A method for predicting pathological pregnancy outcomes

 

The invention relates to medicine, obstetrics. Record the ECG, heart rate variability (HRV) pregnant. Build geometric image HRV in the form of phase portraits (AF) of HRV mother. Visually determine the appearance of AF at rest pregnant and classify it as chaotic, extremely cyclical, simplified geometric and mixed. Predict the outcome of pregnancy and the presence of chronic placental insufficiency in mind the OP in the first or second half of pregnancy. The safe way suitable for screening, allows to improve the analysis of nonlinear HRV components. 2 C.p. f-crystals, 3 ill., 1 PL.

The invention relates to medicine, in particular to obstetrics.

The nature of the course and outcomes of pregnancy (IB) are among the most important factors of well-being not only in utero, but the rest of a person's life. In particular, this was demonstrated in recent years in relation to this indicator of fetal pathology as malovent of the fetus at birth (H. Lithell, 1999, CIT.: Radzinsky C. E., Small P. J. Biochemistry of placental insufficiency. - M.: Publishing house is the action scene frequency worldwide, and also in Russia (Reproductive loss: clinical and medico-social aspects/ C. N. Serov, G. M. Burduli and others - M.: "Triada-X", 1997. - 188 S.).

Pathological IB include placental insufficiency, fetal hypoxia and fetal development, preeclampsia, premature labor, violations of labor, fetal and early neonatal death fetal and others. Despite the large variety of etiology, pathogenesis and clinical manifestations of pathology of pregnancy, there is a certain common pattern corresponding functional States of the parent body. This is because in many pathological processes is a violation of the activity of regulatory systems - endocrine and autonomic, which is accompanied by the relevant metabolic and hemodynamic changes, which is largely nonspecific.

In the last 10-15 years to assess Autonomous (vegetative) nervous system, humoral, metabolic, and hormonal regulation of pregnancy are indicators of heart rate variability (HRV) mother. Parameters of HRV provide an opportunity for early diagnosis and prognosis of pathological IB, which is associated with systematic regulatory systems (Fleishman A. N. Slow hemodynamic oscillations: theory, practical application in clinical medicine and prevention. - Novosibirsk: Nauka, 1999. - 215 C.). This approach uses the frequency spectrum (Fourier transform) of the heart rhythm, and you are to select the low-frequency (LF) and high frequency (HF) spectral power of HRV. As a result, numerous studies have shown that the range of the RF characterizes vagusnye, and NP - sympathetic-adrenal branches of the autonomic nervous system (Heart Rate Variability: standards of measurement, physiological interpretation and clinical use// Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology - Circulation. - 1996. - V. 93. - P. 1043-1065).

Severe medical consequences IB, their social significance encourage researchers to look more sophisticated, based on modern computer technology methods for early diagnosis and prediction of pregnancy complications.

The known method of geometrical analysis of HRV based on the construction of the so-called "HaShem" (Havrilesky A. P., Kiselev S. C., Maslyuk, A. P. Nonlinear dynamics of cardiac rhythm in cardiac surgical patients// Slow oscillatory processes in the human body. Theoretical and applied aspects of nonlinear dynamics in physiology/Collection of trainee complex geometric pattern of the nonlinear dynamics of heart rate (Hashemi plane rectangular coordinate system. The abscissa axis represents duration of RR intervals, and the y - axis increment a given RR interval. The obtained points are connected by a continuous line, i.e., builds a geometric way of HRV.

The authors of this work proposed a classification of visually-defined types aashram, including the so-called pathological or dysfunctional types. However, this classification is adapted to the tasks of the cardiology clinic and includes as differential characteristics of graphic manifestations nakanosawa, ectopic heart rhythm. Obviously, this classification is not applicable in the group of pregnant women, where the average age is 25 years old and cardiovascular pathology is not leading in the structure of morbidity.

