Работа посвящена изучению функционального состояния центральных и периферических отделов гемодинамической системы мать ‒ плацента ‒ плод (ГСМПП) в динамике физиологического течения беременности и беременности, завершившейся рождением плода с перинатальными гипоксически-ишемическими повреждениями (ПГИП). Показано, что плодовая гемодинамика, являющаяся ведущим механизмом обеспечения жизнедеятельности, роста и развития плода, тесно взаимосвязана с центральной гемодинамикой матери и маточно-плацентарным кровотоком. Даны критерии адекватности адаптационных изменений центральной гемодинамики матери. Разработаны способы диагностики начальных нарушений маточно-плацентарного (МП) и плацентарно-плодового (ПП) кровотока по результатам допплерометрического исследования. Разработанные прогностические критерии гемодинамической дезадаптации в системе мать ‒ плацента ‒ плод позволяют выделить группы высокого перинатального риска и на основе объективных данных проводить профилактические мероприятия по снижению перинатальной заболеваемости и смертности.

More than half of unfavorable pregnancy outcomes are caused by foetoplacental insufficiency and preeclampsia. The genesis of these complications is inseparably connected with system and local changes in the mother-placenta-foetus hemodynamic system. Identification of reliable prognostic markers allowing predicting possible foetoplacen-tal insufficiency and preeclampsia, take steps for their timely prevention and correction as well as to prognosticate pregnancy outcomes will promote deeper gestational process understanding and help reduce perinatal morbidity and mortality. The purpose of the research was to identify hemodynamic markers of preeclampsia and foetoplacental insufficiency taking into account specific changes in the mother-placenta-fetus hemodynamic system in the first half of pregnancy.

Examination of 20 women with normal pregnancies and 27 women with pregnancies, complicated with gestosis (47 pregnant women total) was done to develop endothelial and immunological prognostic criteria of gestosis in the first trimester of pregnancy. A complex study of the immunological status and vasodilating function of the endothelium was carried out. As a result, a risk group for gestosis development was detected and early prognostic markers were determined.

A dynamic examination of vasodilative function of endothelium has been carried out in the following groups of pregnant women: 326 patients with uncomplicated pregnancy and 390 patients with pregnancies, complicated with (a) preeclampsia (118), (b) fetoplacental insufficiency (129) and (c) preterm delivery (143). Endothelial predictors of uncomplicated and complicated pregnancies, a degree of vasoregulative dysfunction of endothelium in the case of gestosis, fetoplacental insufficiency and preterm delivery have been identified.

Complex diagnostic criteria are proposed to estimate a degree of severity of primary placental insufficiency, which include echographic, dopplerometric and immunological examination as well as results of trophoblast functional activity assessment. Prediction of a severity degree of primary placental insufficiency early in pregnancy makes it possible to work out an individual approach to prevention of possible complications, offer more effective treatments in case of hypoxic-ischemic affection of the fetus and reduce perinatal disease rate with newborn children.

In admitted patients with purulent salpingoperitonitis in blood the maintenance of CD95 is raised and the same of CD4, CD16and CD25-cells is lowered, in blood plasma the concentration of TNFα, IL-1β, IL-6, IL-8, С3 and С4-components of complement systems, activity of oxygen systems of neutrophils is raised, the concentration of IL-4, activity and intensity of phagocytosis of neutrophils is lowered. The given disturbances of the immune status are aggravated after operation. The given changes of the immune status in patients with chronic salpingophoritis correlate with disturbances of structural and functional properties of erythrocytes. Therefore it is necessary to use in treatment of such patients the preparations, which influence on phospholipids of cell membranes.

The objective of the research is to work out new approaches to the estimation of hemodynamic condition in the mother-placenta-fetus system, contributing to early dyagnostics and prediction of hypoxic condition of a fetus and newly-born child. The complex examination of 218 women in the third trimester of pregnancy with the use of dynamic dopplerometric investigations with the further analysis of perinatal outcomes has been conducted. The complex dynamic examination of the feto-placental hemodynamics is directed to early prediction of initial abnomalities in the functional system of mother-placenta-fetus that may help to improve perinatal outcomes by means of the timely correction of hemodynamic abnomalities and the choice of optimal methods and terms of a delivery.

The purpose of the research was to study the peculiarities of maternal central hemodynamics in pregnancies, complicated with Hypoxic-ischemic outcomes. A total of 898 patients underwent medical examination, with 484 women making controls of uncomplicated single-fetal pregnancies, and 414 patients comprising cases of pregnancies, complicated with chronic intrauterine hypoxia that resulted in birth of children with signs of hypoxia. An evaluation of gestational transformation of maternal central hemodynamics was made in pregnancies, complicated with chronic intrauterine hypoxia; new hemodynamic predictors of chronic intrauterine hypoxia development are designed.

Prospective and retrospective research of 340 healthy patients with the uncomplicated pregnancy. We determined the criteria of adequacy of adaptational changes of the central maternal hemodynamics (CMH) and the utero-placento-feotal circulation during the uncomplicated pregnancy in accordance with the stages of feoto-placental system development. The detected gestational hemodynamic changes are represented at 5 stages, which corresponded to the periods of development and functioning of the foeto-placental system.

The purpose of the research was to study peculiarities of maternal central hemodynamics in pregnancies, complicated with preeclampsia. A total of 898 patients had medical examination, with 484 women making a (control) group of uncomplicated single-fetal pregnancies, and 414 patients comprising a (main) group of pregnancies, complicated with preeclampsia of various degrees of severity and resulted in birth of children with signs of chronic intrauterine hypoxia. An evaluation of gestational transformation of maternal central hemodynamics was made in pregnancies, complicated with preeclampsia; new hemodynamic predictors of preeclampsia development are designed.