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"Child`s Health" 4 (47) 2013

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Antenatal care is the most important link for prevention of intrauterine fetal hypoxia (an analysis of research and literature on)

Authors: V.A. Khomenko, I.A. Mohilevkina, E.B. Yakovleva, Donetsk National Medical University named after M. Gorky, Donetsk Regional Centre of Maternity and Childhood Care

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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antenatal care, intrauterine fetal hypoxia, prevention

Today great importance is placed on obstetric pathology, early diagnosis and the treatment of complications during early pregnancy in antenatal clinics promotes a reduction in the number of complication during the child birth, perinatal pathology and postnatal morbidity. The level of gynaecological morbidity is largely dependent on quality of  obstetric care [1, 6, 7, 33].

The aim of this study is to carry out a comparative assessment through research and a current  of literature and review.

The pathology relating to the antenatal period means the pathology of the embryo and fetus, which arises during the antenatal period that is from the moment of fertilization of the ovum to the beginning of labour. The causes of antenatal pathology are divided into endogenous and exogenous. Some authors  refer to the endogenous causes as changes in the genetic structures of sex cells of the parents, spontaneous and induced mutations in the fertilized egg; endocrine diseases in pregnancy (for example, diabetes mellitus can cause the formation of defects of the central nervous system, muscles, skeleton and cardiovascular system of the fetus); where the parents are older than 35-40 years, due to the suppression of the reproductive functions the frequency of children born with congenital malformations, chromosomal disorders increases; immunological incompatibility between the fetus and a pregnant woman is a risk. According to our research data every second patient had the extragenital pathology, and every fourth patient older than 35 years [5, 19, 28].

Violations of intrauterine development of the fetus may be a result of polygenic multifactorial defects: caused by genetically hypersensitivity of the embryo and the fetus to environmental factors (physical and chemical). In these cases the factors of environment and the pathology usually do not cause its occurrence but exert an adverse effect on the developing embryo/fetus. The hypotrophy of the fetus may be a manifestation of polygenic multifactorial defects after birth, with an increased predisposition to the somatic diseases bronchopulmonary system, kidneys, etc.. [8, 12, 22].

Quite often the antenatal pathology is the result of the effect of various biological factors on the embryo and fetus: viruses, bacteria, protozoa and other microorganisms. Rubella virus, herpes virus, cytomegalovirus, Listeria, Treponema Pallidum exert teratogenic effects more frequently. The highest risk to the developing fetus from exposure to viruses is observed in the first trimester, whereas  the exposure and risk from bacteria and protozoa occurs in the second and third trimester. Viral hepatitis occured in 13.2% of cases and  2.3% with syphilis  [3, 7, 20].

There are several types of antenatal pathology term dependant and can be conditionally distinguished: gametopathy, blastopathy, embryopathy and fetopathy. The fetal abnormalities relating to changes in genetic material during anlage and the development of a germ cells of the parents (gametogenesis) or during fertilization and early cleavage stages of the fertilized egg (zygote) are referred to gametopathy. The changes in genetic structures can lead to fetal  death, spontaneous abortion, stillbirth; major congenital malformations, various hereditary diseases including chromosome (such as Down Syndrome) and fermentopathy.

The data of general and special anamnesis, the targeted survey of women to detect a colonic stasis using Roman criteria of constipation are used in examination of a pregnant patient to assess the general state of the organism. The general objective and specific obstetric examination which allows to detect «incompletely closed interlabial space» during the inspection and to determine the discrepancy of uterine size to the acceptable gestational age at vaginal examination is necessary. Constipation was marked in all patients, a hemorrhoids was in 39.3%.

The changes that do not cause serious complications in the mother but significantly increase the risk of perinatal pathology remain essentially unstudied [13, 15, 23, 30, 31].

Violation of placental blood flow in later periods accompanies the majority of pathological processes during pregnancy. However, the hemodynamic changes in the placenta, which interfere with the normal development of the fetus, have their origins in the early stages of gestation, becoming stronger at various extragenital diseases and complications of pregnancy. At study of abnormality of placental blood flow was occurred in 16.4% using Doppler ultrasound .

Membrane cell pathology occurs in complications of pregnancy and its severity may determine the outcome of pregnancy. The inferiority of placental bed of the uterus seems to be formed at the molecular level where the pathological changes of biomembranes are one of the main parts.

Despite the relevance of Doppler echocardiometry, this region remains poorly understood until now. The results of the study of intracardiac hemodynamics in pathological condition of the fetus are contradictory. The question of nature of the change of blood flow velocity through the atrioventricular valves remains unclear. There is no consensus about the nature of change in the index of diastolic ventricular function in fetuses with violation of functional status. Conflicting results were obtained regarding the performance of heart efferent tracts. Thus, differences in the presented results of research are apparently explained by a small number of observations, the assessment of the intracardiac blood flow in separate groups of fetuses with a varying degree of the functional status violation, lack of a comprehensive study of the intracardiac hemodynamics in general. All the above mentioned dictates the need for research in this area.

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