FETAL HAEMODINAMIC AND NEONATAL CEREBRAL CIRCULATION IN
MATERNAL THREATENED PRETERM LABORG.
Riga О., Senatorova А., Boychenko А., Kondratova I., Vasilyeva I.,
Kharkiv National Medical University, Ukraine
Background. . Maternal threatened preterm labor leads to the fetal distress and may
influence on the central and peripheral hemodynamic. The improvement of
practical approach to cerebral hemodynamic disturbances in neonates starting from
fetal period is important for prevent of hypoxic encephalopathy. Objectives.
Prospective case-control investigation of umbilical and cerebral neonatal
circulation was preformed on 26 multyplay pregnancy women and 27 neonates
during the early neonatal course: I group – 31infants with maternal threatened
preterm labor and 20 ones - with physiologic course maternal pregnancy. Mean
age of fetal circulation investigation was 34.1±4.0 weeks. Methods. The routine
sings of blood flow were estimated: Vmax – peak-systolic blood velocity, Vmin –
end-diastolic blood velocity, S/D - systolo-diastolic ratio, RI – relative resistant
index. In addition to the routine blood flow sings, the correlation and ratio between
every measures of uterus, umbilical, fetal and neonatal cerebral flow were studied.
For statistic analysis the program STATISTICA 7 was used. The dopplerometry
investigation of blood flow at the bilical artery (UA), fetal aorta (FA), fetal
medium cerebral arteri (FMCA), and neonate medium cerebral artery (NMCA)
was performed on the ultrasound apparent "LOGIQ Book XP" («General Electric
Co.» , Germany). Results. The pregnancy course in women with
threatened
preterm labor was characterized by acute respiratory infection (p=0,0026), and
inflectional disease of genitourenal tract (p=0,0033). Statistical frequently the
poly-hydramnion (p=0,0003) and asphyxia of newborn (p=0,0437) were present
during intranatal period. The early neonatal course in newborns from mothers with
threatened preterm labor has shown the significant of respiratory distress syndrome
(p=0.005). The early neonatal course in newborns from mothers with threatened
preterm labor has shown the significant of respiratory distress syndrome (p=0.005).
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There were significant difference (Mann-Whitney U Test) in S/D ratio in uteri
artery in women: 2.2 (I) and 1.9 (p=0,0343). There were no difference of blood
flow parameter in UA. The statistically significant difference was at fetal aorta: RI
0,83 (I) and 0,80 (II) (p=0,0000); and fetal medial cerebral artery: V max 42.8 (I)
cm/sand 47 cm/s (II) [р=0.022]; V min 12.6cm/s (I) and 15cm/s (II) [р=0,000]; RI
0.73 (I) and 0.68 (II) (p=0,0177). The additional parameters of fetal and neonatal
cerebral dopplerometry have shown statistic significant difference in neonates both
groupes: Vmin FMCA/Vmin UMB: 1.3 ( I) and 0.92 (II) [p=0.0235]; SD FMCA SD UMB: 0.008 (I) and 0.71 (II) [p=0.0041]; SD FMCA/ SD UMB: 1.07 (I) and
1.48 (II) [p=0.0062]; Vmin FAo - Vmin UMB: 6.63(I) and 3.03(II) [p=0.0080];
VminFAo/Vmin UMB: 1.04 (I) and 0.92 (II) [p=0.0235]; Vmin FMCA/Vmin
FAo: 1,75(I) and1,44 (II) [p=0,0343]; RI FMCA/IR FAo: 0,80(I) and 0,89(II)
[p=0,0326]; V min NMCA/V min UMB: 0,52(I) and 0,41(II) [p=0,0235].
Conclusions.We conclude that infants with maternal threatened preterm labor
mothers have decreasing of cerebral hemodynamic speeds since intrauterine
period. There is a relation between umbilical flow and cerebral circulation before
and after birth. The replacement of blood flow in fetus of woman with threatened
preterm labor may be a compensatory process for supporting cerebral
hemodynamic during intrauterine life and early neonatal period. The additional
dopplerometric parameters may be early diagnostic criteria of fetal reaction to
distress.
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