DIAGNOSTICS, PROPHYLAXIS AND CORRECTION OF CONGENITAL MALFORMATION DEVELOPMENT

В статье анализируются причины роста аномалий развития плода и новорожденного от женщин группы риска по этой патологии. Предлагается программа ранней пренатальной и постнатальной диагностики, профилактики и коррекции врожденных пороков развития. Реализация предложенного комплекса мероприятий позволила повысить возможности выявления врожденных пороков развития, снизить число инкурабильных случаев, уменьшить летальность и инвалидност

Organization and work of the department of catamnesis of Clinical Perinatal Center of the Saratov region

Objective: to examine the catamnesis of infants born with very low and extremely low birth weight, as well as undergoing critical conditions in the early neonatal period. To assess the health status of children observed, recommendations for further rehabilitation and prognosis. Material and Methods. At the department of catamnesis 4373 children were observed (total 21343 admissions), 62% of them were preterm infants. Children with extremely low body weight and very low body weight (157 patients, 20.3%) were evaluated for physical development, somatic and psychoneuro-logical status. Results. Analyzing the structure of morbidity observed in children hematologic violations are revealed in the form of anemia of prematurity moderate and severe degree in 15 patients (11.4%), slowing growth and development 25 (19.4%), respiratory disorders (19 children, 14.5%). In the assessment of physical development, growth disharmony revealed in 20.9%, weight disharmony in 29.4% of patients. Neuro-psychological development corresponded to the postconceptual age at 49.2% of children. Breastfeeding saved in 44.6%, mixed and in vitro were transferred in 55.4%. In a group of children follow-up observations identified numerous pathological conditions and high morbidity, requiring subsequent mandatory correction. Many of the children belong to the Group of infectious diseases patients (28.4%), with lots of somatic pathology (78.1%). A direct impact of the dynamics of body weight during the first months after birth was revealed in figures physical development of a child and the incidence in the future. The most vulnerable preterm infants from multiple pregnancies, small for gestational body weight deficiency which recovers slowly and have them marked lower psychomotor development. Conclusion. Improving rehabilitation technology, previously early steps, the integrated use of various methods and means, phases taking into accountthe stage of the disease process and individual approach to a child significantly improve the efficiency and effectiveness of rehabilitation therapy.</p

Features of newborns with intrauterine growth restriction (according to the data of perinatal center of the Saratov region)

Objective: to identify risk factors that adversely affect the development of fetus and child small for gestational age; to assess the incidence of the intrauterine development of fetus and newborn; to analyze the health indicators of these children. Material and Methods. Cases of 226 children (6.6%) with diagnosed intrauterine growth restriction of the fetus were examined, including 134 of prematurity (59%). Results. The most common risk factors for the intrauterine development of the fetus were: violation of the utero-placental circulation — 196 cases, the uterine scar — 78 women, urinary tract infection — 94. Extragenital pathology was found in all women, the threat of termination of pregnancy in 109 cases, medical history of abortions in 106 women and 83 anaemia in women. Birth asphyxia was observed in 102 children (45%), prematurity in 71 cases (31.4%). Asphyxia of severe degree accounted 1 (0.5%) premature and 1 (0.45%) full-term baby. Asphyxia of moderate severity (4-6 points) accounted 70 (30.9%) preterm and 31 (13.7%) full-term infants. The most common form of the intrauterine development of the fetus asymmetrical revealed 178 cases (79.1%). Conclusion: Perinatal factors such as medical abortion, urinary tract infection, extragenital pathology are preventable. The predominant form of the intrauterine development of the fetus is asymmetric form, symmetric and dysplastic revealed to a greater degree in premature infants. Children with low weight for gestational age should be adequately provided with the necessary nutrients, fortifiers, vitamins and in the process of rehabilitation — cerebropro-tective therapy.</p

