Метою дослідження була розробка ультрасонографічних критеріїв прогнозування перинатальних наслідків при недоношеній вагітності, усладненій передчасним розривом плодових оболонок. Показано, що висота стовпа амніотичної менш 40,0 мм до 28 тижнів, 37,0 мм в 28-31 і пізніші терміни є критичними і визначають високий ризик неонатальної, антенатальної та постнатальної загибелі новонарождених. Обґоворюється прогностична цінність кількісного визначення висоти стовпа амніотичної рідини при передчасному розриві плодових оболонок.
The purpose of the research was the development of ultrasonographic criteria of prediction of perinatal implications in incomplete pregnancy, complicated by premature rupture of membranes (PROM).
Materials and Methods. During the period of 2007-2012 a comprehensive randomized clinical-laboratory
e x amination of 148 pregnant women and newborns was carried out, pregnancy course and childbirth, as well as
state of newborn in women with PROM during the term of 22-35 weeks of pregnancy was studied. The investigation
has been carried out using the facilities of Odessa maternity hospital No5, specialized in noncarrying of pregnancy
and preterm birth. To e x clude the impact of number of factors onto obstetric complications, pregnant women with
severe endocrine pathology: preeclampsia, multiple pregnancy and newborns with congenital defects of development have not been involved into study. Manifestations of chorioamnionitis were contraindications to prolongation of pregnancy. In case of insufficiency of the therapy, aimed at maintenance of pregnancy, a delivery has been
conducted conventionally in compliance with common principles of preterm labor management, issued by MPH of
Ukraine from 09.01.2014 No 7.
Results and Discussion. The analysis of e x tragenital pathology in all observed pregnant women showed high
frequency of chronic somatic disease. Diseases of the gastrointestinal tract and urinary system were noted with
equal frequency in all gestational groups and have not had a significant impact on the postnatal implications. ENTpathology (chronic tonsillitis, chronic pharyngitis) has been noted the most frequently. Endocrine pathology was
mainly represented by diseases of the thyroid gland, more often by hypothyroidism, as well as hyperandrogenic
state, observed from 21 % to 24 % in all gestational groups.
An important outcome of the study analysis can be high prediction value of quantitative determination of the
height of the amniotic fluid column in PROM. It is considered that the major cause of fetal death in PROM, umbilical
cord compression, in particular, is an e x tremely apparent oligohydramnios. Number of published data (authors)
gives evidence of the relationship between the prolonged oligohydramnios in PROM and term of pregnancy of
22-28 weeks with dysplasia of fetus lungs, umbilical cord compression, and antenatal mortality.
The obtained data have shown that the height of the amniotic fluid column less than 40,0 mm to 28 weeks, 37.0
mm in 28-31 and later terms are critical and define the high risk of neonatal, antenatal and postnatal mortality of
newborns. It is considered that the important outcome of the study analysis can be high prediction value of quantitative determination of the height of the amniotic fluid column in PROM. Consequently, the major cause of fetal
death in PROM, umbilical cord compression, in particular, is apparent oligohydramnios. These data proved that
monitoring of the height of the amniotic fluid column in PROM is of great prediction value as for perinatal outcomes
of pregnancy.
It is associated primarily with the ultrasound determination of volume of residual amniotic fluid, especially in
the dynamics of the duration of anhydrous gap allows a conclusion about the e x istence of certain patterns. If the
average vertical diameters of free areas of amniotic fluid are considered to be normal in healthy pregnant women in
terms of gestation of 28-34 weeks (average 43,0 ± 1.2 mm), forewaters are not defined in 48 hours after the beginning of anhydrous gap in pregnant with PRPOM. The similar dynamics is observed with respect of the posterior and
lateral diameters of free areas of amniotic fluid, which after 48 hours of PRPOM decrease twice to 30.2 ± 2.1 mm,
and after 72 hours – up to 24.7 ± 2.2 mm (p < 0.05), and further up to the complete absence of ultrasound imaging
of amniotic fluid.
Conclusions. The studies have established that the discovered critical height of the amniotic fluid column may
be indication for urgent delivery regardless of the gestation term to prevent neonatal mortality.
Целью исследования была разработка ультрасонографических критериев прогнозирования перинатальных последствий при недоношенной беременности, осложненной преждевременным разрывом плодовых оболочек. Установлено, что высота столба околоплодных вод менее 40,0 мм до 28 недель, 37,0 мм в 28-31 и более поздние сроки являются критическими и определяют высокий риск неонатальной, антенатальной и постнатальной гибели новорожденных. Обсуждается прогностическая ценность количественного определения высоты столба амниотической жидкости при преждевременном разрыве плодовых оболочек.