The main disadvantage of this method of visual assessment aashram and their classification is that it is based on the analysis of HRV only in the rest of the subjects, i.e., outside of functional stress tests. Meanwhile, obstetric clinics should identify and evaluate adaptation reserves system neurovegetative regulation of the maternal body, which is impossible without the use of special load samples in the procedure is the fir IB, in particular miscarriage, based on the spectral-frequency characteristics of HRV mother (Fleishman A. N., Klimenkov S. A., Gorin B. C. a Method for predicting miscarriage/ Patent RF №2164079, M CL 7 And 61 In 5/0452. Bulletin No. 8 of 20.03.2001,). The essence of this method lies in the definition of the integral index - numerical relationship of high/low frequency spectral components of HRV mother, reflecting vegasno-sympathetic balance regulation and, therefore, current conditions neuroautonomic maintenance of pregnancy.

In this way address identified by the authors of the optimal value of the specified integral indicator as in the rest of the subjects, and upon presentation of functional stress tests: mental and breathing. Given the criteria of adequacy dynamics vagosympathetic ratio on the background load of samples and the relevant characteristics of risk of abnormal pregnancy outcomes.

The disadvantage of this method is the lack of a fast algorithm for the visual evaluation of the dynamic structures of the studied sequence of R-interval, and the need for additional calculations to establish the classified types and spectral variants to Frenstat analysis of nonlinear components of HRV pregnant, suggesting a method with sufficient accuracy and reliability, which is non-invasive, safe, suitable for screening, effective when it is used to predict pathological pregnancy outcomes, including in the early stages, identifying adaptation reserves system neurovegetative regulation of the maternal body, and at the same time enabling quick visual estimation of HRV based on a simple algorithm for interpreting the analysis results.

The task is achieved by the fact that pregnant women carry out the analysis of heart rate variability (HRV) at rest and during performance of functional stress tests, and build a geometric image of HRV in the form of phase portraits (AF) of HRV mother, visually determine the appearance of AF at rest pregnant and classify it as chaotic, extremely cyclical, simplified geometric and mixed, and the establishment of a chaotic type AF predicts favorable outcome of pregnancy, when establishing the type of AF maximum cyclic - predict the risk of abnormal pregnancy outcome in the form of miscarriage, when setting type AF simplified hematocele, when establishing a mixed OP - predict the risk of abnormal pregnancy outcome in the form of a combination of chronic placental insufficiency and recurrent miscarriage, and after determining the type of AF at rest pregnant have consistently mental and respiratory stress tests, and the inadequacy of the dynamics of AF on these samples also predict the risk of abnormal pregnancy outcomes in the form of chronic placental insufficiency and miscarriage; the inadequacy of the dynamics of AF on functional stress tests in the first half of pregnancy (1-20 weeks) set when changing the type of AF on the background of the mental stress test in simplified geometric appearance of AF compared with his views in the rest of the pregnant and predict the risk of chronic placental insufficiency, inadequacy of the dynamics of AF in the second half of pregnancy (21-40 weeks) set when changing the type of AF on the background of respiratory stress test at maximum cyclic FP compared to his views in the rest of the pregnant and predict the risk of miscarriage.

The novelty of the method

1. Classification PP HRV, namely established types of OP-Chaotica is their situation in the obstetric clinic, associated with the imbalance of autonomic regulation and the risk of development of pathological processes of pregnancy.

2. Proposed classification PP HRV is based on a visual analysis of the geometric pattern of the variability of sinus rhythm of the heart, reflecting the balance of autonomic regulation in the mother's body, which allows for fast interpretation of the PP HRV in relation to the predicted risk of specific forms of obstetric complications.

3. Established criteria for the adequacy of the dynamics of HRV pregnant when conducting functional stress tests, mental and breathing, differentially for the first (1-20 weeks) and second (21-40 weeks) half of pregnancy, namely: change PP HRV in maximum cyclic until the 20th week and simplified geometric appearance after the 20th week of pregnancy is typical for normal pregnancy and childbirth.

4. The predictive validity of assessments on the results of the design and analysis of PP HRV installed on studying the nature of the course and outcomes of pregnancy in 492 pregnant, which applied the inventive method.

