Наукові праці. Кафедра акушерства та гінекології № 3
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Publication The relationship between fetal and maternal hemodynamic oscillations in normal and growth restricted fetuses(Athens Institute for Education & Research (A World Association of Academics and Researchers), 2017-03-15) Lakhno, IgorThe study was aimed to the investigation of the maternal heart rate variability involvement in regulation of fetal circulatory system in case of healthy pregnancy and in fetal growth restriction. 98 patients at 34-40 weeks of gestation were enrolled in the study. And 30 of them were involved in Group I (control). In Group II 34 pregnant women with fetal growth restriction and normal Doppler indices were observed. 34 patients with decreased values of hemodynamic indices were monitored in Group III. The circulatory abnormalities in the utero-placental bed in patients with fetal growth restriction induced maternal and fetal autonomic response. The development of fetal compromise was due to an increased sympathetic and decreased parasympathetic tones. The fact of the considerable relationship between fetal and maternal heart rate variability in healthy pregnancy demonstrated the oscillatory nature of their interaction. Placental bed pathology in patients with fetal growth restriction and abnormal circulatory indices contributed to failed hemodynamic fluctuations exchange between mother and fetus.Publication HRV descriptors for fetal distress assessment in pregnancy with fetal growth restriction(CSREA Press, 2018-07-16) Guzmán-Velázquez, Bertha Patricia; Lakhno, Igor; Díaz-Méndez, AlejandroThis paper focused on the fetal wellbeing assessment, through the selection of HRV descriptors as evident markers of fetal distress. The study of behavior in experiments with control groups of healthy pregnant women and pregnant women with fetal growth restriction allows obtaining quantitative descriptors that help assess the loss of fetal well-being. The results show that SI (Sp=1, Se=0.9882), and AMo (Sp=0.8118, Se=0.9882) are evident markers of fetal distress.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.Publication Delayed neurological maturation is a cause for distress during fetal growth restriction(Trilist, 2020-07-10) Lakhno, Igor; Malikova, S.Theory of fetal programming contributes to a better understanding of the relationship of many human diseases with antenatal period pathology. Regulatory impact of nervous system is of great importance. Fetal growth restriction (FGR) is a convenient model for investigation of the abnormalities of fetal neurodevelopment. Fetal heart rate variability is a well-known approach for fetal autonomic function detection. The aim of the study was to detect several patterns of autonomic nervous regulation in FGR complicated by fetal distress or without fetal distress. Materials and methods. Totally 64 patients at 26–28 weeks of gestation were enrolled. 23 patients had normal fetal growth and were included in the Group I (control). 20 pregnant women with FGR without fetal distress were observed in Group II. 21 patients with FGR and fetal distress were included in Group III. Fetal heart rate variability and conventional cardiotocographic patterns were obtained from the RR-interval time series registered from the maternal abdominal wall via non-invasive fetal electrocardiography. Results. Suppression of the total level of heart rate variability with sympathetic overactivity was found in FGR. The maximal growth of sympathovagal balance was found in Group III. Fetal deterioration was associated with an increased quantity of decelerations, reduced level of accelerations, and decreased of short term variations and low term variations. But a decelerative pattern before 26 weeks of gestation was normal. Therefore fetal autonomic malfunction could be a result of persistent neurological immaturity in FGR. The approach based on the monitoring of fetal autonomic maturity in the diagnosing of its well-being should be tested in further studies. Conclusion. Fetal heart rate variability variables and beat-to-beat variations parameters could be the sensitive markers of neurological maturation and good predictors for fetal deterioration.Publication Fetal autonomic malfunction as a marker of fetal distress in growth-restricted fetuses: three case reports(Korean society of obstetrics and gynecology, 2019-10-10) Lakhno, Igor; Schmidt, AlexanderFetal growth restriction (FGR) is characterized by fetal compromise and delayed neurological maturation. We report 3 cases of early FGR