Gynecology, Obstetrics and Perinatology

Principles of management of placental insufficiency for correcting impaired renal hemodynamics of the fetus

A complex dynamic examination of 158 pregnant women at terms of gestation from 24 to 41 weeks of gestation was carried out. The basic group comprised 108 women, in whom the course of pregnancy was complicated by placental insufficiency and fetal growth retardation syndrome. The techniques applied included fetometry, placentography, evaluation of quantity and quality of amniotic fluid, morphometry of the fetal kidneys, Doppler analysis of uteroplacental, fetoplacental, arterial and venous blood flow performed by standard methods. The indices of blood flow in main renal arteries of the fetus and arteries of the renal parenchyma were studied. Compensated placental insufficiency was revealed in 52 (48,15%), subcompensated – in 48 (44,44%), decompensated – in 8 (7,41%) observations. It was shown that complex therapy of RI using antiaggregants and drugs that improve metabolism at the cell-membrane level, including Essentiale forte N, in compensated RI resulted in an adequate improvement of fetometric indices and normalization of hemodynamics, renal blood flow included, in 88,5% of cases. In subcompensated RI the indices of fetometry and renal blood flow stabilized or normalized in 41,8% of cases. In decompensated RI stabilization of fetal hemodynamics was obtained in 62,5% of cases, which permitted, due to normal indices of venous blood flow of the fetus, to prolong gestation for 7–10 days, to perform planned cesarean section and to improve the perinatal outcomes.