The clinical significance of HRV, defined as the spontaneous oscillation frequency is exploring) nervous system (ANS). Sustainable predominance of parasympathetic influences (vagusnye) branch of the ANS is reflected in the increase of the total power of HRV and capacity of its high-frequency (HF) range. In turn, the conditions of vagotonia in the mother contribute to the increased contractile activity of the myometrium and often contributes to the development of pathological processes in the form of miscarriage. By contrast, sustainable predominance of the activity of the sympathetic-adrenal branches of the ANS and its effects on the vascular system utero-placental bed may result in a lower diastolic blood flow in the umbilical artery, chronic hypoxia, often entail a syndrome of delayed fetal development. This situation is reflected in the spectral HRV picture of the mother in the form of long-term reduce the total power fluctuations and the predominance of low-frequency (LF) HRV spectrum over its high-frequency region. The ratio of HF/LF components of HRV spectrum allows us to estimate the balance of autonomic regulation in the mother's body and to make a forecast regarding the risk of development of pathological processes of pregnancy. However, it turned out that the state of autonomic balance can be visually assessed the om fast interpretation of the nature of cardiodynamic in relation to the predicted risk factors selected on the basis of mapping certain types of PP HRV and clinical pregnancy outcomes.

The method is as follows.

The patient is examined in a comfortable sitting position, with a slight tilt of the torso to the left to reduce the pressure on the inferior Vena cava. Check ECG signal with cutaneous electrodes is performed at the same time, after 15 minutes of adaptation to the environment. The location of ECG electrodes has meaning only in terms of getting the maximum amplitude of the R wave. ECG signal through the analog device is converted into a discrete (digital) signal, which is subjected to automatic computer processing by a corresponding application build phase portrait of HRV. Last outputted as the final result on paper. Chart PP HRV (Fig.1, 2, 3) is a family of straight lines connecting points on the plane in the projection of rectangular coordinates, where the abscissa shows the number values of the duration of RR intervals of the ECG, and the y - axis increment each subsequent RR interval (in seconds) compared to the previous RR interval (RR). Just at every stage of maintenance is about in this case is logged normal sinus rhythm of the heart, i.e., arising under the influence of the spontaneous rhythmic activity of the sinus node. Registered "random" complexes ectopic excitation of the myocardium are eliminated automatically or manually using the PC editor.

The screening procedure includes the original sample, i.e., in the rest of the subjects, and the sequential presentation of a mental stress test and respiratory samples.

Mental test is carried out in the form of a count in the mind by successive subtraction from 500 to 7 with an arbitrary velocity. If this is allowed to "lose" the account and start over. In this form of mental sample is predominantly sympathetic-adrenal modulator heart rate and allows you to use external effects to identify the signs of a hidden failure or, on the contrary, the increased reactivity of the sympathetic system.

Respiratory test is made in the form of several in-depth breathing with arbitrary frequency, with high reproducibility implements the effects of parasympathetic (vagusnye) activation of low intensity. This test serves to identify the latent failure or, on the contrary, increased reactivity vagusnye system reg is dovetailing stimulation of low intensity, which is mediated by a system of neuroautonomic regulation of body pregnant.

We established that the nature of the load dynamics PP HRV pregnant, i.e., upon presentation of the above-described loading procedure has important prognostic value in relation to the risk of development of pathological processes of pregnancy. While the results of the standard stress tests complement and clarify the prognostic conclusion, formulated on the basis of the original sample in the rest of the examinees.

Obtained in the original sample graphic picture of the phase portraits of HRV allows on the basis of visual experience to highlight the kinds of PP HRV classified as follows (Fig.1):

1. Chaotic FP (Fig.1A) corresponds to the normal dynamics, characterized by considerable complexity of the trajectories cardiovascula process. Chaotic AF is the most frequent in clinically safe during pregnancy and childbirth.

2. Maximum cyclic FP (Fig.1B) was observed in idiopathic predominant activity vagusnye link neuroautonomic regulation. Violation of the autonomic balance in the form of vagotonia promotes increased the existing FP demonstrate the presence of varying degrees of severity cyclic (circular, oval structures that are associated with more or less regular intervals (regularity) of the heart rhythm.