in the 26th week of gestation, based on hemodynamic Doppler monitoring, conventional cardiotocography, and non-invasive fetal electrocardiography (NI-FECG). Fetal heart rate variability (HRV), beat-to-beat variations, and fetal autonomic brain age scores (fABASs) were normal despite the absence of umbilical diastolic flow in the first case and the pregnancy continued to 30 weeks. NI-FECG helped achieve better fetal maturity. Fetal HRV and fABASs were low in the second and third cases. Fetal demise occurred soon in both cases. We conclude that NI-FECG could be a prospective method for the detection of fetal distress in early FGR.Publication Diagnosing antenatal fetal distress(Via Medica, 2021-05-14) Lakhno, Igor; Uzel, KemineObjectives: The values of acceleration capacity and deceleration capacity are known to capture fetal neurological development. The fetal growth restriction was found to be featured by decreased variables of phase rectified signal averaging. We have speculated that acceleration capacity and deceleration capacity could be of use in the detection of antenatal fetal distress during fetal growth restriction. The study was focused on the detection of the accuracy of acceleration capacity and deceleration capacity in diagnosing fetal distress. Material and methods: In total, 124 pregnant women at 26-36 weeks of gestation were included in the study. The patients with appropriate to gestational age fetuses (n = 32) were enrolled in Group I. The patients with fetal growth restriction and an absence of fetal distress (n = 48) were observed in Group II. Lastly, the patients with fetal growth restriction and fetal distress (n = 44) were included in Group III. Fetal cardiosignals were obtained via non-invasive fetal electrocardiography. The maximally decreased acceleration capacity and deceleration capacity values were found in Group III. Results: A correlation was found between umbilical artery resistance index and acceleration capacity and deceleration capacity variables in all study groups. We have found that the application of phase rectified signal averaging in the antenatal period showed high sensitivity and specificity in fetal distress detection. Conclusions: Fetal acceleration capacity and deceleration capacity is a prospective option for the detection of fetal compromise during fetal growth restriction.Publication The hemodynamic repercussions of the autonomic modulations in growth-restricted fetuses(Elsevier, 2017-01-16) Lakhno, IgorObjectives Idiopathic fetal growth restriction is considered to be associated with hemodynamic abnormalities. The study was aimed to the investigation of the relationship between fetal and maternal autonomic balance, arterial and venous hemodynamic Doppler indices and CTG variables in case of normal fetal development and fetal growth restriction. Method 106 patients at 32–40 weeks of gestation were enrolled in the study. 30 of them had healthy pregnancy and were involved in Group I. In Group II, 44 pregnant women with fetal growth restriction and normal umbilical hemodynamic Doppler indices were observed. 32 patients with fetal growth restriction and an absent or reversed end-diastolic umbilical flow were monitored in Group III. The curves of maximum blood flow velocity were isolated and their spectral components were determined from the umbilical Doppler spectrograms. The maternal and fetal heart rate variability, conventional CTG patterns were obtained from RR-interval time series registered from maternal abdominal wall electrocardiographically. Results The increased adrenergic regulation has modulated parasympathetic impact on fetal cardiovascular system. The decreased reactivity was mirrored in low LTV, lack of accelerations and an increased score of decelerations. The CTG findings were also featured by the revealed correlations demonstrated an obvious relationship between fetal and maternal hemodynamics in healthy pregnancy. It was possible to speculate that a controlling signal of 0.5 Hz has played a significant role in the umbilical venous blood flow. The decreased fetal autonomic tone and the fetal and maternal hemodynamic decoupling were found in growth-retarded fetuses. Conclusion Fetal heart rate pattern was influenced by maternal and fetal autonomic tone. Maternal cardiovascular oscillations were reflected in the umbilical circulation in healthy pregnancy Fetal distress was featured by sympathetic overactivity and the reduction of vagal tone. Such autonomic modulations was manifested by the decelerative pattern of CTG and deteriorated umbilical hemodynamics.