| مستخلص: |
Introduction. The activation of the fetal hypothalamo- pituitary-adrenal axis (HPA) with the switch in the synthesis of DHEA/DHEAS/cortisol in the fetal area under the influence of placental CRH is a trigger of birth in mammals and humans. The fetus influences the duration of gestation, increased myometrial contractility by changing fetal cortisol/DHEA and maternal progesterone/ estradiol ratios from the hypothetical estradiol-fetal HHS axis. 2D/3D measurement of fetal adrenal volume – an indirect measure of the exacerbation of function – shows a correlation between its increasing size and triggering birth. Working hypothesis. Enlargement of the fetal area appreciated in the posterior antero diameter is a sonographic marker for the time of birth in 5-7 days. Objective. Measuring the fetal area (ZF) from week 26 in order to predict birth. Materials and method. Prospective study at the “Dr. I. Cantacuzino†Maternity on three groups with single pregnancies (A – apparently normal, B – with preexisting diabetes mellitus, C – premature membrane rupture, from group A), sonographically evaluated at 26-28, 30-32, 34- 36 weeks for calculating the ZF ratio (ZF depth measured in a sagittal plane) with estimated fetal weight (EFW) at the mentioned gestational ages. Results. In group A, ZF increased (0.32 to 0.84 at 26-29s; 0.4 to 0.7 at 30-34s; 0.91 to 1.03 at 36 weeks) parallel to EFW, the EFW/ZF ratio ranged between 2.3 and 1.34/26-29 s; 4.2 and 4.44/30-34s and 3.08 at 2.71/36s. In diabetic patients, ZF increased from 0.29 to 0.56/30-32s; the EFW/ZF ratio decreased from 6.39 to 5.18. In group C, both parameters increased, and the ratio decreased from 2.5 to 1.9. Premature birth in two cases (A and B) at an interval of 7 days, a ratio of 4.76 and 5.18, respectively. Conclusions. ZF sizes increase from 26 weeks, more in diabetic pregnant patients (30-32 weeks), without correlating with the membrane rupture. Data are consistent with those from the specialised literature in the case of asymptomatic/symptomatic pregnant patients for premature birth. In reduced number of cases, the prediction of birth cannot be made. [ABSTRACT FROM AUTHOR] |