3. Simplified geometric OP (Fig.1B) reflects a reduction in the complexity of the trajectories cardiodynamics process on the background of the prevailing activity of the sympathetic-adrenal system. In the structure of FP is the number of simple geometric shapes (triangles, diamonds, and so on). This type PP HRV corresponds to the so-called energodefitsitnym States of the parent body. The last is the most often cause of gestational disorders in the form of chronic placental insufficiency (CRF) combining metabolic and hemodynamic components. Syndrome CRF, as is well known, may be the pathogenetic basis of intrauterine hypoxia, delayed fetal development, as well as a consequence of multiple organ failure in the mother - of preeclampsia. In more severe CRF (the depth of violations and duration) there is a high risk antenatal fetal death.

4. Mixed FC (Fig.1D, e, f) is a transitional form, reflecting the geometric characteristics of all the above types of PP HRV in various combinations. Identified by the following mixed types practical conclusion when setting one of these mixed species PP HRV in the original sample, i.e., in a calm state test, depends in each case on the predominance of one or another of the main components of the nonlinear dynamics of heart rate. Thus, the presence and dominance in the structure of the OP chaotic component determines a favorable prognosis, the maximum round - Robin, and the risk of miscarriage, and simplified geometric - risk chronic placental insufficiency.

The presentation of pregnant standard stress tests, described above, serves to determine the degree of stability of the source, i.e., registered in the state of rest, paintings PP HRV under the influence of sympathetic-vagusnye external load low intensity. Thus there is an indication that the latent failure or, on the contrary, hyperresponsiveness of one of the departments system autonomic regulation in subjects with inadequate load dynamics PP HRV. The signs of the adequacy of the dynamics of AF at presentation of the pregnant exercise testing following.

With physiological pregnancy, in the first half (up to 20 weeks inclusive) in some cases, not observed any changes in the source type PP HRV during stress testing. In other cases, there is a change in any the robe. Both types of reactivity to stress test are normal for the first half of pregnancy, because at this stage prevails, according to our data, the impact vagusnye system neuroautonomic regulation, which is implemented as a rule, in cyclic modification of PP HRV.

With physiological pregnancy in the second half (21-40 weeks) in some cases there is also no change of the form AF, obtained in the original sample. In other cases there is a change in the initial view FC in simplified geometric appearance of AF during mental stress test, and less respiratory sample. This is because the second half of pregnancy is characterized, according to our data, the gradual increase of the influences of the sympathetic-adrenal system in the body of pregnant women, which reflects normal conditions neuroautonomic regulation as the pregnancy progresses.

In pathological situations is logged inadequate dynamics PP HRV pregnant during standard loading procedure. Inadequate dynamics in any of the original OP is manifested in violation of the above laws of normal reactivity to stress test and consists in the following:

1. Change the OP in the first half of pregnancy on a background of mental stress tests, less - respiratory samples. Such abnormal reactivity characterizes the prevailing influences of the sympathetic-adrenal system in the early stages of pregnancy and is a prognostic sign of risk of development of chronic placental insufficiency.

2. A change in any of the original type PP HRV (with the exception of the maximum cyclic) maximum cyclic FP in the second half of pregnancy on a background of respiratory stress test, at least - mental samples. Such abnormal reactivity indicates the predominance of activity vagusnye system neuroautonomic regulation in later stages of pregnancy and is a prognostic sign the risk of miscarriage. Our studies 492 pregnant women (mean age 24.5 years) revealed the following statistical results (table)

When analyzing stories of pregnancy and childbirth found that more than half of this group of pregnant women (54.5 per cent) had various forms of obstetric complications. According to the table the smallest number of pregnancy complications, as expected, it was noted in the subgroup chaotic PP HRV species.

In the subgroup maximum CEC is the total number of these pregnancy outcomes). Anomalies birth in the form of a weak labor activity was often observed in the subgroup simplified geometric OP, and cases of preeclampsia pregnant was distributed approximately equally (40 and 35%, respectively).

