A method for predicting the syndrome of delayed fetal development in women in the second trimester of pregnancy complicated by preeclampsia
(57) Abstract:The invention relates to medicine, in particular to obstetrics. The method provides a prognosis of the syndrome of delayed fetal development in women in the second trimester of pregnancy complicated with preeclampsia at an early stage of its occurrence. Survey the parameters of hemostasis, thus determine the number of platelets, activated partial thromboplastin time, fibrinogen level and calculate the prognostic index S according to the formula S= AK1+VK2+SC3+const, where S is the prognostic index And the number of platelets in 109/l, activated partial thromboplastin time (APTT), fibrinogen level, g/l, K1TO2TO3are coefficients respectively equal to 0.02; 0,046; -0,06, const=-4,39 and if the index value S is less than 0, then predict the risk of syndrome of delayed fetal development, if the value S is greater than 0, proportional to predict the development of the fetus. The invention relates to medicine, namely to obstetrics.The urgency of the problem lies in the fact that newborns with the syndrome of delayed fetal development have adverse perinatal indicators and form somatic protagoni somatic, obstetric history, early onset and progressive course of preeclampsia, the lack of effect of therapy.A similar method to forecast sdfd can be considered as ways of assessing violations of utero-placental and fetal-placental blood flow . Changes are detected in the second trimester of pregnancy. Established a clear relationship between diplomaticheskii assessment of hemodynamics in the system mother-placenta-fetus and the degree of morphological changes in the blood vessels of the placenta, umbilical cord and placental bed and further development of the sdfd. Given that the syndrome of delayed fetal development of the fetus is multifactorial, it should be analyzed based on a set of indicators, taking into account risk groups for development of the sdfd.The prototype of the method are publishing about the possibility of forecasting the complicated course of preeclampsia with subsequent adverse perinatal outcomes, in particular sdfd, reduced platelet counts, hematocrit [2, 3, 5].The aim of the invention is the prediction of the syndrome of delayed development of the fetus in the second trimester of pregnancy in women with somatic and obstetric ginekologicheskoe treatment sdfd.The method is as follows.In women the risk group for the development of sdfd conduct clinical and laboratory research gemostaziogramma determine the platelet count, activated partial thromboplastin time, fibrinogen level. To do this in the washed dry test tube in the morning fasting blood sample of 5 ml from the cubital vein silikonizirovannoj needle by gravity. Valid only short-term ispolzovanie harness. Blood mixed with 3.8% sodium citrate in a ratio of 9: 1. The number and size of platelets is defined as the microscopic method: count of platelets in the Goryayev camera , or by using automatic counters. Activated partial thromboplastin time (APTT) is determined by analysis of coagulation recalcitrance plasma under conditions of standard activated clotting phospholipids (Catalina) and contact with a foreign surface . The determination of fibrinogen in citrate plasma is carried out by gravimetric method R. A. Rutberg . On the basis of mathematical processing of the data by the method of discriminant analysis is derived decision rule development forecast sdfd:
With the level of fibrinogen, g/l;
K1, K2TO3are coefficients respectively equal to 0.02; 0,046; -0,06;
const=-4,39.When the value of S less than zero predict the development sdfd, when the value of S is more than zero proportional to predict the development of the fetus. The forecast accuracy is 79%.Example 1
Trantina T. H., 25 years, re-pregnant, powerseraya was on treatment in the state of NIYOM in 2000, the history of childbirth 74. Heredity burdened by his father's leukemia. Chronic diseases: causes, often respiratory viral infections and gynecological disorders: a ureaplasmosis, a mycoplasmosis. History 1 medical abortion. This pregnancy from an early period was accompanied by the threat of termination with pain and hypertonicity of the myometrium with ultrasound. Edema symptom progressed with 26-27 weeks of pregnancy, blood pressure within normal limits. When coagulation tests revealed: the number of platelets 164109/l, fibrinogen 4,2 g/l, APTT 50,9 sec. According to the formula forecast calculated prognosticeski index:
3,28+2,34-0,25-4,39=0,98.Thus, S>0, the forecast favorable. Odoratissimus live full-term Rebenko treatment in the state of NIYOM. The burdened heredity through the mother cirrhosis of the liver. Somatically woman suffering from chronic gastritis, obstetric history is a medical abortion. 1 trimester was complicated by threatened abortion on ULTRASOUND were recorded hyperons myometrium, the woman is the bearer of a cytomegalovirus. Edema symptom progressed from the 25th week of pregnancy. The parameters of hemostasis: platelet count 126109/l, APTT 32, fibrinogen 4.0 g/L. When calculating according to the formula forecast:
