INTEGRATED ASSESSMENT OF THE SEVERITY OF CHRONIC PLACENTAL INSUFFICIENCY

Objective. To develop a standardized approach to evaluating the severity of chronic placental insufficiency (PI), which is based on a complex diagnostic point scale. Subjects and methods. Diagnostic criteria with chronic PI scores of 0 to 3 were identif ied in 359 pregnant women; in two clinical groups, each included 200 pregnant women, the diagnosis of chronic PI, by applying a developed clinical classification and a clinical classification involving division into compensated, subcompensated, and decompensated PI (DPI), was compared with the morphological estimation of PI severity and perinatal outcomes. Clinical, instrumental, laboratory, and statistical studies were employed. Results. The severity of chronic PI may be evaluated using the complex point scale with a scoring system for the following diagnostic criteria: the discrepancy between ultrasound (US) fetometric data and fetal gestational age; evaluation of PI, by using the diagnostic scale (an US component and laboratory testing), the degree of impaired blood flow, integral fetal state index, and fetal cardiovascular reaction. The complex scale outcome indicator from 1 to 3 scores diagnoses grade 1 chronic PI (placental dysfunction); that from 4 to 9 scores shows grade 2 chronic PI (DPI), from 10 to 13 scores, grade 3 chronic PI (progressive DPI); and 14 scores or more, grade 4 chronic PI (critical PI). Conclusion. Standardization of the diagnosis of chronic PI, using the complex point scale to calculate the outcome indicator of the severity of chronic PI and its based clinical classification increase accuracy in assessing the severity of chronic PI, optimize obstetric tactics, and improve perinatal outcomes.

chronic placental insufficiency, diagnosis, classification