A method for predicting the development of abnormalities of labor in women with preeclampsia

 

The invention relates to medicine, in particular to obstetrics. The method allows a timely manner before the onset of labour with high accuracy to predict the development of abnormalities of labor in pregnant women with preeclampsia. It is also simple to perform and is available for any clinical laboratory. Conducting a study of the biological material in the peripheral venous blood of women at 38-39 weeks of gestation to determine the index of the functional reserve of neutrophils and when it figures, equal to 0.7 and less predict the development of abnormalities of labor activity. table 1.

The invention relates to medicine, namely to obstetrics, and can be used to predict the anomalies of labor in women with preeclampsia.

The relevance of the proposed method is determined by a high frequency of chromosomal anomalies labor (DGS), which in recent times has a tendency to grow and is according to different authors from 11 to 33% [3, 12, 14]. Existing methods antenatal prediction of ARD uninformative and show a large percentage of false-positive results [10].

There is a method of forecasting dismore increase the norm predict discoordination labor activity [1].

The disadvantages of the method: 1) the method is traumatic and can contribute to the development of inflammatory complications; 2) carrying out the reaction requires mandatory production control to determine non-specific phosphatase, as it is also present on the surface of intact cells; 3) metabolism of adenosine also varies greatly in immunodeficiency States and pathological erythrocytes; 4) the indicator activity adenozindezaminazy has a pronounced age-related dynamics and depends on many additional factors, especially in women; 5) increased activity of adenozindezaminazy observed in tumor conditions; 6) the fluctuation level in the serum endogenous adenosine may also lead to changes in the activity of adenozindezaminazy. Because he is the main extracellular regulator of many processes of metabolism fluctuations in activity adenozindezaminazy can be observed in various pathological conditions [6].

The closest technical solution to the claimed method is a method of determining in a sample of the amniotic fluid, the amount of malondialdehyde (MDA) after induction of lipid peroxidation in reactionary activity [2]. This method was chosen as the closest analogue.

The disadvantages of the method: 1) the invasiveness of the method and, consequently, a higher risk of developing inflammatory diseases of the mother and fetus; 2) nespecificnomu of this method, as a change of production of MDA was observed under the influence of external factors [4], high concentrations of MDA observed in patients with any inflammatory diseases, including genital sphere [7, 13], with the development of perinatal damage of the Central nervous system of the fetus [8], miscarriage [5]; 3) the method allows to predict the development of normal labor, but not anomalies;
4) most of the modifications of the method does not allow to identify all the products of lipid peroxidation that reacts with thiobarbituric acid;
5) a large registration error results due to the development of nonspecific staining;
6) large variability of results depending on the methodology sampling the sample and add detergent;
7) lack of accuracy of the method.

These drawbacks can be eliminated in the proposed method. The claimed technical result is achieved by determining the index of the functional reserve of neutrophils in peripheral cromitie ARD in 82.6% of cases.

The technical result is achieved in the following way. In the peripheral venous blood of women with preeclampsia at 38-39 weeks of pregnancy is determined by the rate of HCT-activity: spontaneous (PCT) and after stimulation simhasanam (NSTS). The index of the functional reserve of neutrophils (IFN) was determined by its own formula:
,
where CNT is a measure of the spontaneous production of active forms of oxygen, NSTS - rate production of reactive oxygen species after stimulation of cells simhasanam. When the values IFRN equal to or smaller than 0.7 and forecasted anomalies labor.

The method is as follows.

The selection of neutrophils from peripheral venous blood is carried out according to standard methods [16]. Then counting NBT-positive cells in spontaneous and induced simhasanam NBT-test [9] and is calculated IFRN.

The novelty of the proposed method lies in the fact that for the first time proposed to predict the development of abnormalities of labor in women with preeclampsia at 38-39 weeks of gestation, by definition, the index of the functional reserve of neutrophils.

Figure NBT-test was previously used to determine the bactericidal Akti is erpretation this test is used for the first time. First were the regularities of changes IFRS with the development of abnormalities of labor and the relationship between the change in HCT-activity and development anomalies of labor in pregnant women with preeclampsia. The decrease in functional reserve of neutrophils indicates negative conditioning of neutrophils in pregnant women with preeclampsia, which is estimated as the imbalance in their functional activity. It is known that the condition of neutrophils may serve as an indicator of the direction of immunological processes leading to the development of obstetric pathology [11]. Moreover, neutrophils produce prostaglandins and proinflammatory cytokines, including tumor necrosis factor (TNF), interleukin-1 [11], which are directly involved in the outbreak of a generic instrument [15].

