Clinical significance of Doppler velocimetry of blood flow in vessels of vertebrobasilar system of fetus in pelvic presentation
Complex prospective investigation of 155 pregnant women with pelvic presentation of fetus was carried out. The main group included 132 patients with Caesarean section, and the control group consisted of 23 women with vaginal delivery. It was established that pelvic presentation and non-complicated course of pregnancy was accompanied by hemodynamic disturbances in vertebrobasilar system in 38.4%. Isolated disturbances (beginning from 32nd week of gestation - asymmetric or bilateral increase of pulse index in basilar arteries &-gt-1.7, systolic-diastolic ratio &-gt-4.0, increase of vertebral-aortic ratio &-gt-0.9 and decrease of cerebral-vertebral ratio &-lt-0.85) were evaluated in 82.1% of patients, mixed disturbances in vertebral and medial cerebral arteries (systolic-diastolic ratio &-lt-2.4) had 14.3% of newborns, signs of massive vertebrobasilar insufficiency (absence of diastolic blood flow in vertebral arteries) were revealed in 3.6% of cases. We evaluated no signs of massive vertebrobasilar insufficiency in newborns after Caesarean section, the rate of mixed blood flow disturbances in vertebral and medial cerebral arteries decreased f-in 2 times. Hypoxic-ischemic lesion of CNS was diagnosed in 11.3% of newborns. In cases with vaginal delivery the rate of blood flow disturbances in vertebrobasilar system was counted as 73.9% including mixed disturbances in 21.7% that is more often in 3 times, than those after operative delivery. Hypoxic-ischemic lesion of CNS was diagnosed in 43.5% of newborns. Thus, complex estimation of fetal state using Doppler velocimetry of blood flow in vessels of vertebrobasilar system allowed to expand the indications to operative delivery in women with pelvic presentation.