Objective. To study immediate and long-term results of endovascular reduction of blood flow in placental ingrowth. Patients and methods. The study included 70 pregnant women with ingrowth of the placenta into the uterine scar. The gestational age at time of delivery ranged from 30 to 40 weeks, averaging 35.8 ± 2.9 weeks. In all cases, the reduction of blood flow was performed using balloon catheters placed in the common iliac arteries. Admiral (Invatec) peripheral balloon catheters were used in 55 patients; in 15 patients – balloon catheters used in pediatric practice for dilatation of restrictive interatrial communication (Rashkind balloon). Results. There were no fatal outcomes. Endovascular complications were observed in 4 (5.7%) parturient women. In the longterm period the results were studied in 31 patients. In 22 (71%) patients menstrual function normalized within the first 3 months after the end of lactation. Recovery of menstrual function occurred in 3 (9.7%) women between 3 and 6 months, 2 (6.5%) cases each were in the subgroups with menstrual function recovery between 6 and 9 months and more than 9 months. Menstrual function was not recovered in 2 (6.5%) patients. Conclusion. Temporary balloon occlusion of the common iliac arteries significantly reduces the volume of blood loss, provides better visualization of the surgical area, and creates favorable conditions for subsequent pregnancy. Key words: balloon catheter, placental ingrowth, temporary occlusion of common iliac arteries, bleeding
Objective. To develop reference values for the sFlt-1/PlGF ratio in twin pregnancy and to establish its significance as a marker for pre-eclampsia (PE). Patients and methods. Sixty-two women with a dichorionic diamniotic (DCDA) twin pregnancy were examined: 44 women without PE and 18 women with PE. Levels of sFlt-1 and PlGF and their ratio were studied at 15,0–19,6; 20–23,6; 24–28,6; 29–33,6; 34–36,6 weeks’ gestation. Serum sFlt-1 and PlGF concentrations were measured by the cobas e 411 immunochemical analyzer (Roche Diagnostics GmbH, Germany) that uses electrochemiluminescence technology. Results. In uncomplicated twin pregnancy, serum concentrations of sFlt-1 and PlGF and their ratio were significantly elevated, which were higher than those in singleton pregnancy (SP); the sFlt-1/PlGF ratio was 13.7 by the end of the 37th week of pregnancy versus 9.0 in SP. In patients with PE, the median sFlt-1/PlGF ratio was 66.56, which was 4.8 times higher than in uncomplicated twin pregnancy. Using ROC analysis, threshold values for the sFlt-1/PlGF ratio were determined, allowing us with a high level of significance to exclude (<20.06; 100% sensitivity and 90% specificity) and to diagnose PE (>50.07; 60% sensitivity and 100% specificity). Conclusion. The developed accurate reference values for the sFlt-1/PIGF ratio in twin pregnancy enable early diagnosis of PE and prediction of the course of the disease. Key words: angiogenic factors, twins, twin pregnancy, pre-eclampsia
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