Regulatory and adaptive processes in the maternal-placental-fetal system in varying gestosis

Objective: to study the regulatory and adaptive processes in the maternal-placental-fetal system in gestosis. Setting: Obstetric Clinic, Kemerovo State Medical Academy. Design: a prospective study. Subjects: 237 pregnant women at gestational weeks 28-40 were examined. A study group included 102 pregnant with mild gestosis (n = 28), moderate gestosis (n = 23), and severe gestosis (n = 51). A control group consisted of 135 women with physiological pregnancy. Methods: routine clinical study, ultrasound fetometry and piacentometry, Doppler study of blood flow in the maternai-placentak-fetal system, and feta I cardiotocography. The maternal and fetal autonomic nervous systems (ANS) were studied, by analysing cardiac rhythm variability by cardiointervahgraphy (C1G). Maternal cardiointervals were recorded by the photofrequency; awakening fetal C1G was made by the procedure described by G. A. Ushakova and Yu. V. Rets. The calculations of a mode, its amplitude, a variability range, and a tension index are given. The results were compared using the Mann-Whitney U-test; Pearson’s correlation coefficient was used to analyze the relation of variables. Results: in physiological pregnancy there was a preponderance of the LVF component of a spectrum in the ranges of 26-130 and 2-30 msec 2/Hz in 85.9 and 88.1% in the mother and fetus, respectively; baroreceptive (LF) and parasympathetic (HF) components were 10-30% of the power spectral density of VLF, which suggested that there was a functional balance of centra! and autonomic regulatory circuits. In mild gestosis, maternal and fetal ANS regulation was at the state of equilibrium in 64.2 and 71.4%, respectively; however, 39.2% of the females were found to have a moderate activation of a trophotropic regulation component. Neonatal adaptation was satisfactory in 82.2% of cases. Only 17.8% of cases were diagnosed as having metabolic disorders, which piomoted the formation of groups at risk for central nervous system (CNS) diseases and endocrinopathies and required a follow-up. In moderate gestosis, 82.5 of the mothers and 100% of the fetuses were observed to have abnormal cardiac rhythm regulation types with significant sympathetic regulation tension or exhaustion. In early neonatality, 26.1% of the neonatal infants were diagnosed as having hypoxic-ischemic encephalopathy with the signs of CNS excitation; 8.9% had intracranial hypertension. The posthypoxic syndrome of cardiovascular dysadaptation was recorded in 13.1% of cases, which was mainly characterized by functional systolic murmur in the presence of patent fenestra ovalis with right-to-left shunting. In severe gestosis, the above trends progressed, which was indicative of maternal-fetal system maladjustment and autonomic functioning, and clinically manifested by worsening gestosis and fetal hypoxia, which required emergency delivery. The early neonatal manifestations of dysadaptation were acute mild and severity asphyxia in 17.6% of cases (2.3%; p = 0.002), hypoxic-ischemic encephalopathy with the significant signs of CNS inhibition and (he presence of convulsions. In 5.9% of cases experienced hypoxia led to a dysrythmie type of cardiovascular dysadaptation syndrome appearing as sinus tachycardia, sinus arrhythmia. Conclusion: CIG determination of ANS function evaluates the state of metabolic processes and autonomic nervous regulation of maternal and fetal cardiac rhythm, which makes it possible in gestosis to detect and timely correct abnormalities in the maternal-placental-and-fetal system, to decide the time and method of delivery and to improve labor outcomes.