PERINATOLOGY AS

A SCIENCE
Volkov Andrey Evgenyevich
Candidate of Medical Sciences, Associate Professor
Department of Obstetrics and Gynecology №1
PRENATAL PERIOD
o Natos – childbirth

o Pre – prefix that means something comes

before something
PERINATOLOGY

o «The section of obstetrics and pediatrics

that studies the development and health of
the fetus and newborn in the perinatal
period» (1982, Big Medical Encyclopedia)
o A branch of medicine aimed at studying the
period of a person's life, starting from the
20th week of pregnancy and including the
first 7 days after birth
IN THE PERINATAL
PERIOD THERE ARE
o Antenatal period: from 20 to 40 weeks of
intrauterine development
o Intranatal period: from the beginning of
labor to the birth of a child
o Early neonatal period: first week of life
(6 days 23 hours 59 minutes)
 o E. Zaling (German obstetrician - gynecologist) -
proposed to distinguish ante-, intra- and postnatal
periods of human life. He pointed out the need for a
thorough study of the perinatal period of a person with
the involvement of various specialists in order to
reduce perinatal morbidity and mortality
o In 1976, the European Scientific Society of
Perinatologists was established
o In our country, the founders of perinatology
N.L. Garmashova, L.S. Persianinov
THE HISTORY OF
THE FORMATION
OF PERINATOLOGY
 Biochemical
Invasive (amniocentesis,
Beam screening and (determination of the
cordocentesis, chorionic or
selective (ultrasound, level of serum markers
placental biopsy)
MRI) of blood)

Functional Diagnosis
Laboratory genetic assessment of the verification methods
(cytogenetics, state of the fetus (pathoanatomical
molecular genetics) (dopplerography, and syndromological
CTG, color doppler) studies)

Pre- and postnatal Other laboratory and

counseling clinical studies

METHODS OF MODERN
PRENATAL DIAGNOSTICS
DIRECTIONS OF MODERN
PRENATAL DIAGNOSTICS
o Pre-implantation diagnostics
o Screening for HA in the first trimester of pregnancy
o Molecular diagnosis of chromosomal diseases
o Genetic map of reproductive health
o Analysis of embryonic cells and DNA in the mother's
blood
 MASS SCREENING
identifying, among apparently healthy individuals,
individuals at high enough risk for specific disorders to
justify further diagnostic tests and procedures or direct
preventive action

SCREENING SUBJECT PURPOSE OF SCREENING

pathology with an unfavorable prognosis formation of a risk group with the
for life and health and a high population possibility of further additional examination
frequency, the treatment of which requires
high socio-economic costs
 METHODS OF MORPHOLOGICAL
ASSESSMENT OF THE STATE OF THE FETUS

e pos
lifetim t-m
orte
m

Radiation diagnostics Pathological anatomy, cytology,

(sonography, MRI, CT, X-ray), histology, molecular methods,
endoscopy etc.
 IAN DONALD INTER-
UNIVERSITY SCHOOL OF
MEDICAL ULTRASOUND
«…Although I came from the army with a rudimentary knowledge
of radar, I had a genuine childish interest in all sorts of machines
and electronic devices»

First ultrasonic device

 Ian Donald changed the face of obstetrics and
gynecology with the introduction of ultrasound
Even more, he changed the way we think
Order of the Ministry of Health of the Russian Federation №457
of December 28, 2000 «On the improvement of prenatal
diagnosis in the prevention of hereditary and congenital
diseases in children »
THE FREQUENCY OF
CONGENITAL AND
HEREDITARY DISEASES (WHO)
o Congenital and hereditary diseases among newborns account for
only 4-6%
o Congenital malformations and developmental anomalies – 25:1000
newborns
o Chromosomal disorders – 7-8:1000 newborns
o Chromosomal syndromes – 2-3:1000 newborns
o Monogenic diseases – 0,5-1,4%
ORGANIZATION OF
PRENATAL EXAMINATION
The first level - the formation of risk groups for intrauterine
damage to the fetus.
Conducting a screening examination (mandatory double
screening ultrasound):
o at 10-14 weeks
o at 20-24 weeks
Blood sampling from all pregnant women to study their levels of
at least two serum markers: α-fetoprotein and hCG at 16-20
weeks.
ORGANIZATION OF
PRENATAL EXAMINATION
The second level - genetic counseling for pregnant women at risk
of fetal damage, conducting a comprehensive prenatal
examination and developing pregnancy management tactics in
case of confirmation of pathology in the fetus and
recommendations to the family.
o ultrasound examination
o Invasive diagnostics
If congenital malformations, chromosomal or other hereditary
diseases in the fetus are detected, the tactics of pregnancy
management are determined consultatively.
The consultation should include a geneticist, an ultrasound doctor,
an obstetrician-gynecologist.
THE MAIN TASKS OF ECHOGRAPHY IN
OBSTETRICS

