Method a retrospective (post-partum) rapid diagnosis of placental insufficiency in the delivery room


(57) Abstract:

The invention relates to the field of medicine. The newborn is separated from the placenta, crossing the umbilical cord, some distance of 25-30 cm from the umbilical ring. In this case, the length of the umbilical residue that is attached to the placenta, will be 26-28 see the Placenta immediately after birth looks, osupivaja, defined pathological areas and seals. Then the placenta weighed without preparing entirely with further calculation of the placental-fetal coefficient according to the formula K=(a-b)/C, where K - placental-fetal coefficient; And is the mass of the placenta with shells and the remnant of the umbilical cord; weight unpleasantry shells and stump equal to 103 grams; is the mass of the fetus at birth. For values of K=of 0.13 to 0.19 in the case of children born in the period of gestation 38-40 weeks and coefficient values To=from 0.2 to 0.23 in the case of premature births in the period 32-37 weeks of the placenta are compensated without macroscopically detectable in their pathological changes. When larger or smaller values in the specified period of gestation is diagnosed chronic secondary (developed in II and III trimesters of pregnancy) placental insufficiency important to identify e allows you to enhance, to extend the diagnostic capabilities, to objectively diagnose placental insufficiency immediately after the birth of the placenta. table 1.

The invention relates to medicine and can be used in practical obstetrics and neonatology, pathology.

Proposed many methods to determine the degree of compensation of the placenta during pregnancy and retrospectively.

There is a method of evaluation of the uterine-placental blood flow during pregnancy when the radioisotope placentocentesis. This method is based on the visualization of the body, receiving its shielded areas of the dynamic characteristics of the receipt and distribution of radiopharmaceuticals (protein, labeled with radioactive technetium, indium), injected into the peripheral blood. The disadvantages of this method are its high cost, the introduction of radioactive blood protein, the necessity of special sophisticated equipment, the availability of radioisotope laboratories. Possible radiation exposure to the fetus (Saveliev, M. and other Placental insufficiency - M.: Medicine, 1991, S. 158-163).

In clinical practice the method of ultrasonic diagnosti to evaluate quantitatively and qualitatively the uterine-placental blood flow, the blood vessels in the umbilical cord and great vessels of the fetus and to determine the amount of the placenta and its thickness, the period of gestation in size of the fruit. Advantages: highly informative, non-invasive, relatively simple, the safety for the fetus and the mother, the ability to use throughout pregnancy. Disadvantages of the method: the impossibility of rendering the placenta is located on the rear wall of the uterus, the need for highly qualified staff and the availability of expensive devices with high resolution (Savelyeva, M and other Placental insufficiency. - M.: Medicine 1991, S. 163-169.).

Methods a retrospective assessment of fetoplacental circulation, i.e. after childbirth. The data obtained can be used for prognosis of early neonatal period and status of the newborn. For example, a method Crans, which is based on the perfusion of maternal and fruit parts placental glucose solution and the chemical composition of flowing and flowing solution. It is possible to measure the dynamic parameters of blood circulation. Disadvantages of the method: requires chemical laboratory, special equipment.

Method Savelieva, M with co - stor is: at the moment of the eruption of the occipital tubercles of the head of the fetus to the mother is injected with 5 IU of oxytocin with glucose solution and after birth immediately separate the placenta external methods kateteriziruyut vessels of the placenta and washed them isotonic sodium chloride with heparin at the rate of 5000 IU/l, followed by her brandy 1% silver nitrate solution for Ranvier. Then the placenta is fixed in formalin and examined microscopically with morphometrics terminal of fetoplacental vessels (Saveliev, M. and other Placental insufficiency. - M.: Medicine, 1991, S. 169-170).

A significant drawback of the method is that it can only be applied at physiological childbirth in the head previa. Childbirth by caesarean section or under development in childbirth complications, this method is inapplicable. The method requires special skills of medical personnel (catheterization of blood vessels of the placenta, infusion solutions, brandy), solutions and medicines. Morphometry of placentas takes a lot of time.

Closest to the proposed method long practical use was proposed method a retrospective evaluation of blood supply to the fetus by calculating the placental-fetal coefficient (ACC) as the ratio of the weight of the placenta (the children's place without membranes and umbilical cord) to the weight of the fetus. It is known that CPD at term pregnancy varies from 0.13 to 0.19. It decreases when uvely - 0,22-0,23; 36 weeks - 0,19-0,1. In the event of the birth of premature babies CPD, as a rule, more of 0.2. Increase or decrease the values of CPD evidence of hyperplasia or hypoplasia of the placenta and consequently chronic placental insufficiency. Adverse prognostic sign in the case of premature birth is the value of CPD more 0,3 (Sulkevich Yu, Makkaveev M, Nikiforov B. Pathology of the placenta of man and its effect on the fetus. - Minsk: Belarus, 1968, S. 34-37; zemkova H. P., topchieva O. I. Clinical and morphological diagnosis of placental insufficiency. - L.: Medicine, 1973, S. 74 and 75).

A significant drawback of this method is the necessity of the preparation of the placenta (separation from the placenta unpleasantry shells and the remainder of the umbilical cord) in a specially designed space in the hospital. Problems arise marking, recording and delivery of prepared placenta in the anatomic hospital for subsequent histological examination. In view of these disadvantages of the use of this method in the delivery room immediately after birth, the placenta is difficult. This method has found wide application in the anatomic compartments p what about the studies of the placenta conclusion is transferred to the maternity ward on the fifth-sixth working day and may not be used or lost, if there is no continuity between the pathological anatomical service, service, obstetric and pediatric advice. In this regard, the importance of the method is reduced.

