an initial event in fetal malnutrition and deterioration. Fetal neurological maturation could be detected by monitoring heart rate variability (HRV). The validity of the amplitude of mode (AMo) and stress index (SI) in the diagnosing of fetal distress is known. In this study, we were interested in these variables of HRV in fetal growth restriction (FGR) and fetal deterioration. Methods Totally 197 pregnant women at the end of I trimester with an increased average pulsatility index (aPI) in uterine arteries (>1.5 MoM, FMF score) were enrolled in this research. This cohort was divided into two groups. Women with normal fetal growth (N = 129) were included in Group I. Pregnant ladies with FGR (N = 68) were observed in Group II. Fetal HRV variables were investigated using non-invasive fetal electrocardiography technique with the application of the Cardiolab Babycard equipment (Scientific and research centre “KhAI Medica”, Ukraine). The records were done at the term of gestation 26-27 weeks. The results thus obtained were analysed with an ANOVA test to compare data between groups. The significance was set at p-value <0.05. Relative risk (RR) for fetal compromise was calculated. Results The percentage of fetal growth restriction in the study population was 34.5%. The variables of AMo and SI in Group II was significantly higher than in normal growth Group: SI –1862.4; AMo –80.3% and SI –525.1; AMo – 67.3%, relatively (p < 0.05). The rate of fetal compromise detected by Doppler ultrasound was 14.0% and 44.1%. RR for fetal compromise was 3.407 (95% CI – 1,059 – 26,777). Therefore, FGR was featured by an autonomic malfunction and considerable rise of fetal deterioration. Conclusions Fetal HRV variables could be of use in the prediction of fetal compromise.Publication The utility of phase rectified signal averaging in diagnosing fetal distress(John Wiley & Sons Ltd, 2020-10-15) Vasylieva, Iryna; Lakhno, IgorObjectives Fetal heart rate variability is known as a marker of fetal wellbeing. The variables of phase rectified signal averaging – acceleration capacity and deceleration capacity (AC/DC) – were found to have a significant prognostic value in fetal growth restriction (FGR). Methods A total of 168 pregnant women at 26–28 weeks were examined. The patients with AGA fetases (N = 36) were enrolled in group 1. eFGR without fetal distress (N = 64) were group 2. eFGR with fetal distress (N = 68) = group 3. We used Cardiolab Babycard equipment (the "KhAI Medica" Scientific Research Centre, Ukraine) to non-invasive fetal electrocardiography. Fetal distress was diagnosed via Doppler ultrasound in case of the RD UA, absent A-wave in the DV, and umbilical vein pulsations.The results thus obtained were analysed with an ANOVA test. The significance was set at p-value <0.05. The correlations coefficients were estimated with Spearman's test. Results The maximally decreased AC/DC values were in Group 3 (p < 0.05). The variables of phase rectified signal averaging were lower in Group 2 than in Group 1 (p < 0.05) but higher than in Group 3 (p < 0.05). Thus, the delayed neurological maturation and the autonomic malfunction could be the reasons for fetal distress in FGR. The considerable correlation was detected in the appropriate to gestational age fetuses (R = 0.64, p < 0.05). In Groups 2 and 3, the force of correlation was almost similar (respectively, R = 0.62, p < 0.05; R = 0.68, p < 0.05). Therefore, AC/DC is a prospective marker for the detection of fetal compromise. This result was supported by a significant correlation in the pair “AC/DC vs umbilical blood pH” in all groups. The coefficients of correlation were: R = 0.70, p < 0.05; R = 0.68, p < 0.05; R = 0.72, p < 0.05 in Group 1, 2 and 3, respectively. Conclusions Fetal AC/DC variable is a sensitive tool for the detection of fetal distress in FGR.