Практическое значение результатов популяционных исследований единственной артерии пуповины (обзор литературы)

Статья в Elpub

Акушерство и Гинекология Санкт-Петербурга. 2020; : 11-17

Практическое значение результатов популяционных исследований единственной артерии пуповины (обзор литературы)

Аннотация

Цель обзора литературы – определение практического значения результатов популяционных исследований ЕАП. Материалами служили клинические отчеты, а методом – анализ опубликованных в них данных. В результате проведения последнего при иЕАП были установлены динамика неблагоприятных фетальных исходов при увеличении мощности исследования, их иерархическая структура, обоснованы основные позиции акушерской тактики. При ЕАП определены рейтинг связанных с ней мальформаций плода и готовность к их диагностике, способ управления факторами риска. Заключение. иЕАП выступает самостоятельным фактором внутриутробной / перинатальной смерти. Значение иЕАП для матери заключается в увеличении риска ручного отделения и выделения последа, гипотонического кровотечения, кюретажа матки после родов. Наиболее тесно ЕАП связана с атрезией / стенозом пищевода и аноректальной области и трисомией 13 и 18, а в отсутствие мальформаций плода – с такими аномалиями пуповины, как ее плевистая фиксация и краевое соединение с плацентой. В основе наблюдения за плодом с иЕАП должен находиться принцип комплексного использования диагностических методов (УЗИ, допплерометрия, КТГ) для раннего выявления признаков гипоперфузии плаценты, отставания в развитии и ацидоза плода. Необходимым условием оперативного родоразрешения при иЕАП выступает отрицательная динамика цереброплацентарного отношения / показателей гипоперфузии плаценты и патологический характер кардиотокографии. При родах естественным путем обязателен непрерывный электронный мониторинг частоты сердцебиения плода. После его рождения требуется готовность врача к проведению мероприятий по предупреждению осложнений аномалий прикрепления и локализации плаценты и к диагностике в родильном зале атрезий желудочнокишечного тракта и анеуплоидии у ребенка. Управление факторами риска ЕАП сводится к отказу от курения, стабилизации течения сахарного диабета и артериальной гипертензии

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Obstetrics and Gynaecology of Saint-Petersburg. 2020; : 11-17

The practical significance of population studies single umbilical artery (literature review)

Trusov Y. V., Kramarsky V. A.

Abstract

The purpose of the literature review was to determine the practical significance of the results of population studies of the single umbilical artery (SUA). Clinical reports served as materials, and the analysis of the data published in them served as a method. As a result of the latter, the dynamics of adverse fetal outcomes with an increase in the research power, their hierarchical structure, the basic positions of management were established at the SUA; SUA determines the rating of fetal malformations associated with it and readiness for their diagnosis, a way of managing risk factors. Conclusion: The IAPP is an independent factor in intrauterine / perinatal death. The significance of isolated SUA for the mother is to increase the risk of manual separation and secretion of the placenta, hypotonic bleeding, and uterine curettage after delivery. The SUA is most closely associated with atresia / stenosis of the esophagus and anorectal region and trisomy 13 and 18, and in the absence of fetal malformations - with such umbilical anomalies as its pleural fixation and marginal connection with the placenta. The principle of the integrated use of diagnostic methods (ultrasound, dopplerometry, cardiotocography) for early detection of placental hypoperfusion retardation and fetal acidosis. A necessary condition for operative delivery in patients with IAP is the negative dynamics of the cerebroplacental ratio / placental hypoperfusion and the pathological nature of cardiotocography. During childbirth in a natural way, continuous electronic monitoring of the fetal heart rate is required. After his birth, the doctor’s willingness to take measures to prevent complications of abnormalities of attachment and localization of the placenta and to diagnose atresias of the gastrointestinal tract and aneuploidy in the child is required. EAP risk factors are reduced to smoking cessation, stabilization of diabetes and arterial hypertension.

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