A method for predicting discoordination labor in pregnant women risk group

 

(57) Abstract:

The invention relates to medicine, obstetrics and gynecology. Pregnant women risk group with 37 weeks of gestation register fluctuations in heart rate. Registration is done in the low frequencies (LF) and high frequency (HF). Discoordination labor activity predicted by the values of LF and HF. The method is non-invasive, simple, allows early prediction. table 1.

The invention relates to medicine, namely to obstetrics, and can be used to predict the development of discoordination labor in pregnant women at risk.

The urgency of development due to increased frequency of anomalies labor (DGS) to 17-30% (1, 3), of which discoordinated up to 3% (2, 3). Pathology contractile activity of the uterus leads to an increase in the duration of delivery, number of surgical interventions, the frequency of obstetric injuries, pathological blood loss, intrauterine fetal hypoxia. Dramatically increased perinatal mortality and mestorozhdenii (4).

A significant number of diagnostic and prognostic tests used for predicting the course of childbirth (clinical, and which enable to determine only the risk of developing pathology of labor, and in relation to the individual characteristics of women do not provide the realization of the forecast.

There is a method of predicting discoordination labor activity by determining the blood from the cervix activity adenozindezaminazy and increase the norm predict discoordination labor activity (5).

The disadvantages of the method:

1) the enzyme adenozindezaminazy has a pronounced age-related dynamics and depends on immunodeficiency, extragenital pathology, polyhydramnion, etc.;

2) carrying out the reaction requires mandatory production control to determine non-specific phosphatase, which in pregnant women has initially changed level;

3) may contribute to the development of inflammatory complications;

4) invasive;

5) how is traumatic;

6) the lack of data on the accuracy of the method.

The closest technical solution to the claimed method is a method for predicting anomalies labor before birth by ultrasound echography the body of the uterus on the border with the lower segment. When identifying hyperechoic line on the background hypoechoic myometrium forecast is flexible (30%);

2) late in the forecast the day before delivery;

3) to perform the method requires expensive ultrasound equipment and trained specialist ultrasonographer;

4) lack of data on the accuracy of the method.

These drawbacks can be eliminated in the proposed method.

The technical result of this method is the prediction of discoordination labor in pregnant women risk group on the basis of determination with 37 weeks of gestation according to the spectral analysis of heart rate indices, reflecting fluctuations in heart rate in the low frequencies (LF norm)* (* LF norm reflects fluctuations in heart rate in the low frequencies from 0.04 to 0.15 Hz.) in the high frequency (HF norm)** (** HF norm reflects fluctuations in heart rate in the high frequencies from 0.15 to 0.40 Hz (9)), expressed as a percentage, and when values of LF norm equal to 53,9% or less, and HF norm equal to 46.1 per cent or more, forecast discoordinating generic activities with an accuracy of 87.8%.

Earlier spectral analysis of HRV was used in cardiology for the diagnosis of cardiac arrhythmias, pathology of the coronary arteries, and was also used as a method of formalizability heart rhythm has been used in various computer programs (we have taken the program “Polyspectra”, registration certificate №29/02020300/1987-01 dated 27.07.2001, the firm “Neurosoft”, Ivanovo). Spectral analysis identifies and quantifies the periodic changes in the frequency of sinus rhythm (7, 9).

The novelty of the proposed method

The relationship of indicators of fluctuations in heart rate in the low frequencies (LF norm) and high frequency (FTF norm), with the development of discoordination labor is installed for the first time.

Distinctive features of the way

Established prognostic parameters indicators of fluctuations in heart rate in the low frequencies (LF norm) and high frequency (HF norm) in pregnant women at risk of developing DGS 37 of negligently: when values of LF norm equal to 53,9% or less and HF norm equal to 46.1 per cent or more, are forecasted discoordination generic activities with an accuracy of 87.8%.

The method is as follows.

The initial data for calculation of indicators LF norm and HF norm was the electrocardiogram (ECG), which is registered in 6-lead (I, II, III standard, aUR, aVL, aVF) at rest in the supine position, in the morning on an empty stomach, after a 10-minute rest. The duration of the ECG recording was 5 minutes. Dannemoine No. 29/02020300/1987-01 dated 27.07.2001,, firm “Neurosoft”, Ivanovo), intended for cardiac research. The obtained data were expressed as a percentage.

