Method for predicting labor outcome

FIELD: medicine.

SUBSTANCE: method involves carrying out two-dimensional ultrasonic scanning for determining prevailing placenta arrangement side, taking capillary blood sample and counting lymphocyte number. Left-sided placenta arrangement being the case, and lymphocyte content in blood formula being equal to or below 20%, unfavorable labor outcome is predicted.

EFFECT: high accuracy in detecting pregnant women with unfavorable prognosis and placing them among risk group.

 

The invention relates to medicine, namely to obstetrics, and will be widely used to improve the status of the mother and newborn.

Despite the achievements in addressing reproductive health percentage of obstetric complications remains at a high enough level, fetoplacental insufficiency (NEF) is 22% (Viergangiges, Weltwunder, 1999) and is accompanied by the development of chronic intrauterine hypoxia in 67.5% of cases (Nymphaline et al., 1999), perinatal mortality is according to different authors from 16 to 18‰ (Wasaware, Waspresent, 1999; Gamalia and others, 1999), the threat of miscarriage is registered in 30% (Isidorov, Ioacara 1995-2000; Apirana, 1997).

Generally accepted normative diagnosis and resulting from its results of therapy used to correct the detected violations, often does not lead to a positive effect.

Even widely spread in recent years, sophisticated instrumental methods of control, such as a Doppler ultrasound of the blood vessels of the uterus and the umbilical cord, do not give a full guarantee an objective assessment of the functional state of the system mother-placenta-fetus (FSMP). The outcome of pregnancy and childbirth is determined not so much nosological identity as the degree of severity of drug is deprivation of hemodynamics in FSMP. Our own observations show that the dynamic diplomaticheskii control detects such a significant diurnal and day-to-day variation that the data obtained at a single examination, based on standard rating scales, can be interpreted as indicators of norms, and how serious signs of hemodynamic disturbances. In this regard, do not lose their relevance issues associated with the development of informative prognostic and diagnostic criteria, the search of which is impossible without the study of the phenotypic basics and underlying mechanisms of reactivity and adaptability functional system "mother-placenta-fetus" (Nagarajan, 2003; Chistiakov, 2000).

The prototype of the claimed invention, the selected integrated diplomaticheskaja assessment of blood flow uterine artery and umbilical artery, including Doppler ultrasound of the right uterine artery (MA), measurement of vascular resistance index (ASCS) and systolicdiastolic relations (SRE), while ASCS in the right MA allows the selection of pregnant women at risk of a complicated pregnancy, and improving SRE in more than 2.6 MA to predict adverse pregnancy outcome with a sensitivity of 81% (Doppler uterine-placental - fetal blood flow/http://pregnancy.h1.ru, 20.05.2004).

The objective of the invention RA is to run the algorithm for predicting the nature of pregnancy and birth outcome with regard to adaptive reactions FSMP in its various stereotactically organization.

The problem is solved in that the two-dimensional ultrasonic scanning pregnant determine the direction of the preferential location of the placenta, and then produce a sampling of capillary blood and calculate the percentage of lymphocytes and in the presence of left-sided location of the placenta and content of lymphocytes less than 20% in the formula blood, proving the stress response of the parent body, predict adverse pregnancy outcome.

The most widely known General nonspecific adaptive reactions, first open Gsale in 20-ies of the last century, was supplemented Phharmacy, Abbacies, Tschulena (1988) anti-stress reactions: reaction training and response activation, subdivided into a calm and sensitive (Phharmacy, 1968, 1969). According to the authors, these reactions are formed in the process of evolution as the reaction of anti-stress protection of the body. They develop in response to adequate, relatively weak (reaction training) or medium (reaction activation) acting factors. Changes in each of them different from the stress and from each other and nature is close to various standards (open No. 1958, 1975, Phharmacy, Maunaloa, Ebouaney). Later it was found periodic pattern, objedives what I qualitatively different adaptive response, namely, the periodic repetition of the same name reactions depending on the absolute magnitude (strength, dose) of current stimuli (Phharmacy, Ebouaney, 1975-1997). Because pregnancy causes substantial alterations in the female body and is a serious challenge to its adaptive adaptive system, many authors (I. Arshavsky, 1957; D. Garmashova, NN. Konstantinov, 1978; Savelyeva G.M., 1981) refer to gestational age as stress. Meanwhile, the mechanisms of stress resistance or stress-vulnerability of the pregnant body, are not well understood. Still there are no clear criteria for determining adaptive reactions in pregnant women.

