Morphological features of the system are a mother­placenta­fetus at a antenatal hypoxia with fetus losses

Abstract

DOI: 10.52705/2788-6190-2025-4-03
УДК 618.39-001.8-06:618.33/.36-039:572.7

The objective: to estimate the morphological features of the system mother-placenta-fetus at a antenatal hypoxia with fetal losses.
Materials and methods. The study included 55 cases of fetal death from a antenatal hypoxia in terms of 23–40 weeks at a singleton pregnancy: 55 placentas and 52 fetuses (in 3 cases a section was not produced). These 55 the most difficult for diagnostics supervisions of antenatal fetal death were included by us in our study of research on the basis of the unspecified nosotropic role of placenta and not clear thanatogenesis, they were 52% all antenatal losses. Cases of antenatal death of the set etiology - with infectious fetopathy, by congenital malformations, incompatible with a antenatal period, - from research eliminated, as well as multiple pregnancy.
Results. Among principal reasons of fetal death, associated and combined, dysfunction of fetoplacental complex prevailed in both sub-groups. In a 1th sub-group dysfunction of placenta was conditioned severe preeclampsia in 37,5%, and also premature detachment of a normally located placenta. Pathology of umbilical cord appeared principal reason of antenatal death of 3 fetuses in a 2th sub-group: actual node with the thrombosis of vessels in 23 weeks of pregnancy and with strangulation of umbilical cord in 39 40 weeks of pregnancy, tight neck cast-over in 39 weeks. A sharp ascending amniotic infection as combined factor of thanatogenesis is marked at 3 fetuses of 2th sub-group: with funiculitis, complicated thrombosis of vessels of umbilical cord (1), in combination with willit (2) and by antenatal death in 31, 33-34 and 39 weeks pregnancies. The markers of viral infections were found out in 10 from 19 inspected cases of antenatal fetal death with the search of herpetic, cytomegalovirus, chlamydial, mycoplasma, ureaplasma infections: in 9 from them it was got positive results in single locus with one of markers, here there were signs of focal willit in 2 cases, and in 7 such absented, as well as infectious fetopathy.
Conclusions. It is set two types of fetal losses at a antenatal hypoxia, which differ pathogenesis and thanatogenesis. The basic factors of pathogenesis and type of antenatal losses is dyschrony of villiferous tree of placenta, presence maternal and fetal vasculopathy. Pathogenesis of the first type of antenatal losses is characterized severe preeclampsia, maternal vasculopathy, by a uterine-placental ischemia and premature ripening of villi, dense spatial structure and vertical orientation of villiferous tree, low mass of placenta, fetal hypotrophy. Pathogenesis of the second type of antenatal losses is conditioned by immaturity of villiwith fetal vasculopathy, by the loose spatial structure of placenta with the spiralling and chaotic location of villi, by enhanceable mass of placenta and fetus with his tissue immaturity.