Health status of newborns after vacuum extraction

Objective: to study the outcome of labor and neonatal status after obstetric operations of vacuum extraction method KIWI. Material and Methods. The research and treatment of 58 newborns after the operation method KIWI were carried out. Conducted survey and evaluation of neurological status of newborn, analysis of medical documents (medical card of the pregnant, findings of ultrasound screening of the fetus, birth history and development of the newborn) were performed. Results. Indications for obstetrics KIWI included: narrow pelvis (17.2%), uterine inertia and discoordination (25.9%), fetal distress — 33 (56.9%). The KIWI application was a complete opening of the uterine mouth, the absence of membranes, a living fetus, clinical according to the size of the fetal head and pelvis of mother. The results of the assessment of children by Apgar scale: 1-3 points from 1.7%; 3-6 points of 25.9%; 7 or more points 72.4% of children. Cerebral ischemia 1 degree was diagnosed in 63.8%; of the 2 degree of 34.5%, grade 3 in 1.7% of children. The average stay of children in the Department of physiology was 6.5 days, the 2nd stage is 11.6 days. Generic tumor from the apparatus KIWI was observed in 36.2%, cephalohematoma in 31,0%; no serious complications have to 32.7% of children. All patients were discharged from hospital. Examination of 29 children at the Department of Catamnesis showed that 13.7% of them noted a neurological deficit in the form of small brain dysfunctions. Conclusion. The introduction of new models of vacuum extraction, enhance the delivery through natural patrimonial ways. No significant impact on the course of the neonatal period, which allows us to recommend the method for more widespread use. However, the vacuum extraction of the fetus may be effective and safe only if indications, conditions and technique are strictly followed.</p

Determination of the characteristics of ocean inhomogeneities by the times structure of an acoustic signal

In this report the method of ray differential acoustic tomography of the ocean is discussed. The method is based on the fact that the mean velocity of sound pulse propagation along the ray trajectory depends on the angle of the ray exit. The method efficiency is analyzed numerically for the signal reception to the horizontal array and the single hydrophone. It is shown that the signal of illumination may be suppressed and the scattered signal may be separated by time gating. It is also shown that the depth of the deposition of a space-localized inhomogeneity may be estimated by the width of the scattered signal autocorrelation function. The distance to the inhomogeneity may be defined by the cross correlation function of the scattered signal at various array receivers. The influence of the depth of the submergence of a scatterer and the distance between a source and a receiver on the scattered signal structure is analyzed

A clinical case of hereditary hydrocephalus (Dandy-Walker's syndrome)

Congenital malformations are considered as one of the main causes of mortality and disability in early childhood. Congenital anomalies resulting in serious disorders often accompany pathology of the brain. The results of clinical observation and treatment of the patient with significant malformation of the central nervous system, hereditary hydrocephalus (Dandy — Walker's syndrome) have been presented in the work. The issues on early prenatal diagnosis and correction of this malformation in the neonatal period have been stressed

Assessment of health state of newborns depending on duration of waterless interval and infectious process at mother

Objective: to reveal and estimate dependence between a long waterless interval, infectious process at mother and pathology of newborn children. Material and Methods: Supervision and research have been carried out in Perinatal Center of Saratov region for the last 2 years. 167 women and 173 newborns were included in the research. The big group was composed by prematurely born children. Women were divided into 2 groups depending on infectious process of patrimonial ways and on duration of a waterless interval. Children were divided on gestation term. Results: fetoplacental insufficiency and threatened miscarriage are the main factors of extremely immature children birth. Under these conditions, prolongation of pregnancy and preparing a fetus to labor act are important factors for improving the adaptive capacity of a premature baby. One of the important factors of insolvency is membranes infection. It is a distinct disease or a result of complications of pregnancy prolongation in women with PROM, is a precursor of systemic inflammatory response and in the majority of newborns was realized in infectious process. Conclusion. Women with infectious pathology of birth canal should be thoroughly sanitized, preventive treatment should be carried out, it would prevent the implementation of fetus infection, reduce posthypoxic disorders and incidence of preterm birth and IUGR. Long PSU without infectious support contributes to a lesser extent implementation of infection in fetus and less effect on a child's neurological status

Estimation of health indicators of children born by means of application of reproductive technologies

Objective: To examine health of children born by means of ART according to Perinatal Center of Saratov region for the last 2 years. Material and Methods: 70 pregnant women and 96 newborns with the use of ART were under examination. The causes of premature birth by women with ART, high degree of disease incidence among newborns and mortinatality are considered (рассматриваются) in the article. Results: The important factors of amnionic membranes breaking are distinguished: maternal age, multifetation, genital and extragenital pathology, antenatal infections and fetation anomaly. Highly premature babies cause not only high neonatal disease rate and disability, but also are key element in procreational loses. Women with congelated embryo transfer less often experience premature birth, also disease rate and neurologic abnormalities are less frequent. Two and more embryo transfer more often leads to habitual miscarriage. Conclusion: Mothers-to-children health indicators after using ART demonstrate the necessity of prenatal diagnostics improvement and taking measures in monitoring such women and newborns. High quality preimplantation preparation plays a major role in fetus pathology reduction. Prescriptions and counter indications to this procedure should be thoroughly evaluated; no more than 1-2 ova should be transferred