To study adaptive responses as the most adequate model, we chose the system of blood, the ratio of the formed elements which identified the nature of the adaptive response. The reaction of anxiety, stress observed leukocytosis, reasinable, lymphopenia (number of lymphocytes below 50%), and segmented neutrophils and monocytes in normal or above normal. Unlike stress in stage orientation in rats the number of lymphocytes is within the lower half of the zone standards (51-60%), the number of segmented neutrophils within the upper half of the zone standards, the number of leukocytes, eosinophils, stab neutrophils and monocytes varies. The people who (compared to animals) under reference number of lymphocytes is within the lower half of the zone standards (21-27%), the number of leukocytes, eosinophils, stab neutrophils and monocytes varies. It should be noted that the system of blood during pregnancy is undergoing significant changes: there are variations in the level of red and white blood cells: decreased hemoglobin and hematocrit due to automodelli (MEM, Gambardella, 1997). Along with this gradually increasing leukocytosis, ESR and neutrophiles (Vaalputs, Bavarese, 1979; MTM, Gambardella, 1997). Type of reaction is determined by the percentage of lymphocytes in the leukocyte formula. Other elements of the white blood cells and the total number of leukocytes, being the only additional signs reactions, indicate the extent of usefulness, physiology reaction, the degree of tension and with respect to the standard norm. The effectiveness of the functioning of red and white blood cells largely depends on the level of transplacental exchange, and hence the nature of pregnancy, functional status and development of the intrauterine fetus.

The lateral location of the placenta in humans determines the formation proforientirovanie, levonorgestrelbuy and combined FSMP, with a characteristic for each of them chronometrically functional organization (Nagarajan, Whirlow, TLB tasheva, 1999). The factor of lateralization of the placenta significantly affects the process of lateralization of uterine activity and uteroplacental hemodynamics, modulates the resistance of the female body and largely determines the likelihood of obstetric pathology (Aborescent, 1985; Vierow, 1987; Tolbatova, 1992; Casamassa, 1994; Avernite, 1994; Avilov, 1998). Because of the lateral arrangement and functioning of the placenta causes the formation of gestational dominant in the contralateral (to the placenta) hemisphere of the brain (Aborescent, 1984; Vierow, 1981-2001; Avernite, 1994; Tolbatova, 1999), where it is localized, including the Central link in the regulation of haematopoiesis: according to the literature stimulation paraventrikulyarnoe nuclei of the hypothalamus is accompanied by leukocytosis with neutrophil shift, with a concomitant inhibition of erythropoiesis (MEM, Gambardella, 1997), we should expect certain differences in the dynamics of indicators of red and white blood cells under conditions of atropoisomeric FSMP. Features adaptive responses at different stereotactically organization FSMP in this key has not previously been considered. Is also considerable interest in the study of lateral functional provide basic adaptive responses depending on the nature of the pregnancy.

Our research and discovered for the first time, what adaptive reactions of the parent body modulate the nature of uterine and fetal blood flow: when the stress response is logged increase VS/VD in the uterine and umbilical arteries by 4.2% (p<0,05). When pregnancy is high risk and the probability of adverse birth outcomes is increased in the case of left-sided location of the placenta and the stress response of the parent body (p<0,05). Stereotactically organization FSMP and nature of adaptive responses affect the course of pregnancy, growth and development of the fetus: with left-hand location of the placenta often registered the stress reaction, which is accompanied by the development of gestational complications and adverse birth outcome.

Detailed description of the method

Method two-dimensional ULTRASONIC scanning investigated the scope of preferential localization of the placenta relative to the median line (SONOACE-4800 with the Doppler unit firm "Madison", Korea, registration number №93/68, convex probe 3.5 MHz).

The study hemogram red and white blood cells was carried out from 8 to 9 o'clock in the morning, on an empty stomach. Got capillary blood from the Palmar surface of the nail phalanx of the ring finger of the left hand.

Leukocyte formula represents a percentage of the blood of different types of leukocytes, in particular neutrophils, eosinophil is s, basophils, lymphocytes and monocytes. To count leukocyte formula to prepare a blood smear stained by Romanovsky-Giemsa. The smear was fixed within 10 minutes, methyl alcohol, stained with Azur II, methyl alcohol and glycerin, and then was rinsed with water and dried in a vertical position. Stained smear was examined under the microscope with oil immersion system.

The erythrocyte sedimentation rate (ESR) was determined by the method Panchenkov. Mixed with anticoagulant blood was collected in capillary pipette to the mark "0", placed in a vertical position in a rack Panchenkov. After one hour was determined by the value of the ESR, which is measured in millimeters per hour (mm/h).

The efficiency of the method is confirmed by clinical examples.

Example 1.

Pregnant And Jan, 22 years old, pregnancy 32 weeks.

Ultrasound scan detected: biparietal head size 80 mm, which corresponds to 30 weeks and 1 day pregnant, head circumference - 292 mm at 32 weeks and 2 days pregnancy, the length of the thigh - 62 mm at 32 weeks and 1 day, abdominal circumference - 179 mm at 32 weeks of pregnancy. Marked right-sided location of the placenta, the thickness of 32 mm, the amount of amniotic fluid was normal. Diagnosis: Pregnancy 32 weeks.

When diplomaticheskii study found the following indicators of blood flow: ar is a series of umbilical cord - V/S to 2.5; right uterine artery - V/S - 1,73; left uterine - V/S - 1,71. Violations of Feto - maternal-placental hemodynamics is not revealed. In order to predict the nature of pregnancy and birth outcome:

conducted two-dimensional ultrasound examination of the uterine-placental-fetal complex and defined the scope of the preferential location of the placenta is right;

conducted sampling of capillary blood on an empty stomach in the morning to determine the General analysis of blood;

determined the percentage of lymphocytes in the blood content of lymphocytes in the evaluation of complete blood count was 19%.

