Diabetic fetopathy in the fetus leads to the development of cardiomegaly.

THE PURPOSE OF THE STUDY

Evaluation of the values of cardiotocogram parameters for the diagnosis of diabetic fetal cardiomyopathy

MATERIAL AND METHODS

668 pregnant women were examined. The main group included 241 pregnant women with diabetes mellitus. The control group included 427 pregnant women with excluded diagnosis of diabetes mellitus. Among the pregnant women whose fetuses were diagnosed with cardiomegaly, 3 subgroups were distinguished: subgroup 1 included 43 pregnant women of the control group, subgroup 2 included 24 pregnant women with diabetes mellitus, the fetuses of which have cardiomegaly in the absence of diabetic fetopathy; subgroup 3 included 55 pregnant women whose fetuses have diabetic fetopathy and cardiomegaly. All pregnant women underwent echocardiographic and cardiotocographic examination of the fetuses.

RESULTS

A statistically significant difference in cardiotocogram parameters compared with those in the control subgroup was revealed at 36—37 weeks of gestation in both subgroups of patients with diabetes mellitus in the number of accelerations and high episodes of the basal rhythm of the fetal heart. A statistically significant difference in the number of basal rhythm accelerations was also detected in fetuses with cardiomegaly with diabetic fetopathy at 34—35 weeks of gestation compared with the control group. In fetuses with diabetic fetopathy and cardiomegaly, the number of accelerations of the basal heart rhythm increased with an increase in contractility of the interventricular septum. At the same time, it was found that in fetuses with cardiomegaly with diabetic fetopathy, the contractility of the interventricular septum at full term gestation was significantly lower than in fetuses with cardiomegaly without diabetic fetopathy and fetuses of the control subgroup. These changes may indicate the development of arrhythmogenic activity of the fetal myocardium and the formation of cardiomyopathy on the background of cardiomegaly.

CONCLUSION

Psrameters of cardiotocograms can be used to diagnose diabetic fetal cardiomyopathy and to clarify the severity of diabetic fetopathy. Proposed the reference limits of variability parameters, the number of accelerations and high episodes of the basal rhythm of the fetus during 30—40 weeks of gestation.