OPTIMIZATION OF OBSTETRIC TACTICS FOR CHRONIC FETAL DISTRESS IN WOMEN WITH A HISTORY OF RECURRENT MISCARRIAGE

Objective. To optimize obstetric tactics for varying severity of fetal distress in women with a history of recurrent miscarriage, by studying the fetoplacental system and following up infants of the first year of life. Subjects and methods. The investigation involved an analysis of the course of pregnancy in female patients with chronic fetal distress and at least two early pregnancy losses in the history, by conducting a retrospective study of 53 labor histories and a prospective observational study of 57 pregnant women. According to the fetal status (FS), the study group was divided into 3 subgroups: 1) 18 patients from a prospective series and 19 patients from a retrospective one, who had a FS value of 1.1-2.0; 2) 22 and 19 patients, respectively, whose FS value ranged 2.1 to 3.0; and 3) 17 and 15 patients, respectively, who had a FS value of above 3.0. The control group comprised 11 women with a history of recurrent miscarriage who had delivered babies via cesarean section due to the presence of a somatic disease with none episode of impaired fetal status (with a normal FS value of 0 to 1). Results. Analysis of the hormonal and biochemical parameters of peripheral blood from pregnant women before delivery revealed that the markers of fetoplacental dysfunction were thiobarbituric acid reactive substances, alpha-fetoprotein, cortisol, and ß-microglobulin. A cardiotocographic study of the health status of infants of the first year of life in relation to FS values indicated that the most evident abnormalities as different manifestations of postnatal maladaptation were observed in infants with a FS value of 2 to 3 during the first year of life, which may be suggestive of experienced chronic antenatal hypoxia. Conclusion. Detailed individual intragroup analysis of the health status of Subgroup 2 babies with a FS value of 2.1 to 3.0 established that during delivery within 5 days of the appearance of the signs of intrauterine suffering at over 37 weeks gestational age, the infants with lower values had abnormalities in their physical development and health status as compared to those from the same group, who had sustained longer (over 5 days) chronic hypoxia and had been born accordingly in later periods after the emergence of the cardiotocographic signs of fetal distress.

chronic fetal distress, recurrent miscarriage, obstetric tactics