A method for predicting anomalies of labor in women with diseases of the spine

 

(57) Abstract:

The invention relates to medicine, obstetrics. Pregnant for 2-3 days prior to the birth of a child are cardiointervalography. Define a variant of the original vegetative tone and autonomic reactivity. Spend clinorotation the sample. Determine the sufficiency of autonomic activity. In the case of Hyper sympathicotonic original tone and autonomic reactivity with insufficient provision of autonomic activity predict the development of abnormal labor. The method allows to predict pathological preliminary period, discoordination labour forces. 5 table.

The present invention relates to medicine, namely to methods for predicting anomalies of labor in women with diseases of the vertebral column.

Physiological course of pregnancy and childbirth at the present time there is no more than 15-18% of women. A significant number of diagnostic and prognostic tests used in the prenatal period (clinical and anamnestic, hysterography, hormonal, genetic and anthropometric tests, prognosticate with regard to individual mothers it is not always provides an implementation of the forecast. Therefore, the development of other options forecasting remains an actual problem of modern obstetrics.

In order to predict the development of complications in childbirth in women with diseases of the spine using analysis of cardiointervalogram and results clinorotation samples recorded for 2-3 days before giving birth. Theoretical background applications in clinical practice kardiointervalografii (KIT) is the concept of the cardiovascular system as the indicator of compensatory-adaptive activity of the entire organism. This is due to the fact that changes in heart rate are universal reaction to any load, because the cardiovascular system is the most labile of all the vital systems of a person[1, 3, 14].

Heart rate reflects the end result of numerous regulatory effects on the circulatory system, developed in the process of ontogenesis and phylogenesis. Information about how formed homeostasis, what is the degree of adaptation of a particular person contained in the structure of his heart rhythm and “encoded” in the sequence cardio is selected. All departments of the uterus as any other body have double vegetative management [12]: the sympathetic division of the autonomic nervous system (ANS) innervates the outer layer of the myometrium (longitudinally and obliquely arranged smooth muscle fibers), most pronounced in the bottom and the body. The most powerful layer of myometrium - middle - with maprotiline direction in the bottom and body of the uterus is provided sympathetic, and in the lower part and the cervix (circular muscle fibers) - the parasympathetic innervation. Internal (subbaswamy) muscular layer of the uterus, with circular and spiral going fibers is governed by the parasympathetic activity of the ANS. Physiologically occurring labor activity is influenced by the sympathetic and parasympathetic divisions of the ANS is characterized by alternating excitation and contraction of the corresponding muscle layers of the myometrium. Clinically, this manifests itself regularly and systematically growing in strength and duration of contractions.

Numerous studies have established that on the eve of physiological birth notes or the same frequency of the sympathetic and parasympathetic reactions - atonia [9, 15], or the prevailing tone of parasimpaticalkie, causes abnormalities of contractile activity of the uterus [11, 19, 21]. For example, the prevalence of birth influence of the sympathetic often causes clinical manifestations of discoordination labor activity: tonic spasm and tension of the uterus, reducing its arterial blood supply with simultaneous increase of venous stagnation that supports hypertonicity Oxytocics contributes to early rupture of amniotic fluid, dystocia cervix, the violation of the fetal-placental and uterine-placental blood flows and some other pathological manifestations [11].

From the conducted researches it is established that a classic example of a violation of the trophic function of the ANS is such diseases as osteochondrosis [5, 6, 7]. In osteochondrosis, as with any other vertebral pathology, as a rule, decreases the activity of the parasympathetic division of the ANS and compensatory increases the tonus of the sympathetic, to pathological (hypersympathicotonia) its variants, with a relevant increase clinical manifestations. When neurohistological study in patients with osteoarthritis of the most important anatomical structures of the sympathetic is rotilio, the vacuolation, leukocyte infiltration, atrophy of individual nerve cells [16].

The proposed method for predicting anomalies of labor in women with diseases of the vertebral column is the following: if kardiointervalografii and clinorotation samples from pregnant with pathology of the spine Hyper sympathicotonic registered variants of the autonomic tone and autonomic reactivity with insufficient provision of autonomic activity, then with high probability the expected development anomalies of labor activity, primarily pathological preliminary period and discoordination labour forces.

When conducting a patent search, we found no publications on methods for predicting anomalies of labor in women with diseases of the spine through research they state ANS. As the prototype used the method of differential diagnosis of superficial and atrophic gastritis and gastroduodenitis in children described in thesis of C. L. Okuneva [13]. The basis of the method is the definition of vegetative homeostasis in children is e changes in the lining of these organs: if you are holding a CIG and clinorotation sample is logged source sympathicotonia, excessive BP and inadequate provision of WATER, changes in mucous a functional character. When the source of vagotonia with inadequate options BP and WATER, the patient is suffering from organic disease of the stomach and duodenum.

Clinical material and methods. We apply the method of forecasting is developed on the basis of the analysis of cardiointervalogram and results clinorotation samples 88 pregnant. Among the surveyed 72 (81.8 percent) women had severe disease of the spine: osteochondrosis of the lumbar and lumbosacral spine with root symptoms - 40 (55,5%) women, scoliotic disease II-III severity - 16 (22,2%) women, congenital anomalies of the lumbosacral region - 9 (12.5%) of the women, the consequences of uncomplicated compression fractures of the vertebral bodies in the thoracolumbar and lumbar regions - 7 (9,8%) women.

