The dissertation is focused on the identification of new pathogenetic factors in the development of placental dysfunction and the optimization of management strategies for women with placental dysfunction.
Placental dysfunction (PD) is a complex clinical syndrome caused by morphological and functional changes, as well as impaired compensatory and adaptive responses that ensure the full functioning of the placenta as an organ, adequate fetal growth, and normal development of fetal organs and systems.
The causes of PD development can be divided into endogenous (genetic, infectious, endocrine factors that cause placental disorders, angiogenesis and vascularization, and impaired differentiation of chorionic villi, leading to the formation of primary PD) and exogenous (extra-genetic diseases, complications of pregnancy that lead to impaired uterine-placental and fetal-placental blood circulation, resulting in the formation of secondary PD).
Clinically, PD manifests itself in the form of chronic or acute fetal hypoxia and can lead to fetal growth restriction (FGR). Among pregnant women with obstetric and extragenital pathology, the frequency of PD is 24-45%; in cases of threatened miscarriage, it is diagnosed in 85-99% of women; in cases of bacterial and viral infections, it is diagnosed in 60% of women; in cases of arterial hypertension, it is diagnosed in 45% of women; and in preeclampsia, it is diagnosed in 30% of women. In 40-60% of cases of perinatal mortality, it is associated with placental pathology, and the frequency of perinatal morbidity associated with PD ranges from 587 ‰ to 880 ‰. At the same time, hypoxic-ischemic lesions of the central nervous system (CNS) account for 50% (according to some data, up to 60-90%), respiratory disorders and meconium aspiration syndrome occur in 11%, and resuscitation measures are performed in 15%.
IUGR is also one of the most important medical problems associated with high perinatal morbidity and mortality, disability in children, and the development of chronic pathology in them. In accordance with ICD-10 and Order of the Ministry of Health of Ukraine No. 782 of 29.12.2005, SGA is a complication of pregnancy that develops as a result of placental insufficiency and leads to the birth of an infant with weight and height parameters below the 10th percentile for the given gestational age. According to WHO data, the incidence of IUGR ranges from 6.5% in European countries to 31.1% in Central Asian countries. According to perinatal statistics, in Ukraine, the incidence of IUGR in different regions ranges from 10 to 22% among fullterm newborns.
Materials and methods. The research was conducted at the Kyiv Perinatal Centre, a municipal non-profit enterprise, between 2022 and 2024. The Department of Obstetrics and Gynaecology No. 1 of the Bogomolets National Medical University is located at the Kyiv Perinatal Centre, and the study was conducted as a part of the department's research work.
The research was conducted using a prospective cohort design.
Considering the stated objective, the research included pregnant women diagnosed with placental dysfunction and/or fetal growth restriction (as the main clinical manifestation of placental dysfunction). Women with multiple pregnancies, antenatally confirmed fetal malformations, as well as pregnant women with decompensated extragenital pathology and a history of oncopathology (of any location and stage) were not included in the study.
164 parturients and 164 newborns were included in the research. The women under study were divided into two groups: Group I – 67 parturients with fetal growth restriction who used acetylsalicylic acid (ASA) during pregnancy and 67 newborns.
Group II – 51 women with fetal growth restriction who did not use ASA during pregnancy and 51 newborns.
The control group (СG) consisted of 46 women with a physiological course of pregnancy and a physiological course of labour and 46 newborns.
Acetylsalicylic acid was prescribed orally in a prophylactic dose of 150 mg to pregnant women once a day from the 12th to the 16th week, taking into account the risk factors for the development of preeclampsia in accordance with the Order of the Ministry of Health of Ukraine "On the organisation of outpatient obstetric gynaecological care in Ukraine‘ dated 15 July 2011 № 417 and the Order of the Ministry of Health of Ukraine ’Normal pregnancy" dated 9 August 2022 № 1437.
All women included in the study signed an ‘Informed Consent’ form for participation, which outlined the potential benefits of the research.
