Ultrasonography of the uteroplacental-fetal complex in pregnant women with hyperproliferative diseases of the uterus

Hyperproliferative diseases (HPD) of the uterus (uterine leiomyoma, adenomyosis, polyps and/or endometrial hyperplasia) are the most common diseases in women that can negatively affect the course of pregnancy and childbirth. Therefore, timely ultrasound screening of the uteroplacental-fetal complex in pregnant women with HPD can prevent the development of pregnancy complications.The objective: to determine ultrasound features in the mother-placenta-fetus system in pregnant women with HPD of the uterus.Materials and methods. A prospective examination of 680 pregnant women was conducted. The main group included 517 pregnant women of reproductive age with HPD of uterus in anamnesis. The comparison group consisted of 82 pregnant women without HPD, the control group – 81 pregnant women without HPD and without pregnancy complications. Ultrasound feto- and placentometry was performed on all examined pregnant women from 5 to 40 weeks of gestation. In the II and III trimesters, an additional Doppler study of blood flow in the uterine arteries, umbilical artery, and middle cerebral artery of the fetus was performed. The resistance index, pulsatility index, systolic/diastolic ratio were studied.Results. In I trimester of pregnancy, 465 (89.9%) women with HPD of uterus and 57 (69.5%) patients in the comparison group were hospitalized due to the threat of early miscarriage. Subchorionic hematoma was diagnosed in the I trimester of pregnancy in 37.9% of pregnant women with HPD (odds ratio = 2.519; 95% confidence interval [1.418–4.473]). Almost half of them did not have complaints of lower abdominal pain or bloody discharges. Placental dysfunction was found in 165 (31.9%) pregnant women of the main group (in the comparison group – in 16 (19.5%) patients), cervical insufficiency – in 82 (15.9%) and 6 (7.3%) pregnant women, respectively. Blood flow in the uterine arteries and umbilical artery in the II trimester was characterized by an increased intensity relative to pregnant women of the control and comparison groups, which was expressed in an increased resistance index and pulsatility index (p < 0.05).Conclusions. In pregnant women with HPD of uterus, ultrasound scanning reveals pathological changes in the fetal-placental complex in a higher percentage than in pregnant women without HPD of uterus and healthy pregnant women. This is manifested mainly in the presence of subchorionic hematoma, cervical insufficiency, leiomyoma necrosis, disorders in vascular blood flow in the uterine arteries and umbilical artery.