Science and Innovations in MedicineScience and Innovations in Medicine2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation4372910.35693/2500-1388-2019-4-1-8-15Research ArticleCombined approach to clinical classification of chronic placental insufficiency in perinatal period: setting standard in diagnostic and obstetric managementTezikovYurii Vladimirovich<p>PhD, Professor, Head of chair №1 of obstetrics and gynecology of the SamSMU</p>yra.75@inbox.ruhttps://orcid.org/0000-0002-8946-501XLipatovIgor' S.<p>PhD, Professor, Professor of chair №1 of obstetrics and gynecology of the SamSMU</p>i.lipatoff2012@yandex.ruhttps://orcid.org/0000-0001-7277-7431GogelLyudmila Yu.<p>PhD, assistant Professor of obstetrics and gynecology chair №1 of the SamSMU</p>golliudmila@yandex.ruhttps://orcid.org/0000-0003-0769-2954AzamatovAmir R.<p>resident of obstetrics and gynecology chair №1 of the SamSMU</p>azamatov.amir@yandex.ruhttps://orcid.org/0000-0003-0372-6889ErmetovValibek K.<p>resident of obstetrics and gynecology chair №1 of the SamSMU</p>vali_ermetow@mail.ruhttps://orcid.org/0000-0001-7811-0240Samara State Medical University150320194181508092020Copyright © 2019, Tezikov Y.V., Lipatov I.S., Gogel L.Y., Azamatov A.R., Ermetov V.K.2019<p><strong>Objectives</strong> 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.</p>
<p><strong>Material and methods.</strong>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 1824 and 2838 via blood analysis. It served the basis for development of the CPI severity rating scale. Diagnostic correlations in 359pregnant women with various clinical and morphological manifestation of chronic PI allowed us to develop an original method of diagnosing the severity of this complication.</p>
<p><strong>Results and Discussion.</strong>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.</p>
<p><strong>Conclusion.</strong>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.</p>placental insufficiencyapoptosisgrowth factorsendothelial dysfunctionclinical classificationdiagnostic scaleплацентарная недостаточностьапоптозфакторы ростаэндотелиальная дисфункцияклиническая классификациядиагностическая шкала[Barker DJ, Thornburg KL. The obstetric origins of health for a lifetime. ClinObstet Gynecol. 2013;56(3):511–519.][Benirschke K, Burton GJ, Baergen RN. Pathology of the Human Placenta. New York: Springer. 2012; 941.][Ahmed A., Dunk C. Regulation of placental vascular endothelial growth factor (VEGF) and placenta growth factor (PIGF) and soluble Flt-1 by oxygen – a revier. Placenta. 2009;21:16–24.][Neerhof MG, Thaete LG. The Fetal response to chronic placental isufficiency. Semin. Perinatol. 2008;32 (3):2549–2554.][Giussani DA, Niu Y, Herrera EA. Heart disease link to fetal hypoxia and oxidative stress. Adv Exp Med Biol. 2014;814:77–87.][Курманбаев Т.Е., Яковлев Н.В., Хасанов А.А. и др. Современные методы оценки состояния системы гемостаза в акушерстве. Аспирантский вестник Поволжья. 2016;5–6:68–73. [Kurmanbaev TE, Yakovlev NV, Khasanov AA et al. Modern assays of hemostatic system in obstetric practice. Aspirantskij vestnik Povolzh'ya. 2016;5–6:68–73. (In Russ.)].][Овчинникова М.А. Влияние рецидивирующего течения герпетической инфекции у беременных на фетоплацентарный комплекс и состояние здоровья новорожденных детей. Аспирантский вестник Поволжья. 2014; 1–2: 123–127. [Ovchinnikova MA. The impact of recurrent flow of herpes infection in pregnant by the fetoplacental complex and the health condition of newborn children. Aspirantskij vestnik Povolzh'ya. 2014;1–2:123–127. (In Russ.)].][Devisme L, Merlot B, Ego A et al. A case-control study of placental lesions associated with preeclampsia. Int. J. Gynaecol. Obstet. 2013;120(2):165–168.][Cerilli J, Brasile L. The vascular endothelial cell-specific antigen system: Three years experience in monocitecrossmathing. Transplant. Proc. 2002;17(1):567–510.][Anderson UD. Fetal hemoglobin, 1-microglobulin and hemopexin are potential predictive first trimester biomarkers for preeclampsia. Pregnancy Hyperten. 2016;6(2):103–109.][Кузнецов М.И., Ордынский В.Ф., Васильев А.Р. Анализ результатов 3-летнего применения шкалы определения плацентарной недостаточности и шкалы оценки реактивности сердечно-сосудистой системы плода. Ультразвуковая диагностика в акушерстве, гинекологии и педиатрии. 2000;2:113–122. [Kuznetsov MI, Ordynskiy VF, Vasilyev AR. Placental insufficiency scale and fetal cardiovascular reactivity scale: results of application within 3 years. Ultrazvukovaya diagnostika v akusherstve, ginekologii i pediatrii. 2000;2:113–122. (In Russ.)].][Стрижаков А.Н., Игнатко И.В., Тимохина Е.В., Белоцерковцева Л.Д. Синдром задержки роста плода: Патогенез. Диагностика. Лечение. Акушерская тактика. М.: ГЭОТАР-Медиа; 2012:120. [Strizhakov AN, Ignatko IV, Timokhina YeV, Belotserkovtseva LD. Sindrom zaderzhki rosta ploda: Patogenez. Diagnostika. Lecheniye. Akusherskaya taktika. M.: GEOTAR-Media; 2012:120. (In Russ.)].][Сидорова И.С., Макаров И.О. Методы исследования при беременности и в родах. Стандартные и новые технологии. М.: МЕДпресс-информ; 2005: 128. [Sidorova IS, Makarov IO. Metody issledovaniya pri beremennosti i v rodakh. Standartnyye i novyye tekhnologii. M.: MEDpress-inform; 2005:128. (Russ.)].][Милованов А.П., Кириченко А.К. Морфологическая характеристика второй волны цитотрофобластической инвазии. Архив патологии. 2010;1:3–6. [Milovanov AP, Kirichenko AK. Morphology of the second wave of cytotrophoblast invasion. Arkhiv patologii. 2010;1:3–6. (In Russ.)].][Котельников Г.П., Шпигель А.С. Доказательная медицина. Научно-обоснованная медицинская практика. М: ГЭОТАР-Медиа; 2012:210–222. [Kotel'nikov GP, Shpigel' AS. Dokazatel'naya medicina. Nauchno-obosnovannaya medicinskaya praktika. M: GEOTAR-Media; 2012: 210–222. (In Russ.)].]