5 research outputs found
Doppler velometry flow miometiy especially in pregnant women in the period from the 7 th to the 10 th week of gestation with thrombophilia complex origin
No full textUltrasonography was made at pregnant woman for the period from 7 th to С0 th week. 2 types of miometry blood flow were allocated at pregnant woman in the period from 7 th to С0 th week. The course of pregnancy until the end of the first trimester was analyzed. The high specificity and sensitivity of doppler velometry miometry bloodstream was shown and was proposed to use this method to predict spontaneous abortion and missed abortion in the first trimester
THREE-DIMENSIONAL ECHOGRAPHIC EVALUATION OF CHORION VASCULARIZATION IN 1st TRIMESTER OF GESTATION IN WOMEN WITN THROMBOFILIA
No full textAim. Determine the threshold values of quantitative indices of chorionic volume flow in pregnant women with thrombophilia in the first trimester of pregnancy for the prediction of miscarriage and evaluate the effectiveness of anticoagulant therapy.Materials and methods. Ultrasound examination of the embryo and extraembryonic structures with volume reconstruction of the chorion and determination of quantitative indices using VOCAL program − vascularization index (VI), flow index (FI), vascularization flow index (VFI) in women with thrombophilia from 7th to 10th of the week of gestation. Results. The analysis of the quantitative parameters VI, FI and VFI in pregnant women in the first trimester showed high reliability (p<0.001) in the value of VI and VFI in pregnant women with thrombophilia without treatment and in the pregnant control group, as well as in pregnant women with thrombophilia before and after anticoagulant therapy. Among the most informative parameters for assessing the chorion vascularization in predicting miscarriage VFI≤7,80 has highest value for negative outcome. Index VI due to the very high specificity (SP = 82.6%) better more informative for predicting a favorable outcome. Conclusion. The use of the proposed method allows us to identify a risk group for predicting miscarriage in the first trimester in pregnant women with thrombophilia and promptly prescribe anticoagulant therapy and evaluate its efficiency
Оценка типов трофобластического кровотока у беременных с тромбофилией на сроке с 7-й по 10-ю неделю методом объемной реконструкции
No full textSpontaneous abortion occur in 15–20% of all detected pregnancies, and 45–70% of all spontaneous miscarriages take place up to 10 weeks. Thrombophilia is one of the main causes of miscarriage and its effect on the course of pregnancy remains poorly understood. In this regard, there is great interest in the problem of diagnosing thrombophilia and further prevention of thrombosis in obstetric practice.Purpose. Compare the parameters of volumetric blood flow in the chorion with different types of trophoblastic blood flow disturbance in pregnant women with thrombophilia in the first trimester for their quantitative verification.Materials and methods. The study included 129 pregnant women at the 7th to 10th week of gestation with a diagnosis of thrombophilia and a control group - pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies.The patients were divided into III clinical groups:I. Pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies (n = 33) – comparison group;II. Pregnant women with thrombophilia, in whom current pregnancy occurred on anticoagulant therapy (n = 28);III. Pregnant women with thrombophilia without taking anticoagulant drugs before registration of pregnancy (n = 68).Ultrasound was performed on Voluson E8 and S8 machines. All pregnant women underwent transabdominal and transvaginal ultrasound in B-mode, in color-doppler (CD) mode, and volumetric reconstruction of chorion was performed using the VOCAL program. In B-mode, the state of the embryo and extraembryonic structures were examined. The identification of trophoblastic vessels was carried out using the CD – region of interest was placed in the trophoblast area detected in B-mode, size and shape was adapted for a particular section.Using three-dimensional echography, the chorion volume was performed. The degree of blood supply in chorionic volume were calculated; vascularization index (VI), flow index (FI) and perfusion index (VFI) were displayed on a histogram with quantitative indicators.ResultsIn the CD mode, the types of trophoblastic blood flow were identified in the chorionic vessels:1) continuous type – blood flow loci are continuously identified over the entire area of the basal surface of the trophoblast;2) intermittent type – blood flow loci are unevenly identified along the basal surface of the trophoblast;3) single loci – single blood flow loci are identified along the basal surface of the trophoblast;4) lack of blood flow – blood flow loci are not determined along the basal surface of the trophoblast.Assessment of the quantitative parameters of the volumetric blood flow was used in the corresponding type of blood flow to verify the classification of types of trophoblastic blood flow in the CD mode.Statistical analysis of the volumetric blood flow indices using three-dimensional chorionic reconstruction showed a high degree of reliability (p < 0.0001) in the VI and VFI values between all corresponding types of blood flow.Discussion. High incidence of spontaneous abortion and the significant role of thrombophilia in this pathology leads to necessity of expanding the research in this area. There has been a lot of research done over the past decade. The quantitative threshold values of the resistance indices in the chorionic vessels were calculated using pulse-wave Doppler, the chorionic blood supply indices were determined using volumetric reconstruction for various pathologies.However, we have not previously met the classification of chorionic blood supply in the CD mode. This technique is very