Basic principles and structure of risk assessment of Great obstetrical syndromes

Abstract

The objective: to develop a method for predicting the individual risk for great obstetric syndromes (GOS).Materials and methods. An analysis of the somatic, reproductive, and obstetric anamnesis was conducted in 572 pregnant women with clinical manifestations of GOS, in 81 of them (prediction group) signs of placental dysfunction were detected based on clinical, functional, laboratory, and ultrasound data. Control group (CG) – 50 practically healthy pregnant women with a favorable reproductive history and an uncomplicated course of this pregnancy.Functional, biophysical, hormonal, immunological and hemocoagulation indicators were calculated to determine the informative (prognostic) significance. Quantitative signs were divided into diagnostic intervals, and qualitative signs were assigned a code. The following indicators were included in the standard protocol: age, data on somatic and gynecological history, data on the pregnancy course, results of functional and laboratory examinations. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. In the I trimester of pregnancy the concentration of placental lactogen (PL) in the prediction group was 29.4 % lower than the CG indicator, estradiol (E2) amount – by 27.4 %, estriol (E3) – by 28.6 %, progesterone (PG) – by 34.4%, human chorionic gonadotropin (hCG) – by 28.3 % lower, and cortisol (CR) – by 36.1 % higher. At the beginning of the II trimester of pregnancy in the prediction group the level of PL was already reduced by 33.8 %, E2 – by 26.2 %, E3 – by 32.3 %, PG – by 37.4 %, hCG – by 30.6 %, and CR – increased by 43.6 % compared to CG.The indicators of placenta hormonal activity in the early stages of pregnancy and at the beginning of the II trimester can be prognostic signs of further disruption of the adaptive compensatory and adaptive reactions of the fetal placental complex (FPC) in the II and III trimesters of pregnancy. Among a wide range of hemostasiological indicators in the I trimester of pregnancy in the prediction group the most informative were: activated partial thromboplastin time (-23 %) and activated recalcification time (+16.2 %), the changes of which remained at the beginning of the II trimester (-40% and - 11.7% respectively). During the evaluation of thromboelastogram data, the value of “r+k” was fixed by 33.3 % lower in the I trimester and by 36 % – at the beginning of the II trimester of pregnancy. As a result of the analysis the indicators with a high information value (more than 3.0 c.u.) were selected for quantitative assessment of the degree of individual risk for the development of maladaptive disorders in the FPC. The clinical trial of the scoring method of prediction proved its high sensitivity (91.8 %) and specificity (85.6 %). Conclusions. A multi-faceted analysis of anamnestic data, features of the pregnancy course, basic clinical, laboratory and functional indicators in women with clinical manifestations of GOS made possible to develop an effective methodology for predicting the risk for GOS development with high levels of sensitivity and specificity.