Combined approach to clinical classification of chronic placental insufficiency in perinatal period: setting standard in diagnostic and obstetric management

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Abstract

Objectives – to implement both a new clinical classification of chronic placental insufficiency (CPI) and a new complex rating scale based on calculation of an integral indicator of compensatory-adaptive placental reactions in order to improve perinatal outcomes.

Material and methods. We examined 154 pregnant women with high risk of severe placental insufficiency (PI) in whom the markers of apoptosis, endothelial dysfunction, cell transformation and energy exchange were detected in gestation weeks 18–24 and 28–38 via blood analysis. It served the basis for development of the CPI severity rating scale. Diagnostic correlations in 359 pregnant women with various clinical and morphological manifestation of chronic PI allowed us to develop an original method of diagnosing the severity of this complication.

Results and Discussion. The sequential changes in placenta in CPI ("placenta dysfunction" → "decompensated PI" → "progressive decompensated PI" → "acute PI") formed the basis of a new CPI clinical classification. The final indicator was calculated according to the complex point scale. The indicator's value from 1 to 3 points corresponds to placental dysfunction; the decompensated PI is diagnosed at 4 to 9 points; at 10 to 13 points – progressive decompensated PI; starting from 14 points – acute PI. The absence of PI is reported if the value of the final indicator scores zero.

Conclusion. Setting a standard in the CPI diagnostic makes it 39% more accurate in severe PI, improves the perinatal outcomes by 60%, helps to avoid the disabling conditions in the neonates. High informativity and reliability of the developed PI severity rating diagnostic method was confirmed within the evidence-based medicine approach.

About the authors

Yurii Vladimirovich Tezikov

Samara State Medical University

Author for correspondence.
Email: yra.75@inbox.ru
ORCID iD: 0000-0002-8946-501X

PhD, Professor, Head of chair №1 of obstetrics and gynecology of the SamSMU

Russian Federation, Samara

Igor' S. Lipatov

Samara State Medical University

Email: i.lipatoff2012@yandex.ru
ORCID iD: 0000-0001-7277-7431

PhD, Professor, Professor of chair №1 of obstetrics and gynecology of the SamSMU

Russian Federation, Samara

Lyudmila Yu. Gogel

Samara State Medical University

Email: golliudmila@yandex.ru
ORCID iD: 0000-0003-0769-2954

PhD, assistant Professor of obstetrics and gynecology chair №1 of the SamSMU

Russian Federation, Samara

Amir R. Azamatov

Samara State Medical University

Email: azamatov.amir@yandex.ru
ORCID iD: 0000-0003-0372-6889

resident of obstetrics and gynecology chair №1 of the SamSMU

Russian Federation, Samara

Valibek K. Ermetov

Samara State Medical University

Email: vali_ermetow@mail.ru
ORCID iD: 0000-0001-7811-0240

resident of obstetrics and gynecology chair №1 of the SamSMU

Russian Federation, Samara

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Supplementary files

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2. Figure 1. Predictive values for laboratory testing of chronic PN in the second trimester of gestation.

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3. Figure 2. Diagnostic criteria for the severity of chronic PN.

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4. Figure 3. Pathogenesis of chronic placental insufficiency.

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5. Figure 4. Coincidence of clinical and histological diagnoses of PN, perinatal outcomes during approbation of the clinical classification of CRF.

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Copyright (c) 2019 Tezikov Y.V., Lipatov I.S., Gogel L.Y., Azamatov A.R., Ermetov V.K.

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