simple to perform and is a highly informative for predicting miscarriage in the first trimester. For the first time, we proposed the above classification of trophoblastic blood flow; for the first time, we proved the reliability of the classification developed by us using the method of volumetric reconstruction of the chorion with an assessment of trophoblastic blood flow, which allows us to recommend its use when writing a protocol for ultrasound of the fetus in the first trimester in pregnant women with thrombophilia.Conclusion. The classification of trophoblastic blood flow was verified by three-dimensional echography with quantitative indicators of the volumetric blood flow of the trophoblast vessels, with a high degree of reliability (p < 0.001) which to indicates the reliability of this classification. It can be recommended to conduct a multicenter study for investigating fetal ultrasound with the additional use of the CD in the first trimester in pregnant women with a diagnosis of thrombophilia.Цель исследования: сравнить показатели объемного кровотока в хорионе с разными типами нарушения трофобластического кровотока для их количественной верификации у беременных с тромбофилией в I триместре.Материал и методы. Проведено ультразвуковое исследование (УЗИ) эмбриона и экстраэмбриональных структур с применением метода цветового допплеровского картирования (ЦДК) у 129 беременных женщин в возрасте от 18 до 45 лет на сроке беременности с 7-й по 10-ю неделю. По данным ЦДК выделено 4 типа трофобластического кровотока. Дополнительно всем беременным проведена объемная реконструкция хориона с применением программы VOKAL для оценки васкуляризации хориона в полученном объеме с определением количественных показателей – индекса васкуляризации (VI), индекса потока (FI), индекса перфузии (VFI) в соответствующем типе кровотока, представленного по данным ЦДК.Результаты. Анализ количественных показателей, полученных при выполнении объемной реконструкции хориона с использованием программы VOCAL, при различных типах трофобластического кровотока в режиме ЦДК показал высокую достоверность (p < 0,05) в значении VI и VFI между всеми типами кровотока, что указывает на высокую надежность классификации трофобластического кровотока в режиме ЦДК.Заключение. Учитывая высокую надежность предложенной классификации рекомендовано использовать ее в описательных протоколах при проведении УЗИ плода с применением режима допплерометрии
Особенности трофобластического кровотока у беременных на сроке с 7-й по 10-ю неделю с тромбофилией сложного генеза
No full textObjective. To identify the features of trophoblastic blood flow in pregnant women with thrombophilia in the first trimester of pregnancy, according to doppler velocimetry.Materials and methods. It was made ultrasound doppler velocimetry and the determination of parameters of blood flow in the vessels of the trophoblast in 80 pregnant women aged between 18 and 40 years on the stage of pregnancy from 7 th to 10 th weeks of gestation. According to the doppler velocimetry it was allocated 4 types of trophoblastic blood flow in pregnant women in this period. According to the pulse – wave doppler highlighted type 2 trophoblastic blood flow.Results. In pregnant women with indicators of highly resistant type of blood flow, as well as a lack of locus trophoblastic blood flow there is a high correlation between the resistance index in the vessels of the trophoblast with indicators of blood hemostasis analysis system. The course of pregnancy until the end of the first trimester. It was determined that: highly resistant type, as well as the absence of loci trophoblastic blood flow is poor prognostic ultrasound feature and lowe resistant blood flow – prognostically favorable US-sign percentage safely occurring pregnancies in women with lowe resistant trophoblastic blood flow in the two times higher than in the group with highly resistant type loci and absence trophoblastic circulation. It was show the high specificity and sensitivity of the doppler velocimetry study trophoblastic blood flow.Conclusions. Using the proposed method allows to reveal risk to predict spontaneous abortion and missed abortion in the first trimester and assign anticoagulant therapy in a timely manner.Цель исследования: выявить особенности трофобластического кровотока у беременных с тромбофилией в I триместре беременности по данным допплерометрии.Материал и методы. Проведено ультразвуковое исследование с применением метода допплерометрии и определением показателей кровотока в сосудах трофобласта у 80 беременных женщин в возрасте от 18 до 40 лет на сроке беременности с 7-й по 10-ю неделю. По данным ЦДК выделено 4 типа трофобластического кровотока у беременных на этом сроке. По данным импульсноволновой допплерометрии выделено 2 типа трофобластического кровотока.Результаты. У беременных с показателями высокорезистентного типа кровотока, а также с отсутствием локусов трофобластического кровотока отмечали высокую корреляцию показателей индекса резистентности в сосудах трофобласта с показателями анализа крови системы гемостаза. Проанализировано течение беременностей до конца I триместра. Было определено, что высокорезистентный тип, а также отсутствие локусов трофобластического кровотока являются прогностически неблагоприятным УЗ-признаком, а низкорезистентный кровоток – прогностически благоприятный УЗ-признак, процент благополучно протекающих беременностей у беременных с низкорезистентным трофобластическим кровотоком в 2 раза выше, чем в группе с высокорезистентным типом и отсутствием локусов трофобластического кровотока. Показана высокая специфичность и чувствительность допплерометрического исследования трофобластического кровотока.Выводы. Использование предложенного метода позволяет выявить группу риска для прогнозирования самопроизвольного выкидыша и замершей беременности в I триместре и своевременно назначить антикоагулянтную терапию.