S=1260,02+320,046-4,04,25-4,39=-0,86.Thus, S<0, the woman has a poor prognosis for fetal growth, projected syndrome of delayed fetal development. Sdfd 1-2 degrees was diagnosed with ultrasound examination at 33 weeks of gestation the fetus was behind in development for 2 weeks, the woman was rodorazresheniye prematurely at 34 weeks of pregnancy due to progression of the symptoms of preeclampsia and the lack of effect of therapy by way of caesarean section. The baby was born prematurely, had neurological symptoms, syndrome musculoskeletal and respiratory disorders, periventricular ischemia, morphological immaturity of the internal organs. After nursing in otdeleniya. Thus, using this rule, we can predict the development of the sdfd.Sources of information
1. The Summary A. N., Bunin, A. T., Medvedev, M. C. Ultrasound diagnosis in obstetrics clinic. - M.: Medicine, 1990. - 150 S.2. Saveliev, M. Kulakov Century. And., Serov, C. N., The Summary A. N., Shalin R. N. , Murashko L. E. Modern approaches to diagnosis, prevention and treatment of preeclampsia. HOWTO health Ministry. M., 1999.3. Shechtman, M. M. Guide extragenital pathology of pregnant women. - M.: Medicine, 1999. - 600 C.4. Mathematical modeling in obstetrics and gynecology: a Collection of scientific papers. Donetsk, 19945. Shechtman, M. M., Elokhin, B. Some methods of forecasting of late toxemia of pregnancy// Akush. and gin. - 1996. 3. C. 3-6.6. Barkagan the legislative Assembly, the Mammoth A. L. Main methods of laboratory diagnostics of disorders of hemostasis. - Barnaul, 1998. - 127 S. A method for predicting the syndrome of delayed fetal development in women in the second trimester of pregnancy complicated by preeclampsia, by studying the parameters of hemostasis, characterized in that to determine the number of platelets, activated partial thromboplastin time, fibrinogen level is S - prognostic index; And - the number of platelets in 109/l; activated partial thromboplastin time (APTT); - the level of fibrinogen, g/l; K1TO2TO3are coefficients respectively equal to 0.02; 0,046; -0,06; const=-4,39, and if the index value S is less than 0, then predict the risk of syndrome of delayed fetal development, if the value S is greater than 0, proportional to predict the development of the fetus.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.
EFFECT: higher efficiency of studying.
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SUBSTANCE: method involves checking consciousness, blood coagulation state, peripheral blood leukocytes number, K+ ions, bilirubin, fibrinogen, hemolysis and hemoglobinuria availability, prothrombin index and exotoxic shock development. Each value is calculated in points as follows. Lucidity is evaluated as -2 points; depression - +3 points; coma - +6 points; lack of changes in blood coagulation system - -2 points; coagulation availability without clinical injuries - +2 points; coagulopathy with clinical manifestation signs - +19 points; K+ ions concentration being less than 3.0 mmole/l - +3 points, from 3.1 to 3.5 mmole/l - -5 points, from 3.6 to 5.0 mmole/l - 0 points, greater than 5.0 points - +7 points, failure in determining K+ ions concentration - 0 points; hemolysis availability - +6 points, its lack - -3 points; hemoglobinuria availability - +8 points, its lack - -1 points; leukocytes number being less than 12.0x109/l - -2 points, from 12,1 to 18.0x109/l - 0 points, higher than 18.0x109/l - +8 points; hourly urine output being less than 30 ml/h - +6 points, greater than 30 ml/h - -2 points; bilirubin content being less than 31 mcmole/l - -2 points, from 30.1 to 50.0 mcmole/l - 0 points, greater than 50.0 mcmole/l - +2 points, failure in determining bilirubin content due to hemolysis being available -+6 points; prothrombin index being equal to or less than 60% - +3 points, greater than 60% - 0 points, failure in determining prothrombin index due to hemolysis being available - +12 points; fibrinogen concentration in blood plasma being less than 2.1 g/l - +4 points, from 2.1 to 4.0 g/l - -1 point, from 4.1 to 6.0 g/l - +1 point, failure in determining fibrinogen concentration due to erythrocyte hemolysis being available - +13 points; exotoxic shock development - +9 points, its lack - -1 point. The points are summed up. The value being greater than +13, admission for treatment in resuscitation department is indicated. The value being less than -13, admission for treatment in therapeutics department is indicated. The value being from -13 to +13, resuscitation expert consultation is advised.
EFFECT: high evaluation accuracy.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.
EFFECT: shortened terms of research.