Diagnosis of
pregnancy and
fetal life
Establishment of
Number of fetus term and mass

Number of waters Localization of the

placenta

Anomalies of fetal Position and

development, EG presentation of
markers the fetus
Diagnosis of
ectopic pregnancy
PRENATAL DIAGNOSIS -
MAIN STAGES
1866 First description of Down Down J.L.H.
syndrome
1983 Diabetes mellitus screening
for low AFP
1988 Diabetes mellitus screening
for AFP, hCG, uE3, «triple
test»
1988 Ultrasound markers as an Wladimiroff J.W.
indication for prenatal
diagnosis
1990 Detection of an increase in
the thickness of the collar
space in diabetes mellitus
2001 Detection of the absence of
the nasal bone in diabetes
mellitus in the first trimester
 ULTRASOUND MARKERS OF
CHROMOSOMAL DISEASES - MAIN STAGES
1985 Description of neck fold enlargement Benacerraf B.
1987 Description of shortening of long tubular bones Lockwood C.
1988 Description of hypoplasia of the middle phalanx of the V finger Benacerraf B.
1990 Description of moderate pyelectasis Benacerraf B.
1990 Detection of an increase in the thickness of the collar space in Nicolaides K.
diabetes mellitus
1991 Description of the reduction in the transverse size of the cerebellum Hill L.M.
1993 Description of the hyperechoic bowel Nyberg D.A.
1994 Description of the sandal foot Wilkins I.
1994 Description of the dimensions of the auricle Gill P.
1995 Description of intracardiac hyperechoic focus Bromley B.
1996 Description of the change in the angle of the ilium Kliever M.A.
2001 Detection of the absence of the nasal bone in diabetes mellitus in the
1st trimester
1983
1984
1984
 PREGNANCY 13 WEEKS.
MEGACYSTIS IN A FETUS WITH THE
SYNDROME PRUNE-BELLY.
TRANSVAGINAL ACCESS
 TUBAL PREGNANCY 6 WEEKS ON
THE LEFT. TRANSVAGINAL ACCESS
PREGNANCY 4 WEEKS
 7 WEEKS PREGNANT: YOLK SAC

o Movement and heartbeat are always visible

o The diameter of the fetal egg is more than 20
mm in the absence of visible embryonic
structures - anembryony
o Yolk sac presenting as a ring structure 4-5
mm in diameter
PREGNANCY 7 WEEKS
PREGNANCY 10-14 WEEKS : EMBRYONIC STRUCTURES
PREGNANCY 10-14 WEEKS : FETO-EMBRYONIC STRUCTURES
PREGNANCY 10-14 WEEKS : EMBRYONIC STRUCTURES
PREGNANCY 27 WEEKS : FETAL FACE
FETOSCOPY
 AGENESIS OF THE CORPUS CALLOSUM

AXIAL PROJECTION CORONAL PROJECTION

TRISOMY 18
FETAL SURGERY
 MICHAEL HARRISON -
FATHER OF FETAL SURGERY
SAMUEL ALEXANDER ARMAS
CRITERIA FOR THE USE OF
INTRAUTERINE SURGICAL

o Accurate diagnosis and prognosis

o Lack of effective treatments for the disease after birth
o Availability of experimental data on the effectiveness of
intervention in the prenatal period and its safety
OPEN FETAL SURGERY (HYSTEROTOMY)
MYELOMENINGOCELE
FETOSCOPIC SURGERY
FETO-FETAL TRANSFUSION SYNDROME
REVERSE ARTERIAL PERFUSION
SYNDROME
 ISOLATED CONGENITAL
DIAPHRAGMATIC HERNIA
 INTRAUTERINE, INTRAVASCULAR
BLOOD TRANSFUSION FOR ANEMIA
SACROCOCCYGEAL TERATOMA
LEFT SIDED FETAL HYDROTHORAX
 BALLOON
OCCLUSION OF
THE TRACHEA
LOWER URINARY TRACT
OBSTRUCTIONS
VALVUPLASTY OF AN ATRISED
AORTIC VALVE