The most frequently abnormal pregnancy outcomes were observed in individuals with simplified geometric form PP HRV (54%). On the first place in the group with simplified geometric OP marked by chronic placental insufficiency, hypoxia and malnutrition of the fetus. In this subgroup was observed a high percentage of perinatal mortality (12.5 percent). A measure of the sensitivity of the indicative simplified geometric form PP HRV was 86.3%. This indicator reflects the percentage of positive test results in a group of pregnant women with the revised diagnosis of chronic placental insufficiency.

As for subgroups of mixed variants PP HRV, there were mainly observed moderate risk of abnormal pregnancy outcomes, which is reflected in the low value of the sensitivity characteristic of the presence of mixed species PP HRV.

Example 1

Pregnant-on, 23 years old, first pregnancy; surveyed in the period of 14 weeks. No complains. The hospital treatment within two weeks received urinal, conducted injections of progesterone; pain in the abdomen stopped. By ultrasound (ultrasound) of fetoplacental complex in the period of 13 weeks with no signs of pathology.

Phase portraits of the heart rate of a pregnant shown in Fig.2. The presence of chaotic type PP HRV at rest under test (Fig.2A) and the same kind of AF at presentation of the mental (not illustrated) and respiratory stress test (Fig.2B). Predicted normal during pregnancy and childbirth due to the fact that there is a chaotic view of the OP in the original sample, which remains unchanged when stress testing in the first half of pregnancy. Pregnancy outcomes were consistent with this prediction: a birth in term healthy body weight 3400 g, the assessment Apgar 8-9.

Example 2

And society, 25, parvovirinae. Surveyed in pregnancy 19 weeks. Complaints of chronic rhinosinusitis during pregnancy, frequent deep breaths alone, sometimes pressing pain in region of heart. History of neurological manifestations of cervical osteochondrosis (agicheskii syndrome), chronic adnexitis, endometrial polyposis. RH negative belonging blood. According to the mu mind combining features of chaotic and simplified geometric. When mental load (not illustrated) retaining the original look of AF, whereas respiratory sample (Fig.2) there is a change in the initial view FC in simplified cyclic (mixed) type of AF. On the basis of visual analysis of PP HRV in the original sample predicted the risk of chronic placental insufficiency due to availability of components simplified geometrical character that reflects the significant influence of sympathetic activity in the first half of pregnancy. However, the presence of the random component in the original sample, as well as the emergence of cyclic trajectories on the background of respiratory samples characterizes the normal structure of the OP for early pregnancy. This dictates a favorable prognostic solution, which corresponded to the follow-up data: pregnancy resulted in a normal individual the birth of a healthy baby weighing 2800 g, score Apgar 7-8 points.

Example 3

With society, 24, parvovirinae. Surveyed in pregnancy 16 weeks. In the first 12 weeks. pregnancy was noted preeclampsia mild as nausea, lack of appetite, single vomiting in the morning; for this perihepatitis on the background of diffuse enlargement of the thyroid I-II century According to the ULTRASONIC study showed signs of increasing uterine tone, the regional location of the chorion in the period of 15 weeks. Gets the preparations of iodine, calcium, thyroxine, injection cocarboxylase.

When you register at rest under test has maximum cyclic PP HRV (Fig.2D), which remains unchanged on the background of the mind (not illustrated) and respiratory samples (Fig.2E). According to the results of the original sample is predicted risk pregnancy due to the presence of the maximum cyclic type PP HRV. However, it is known that for the first half of pregnancy in normal characteristic of cyclic components in the structure of the FP effect significant prevalence in this age effect vagusnye system. Therefore, in this case to clarify the forecast needed re-examination. When registering in the period of 26 weeks has simplified chaotic (mixed) type of AF in the original sample (Fig.2ZH). Mental stress test (not illustrated) revealed no changes to the original OP, while when the breathing test is observed, changing the original OP in maximum cyclic PP HRV (Fig.2H). Predicted risk of miscarriage in the background of ESRD due to the presence of the CEC is Bach, and simplified geometric component in the 2nd half of pregnancy in a state of rest to be tested.

