Эхографические и допплерометрические показатели в оценке течения беременности у женщин с угрозой выкидыша в ранние сроки

Abstract

Целью данной работы было оценить ультрасонографические показатели и систолодиастолическое отношение у пациенток с угрозой выкидыша в ранние сроки гестации. Материал и методы. Обследовано 104 беременных женщин в сроки гестации 5 - 12 недель. В основную группу вошли 84 беременных с угрозой невынашивания ранних сроков, в контрольную группу - 20 женщин с физиологическим течением беременности без признаков угрозы невынашивания. В контрольной группе средний возраст составил 25,24±1,0 лет, в основной группе 26,8±1,07 лет. Наряду с клиническими методами проведены УЗИ и допплерометрическое исследование. Результаты. Среди гинекологической патологии достоверно чаще встречались заболевания воспалительного характера (эндометрит, аднексит) - 38,1%. При УЗИ гематома различной локализации отмечалась в 98,8% случаев, гипертонус миометрия - в 57,1%, нарушение формирования желтого тела - в 48,8%. В 54,8% случаев встречались все три признака. У 66,7% беременных объем внутриматочной гематомы не превышал 9 см3. В основной группе хорион чаще располагался в области внутреннего зева (40,5%), в контрольной группе наиболее часто хорион локализовался по передней стенке (40,0%). В основной группе систоло-диастолическое отношение в правой маточной артерии по сравнению с контрольным показателем был снижен на 27,0% (р<0,05), в левой - на 23,7%. Выводы. Всем беременным женщинам целесообразно проводить ультрасонографию в I триместре в сроке до 12 недель. Полученные нами результаты четко демонстрируют ценность этого исследования.

The aim of this study was to evaluate ultrasonographic parameters and systolic-diastolic ration in patients with threatened miscarriage in the early gestation period. Material and methods. The study included 104 pregnant women at the gestation period of 5-12 weeks. The main group included 84 pregnant women with the threat of early miscarriage; the control group covered 20 women with physiological pregnancy without signs of the threatened miscarriage. In the control group, the mean age was 25.24±1.0 years, in the main group the mean age was 26.8±1.07 years. During the investigation we applied clinical techniques, ultrasound and dopplerometric imaging techniques. Ultrasound (US) and Doppler scanning were carried out by the device "Aloka-1400" and "Aloka-1700" (Japan), operating in the mode of gray scale and real time scale with the help of a convex abdominal and vaginal sensors with a frequency of 3.5 and 5 MHz. Dopplerometry was used to assess the systolic-diastolic ratio (S/D) in both uterine arteries. Results. In the group of the patients with the threat of miscarriage, primigravidae made up 22.6%, secundigravidae made up 77.4%; respectively, in the control group there were 25.0% of primigravidae and 75.0% of secundigravidae. There were 30 (35,7%) primigravidae and in 9 (45%) secundigravidae in the control group. Preterm labour occurred in 11.9% of cases in the main and in 5.0% of cases in the control group. Reproductive losses manifested by early spontaneous miscarriages were observed to be significantly more frequent in the main group (p<0.01), and late spontaneous miscarriages were observed only in the main group in 14.3% of cases. Among gynaecological pathology, inflammatory diseases (endometritis, adnexitis) were significantly more frequent, and made up 38.1%. Ultrasound-detected hematomas of various localization were observed in 98.8% of cases, myometrium hypertonicity was registered in 57.1%, and the disruption of the corpus luteum was registered in 48.8% of cases. In 54.8% of cases all these three signs were found out. In 66.7% of pregnant women, the volume of intrauterine hematoma did not exceed 9 cm3. In the main group, chorion was more often detected in the area of external orifice of uterus (40.5%), while in the control group chorion was most often detected along the anterior wall (40.0%). In the main group of SDS in the right uterine artery compared with the control indicator was reduced by 27.0% (p<0.05), in the left uterine artery – by 23.7%. Conclusion. The first trimester (up to 12 weeks of gestation) US scan should be implemented into the pregnancy management as it enables to detect risks associated with possible miscarriages. Our findings clearly demonstrate the value of the US scan.