Distinctive features of the method are:
established prognostic index parameter functional reserve of neutrophils in the peripheral blood of pregnant women with preeclampsia at 38-39 weeks of gestation, when the quantitative value is 0.7 and less than forecasted anomalies labor.

The essence of the proposed method is illustrated by the following examples.

Survey data on the prototype method: the amount of MDA in the sample of the amniotic fluid - 2 µmol/l Predicted ARD.

Survey data by the present method: the index of the functional activity of neutrophils (IFN) was 1.6. Predicted normal family activities (DGS is not expected).

The pregnancy ended in a timely childbirth without complications and birth full-term baby weighing 3200 g, height 50 cm, as assessed by the Apgar scale 8-9. Conclusion: the prediction by the present method was confirmed, and the method prototype was not confirmed.

Example 2. Pregnant So, 25 years. This first pregnancy. History of gynecological diseases notes of menstrual function: menstruation 17 years, irregular, with delays of up to 3-4 months, about which repeatedly surveyed in the gynecology Department, were treated without efficiency is (a) on the background of anemia of I degree. Polyhydramnios. Burdened obstetric history. Mature cervix.

Survey data on the prototype method: the MDA level in the sample of amniotic fluid is 2.5 µmol/l Predicted ARD.

Survey data by the present method: the index of the functional activity of neutrophils (IFC) was 0.33 - projected ARD.

The pregnancy ended in a timely and responsive delivery at 39 weeks. In childbirth developed primary weakness of patrimonial activity, for the treatment which was provided to medical-obstetric anesthesia, were redistillate solution of oxytocin. He was born full-term baby weighing 3400 grams and height of 50 cm, as assessed by the Apgar scale 7-8 points. Conclusion: the prediction by the present method and the method prototype has confirmed.

Example 3. Pregnant J., 28 years. This third pregnancy, desirable in marriage. History of timely delivery with no complications. Second pregnancy ended in a medical abortion, without complication. From gynecological diseases notes the erosion of the cervix, about which the woman was diathermocoagulation. He enrolled in the Department of pathology of pregnant women with a diagnosis of Pregnancy 39 weeks. Nephropathy of I degree. SIPO: the MDA level in the sample of the amniotic fluid 4 µmol/ml Predicted normal family activities.

Survey data by the present method: the index of the functional activity of neutrophils (IFN) was 0.7. Projected ARD.

The pregnancy ended in a timely and responsive delivery at 39 weeks. In childbirth, despite preventive measures, developed anomaly of labor activity in the form of discoordination. To treat discoordinating labor activity of the patient was conducted epidural anesthesia, but in the future, given the lack of effect from treatment discoordination labor, childbirth were completed by caesarean section. He was born full-term baby weighing 2400 grams and height of 50 cm, as assessed by the Apgar scale 6-7 points. Conclusion: the prediction by the present method was confirmed, and the method prototype was not confirmed.

In this way were examined 46 pregnant women with preeclampsia at 38-39 weeks of gestation, research data in the table.

The advantages of the proposed method:
1. The use of the proposed method can improve the accuracy of prediction of anomalies of labor in women with preeclampsia at 38-39 weeks of gestation (82,6%).

2. The way peswaltm.

3. The method is simple in execution, are available to perform any clinical laboratory obstetrics institutions, does not require the use of expensive reagents and equipment.

4. Conduct intake study material safe for the fetus.

5. The duration of the methodology for determining IFRS does not exceed 1 hour and 30 minutes

6. The method has a high accuracy of 82.6%, a sensitivity of 81.8%, and a specificity of 83.3%.

Sources of information
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2. A. C. 1469463. A method for predicting a normal labor. Chernukha E. A. , Murylev C. A., Wysokosc E. I., Komissarova, L. M., Hassan Yousef Ahmad, Galstyan, A. A. //ABOUT "Opening. The invention". 1989. - 12. - S. 216.

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4. Andreeva, L. P., Kozhemyakin L. A., Kiskun A. A. Modification of the method of determination of lipid peroxides in the test with thiobarbiturate acid// lab. case. - 1988. - 11. - S. 41-43.

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8. Gasenko O. C., eagles, C. I., Pogorelov, Etc., Shevko, I., Rosina C. I., Krukier I. I. Biochemical analysis of amniotic fluid in the assessment of intrauterine fetal// Sat. "Threatening condition of the fetus and newborn. New technologies in diagnostics and treatment". - Suzdal. -1995. - C. 27.

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Claims

A method for predicting the development of abnormalities of labor in pregnant women with preeclampsia by examining biological material, characterized in that the peripheral venous blood of women at 38-39 weeks of gestation to determine the index of the functional reserve of neutrophils and when it figures, equal to 0.7 and less predict the development of abnormalities of labor activity.