EP19.12: Doppler investigation of the blood flow in fetal bain in breech presentation

Objectives: The aim of the investigation was to explore the nature and changes in blood flow in the vertebrobasilar system of the fetus and newborn in breech presentation. Methods: Was conducted the study of the cerebral blood flow (middle cerebral artery, vertebral artery, basilar artery) in 262 fetuses with breech presentation. Results: At 32–34 weeks of pregnancy impaired blood flow in the vertebral arteries was diagnosed in 38.4% of cases. The indicators characterising the impaired blood flow are symmetrical or asymmetrical increase SDR more than 4.0, PI more than 1.7 ; increase in vertebral-aortic ratio greater than 0.9; reduction of cerebro-spinal less than 0.85.Hemodynamic disturbances in the fetal brain characterised by a decrease in vascular resistance index: SDR less than 2.4, the PI less than 1.2. Disorders of blood flow in the middle cerebral artery of the fetus were discovered by us only against a background of blood flow disturbances in the vertebrobasilar system of the fetus, and their frequency was 17.9%.The antenatal study of a blood flow in the fetal vertebrobasilar system was found that the most frequently identified isolated changes (82.1%), 14.3% combined disturbance observed in 3.6% pronounced signs of vertebrobasilar insufficiency. When delivery of the fetus in pregnant women with pelvic previa by Caesarean section incidence of blood disorders in newborn vertebrobasilar system decreased to 33.8%. This changes detected in 2 times less, and severe symptoms of vertebrobasilar insufficiency are not marked. In neonates born vaginally, impaired blood flow in the vertebrobasilar system are diagnosed in 73.9%. Conclusions: At 8.7% of infants born vaginally in breech presentation at neurosonography revealed expansion of the brain ventricles with increased echogenicity of the vascular plexus, from 4.3% – the signs of intracerebral hemorrhage, at 26.1% – the echosigns of hypoxic-ischemic CNS.