Analysis of status of preterm infants with bronchopulmonary dysplasia

Objective: the combination frequency of BPD in premature infants, assessment of the degree of functional lesion of the respiratory tract and the efficiency of respiratory support. Material and Methods. The survey included 36 women and 38 preterm infants (two twins). Results. In 99% of the surveyed women pregnancy was complicated by chronic intrauterine fetal hypoxia, 2.1% — RH-conflict. At 43.2% of cases acute respiratory viral infection during pregnancy was revealed, 15.3% of bad obstetric history, 5% of women who had bad habits (smoking, alcohol intake). In 2015 there were 5 deaths (13.2%). 14 children (36.8%) were transferred to other hospitals for further treatment, the remaining 19 (50%) were discharged from the hospital. One child — full-term, the other— premature. At 87.7% of children with BPD, the diagnosis was RDS, in 4.2% — aspiration of meconium, 8.1% — congenital pneumonia. 15 children (30.5%) received therapy with surfactant once, including 9 newborns (23.7%) received medication twice. All newborns were carried out intensive care, including respiratory support. Mechanical ventilation in 14 children had been conducting for 8.4±2.3 day, in 13 cases for 17.3±3.8 day, in 11 cases for 23.4±4.1 day. Nasal CPAP was conducted in 23 newborns: from 4 to 6.8±1.9 day, 13 — less of 16.8±2.9 per day, 6 children have had more than 23.2±3.8 day. Conclusion. There is necessity for prevention during pregnancy with glucocorticoids, the prolongation of pregnancy; preterm neonates — surfactant therapy; adequate provision of resuscitation care in the delivery room and respiratory support. The reduction of time of mechanical ventilation and the expansion of the indications for non-invasive methods of respiratory therapy reduced the incidence of BPD, the severity of the disease and improve the prognosis.</p

Congenital malformations in a fetus and a newborn according to the data of Perinatal Center of the Saratov region

The aim: to study the frequency of birth defects in Perinatal Center of the Saratov region from 2014 till 2015, the possibility of prognosing, early diagnosis and optimization of programs for the prevention and correction of congenital malformations, the evaluation of treatment outcomes. Materials and Methods. The study included newborn babies and fetuses with birth defects for the period 2014-2015 according to data received from Perinatal Center. The data on ultrasound examination of pregnant women and about 149 fetuses with malformations in case of early terminated pregnancies were analyzed. Results. In 2014 Perinatal Center of the Saratov region found 77 newborns with congenital malformations, in 2015-72; 24 children (16.1%) required early surgical intervention. The comprehensive assessment of the health status of women and their children, the assessment of placental blood flow and fetal development, the identification of chromosomal and genetic abnormalities were conducted. 5 children of 149 children with congenital malformations died at the stage of the maternity hospital where average mortality accounted for 3.3%. Congenital malformations of central nervous system and sense organs accounted for 13.4%, malformations of the face and neck — 5.4%, malformations of the cardiovascular system — 28.8%, malformations of the respiratory system — 2.7%, malformations of the gastrointestinal tract — 4%, malformations of the musculoskeletal system — 9.4%, malformations of the urinary system — 27.5%, genital malformations — 4%, defects of the skin and its appendages — 1.3%, other malformations — 2.7%. Multiple malformations accounted for 4.7%. During 2014-2015 due to congenital malformations 311 births (4.4%) were interrupted, the main cause was determined as chromosomal abnormalities. Training, diagnosis, management of pregnant women and their delivery is carried out in Perinatal Center of the Saratov region in accordance with the complex program and algorithm methods for the prevention and correction of congenital malformations. Conclusion: This study has shown that there is a growth of small anomalies and reduction of frequency of multiple malformations. Comprehensive preventative program is possible to reduce the number of infants with untreated birth defects (13,5%), increase the percentage of defects detected by ultrasound from 51.7 to 66.7%