The morphofunctional state of the foetoplacental complex in women of reproductive age who are giving birth for the first time
The objective. To study specificities of the functional and structural state of the system «mother-placenta-foetus» in primigravidas/nulliparas of varied reproductive age. Patients and methods. The study included 638 primigravidas/nulliparas, 378 secundigravidas/primiparas and their foetuses. In all, 1016 pregnant women and 1019 foetuses were examined. The following methods were used: ultrasound foetoplacental imaging; cardiotocography; Doppler examination by detection of the angle-independent index of vascular resistance, blood flow rates in the umbilical artery and the foetal middle cerebral artery; detection of hormones and foetal protein in blood serum of pregnant women 2-7 days before and during labour; analysis of heart rhythm variability in mother and foetus; morphological examination of afterbirth. Results. By the end of pregnancy, a decrease of basic foetometric indices was found in foetuses of primigravidas as compared with similar foetal indices of secundigravidas from identical age groups (biparietal diameter (BPD) (89.5 ± 4.6 and 92.0 ± 3.9 mm, р = 0.000), femur length (FL) (73.1 ± 4.6 and 78.6 ± 3.8 mm, р = 0.000), abdominal circumference (AC) (288.4 ± 24.7 and 335.0 ± 20.7 mm, р = 0.000), the mean Fischer score (7.1 ± 0.4 and 7.8 ± 0.8 scores, р = 0.000), worsening of haemodynamic indices and more frequent disorders of foetoplacental blood flow (16.6 ± 2.0 and 8.5 ± 1.0%, р = 0.000). The structural and functional specificities of the system «mother-placenta-foetus» in primigravidas/nulliparas, irrespective of reproductive age (young, active, elderly), is characterized by worse indices of ultrasound placentometry, greater incidence of pathological changes of the placenta (by the end of pregnancy, the placenta of women who are giving birth for the first time was more often located on the anterior (40.1 and 27.7%, р = 0.001) and lateral walls of the uterus (12.1 and 5.4%, р = 0.038), was low lying (12.2 and 5.3%, р = 0.040) or had marginal presentation (5.8 and 2.0%, р = 0.040), in the structure of the placenta of nulliparous women of varied reproductive age dystrophic and degenerative changes were diagnosed significantly more often (94.6 and 54.6%, р = 0.000)), decrease of its hormonal equivalents (lower levels of hCG (32000.0 ± 6287.9 and 86200.0 ± 21305.5 IU/l, р = 0.000), uÉ3 (18.0 ± 1.9 and 23.8 ± 1.3 ng/ml, р = 0.000) and higher levels of PG (290.0 ± 6.8 and 287.0 ± 14.2 nmol/l, р = 0.030) and AFP (171.0 ± 15.8 and 111.5 ± 21.6 lU/ml, р = 0.000) in blood serum). Regulatory and adaptive processes in the placenta are characterized by prevalence of energy-deficient conditions, worsened and poor adaptive potential of mother and foetus. Conclusion. The results obtained in the study reflect the imperfection of relationships in the unified functional system «mother-placenta-foetus» during the first pregnancy and first labour, irrespective of a women's reproductive age.