THE USE OF MAGNETIC RESONANCE TOMOGRAPHY IN THE STUDY OF THE STATE OF THE CENTRAL NERVOUS SYSTEM OF THE FETAL IN WOMEN AFTER ORGAN PRESERVING TREATMENT OF PRECANCER AND THE INITIAL STAGES OF ENDOMETRIAL CANCER WHICH BECAME PREGNANT AS A RESULT OF THE APPL

Abstract

Summary. Aim: to study the state of the central nervous system of the fetus in women after organ-sparing treatment of precancer and early stages of endometrial cancer who became pregnant as a result of the use of assisted reproductive technologies. Object and methods: the main group consisted of 40 women who, from 2 to 5 years ago, underwent organ-preserving treatment for precancer and early stages of endometrial cancer Tis and T1aN0M0G1; T1aN0M0G2, who became pregnant as a result of the use of assisted reproductive technologies. The comparison group included 40 pregnant women with a physiological course of pregnancy and an uncomplicated history, in whom pregnancy occurred spontaneously. In the selected groups of pregnant women, magnetic resonance tomography examination of the central nervous system of the fetus was performed at a gestational age of 35–40 weeks on a “Philips” tomograph. Results: in women from the comparison group, all structural formations of the fetal central nervous system were determined, the median structures were not displaced, and no focal changes in the brain substance were detected in different study modes. Considering that among the main group after in vitro fertilization, a significantly higher frequency of multiple births (27,5%) was found compared to 17,5% in the comparison group, a comparative assessment of the state of the fetal central nervous system was conducted in the studied groups of patients with singleton and multiple pregnancies. Hypoxic lesions of the fetal central nervous system in pregnant women of the main group with singleton pregnancies were detected in only 5,0% of cases. These were functional hypoxic lesions of the fetal central nervous system — external and internal hydrocephalus, which is the result of impaired production and resorption of cerebrospinal fluid in the fetus, which occur in response to hypoxia. In pregnant women in the comparison group with singleton pregnancies, functional hypoxic lesions of the fetal central nervous system were observed in 2,5% of cases. The results of studies of the state of the fetal central nervous system in multiple pregnancy in women of the main group after in vitro fertilization showed that ischemic hypoxic lesions of the fetal central nervous system were observed in 10,0% of cases, hemorrhagic hypoxic lesions of the fetal central nervous system — in 12,5% of cases, combined hypoxic lesions of the fetal central nervous system — in 7,5% of cases. Among pregnant women in the comparison group with multiple pregnancies, ischemic, hemorrhagic, and combined hypoxic lesions of the fetal central nervous system were absent. Conclusions: when conducting a magnetic resonance tomographic study of the state of the central nervous system of the fetus as a result of the use of assisted reproductive technologies in women after organ-sparing treatment for precancer and the initial stages of endometrial cancer in singleton pregnancies, no significant differences were found with the state of the central nervous system of the fetus in pregnant women with a physiological course of pregnancy and an uncomplicated history, in whom pregnancy occurred spontaneously. While hypoxic lesions of the fetal central nervous system were detected in multiple pregnancies as a result of the use of assisted reproductive technologies in women after organ-sparing treatment for precancer and the initial stages of endometrial cancer.