1 ex, 4 tbl
SUBSTANCE: method involves analyzing symptoms manifesting initial disseminated intravascular blood coagulation syndrome danger like burn area, availability of upper air passages burn, shock with its severity degree taken into consideration, sepsis development; clinical manifestations of disseminated intravascular blood coagulation syndrome like lung, kidney, liver function insufficiency, cerebral dysfunction, local and multiple hemorrhages, thrombosis, infarction; homeostasis system laboratory analysis data, hyper- and hypocoagulation based on chronometry test data, number of blood platelets, fibrin-monomer complexes, D-dimers, activity of antithrombin III, C and S proteins, XIIa-dependent fibrinolysis plasminogen content, availability of injured erythrocytes, combinations of laboratory tests for recognizing disseminated intravascular blood coagulation syndrome. Each sign under consideration receives a number of points corresponding to its diagnostic significance and integral value is calculated DIBCSIV=(X1+X2+…+Xn)/n, where n is the number of signs taken into consideration. DIBCSIV value equal to 1.0-1.5 units shows physiological norm. The value being between 1.6 and 2.5 units, light disseminated intravascular blood coagulation syndrome is diagnosed. The value being between 2.6 and 3.5 units, disseminated intravascular blood coagulation syndrome of medium severity is diagnosed; 3.6-4.5 points to one heavy severity degree; 4.6 and greater indicates highly severe case of disseminated intravascular blood coagulation syndrome.
EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.
FIELD: medicine, diagnostics.
SUBSTANCE: one should study blood components to detect anticoagulant-fibrinolytic activity. Moreover, patient's blood should be sampled: in whole blood one should detect the presence of affected erythrocytes and evaluate the quantity of thrombocytes, in plasma it is necessary to study the activity of antithrombin III, XIIa-dependent fibrinolysis, the content of soluble fibrin-monomeric complexes, in blood serum of the sample taken one should detect the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, moreover, one should calculate integral value of renal-hepatic deficiency, to put corresponding point for the degree of parameters under testing, then one should calculate integral value of disseminated intravascular clotting (IVDIC) and at its value being 6.3 U and more DIC-syndrome should be diagnosed, moreover, at IVDIC value ranged 6.3-10.1 U it is possible to diagnose latent DIC-syndrome, at 10.2-14.6 - subacute DIC-syndrome and at 14.7 and higher - acute DIC-syndrome should be concluded.
EFFECT: higher accuracy and efficiency of diagnostics.
4 ex, 2 tbl
FIELD: medicine, obstetrics.
SUBSTANCE: the present innovation deals with predicting disadaptive processes in women in dynamics of menstrual cycle. During menstrual cycle beginning since the 1st d to the 21st d one should detect the dynamics for alteration in coefficient of activity of syntoxic adaptation programs (CASAP), calculated by the following formula:
where CST - concentration of blood serotonin, AAT-III - activity of antithrombin III, Aaoa - total antioxidizing activity of plasma, CCD8 + - concentration of T-suppressors, Cad - concentration of blood adrenalin, Cα2MG - concentration of α2-macroglobulin, CMDA - concentration of malonic dialdehyde, CCD4 + - concentration of T-helpers. Moreover, normally CASAP value alters two-fold against the first day of the cycle - since 0.70 up to 1.40 on the 21st d of the cycle, at no alterations in CASAP value one should diagnose female disadaptive alterations leading to failed pregnancy. The innovation enables to perform diagnostics of disadaptive processes in women in dynamics of menstrual cycle followed by prognostic conclusion upon future pregnancy.
EFFECT: higher accuracy of diagnostics.
SUBSTANCE: method involves determining spontaneous blood platelets aggregation and one induced by adrenalin and collagen, thrombocytospecific peptides activity of β-thromboglobulin and thrombocytic factor 4 in blood plasma.
EFFECT: high accuracy of diagnosis.
SUBSTANCE: method involves determining coagulating blood viscosity values like reaction period r, thrombin constant K, maximum amplitude MA, time T for forming fibrin-thrombocytic blood clot, spontaneous blood platelets aggregation intensity Ar, retraction and spontaneous clot lysis total FA. The r being within 5-7 min, Ar from -2 to -6 relative units, K being within 4-6 min, MA within 500-700 relative units, T within 40-60 min and FA equal to 10-20%, low inflammatory process activity is considered to be the case. The r being less than 5 min, Ar equal to -8 to -12 relative units, T less than 40 min and FA less than 10% with no changes in K and MA being observed, inflammatory process activity in chronic glomerulonephritis case is considered to be of high severity degree.
EFFECT: high accuracy of diagnosis; enhanced effectiveness of treatment method selection.
FIELD: medicine, clinical neurology, neurosurgery.
SUBSTANCE: one should study both activation and aggregation of thrombocytes in blood of carotid artery, at the quantity of thrombocytic active forms being above 70% and the number of aggregated thrombocytes being above 9.0% one should predict the development of cerebral ischemic lesion along with stable focal neurological symptomatology, and at the quantity of thrombocytic active forms being below 30% and the number of aggregated thrombocytes being below 8.0% it is possible to predict positive dynamics in the course of the disease mentioned without developing cerebral ischemic lesion.
EFFECT: higher accuracy of prediction.
FIELD: medicine, clinical neurology, neurosurgery.
SUBSTANCE: one should study the level of von Willebrand's factor in patient's carotid artery blood. At its content being below 105% one should predict the development of repeated AICH. The innovation improved information value of testing due to possibility to obtain reliable prediction in latent period, as well.
EFFECT: higher accuracy of prediction.
2 ex, 1 tbl