Standardization of diagnosis and clinical classification of chronic placental insufficiency
The objective. Development of a new clinical classification of chronic placental insufficiency (CPI), based on a complex rating scale with calculation of the total diagnostic score. Patients and methods. For working out a rating scale for diagnosing the severity of CPI 154 pregnant women from a group of high risk for severe forms of PI were examined, in whom at terms 18-24 and 28-38 wks blood levels of the markers of apoptosis, endothelial dysfunction, decidualization, cell transformation, energy metabolism were detected. Diagnostic parallels in 359 pregnant women with various clinical and morphological realization of CPI permitted to work out a new method of diagnosing the severity of this complication of pregnancy. Results. The revealed functional changes of the placenta permitted to logically consider the consecutive chain of changes in the placenta in CPI: placental dysfunction → decompensated PI → progressing DPI → critical PI, which underlay a new clinical classification of CPI. The main point of the proposed method for diagnosing the severity of CPI is that using the developed complex rating scale the total score is calculated. Its value from 1 to 3 scores indicates the diagnosis of placental dysfunction; from 4 to 9 scores - DPI; from 10 to 13 scores - progressing DPI; from 14 scores and more - critical PI. The total score of 0 states the absence of PI. Standardization of approach to diagnosing CPI based on a complex rating scale with calculation of the total diagnostic score and the developed clinical classification of CPI enhanced the accuracy of diagnosing severe forms of PI by 39 ± 3.5% (p < 0.05), improved perinatal outcomes by 60 ± 4.7% (p < 0.05), permitted to avoid the disabling state of newborns. Conclusion. The use of a new system of estimating the severity of PI standardizes diagnosis, control of the effectiveness of treatment, and obstetric tactics in PI.