Method for early prediction of placental insufficiency

FIELD: medicine.

SUBSTANCE: in a first trimester of pregnancy, the microalbuminuria level is determined. If the value is 45 mg\l and more, placental insufficiency is predicted.

EFFECT: method enables early prediction of placental insufficiency by a simple quantitative estimation and thereby ensures early adequate preventive treatment.

3 ex

 

The invention relates to medicine, namely to obstetrics, and is intended for early prediction of placental insufficiency.

Today the problem of placental insufficiency (PI) in obstetrics is one of the Central places. There is no unified theory regarding the etiology and pathogenesis of GON, which greatly complicates forecasting, assessment of severity and, accordingly, the carrying out of preventive actions with this type of pathology. Thus, among the many problems associated with the development of MON, forecasting is one of the most important places and is of great importance in the prevention and in the choice of obstetric tactics.

It is known that MO violated transport, trophic, endocrine, metabolic and antioxidant functions of the placenta, which leads to the pathology of the fetus and newborn. Often placental insufficiency has been associated with the syndrome of delayed fetal growth, which is the end result of a complex morphological and functional changes in the system "mother - placenta - fetus"that occurs when occurs, MO (F.C. Battaglia, Regnault T.R. Placcntal transport and metabolism of amino acids. Placenta 2001; 22: 2-3: 145-161. Butler E.L., Dashe J.S., R. Ramus Association between maternal serum alpha-fetoprotein and adverse outcomes in pregnancies with placenta previa. Obstet Gynec 2001; 97:1:35-38).

A known method for the diagnosis of placental insufficiency, foundations of the config on the determination of the level of fetal-placental hormones in the blood of pregnant women (estriol, progesterone, cortisol and prolactin). (Gamalia and other Placental insufficiency. - M.: Medicine, 1991, s-176).

The disadvantages of this method are:

- the need for special expensive equipment;

- need high qualification of the doctor-laboratory assistant, performing research data;

- the high cost of the method, which is due to the high cost of reagents and equipment;

- inability to use the above method in clinical routine antenatal clinics or maternity homes.

A known method for the diagnosis of placental insufficiency by examining the activity of the dehydrogenase and the value of 1.4; 1.8 and 2.2 mmol/l or less, respectively, at the end of the first trimester, the second and third trimesters of pregnancy diagnose placental insufficiency (Tintoreria and other SU 1627987, 15.02.91).

The disadvantages of the above method are:

- the difficulty of using the method in the screening of the pregnant women at risk of developing placental insufficiency;

the inability of the wide use of this method in daily practice obstetrician-gynecologist female consultations;

- the impossibility of forecasting the first weeks of pregnancy.

Closest to the claimed method are the two which is the way the same destination, including the determination of markers of endogenous intoxication of molecules of average weight in the serum, and the higher 0,220; 0,230 and 0,240 srvc. units respectively in the first, second and third trimesters of pregnancy predict the development of placental insufficiency. (Smirenina IV and other RU, 2148256, 12.01.1999).

The disadvantages of the above method are:

the method is invasive (requires intravenous blood sampling);

molecules of medium density are not strictly specific markers of placental insufficiency, because they indicate the presence of any of endotoxemia in the body, such as reumatoide arthritis, acute pancreatitis, or worsening of his chronic, acute pyelonephritis or acute exacerbation of his chronic, inflammatory diseases of ENT-organs, and so on - this way it's hard to recommend for screening examinations of pregnant women.

We set ourselves the task of finding enough reliable prognostic factor for predicting MO. This factor was the determination of the quantitative level of microalbuminuria (MAU) in the urine. Under MAU understand the allocation of kidneys by glomerular filtration) of albumin in quantities to determine using conventional methods cannot. MAU diagnosed, according to different authors, from whom Ergani albumin from 25 to 300 mg/day in daily urine, or from 20 to 200 µg/min Protein in quantities of less than 25 mg/day may be contained in the urine of healthy people (Dedov I.I. and others 2002; Bar J., Hod M. 2003).

In recent decades, appeared in print numerous works devoted to the study of clinical (including forecasting) significance of microalbuminuria, methods of detection and quantification, as well as therapeutic measures aimed at combating this pathological condition. Interest in the problem of microalbuminuria due to the fact that it is regarded as one of the early unfavorable prognostic signs and risk factors for the development of lesions in target organs with common kidney diseases, cardiovascular diseases, diabetes, etc.

Studies over the last few years, make for a fresh look at the essence of the potential mechanisms underlying the pathogenesis of placental insufficiency. Despite numerous factors such as genetic, immunological, behavioral, environmental background, involved in the pathogenesis of GON, the main point is the study and understanding of the role of endothelial dysfunction. The common initial stages of pathogenesis of preeclampsia and placental insufficiency caused by disturbances of the early stages of the development of the functional system mother-placenta-fetus,leads to a significant violations compensation status not only of the mother, but fruit. MO, as I believe, ends with the release of many placental factors that have a profound effect on the vascular endothelium. These effects result in hypertension, and multiple organ dysfunction. These considerations formed the basis of the use of microalbuminuria in placental insufficiency.

The objective of the invention was to develop a simple method of prediction, MON.

The technical result of the proposed method is the prediction of MO in the early stages using a simple quantitative determination and, accordingly, with the possibility of early adequate preventive treatment.

The technical result is achieved by determining the quantitative level of MAU in the urine during the first trimester of pregnancy.

To determine the level MAU was used the apparatus of the HemoCue® Albumin 201, based on immunoturbidimetric reaction.