Сравнение границ субталамического ядра по данным МРТ с высоким пространственным разрешением и интраоперационной микроэлектродной регистрации
No full textBackground. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an acknowledged efficient and safe method of treatment of advanced stages of Parkinson’s disease. The traditional way of intraoperative target verification is a combination of microelectrode recording (MER) and intraoperative macrostimulation. The appearance of high-field tomographs, new sequences, and methods of computer processing of the obtained images raises the question whether it’s necessary to use intraoperative verification of the target.Objective. The aim of the study was to analyze the comparability of 3T MRI data and microelectrode registration data in determining the boundaries of the subthalamic nucleus in patients with Parkinson's disease.Material and methods. 20 patients who have been undergone 3T MRI for preoperative planning for STN-DBS were included in the study. We determined the upper and lower boundaries of 40 subthalamic nuclei in high-resolution T2 and SWAN modes and compared these data with the data obtained during surgery using the MER.Results. The discrepancy between the MED and 3T MRI data when determining the upper STN border was 1.2 mm in SWAN mode and 1 mm in high-resolution T2 mode. The lower border of the subthalamic nucleus could be determined with an accuracy of 0.85 in SWAN mode and 0.75 mm in T2 mode. The groups didn’t have significant differences (Wilcoxon sign-rank test, p > 0.05).Conclusion. 3T MRI in high-resolution T2 and SWAN modes demonstrated high comparability with microelectrode data in determining the upper boundary, lower boundary and middle of the subthalamic nucleus, which makes it possible to use it as a method for direct STN imaging.Введение. Электростимуляция субталамического ядра (STN) считается общепризнанным эффективным и безопасным методом лечения развернутых стадий болезни Паркинсона. Классическим методом интраоперационной верификации цели является сочетание микроэлектродной регистрации (МЭР) с интраоперационной стимуляцией. Появление высокопольных томографов, новых последовательностей и способов компьютерной обработки полученных изображений ставит вопрос о возможности проведения операции, основываясь только на данных нейровизуализации без использования интраоперационной верификации структуры-мишени.Цель исследования: анализ сопоставимости данных 3Т МРТ и МЭР в определении границ STN у пациентов с болезнью Паркинсона.Материал и методы. В исследование было включено 20 пациентов, которым проводилась 3Т МРТ для предоперационных расчетов для проведения имплантации электродов для хронической электростимуляции в STN. Мы определили верхнюю и нижнюю границы 40 субталамических ядер в режимах Т2 с высоким пространственным разрешением и SWAN и сравнили эти данные с результатами, полученными во время операции с помощью МЭР.Результаты. Расхождение между данными МЭР и 3Т МРТ при определении верхней границы STN составило 1,2 мм в режиме SWAN и 1 мм в режиме Т2. Нижнюю границу STN удавалось определить с точностью 0,85 в режиме SWAN и 0,75 мм в режиме Т2. Группы не отличались между собой статистически достоверно (Wilcoxon sign-rank test, p > 0,05).Заключение. 3Т МРТ с высоким пространственным разрешением демонстрировала высокую сопоставимость с данными МЭР в определении верхней границы, нижней границы и середины STN, что позволяет использовать ее в качестве метода прямой визуализации STN
