Неинвазивни методи за пренатално одредување на фетална зрелост

Abstract

Introduction: Neonatal respiratory distress syndrome (RDS) occurs as a consequence of atelectasis due to hyaline membrane disease, and is one of the main biggest causes of fetal mortality. The main motive of performing this study is timely determination of fetal immaturity with noninvasive methods that provide timely treatment, lowering the risk of complications from invasive intervention and determining the optimal dose of fetal lung maturation treatment depending on the fetal response to the given therapy. Objectives: To examine the validity of a new original integrated method for prediction of fetal maturity which will be non-invasive, inexpensive, accessible, simple, repeatable, and can be performed in a routine use in any hospital facility where there will be available a good ultrasound device and educated staff. To determine which group according to the gestational age of the fetus has the best response to the given therapy and where it is necessary to be repeated, to get a better fetal maturity, and thus reduce fetal mortality and morbidity that are among the main objectives of the Action Plan of the World Health Organization 2012 and Healthy people 2020. Material and Methods: The study is a prospective observational-interventional clinical study. During this study we examined 100 patients of which 50 with impending preterm birth (studied cases) and 50 control cases. The study was performed at the University Clinic of Gynecology and Obstetrics, Medical Faculty, University “Ss. Cyril and Methodius”, Skopje, Macedonia. In the study, fetal maturity was examined before and after treatment using the following indicators: Measurement of the flow of the fetal pulmonary artery (Systolic Peak Velocity (PSV), and the relationship between time of acceleration and ejection (AT / ET); Measurement of total pulmonary volume (VolBD); Histogram intensity signal from fetal lung compared to the density of the fetal liver (BD / Hep); Histogram density of the fetal thalamus compared to the surrounding brain tissue (Th / Mo) and determination of the ratio of the fetal chest circumference against the abdominal circumference (TC / AC). They were compared with current invasive test, lamellar body count (LBC) in amniotic fluid, where the test did not jeopardize the health status of both the mother and the fetus, and with the gold standard - postpartum respiratory distress syndrome (RDS). For further evaluation as additional methods were also used: the presence of particles in the amniotic fluid and the degree of maturity of the placenta. Patients were divided into five groups: 28-30 g.n .; 30 (1 day +) -32 g.n .; 32 (1 day +) - 34 g.n .; 34 (1 day +) -36 (+ 6dena); ≥37 weeks (controls). The investigation was performed in two measures, before and 72 hours after given treatment, Amp. Betamethasone a 14 mg / II dose / 24h, according to a standard protocol for fetal lung maturation. The results were followed for up to 72 hours, and then compared with the extent of postpartum respiratory distress syndrome (RDS), which was used as the gold standard. If the patient was not delivered up to 72 hours of measurement, it was excluded from the study. Results: AT / ET, TC / AC, VolBD, growed linearly with gestational age. With increasing gestational week, Th / Mo and BD / Hep were approaching the number 1. PSV does not change significantly with gestational age. All methods showed significant difference before and after the administered therapy protocol for fetal lung maturation. Methods Th / Mo, BD / Hep. Vol BD, showed significant correlation with LBC. Regarding the prediction of RDS, significant results in all groups showed Th / Mo, BD / Hep. Vol BD, PL and OPVpart, with significance of p <0,0001. These methods were used to create a new original method, fetal maturation score, which showed greater sensitivity and specificity, positive and negative predictive value of all previous methods individually. Conclusions: The methods: Th / Mo, BD / Hep, Vol BD, PL and OPVpart, were with high sensitivity and specificity in the prediction of fetal maturity with significance p <0,0001; We integrated all of these methods to create a new combined original model, where the prediction of fetal maturity will be with a higher sensitivity and specificity of each method separately; The new original integrated method, fetal maturation score, is highly sensitive and specific method with excellent prediction of fetal immaturity; Fetal maturation score (FMS), as a new original method is non-invasive, inexpensive, accessible, simple, repeatable method and can be performed in routine use in any hospital facility where there will be good ultrasound device available and trained staff; Also, fetal maturation score as a new original method gives us the opportunity to determine which group of patients according to gestational age of the fetus have best treatment response and where it is necessary to be repeated to get a better fetal maturity and thereby to reduce the fetal mortality and morbidity that are among the main objectives of the action plan of the World Health Organization in 2012 and Healthy people 2020.