This pregnant does not belong to the risk group and it is possible to predict a favorable course of pregnancy.

Delivery term. The fruit mass 3 kg 500 g, height 52 cm, with estimation on Apgar scale 9-10 points.

Example 2.

Pregnant N-VA, 24 years, gestational age 30 weeks.

Ultrasound is logged left-hand location of the placenta. When diplomaticheskii study found a violation of fetoplacental hemodynamics. The content of lymphocytes in the evaluation of complete blood count was 19%.

In this case, it is possible to predict adverse pregnancy.

The pregnancy proceeded with symptoms of preeclampsia and placental insufficiency.

Childbirth urgent way the cesarean section in the lower uterine segment. The fruit mass 2 kg 700 g, height 49 cm, with estimation on Apgar scale 6-7 points.

Thus, the pregnant woman's body is in stress response, is a violation of fetoplacental hemodynamics in diplomaticheskii study and signs of placental insufficiency ultrasound.

This pregnant should be considered at risk and to predict adverse pregnancy outcome.

Example 3.

Pregnant With Ko, 22 years, gestational age 32 weeks.

Ultrasound is logged left-hand location of the placenta. When diplomaticheskii the study of disorders of the Feto - maternal-placental hemodynamics is not revealed. The content of lymphocytes in the evaluation of complete blood count was 20%.

In this case, it is possible to predict adverse pregnancy.

The pregnancy proceeded with symptoms of placental insufficiency.

Delivery term. The fruit mass 2 kg 600 g, height 48 cm, with rating on a scale of Apgar scores 7 points.

Thus, the pregnant woman's body is in stress response, is a violation of uteroplacental hemodynamics in diplomaticheskii study and signs of premature sozrevaniya placenta ultrasound. This pregnant should be considered at risk and to predict adverse pregnancy outcome.

the example 4.

Pregnant Peninsula, 22 years, gestational age 29 weeks.

Ultrasound is logged left-hand location of the placenta. When diplomaticheskii the study of disorders of the Feto - maternal-placental hemodynamics is not revealed. The content of lymphocytes in the evaluation of complete blood count was 25%.

In this case, we can predict a favorable course of pregnancy.

Delivery term. The fruit mass 3 kg 200 g, height 50 cm, with rating on a scale of Apgar 8-9.

For solving the tasks conducted a screening survey of women with physiological and complicated pregnancy and pathology, residing in the city of Rostov-on-don and Rostov region. The total sample consisted of 511 people. The research was carried out in the same period of the day from 8 to 9 hours. The sequence and rate studies every pregnant were identical.

Of these, 106 (20,74%) pregnant first trimester, 191 (37,38%) second trimester and 214 (41,88%) third trimester. The formation of the clinical groups was carried out on the basis of the data of anamnesis, results of ultrasound, cardiotocographic and diplomaticheskogo research.

To accomplish the task all of the studied pregnant women were divided into two clinical groups: group I was 250 be the temporal with no violations on all of the above parameters; pregnant women with placental insufficiency, threat premature birth and chronic intrauterine hypoxia were United in the second clinical group "complicated pregnancy", because each of these pregnancy complications according to the literature (Schechtman M.M., Burduli G.M., 1997; shiffman FD, 2000) is not accompanied by significant changes in the hemogram. In complicated pregnancy (261 female), right-sided location of the placenta was recorded in 76 (29,10%)l - 90 (34,6%), ambilateral - 95 (36,3%).

When examining patients with physiological and complicated pregnancies account of complaints, anamnesis, information about during this pregnancy, the results of laboratory tests.

All pregnant was carried out by ultrasound maternal-fetal-placental complex with ultrasonic Doppler uteroplacental and fetoplacental blood flow, external cardiotocography, General blood analysis, determined the content of sodium, potassium, calcium and iron in the serum.

During the study determined the position and presentation of the fetus, indicators of Geometrie, has been planetography, assessment of fetal status and the amount of amniotic fluid.

In the study of stress reactions in 74 women with left-sided is the eating of the placenta was noted a decrease in the level of lymphocytes in the blood up to 20% or less, all these pregnant women was observed adverse outcome of pregnancy and childbirth.

Thus, the claimed method allows us simply, quickly and with high accuracy (100%) to predict the outcome of pregnancy.

The method can be widely used in obstetric hospitals and antenatal clinics, including monitoring of pregnant women and evaluate the effectiveness of therapy.

A method for predicting pregnancy outcomes, including dopplerometrical study, characterized in that the pre-method two-dimensional ultrasound scanning to determine the direction of the preferential location of the placenta, producing a sampling of capillary blood, calculate the percentage of lymphocytes and in the presence of left-sided location of the placenta and content of lymphocytes in the blood content is 20% or less predict adverse pregnancy outcome.



 

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