THE UTERINE AND FETOPLACENTAL HEMODYNAMICS IN PREGNANT WOMEN WITH PLACENTA PREVIA AND PLACENTA ACCRETA

The aim of the study was to analyze the uterine and fetoplacental hemodynamics in pregnant women with placenta abnormalities.

Materials and methods. Fifty pregnant women with normal placentation (Group 1), 50 women with placenta previa (Group 2) and 28 women with placenta accreta (Group 3) were examined in this study. The ultrasound examination included the traditional fetometry and an assessment of fetus anatomy and localization of the placenta. In addition, the Doppler ultrasound was used to examine the blood flow in the uterine arteries as well as the umbilical artery and the middle cerebral artery of the fetus. The measurements were performed on the 20-22nd, 30-32nd and 35-36th weeks of gestation.

Results. According to the data obtained, the blood flow in the uterine arteries of patients with placenta pervia was much higher as compared with women with normal placental localization. The right uterine artery blood flow indices in the placenta previa cases significantly differed from those in women with placenta accreta. The pulsatility index in the right uterine artery was significantly lower in patients with placenta accreta as compared with the two other groups. The data on fetoplacental hemodynamics indicated differences in the umbilical artery blood flow between women with placenta accreta, placenta previa and normal placental localization on the 20-22nd and 35-36th weeks of gestation. Along with the above findings in the uterine and fetoplacental hemodynamics, the parameters of blood flow in the fetal middle cerebral artery did not differ significantly between the three groups of women at any period of gestation.

Conclusion. The conditions of placenta accreta and placenta previa are associated with a decrease in the peripheral vascular resistance in both uterine arteries during all periods of gestation. This conclusion is supported by the lower values of the pulsatility index in these blood vessels in comparison to the values in patients with normal placental localization.

1. Savelyeva G.M., Kurtser M.A., Breslav I.Yu., Panina O.B., Andreev A.I., Barykina O.P., Latyshkevich O.A. Growth of the placenta (placenta accreta) in patients with a scar on the uterus after cesarean section. Clinical and morphological comparison [Vrastanie predlezhashchej placenty (placenta accreta) u pacientok s rubcom na matke posle kesareva secheniya. Kliniko-morfologicheskoe sopostavlenie]. Akusherstvo i ginekologiya. 2015; 11: 41-5 (in Russian).

2. Radzinsky V.E., Milovanov A.P., Orazmuradov A.A., Khubetsova M.T., Prozorov V.V., Kornilova N.K. Features of the placenta and the placental bed of the uterus with premature detachment of the normally located placenta [Osobennosti placenty i placentarnogo lozha matki pri prezhdevremennoj otslojke normal'no raspolozhennoj placenty]. Akusherstvo i ginekologiya. 2003; 3: 21-5 (in Russian).

3. Latyshkevich O.A. Placenta growth in patients with a scar on the uterus after cesarean section. Organ saving operations: Author's abstract [Vrastanie placenty u pacientok s rubcom na matke posle kesareva secheniya. Organosohranyayushchie operacii]. Avtoref. dis. kand. med. nauk. Moskva. 2015: 23 s (in Russian).

4. Abuhamad A. Morbidly adherent placenta. Semin Perinatol. 2013; 37 (5): 359-64.

5. Orlov A.V. Screening markers of physiological and complicated pregnancy: Author's abstract. [Skriningovye marker fiziologicheskoj i oslozhnennoj beremennosti]. Avtoref. dis. dokt. med. nauk. Rostov-na-Donu. 2006: 49 s (in Russian).

6. Medvedev M.V. Fundamentals of dopplerography in obstetrics: a practical guide for doctors. [Osnovy dopplerografii v akusherstve: prakticheskoe posobie dlya vrachej]. Moskva: Real Tajm. 2015: 77 s (in Russian).

7. Transvaginal color doppler: infertility, assisted reproduction, obstetrics [Transvaginal'nyj cvetovoj doppler: besplodie, vspomogatel'naya reprodukciya, akusherstvo (Pod red. A. Kur'yaka, A. Mihajlova, S. Kupeshich)]. SPb.: Petropolis. 2016: 294 s (in Russian).

8. Panina O.B. Hemodynamic features of the mother-placenta-fetus system in the early stages of pregnancy [Gemodinamicheskie osobennosti sistemy mat'-placenta-plod v rannie sroki beremennosti]. Akusherstvo i ginekologiya. 2000; 3: 17-21 (in Russian).

9. Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. Ultrasound Obstet Gynecol. 2005; 25: 323-30.

10. Early pregnancy [Rannie sroki beremennosti (Pod red. V.E. Radzinskogo, A.A. Orazmuradova)]. Moskva: MIA. 2005: 448 s (in Russian).

11. Causes and reserves of reducing maternal mortality at the present stage. Manual for Physicians (second supplemented edition) [Prichiny i rezervy snizheniya materinskoj smertnosti na sovremennom ehtape. Rukovodstvo dlya vrachej (vtoroe dopolnennoe izdanie) (Pod red. A.P. Milovanova, I.O. Bushtyrevoj)]. Moskva: MDV. 2014: 336 s (in Russian).