With the aim of obtaining reliable placental-fetal coefficient, standardized and simplified man-made processing of the placenta in the delivery room immediately after birth of the placenta, the maximum low cost method of determining the CPD was studied 270 placentae in cases of children born alive. We determined the size of the placenta, its thickness in the Central division, weight without membranes and umbilical cord, the weight of the shells and the remainder of the umbilical cord was measured length of the stump Considering that the length of the umbilical cord in normal full-term fetus 50-60 cm, the newborn was separated from the placenta, crossing the umbilical cord, some distance of 25-30 cm from the umbilical ring. Calculated placental-fetal ratio. Statistically obtained data is processed in the program Microsoft Excel. Placental histology was studied By morphological picture (Kalashnikov, E. P. Clinical and morphological aspects of placental insufficiency. Archives of pathology. So 50. - 1988, No. 5, S. 99-105; Milovanov, A. P. Pathology of the system mother - placenta - fetus: guidelines for physicians. Medicine, 1999, S. 279-309) all of the placenta in the article is; ) subcompensated placental insufficiency (second degree); 3) asthma placental insufficiency(third degree); 4) placenta without pathology (control group).

In the control group, the weight of the shells and the stump was 103,677,5 g, stump length of 26.3±1,03 cm, mask placenta 510,922,84, fruit Weight 3406,9111,25, CPD 0,1501. Significant differences in the mass of the membranes and umbilical cord in 1-, 2-, 3-St group compared to the control was not detected (see table). In placentae 1-, 2-, 3-th groups identified macroscopically singular and plural white infarcts (seals in the placenta gray or white in color, determined macroscopically and with the feeling of the placenta), which are signs of chronic placental insufficiency. In groups of placentas with secondary (developed in II and III trimesters of pregnancy) chronic compensated and subcompensated placental insufficiency significant differences of the values of the placental-fetal coefficient compared with that of the control group (see table). Morphologically 30% of placentas with varying degrees of chronic placental insufficiency was detected signs of infection.

ACC=(weight of placenta - 103 g)/ weight of the fruit.

The proposed method is retrospective (post-partum) rapid diagnosis of secondary chronic placental insufficiency (developed in II and III trimesters of pregnancy) ensures the achievement of the technical result consists in raising awareness and expanding diagnostic capabilities.

In addition, compared with the prototype method retrospective rapid diagnosis of placental insufficiency does not require preparation of the placenta, therefore, can be applied directly in the delivery room immediately after birth of the placenta. The method does not require additional financial costs, special skills and qualifications of medical personnel. To conduct this diagnostic method takes a minimum amount of working time is 1-2 minutes

Further clarification of the degree of compensation of the placenta does not preclude its subsequent morphological study.

The proposed method is rapid diagnosis of secondary chronic placental insufficiency (razbivsheysya in the II-III trimesters of pregnancy) is as follows.

After the birth of the placenta, while looking through the cold factor suggested above formula.

Example 1. Newborn, was born in the gestation of 40 weeks. Birth weight 3660 g, body length 56 cm, score on a scale of Apgar at birth 6 points in 5 min - 8 points. The weight of the placenta 573, Macroscopically in the placenta diagnosed in three slices white heart attacks that are based on the maternal surface. Calculated placental-fetal ratio: ACC=(573-103)/3660=0,13. In this case, there are macroscopic signs of chronic placental insufficiency, the value of CPD corresponds to the lower limit of normal. The newborn clinically diagnosed hypoxia moderate severity. Conducted intensive therapy. On the third day with an increase of respiratory disorders of the newborn dies, despite ongoing therapy. Postmortem conclusion: the underlying disease. Telematicheskie form of pneumopathy (Code ICD-10 - P22.0). Background. Viral and mycoplasmal placenta. Etnicheskie placental insufficiency second degree.

Example 2. Newborn P., gestation 39-40 weeks. Birth weight 3200 g, body length 54 cm, score on a scale of Algar 7 points after 5 min - 8 points. The weight of the placenta 440 g, placenta looked juicy, pathological changes macroscopically not found.

Example 3. Newborn, born in gestation 38-39 weeks.

Birth weight 3450 g, body length 55 cm, score on a scale of Apgar at birth 8 points after 5 min - 10 points. The weight of the placenta b g, the length of the umbilical residue 26 see Macroscopically in the placenta pathology was not detected. Calculated placental-fetal ratio. ACC=(650-103)/3450=0,16. Physiological loss of body weight was 2%. Discharged home on 6 days with a diagnosis of healthy. In the placenta pathological changes in the histological examination not found.

Method a retrospective (post-partum) rapid diagnosis of placental insufficiency in the delivery room to identify groups of newborn infants at high risk of developing pathology in the neonatal period and the neonatal period, including the weighing of the placenta and the calculation of the placental-fetal coefficient, characterized in that the placenta weighed directly in the subsequent calculation of the placental-fetal coefficient according to the formula


where K - placental-fetal coefficient;

And the weight of the placenta;

In mass unpleasantry shells stump, equal to 103 g;

With the weight of the fetus at birth

and when the value of K = of 0.13 to 0.19 in cases of children born in the period of gestation 38-40 weeks and when the value of K = 0,2-0,23 in the case of preterm birth in gestation 32-37 weeks, the placenta is considered to be compensated if there is no macroscopically detectable in her pathological changes, but larger or smaller values of the coefficient in the case of children born in the specified period of gestation is diagnosed reliable secondary chronic placental insufficiency developed in II and III trimesters of pregnancy.


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