The prediction was confirmed by subsequent observation: pregnancy developed clinical signs of fetal hypoxia and ended preterm delivery in the period of 32 weeks. Newborn with signs of malnutrition, weight 2200 g, hospitalized in the neonatal unit of children's hospital with symptoms of acute hypoxia.

Example 4

Patient B-VA, 22, parvovirinae. Surveyed in pregnancy 17 and 28 weeks. History of chronic pyelonephritis, syndrome of vegetative-vascular dystonia of hypotonic type, thyroid insufficiency. According to the ultrasound signs of increasing uterine tone (17 weeks).

In the first registration (17 weeks) celebrated simplified geometric appearance PP HRV at rest (Fig.3A), mental (not illustrated) and respiratory samples (Fig.3b). The average heart rate is equal to 114 beats/min respiratory sample there is some positive dynamics of AF in relation to amplitude changes of successive RR intervals, i.e., the variability of the heart rhythm.

Predicted risk of ESRD in force for sustainable simplify PP HRV in the first half of the ber is this the conclusion of testing in pregnancy 28 weeks. Registered simplified chaotic (mixed) type PP HRV at rest under test (Fig.3b). The average heart rate was 90 beats/min. With a mental (not illustrated) load retaining the original look of the OP, while respiratory stress test causes a change in the source view FC in randomly-cyclic (mixed) type of AF (Fig.3G), which is a sign vagusnye (cholinergic) type of reactivity. Because this type of reactivity takes place in the second half of pregnancy, diagnosed the risk of spontaneous abortion.

Adjusted the conclusion includes a forecast of the risk of miscarriage in the background of ESRD due to sustainable simplify the OP, and also the appearance of cholinergic orientation of the response to respiratory load in the second half of pregnancy.

The prediction was confirmed by subsequent observation: this pregnancy ended in a premature birth in the period of 36 weeks. when clinical signs of hypoxia. Delivery was complicated by secondary weakness of patrimonial activity, prolonged dry period. Newborn with signs of malnutrition and hypoxia, weight 2400 g score Apgar 6-7 points; hospitalized in the neonatal Department of the Kai encephalopathy".

Example 5

Pregnant-Kai, age 31 years. This 7th pregnancy. Has two children from normally proceeding pregnancy. In terms of 6 and 12 weeks of this pregnancy was observed detachment of the chorion, and therefore was hospitalized for preserving therapy. Examined in terms of 8 and 22 weeks of pregnancy. When you first sign up (8 weeks) has a chaotic appearance PP HRV in the original sample (Fig.3D). Mental exercise reveals hyperaptive answer by stressor type with increasing heart rate of 95 beats/min at rest to 125 beats/min during mental stress test. Corresponding AF (Fig.3E) shows the simplified structure, the shift of the trajectories to the left, in the region of lower values of the FIR intervals. This type of AF on the background of the mental stress test should be attributed to the simplified geometry. When respiratory sample (not illustrated) is simplified geometric appearance of AF. Due to the observed high reactivity of the sympathetic-adrenal type in the first half of pregnancy predicted the risk of ESRD, intrauterine fetal hypoxia.

To clarify this conclusion, the patient was re-examined in the pregnancy of 22 weeks. In the original sample celebrated the mental sample (Fig.S). Initial heart rate of 110 beats/min, increased mental load up to 135 beats/min, i.e., there is similar to the previous in pregnancy 8 weeks. hyperaptive reaction stressor type change OP in simplified geometric appearance. When respiratory sample (not illustrated) registered chaotically mixed-cyclic AF.

The revised forecast includes an increased risk of ESRD, intrauterine hypoxia, miscarriage due to sustainable simplicity and cyclic variation of AF with respiratory sample in the second half of pregnancy.

This pregnancy was with clinical signs of fetal hypoxia and ended antenatal death of the fetus against the background of increasing asthma placental insufficiency in the period of 27 weeks of pregnancy.