The diagnosis of spinal pathology among all women was established on the basis of complaints, anamnesis, analysis of the available medical documents (discharge instructions, x-rays and CT scans of the spine), clinical vertebrogenic research, the result is[17] by the original method [18]. In the postpartum period, clinically, did x-rays of the spine to establish the nature and severity of vertebral pathology.

As a control, we analyzed the results of the WHALE and clinorotation samples in 16 (18.2 per cent) of pregnant women in the same period of gestation, had no complaints and clinical symptoms of vertebral pathology.

To obtain kardiointervalogrammy on the electrocardiograph in the second standard lead, when the belt speed of 50 mm/s, recorded at least 100 cardiocycle (50 cardiocycle in the position of women lying on the back, 50 - standing). Then the line on the tape was measured each distance between the R-R, restating it in seconds, has created the series and the data obtained are entered into a computer program, based on the algorithms proposed by P. M. Baevsky [2].

Used by us to assess autonomic homeostasis in pregnant and control groups computer program “was issued” the end result with regard to indicators 13 basic parameters:

- mathematical expectation (M);

- fashion (Mo);

the amplitude of the mode (AMO);

- variationnal the - index of autonomic balance (IIA);

vegetative indicator rhythm (CDF);

- adequacy regulation (PAPR);

- the relationship of the standard deviation to the mathematical expectation of (/M);

- relationship variational scale to the mathematical expectation of (X/Mo);

- tension, heart rhythm (NDS);

- tension index (ti);

After digital display of each of these indicators on the screen appeared the final result, namely the nature of the source of the autonomic tone (IWT) and autonomic reactivity (VR) for each child.

The obtained results. Table 1 shows the results of the study - pregnant main and control groups.

As follows from the table, in pregnant women of the main group in most clinical observations recorded activity of the sympathetic division of the ANS with abnormal (Hyper sympathicotonic) one. In total, the prevalence of this Department was observed in 54 (75,0%) pregnant women: Hyper sympathicotonic IWT - 43 (59.7 per cent) women and the original sympathicotonia - 11 (15.3%) and women. In the control group, the pathological hypersympathicotonia lausiaca, as follows from the literature data, “harbingers” physiological childbirth in the main group were recorded in total, only 18 (25,0%) women: Estonia 13 (18.1 per cent) and vagotonic 5 (6,9%) pregnant. In control group the original atonia was observed in 8 (50.0%) were pregnant.

The state of BP in pregnant women studied groups is presented in table 2.

As can be seen from the table, in pregnant women of the main group was dominated by Hyper sympathicotonic variant BP-64 (88,2%) pregnant. In the control group, this version was recorded in 5 (31.3 percent) of pregnant women. Normal coefficient BP marked accordingly in 8 (11,8%) and 11 (68.7 per cent) of pregnant women. Asimptoticheskih indicators were not reported in any of the clinical observations.

Vegetative management activities were assessed by the dynamics of blood pressure and heart rate when performing a pregnant clinorotation samples [4, 6].

The results obtained when carrying out clinorotation samples are presented in table 3.

In the analysis table in pregnant women major group noted the prevalence of insufficient options WATER - 59 (82,0%) clinical observations. Similar is rmally option WATER - 11 (68.7 per cent) of pregnant women. In the main group this option is registered in 6 (8.3%) of women. Excess WATER indicators were obtained, respectively, at 7 (9.7 per cent) and in 2 (12.5%) of the pregnant women.

Table 4 presents the main [19] anomalies generic activities developed during birth the pregnant women studied groups.

As the table shows, more than half of the mothers of the main group (56 (77.8 per cent) during childbirth developed abnormalities of labor activity. In the control group anomalies labor activity registered in 6 (37.5%) of the women. The analysis of the obtained results statistically significant prevalence in pregnant women of the main group frequency of pathological preliminary period and discoordination labor.

After comparison of the frequency of pathological variants IWT, BP and WATER with a frequency of anomalies of labor, noted the frequent coincidence of options vegetative frustration on the one hand, and complications in childbirth in women of the main group on the other side.

The conclusions. Diagnosed with conduct WHALE and clinorotation sample options vegetative maladjustment likely indicate formirovaniya forces.

These results, based on “a Method for predicting anomalies of labor in women with diseases of the spine”: if kardiointervalografii and clinorotation samples recorded Hyper sympathicotonic options initial autonomic tone and autonomic reactivity with insufficient provision of autonomic activity, then with high probability the expected development anomalies of labor.

We use in the practice of the method of prediction anomalies of labor in women with diseases of the spine available, noninvasive, does not require prior training women to the study, expensive equipment and reagents, long time to obtain results. Its use eliminates the transfer of various pathogenic viruses that may occur during invasive research.

As a clinical example of the present comparative results KIT two pregnant women (table 5). Pregnant K., 23 years (I. p. No. 1225), diagnosis: Lumboischialgia, osteochondrosis, spondylosis of vertebral motor segments, LIV-LV, LV-SI. Pregnant B., 22 years (I. p. No. 0840) had no clinical ins Hyper sympathicotonic options - and BP, pregnant b - source atonia normally BP.

Sources of information

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A method for predicting anomalies of labor in women with diseases of the spine, characterized in that for 2-3 days prior to the birth of a child are cardiointervalography determine the version of the source autonomic tone and autonomic reactivity, conduct clinorotation sample, determine the sufficiency of autonomic activity, and when registering Hyper sympathicotonic original tone and autonomic reactivity with insufficient provision of autonomic activity, predict the development of abnormal labor, primarily pathological preliminary period and discoordination labour forces.



 

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