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

Example 1. Pregnant K., 28 years. Obstetric history burdened. The first pregnancy ended in a medical abortion in the period of 10 weeks, the second - spontaneous miscarriage during pregnancy 8-9 weeks of pregnancy, third and fourth - minibottle. This fifth pregnancy, desirable in marriage. The woman identified as high risk of developing abnormalities of labor activity. He enrolled in the Department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. Nephropathy of I degree. The OAS (burdened obstetric anamnesis). Immature cervix.

Survey data by the present method: the estimate of the HRV index LF norm made up 48.2%, lower than the declared parameter, HF norm - 51,8%, which is higher than the stated parameter. Forecasted discoordinated labor. The pregnancy ended in timely delivery, which was complicated by discoordinating labor. He was born full-term baby weighing 3200 g, height 50 cm, ozenna So, 26 years. Gynecological anamnesis burdened. This first pregnancy. History of gynecological diseases notes the 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 effect. The woman identified as high risk of developing abnormalities of labor activity. He enrolled in the Department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. Polyhydramnios. Burdened gynecological anamnesis. Mature cervix.

Survey data by the present method: the estimate of the HRV index LF norm was 53,9%, HF norm - 46,1%. Forecasted discoordinated labor.

The pregnancy ended in a timely birth at 39 weeks. In birth prevention discoordinating labor was used antispasmodic drugs, with a positive effect discoordinated labor has not developed. He was born full-term baby weighing 3400 g, height 50 cm, with rating on a scale of Apgar 7-8 points. Conclusion: the Outlook for the claimed method was not confirmed in connection with the timely prevention.

Survey data by the present method: the estimate of the HRV index LF norm stood at 64.5%, which is higher than the stated parameters, HF norm - of 35.5%, which is below the stated parameters. Predicted normal family activities.

The pregnancy ended in a timely birth at 40 weeks. Delivery was uneventful. He was born full-term baby weighing 2600 grams and height of 51 cm, with rating on a scale of Apgar 8-9. Conclusion: the prediction by the present method were confirmed - the anomaly of labor has not developed.

In this way were examined 142 pregnant women at risk for the development of ARD. Research data in the table.

The advantages of the proposed method:

1. The possibility od simple in execution, it has high accuracy.

3. Method neuvation.

4. Method objective.

5. The duration of the methodology and calculation of the indicators is 15 minutes.

6. The method does not require expensive equipment.

Bibliography

1. Abramenko centuries of Active management of labour. St. Petersburg: Special literature, 1997.

2. Sidorov I. S. Physiology and pathology of labor activity. - M.: Medpress, 2000. - 318 S.

3. Chernukha E. A. Generic unit. - M.: “Triada-X, 1999. - S. 181-222.

4. Kulakov Century. And., Serov Century. N. and other labor Pain relief. - M.: “Triada-X, 1998. - 152 C.

5. Eagles Century. And., Pogorelov I.e., Drucker N. A., Yurovsky, C. L. a Method for predicting discoordination labor. //Official Bulletin “Discoveries. The invention.” - 1991. - №18. - C. 17.//A. S. No. 1648346.

6. Glushko A. A., Fedorov, M. C., Kotov, Y. B., Tumanyan E. E. a Method for predicting anomalies labor before the birth.// Bulletin “Inventions”. - 1999. - No. 22. h 2. - S. 390.// Patent No. 2134418.

7. Ryabikin, C., Sobolev A. B. heart rate Variability. - M.: Publishing house “the Old Co, 1998. - 200 S.

8. Ryabikin, C., Sobolev A. C. Analysis of HRV. //Cardiology. - 1996. - so 36. No. 10, S. 87-97.

9. Variab The Recommendations. //The Bulletin of Arrhythmology. - 1999. No. 11. - S. 53-78.

A method for predicting the development discoordinating labor in pregnant women risk group method of functional diagnostics, characterized in that in women with 37 weeks of gestation identify indicators of fluctuations in heart rate in the low and high frequencies and at low frequencies, equal 53,9% or less, and a high frequency equal to 46.1 per cent or more, predict the development of discoordination labor.

 

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