Thus, the results indicate a fairly high sensitivity of the method of geometric display and analysis of HRV pregnant in the form of phase portraits. The proposed method for predicting pathological pregnancy outcomes, based on the construction of PP HRV, a number of distinct advantages. Having a high reliability in relation to identifying Titov, non-invasive, safe, suitable for screening and dynamic studies that require a small investment of time, effective at the early stages of pregnancy. The method has significant information about the current state of regulatory systems of the organism of the mother. With the inclusion of pregnant women in appropriate risk groups according to the results of the analysis of the PP HRV is formed corresponding to the tactics of the correction of such conditions with the use approved in the obstetric clinic of funds. It must be emphasized that the study HRV pregnant is a completely independent approach, i.e., similar results cannot be obtained by other methods.

The inventive method is used in clinical practice, women's consultation # 1 and # 3, maternity home No. 3 (, Novokuznetsk), where he established himself as an effective means of predicting pathological pregnancy outcomes can significantly improve the quality of pregnancy management, primarily in the outpatient stage.

Claims

1. A method for predicting pathological pregnancy outcomes, including analysis of heart rate variability (HRV) at rest and during exercise adalat view AF and classify it as chaotic (Fig.1A), maximum cyclic (Fig.1B), simplified geometry (Fig.1B) and mixed (Fig.1D, e, f), and the establishment of a chaotic type AF predicts favorable outcome of pregnancy, when establishing the type of AF maximum cyclic predict the risk of abnormal pregnancy outcome in the form of miscarriage, when establishing the type of AF simplified geometric - predict the risk of abnormal pregnancy outcome in the form of chronic placental insufficiency, and in the establishment of mixed species AF predict the risk of abnormal pregnancy outcome in the form of a combination of chronic placental insufficiency and recurrent miscarriage, the patient impose mental and respiratory load tests, and when the inadequacy of the dynamics of AF on these tests also predict the risk of abnormal pregnancy outcomes in the form of miscarriage and chronic placental insufficiency.

2. The method according to p. 1, wherein when establishing mixed AF, including visually-defined characteristics maximum cyclic and simplified geometric types AF, predict the risk of abnormal pregnancy outcome in the form of a combination of chronic placental insufficiency, Nevins the signs of the maximum cyclic or simplified geometric types AF, predict moderate risk of abnormal pregnancy outcomes in the form of miscarriage and chronic placental insufficiency.

3. The method according to p. 1, characterized in that in the first half of pregnancy (1-20 weeks) on the background of the mental stress test the inadequacy of the dynamics of AF set via an FC in simplified geometric appearance of AF, when compared with the views of the OP alone and predict the risk of chronic placental insufficiency in the second half of pregnancy (21-40 weeks) against respiratory samples inadequacy of the dynamics of AF set via an FC in the maximum cyclic FP, when compared with the views of the OP alone or in first half of pregnancy and predict the risk of miscarriage.



 

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3 cl, 8 dwg, 1 tbl

FIELD: medicine, electrocardiography.

SUBSTANCE: the present innovation deals with measuring parameters of electrocardiosignal (ECS) ST-segment and their analysis to detect deviations against the norm. At every step of quantization one should form the readings of first-order differences and modules of first-order differences. One should memorize N of readings for the modules of first-order differences coming after ECS readings that correspond to the onset of cardiocycle. Then it is necessary to sum up memorized values of modules and at every step of quantization one should compare the obtained current sum value with previous one. It is necessary to memorize the greater of them and according to maximal value one should form threshold level to compare current value of modules sum. Time moments when sum value is at first greater and then lower against threshold level one should consider to be, correspondingly the onset and the end of ST-segment. Time segment between the onset and the end of ST-segment should be considered as duration of ECS ST-signal. Device to isolate ECS ST-signal on-line contains a block for forming ECS, a block for primary ECS processing, a quantization block, a block for isolating the point of cardiocycle onset and measurement of its duration, a block to form first-order differences, a block to form modules of first-order differences, a block to memorize readings for the modules of first-order differences, a block to detect the number of summarized readings for the modules of first-order differences, a summarizing block, a block to form a threshold level, a block for comparison and a key device. The innovation enables to isolate ST-segment more reliably for wider class of electrocardiograms at different modifications of QRS-complex form.

EFFECT: higher efficiency.

2 cl, 12 dwg

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