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Резюме Резюме Summary Рецензент: д.мед.н., проф. В.В. Сімрок УДК 616-01 ДЗ «Запорізька медична академія післядипломної освіти МОЗ України» ГУ «Запорожская медицинская академия последипломного образования МЗ Украины» SI “Zaporizhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine” irinasokolovskaya@list.ru The definition of the supposed weight of the fetus is no less important aspect at the selection of delivery tactics than the definition of the outer sizes of the pregnant woman pelvis and other indicators. The statement of MPH from 27/12/2006 under No. 899 About approval of the clinical protocol on the obstetric assistance “Pelvic presentation of the fetus” suggests the natural delivery at the fetus weight no more than 3700 g, and this parameter is the basic one at selection of the delivery tactics. At the stage of input into obstetric hospital the supposed weight of the fetus is determined by means of the outer examination, and based upon the data received the conclusion is made about possibility of the natural deliveries. However, at the full-term pregnancy, which can be accompanied by the range of distorting factors, such as obesity, edemas of the anterior abdominal wall, hydramnios and hypamnions and etc. the error in detection can be substantial. Maximally accurate definition of the supposed weight of the fetus in the pelvic presentation can sufficiently change the delivery tactics and the quantity of the negative perinatal and obstetric consequences. In order to implement the aim the group of the examined women was chosen, who cesarean section at the pelvic presentation of the fetus was conducted to according to the indicator “big fetus”. The basis for such indication is detection of the supposed weight according to the outer measurements under the following formulas: Lebedev formula” (W – AS x FHOB, where W – supposed weight of the fetus, AS – abdominal circumference of the pregnant woman in centimeters, FHOB – fundal height over bosom in centimeters); Yakubova formula (W = (AS + FHOB)) 4 х 100); Bublichenko formula (W = 1/20 of the body weight of the pregnant woman). At the same time the study of anthropometric parameters with detection of the fetus weight was conducted by the method of medical visualization – ultrasonography on the apparatus Philips En Visor, namely the following indicators were measured as: biparietal diameter, frontal occipital circumference size, abdominal circumference, femoral bone length. These parameters were introduced into the Hadlock formula 1: (EFW = 10^(1,304 + (0,05281*AC) + (0,1938*FL) – (0,004*AC*FL)). SD = 0,154*EFW Type SD = ±2SD The group of patients was composed of 34 persons in the term of gestation 37-39 weeks. The results show that the diagnosis “big fetus” was made based upon all three formulas. However, the detection according to Lebedev formula gives the biggest weight of the fetus in comparison with other ones and also the maximal error. From 34 patients at the delivery the diagnosis “big fetus” was confirmed at 23 (67,64%), 11 (32,36%) of the new-born children had the average weight 3370 g. At that the maximal error made 580 g. By the method of ultrasound visualization the supposed weight of the fetus consisted of the following indicators: biparietal diameter, abdominal circumference, and femoral bone length. The method of ultrasound visualization excludes “the distorting factors” based upon the measurement of the bone reference points. The average difference between detection under ultrasonography and actual weight is minimal. Regardless of it, the error still existed and the maximal error in 270 g was at the patient with physiological gestation course, of 167 cm high and 67 kg weight. However, only at five pregnant women according to the ultrasound investigation the weight was unfaithful, i.e. three (8,8%) had the top-heavy weight, two had (5,85) understated weight with the difference in 171 g. Such result evidences about information capacity of the ultrasound method not only for detection of the supposed weight, but for evaluation of the concomitant indicators. Thus, the moderate and evident hydramnios at five (14,7%) pregnant women, and limited and evident hypamnions at 7 (20,5%) was observed. It is interesting to note the fact the at the patients with placenta disposition in the uterus anterior wall the error with overstatement of the indicators in the fetus weight made the biggest meaning at definition according to the outer reference points (8 persons – 23,5%). Based upon the data received that the ultrasound method was the most accurate at detecting the fetus weight, it allowed taking into account the other obstetric parameters, which it was impossible to take into account at the outer methods of research. Thus, the possibilities of ultrasonography in comparison with the clinical ones can be visually represented in table 3. The detection of the supposed weight of the fetus by the method of ultrasound visualization is more accurate than the outer examination. Thus, the accuracy of US-method made 85,4%, maximal error 270 g. The accuracy of the outer method of measurement made 67,64%, and maximal error – 580 g. At pregnant women with placenta disposition on the uterus anterior wall (23,5%) the maximal deviation from the actual weight was observed. The ultrasound method excludes “the distorting” factors for detection of the fetus weight at the full-term pregnancy. Литература 1. Амирова Ш.А. Выбор оптимального метода родоразрешения и исход родов при тазовом педлежании плода / Ш.А. Амирова, Т.М. Укыбасова // Денсаулык сактауды дамыту. - 2012. - № 1, ч. 1. - С. 66-72. 2. Баева И.Ю. Возможности дородовой диагностики крупного плода (обзор литературы) / И.Ю. Баева, И.И. Каган, О.Д. Константинова // Вестник новых медицинских технологий. - 2011. - Т. 18, № 2. - С. 226-230. | |
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