Borzenko I. Prediction and early diagnosis of fetal growth retardation in pregnant women with placental dysfunction

The dissertation is devoted to optimization of prognosis and early diagnosis of fetal growth retardation in women with placental dysfunction by substantiation and development of a personalized diagnostic algorithm. Assessment of obstetric histories of women with placental dysfunction showed that previous pregnancies in women with placental abnormalities were complicated by miscarriages, artificial abortions, disorders of the vaginal microbiocenosis. Threatened abortion should be assessed as an integral indicator of the clinical manifestation of cytotrophoblast invasion deficiency, which in the future may cause placental dysfunction. Patients with placental dysfunction were found to have significantly reduced concentrations of endothelium-dependent markers of vascular wall athrombogenicity, increased concentrations of thrombomodulin and thrombospondin levels, as well as impaired time course of the production of soluble forms of vascular molecules of cell adhesion 1 and thrombocyto-endothelial molecules of cell adhesion 1 as compared to women with physiological course of gestation. The development of placental dysfunction of endotheliotropic origin is accompanied by changes in intracellular metabolism, in particular the formation and impairment of the utilization of reactive oxygen species and a severe disruption of fetoplacental hemodynamics. Placental spiral arteries in fetal growth retardation in women with placental dysfunction are characterized by a decrease in the area size of the lumens by 57%. Based on the obtained clinical-morphological and endotheliotropic criteria, a personalized clinical algorithm for managing pregnant women with placental dysfunction was developed and implemented, which helped not only to avoid cases of antenatal mortality, but also to prevent intranatal and early neonatal mortality.