Immunoturbidimetric method is the most specific and accurate for determining the MAU. Based latex particles with covalently attached to albumin, which form complexes with the solution of monoclonal antibodies to albumin (PETINIA - particle enhanced turbidimetric inhibition immunpassay). The sensitivity of the method is 1.3 mg/l, and the scope of work Konzentrat the th - from 1.3 to 300 mg/l without dilution. The analysis time is not more than 90 seconds. The advantages of this method are, first and foremost, high precision and specificity in relation to albumin, even when working with small quantities of liquid.

Pregnant examined in the first trimester for the period of 5-8 weeks. Level MAU was determined in accordance with the recommendations of the National Kidney Foundation, night and morning portion of urine, at least three times during his stay pregnant in the hospital.

We surveyed 271 woman.

After the research and study of the obtained data, we retrospectively identified two groups - group 1 level MAU ≤ 44 mg/l; and group II with level UIA ≥ 45 mg/l Threshold value MAU 45 mg/l in the first trimester indicates the possible development of MO, and the sensitivity of the method was 85.3%.

The method is as follows.

For analysis MAU use, as is customary, the urine collected during the night (8-12 hours). The level of albumin excretion with urine expressed in mg per 1 l of urine. When the level of the MAU 45 mg/l or more in the first trimester predict MO.

The method is illustrated by the following specific examples of its implementation. Example No. 1.

Pregnant U., 28 years old, diagnosed with "I preterm delivery at 36-37 weeks. Prenatal pouring out water. Sdfd 1 tbsp. Gestational edema. Inspection generic paths"

The patient was registered female consultations with 6-7 weeks of pregnancy. Somatic and hereditary anamnesis is not burdened. Profession Manager. Menstrual function is not violated: 12 years, 5 days, after 28 days, the regular cycle. This pregnancy first came spontaneously. In 5-6 weeks was an in-patient in the gynecological Department of the city clinical hospital No. 55 with a diagnosis of "Pregnancy 5-6 weeks. The threat of miscarriage.". Average MAU - to 52.4 mg/l, which allows us to predict MO.

At 25-26 weeks was in GB No. 8 with the diagnosis of Pregnancy 25-26 weeks. Head previa. The threat of late spontaneous abortion. NEF". According to the U.S. premature maturation of the placenta, which confirms the presence of MO. Prophylactic treatment of MO was not conducted.

Re-hospitalization at 36-37 weeks with the diagnosis of Pregnancy 36-37 weeks. Head previa. The threat of premature birth. NEF. Sdfd 1 tbsp." According to the ULTRASONIC research - hypoplasia of the placenta, multiple calcium, sdfd 1 tbsp., impaired uteroplacental blood flow 1B class.

The baby was born alive, premature, male, weight 2400, growth 47 see score on a scale of Apgar scores in the first minute 6 points, pas fifth minute 7 points. The absence of preventive measures, the GON has led to the development of the sdfd.

Example No. 2.

p> Pregnant With., 25 years with the diagnosis: "I timely delivery. Myopia of a weak degree. Chronic gastritis (REM.)".

The patient was registered antenatal clinic with 8 of pregnancy. Profession - seller. Somatic and hereditary anamnesis is not burdened. Menstrual function is not violated: 12 years, 4 days, 30 days, regular cycle. Pregnancy first came spontaneously. Surveyed PA IGO, the result is negative.

In 5 weeks inpatient treatment in gynecological Department of the city clinical hospital No. 55 with a diagnosis of Pregnancy 5 weeks. The threat of termination. Myopia of a weak degree." According to U3-hypertonicity of the rear wall of the uterus. Average MAU of 34.6 mg/l, which indicates that this patient is not included in the risk group for the development of MON.

At 25 weeks of inpatient treatment in GB No. 8 with the diagnosis of Pregnancy 25-26 weeks. Head previa. The threat of late spontaneous abortion. Myopia of a weak degree. Chronic gastritis (REM.)". Upon receipt held ULTRASONIC examination and Doppler ultrasonography revealed no pathology.

At 32 weeks the doctor of female consultation aimed in GB No. 8 with the diagnosis of Pregnancy 32 weeks. Head previa. The threat of premature birth. Myopia of a weak degree. Chronic gastritis (REM.)" According to the ULTRASOUND and abnormal Doppler waveforms revealed no pathology.

Birth on the activity developed independently, delivery was uneventful. The total duration of labour 8 hours. Water light. The baby was born alive, Mature, male, weight 3550, growth 51 see score on a scale of Apgar scores in the first minute 8 points in the fifth minute of 8 points. The mother was discharged home with the child for 5 days.

Example No. 3.

Pregnant Century, 30 years with the diagnosis: "I urgent delivery. Gestational edema. NEF. The mild myopia"

The patient was registered antenatal clinic with 6 weeks of pregnancy. Somatic and hereditary anamnesis is not burdened. Profession - d/H. the Menstrual function is not impaired: from 11.5 years, 6 days, after 28 days, the regular cycle. This pregnancy first came spontaneously. In 5 weeks was an in-patient in the gynecological Department of the city clinical hospital No. 55 with a diagnosis of "Pregnancy 5-6 weeks. A threatened miscarriage". Average MAU - 48,2 mg/l, which allows us to predict MO.

At 24 weeks was in GB No. 8 with the diagnosis of Pregnancy 24-25 weeks. Head previa. The threat of late spontaneous abortion. NEF". According to the U.S. violation of uteroplacental blood flow 1A extent that confirms the presence of MO. Started prophylactic treatment of PN.

Re-hospitalization at 38-39 weeks with the diagnosis of Pregnancy 38-39 weeks. Head previa. NEF. Gestational edema. Myopia poorly the degree." According to the ULTRASONIC research - the presence of a single calcium. The blood flow in the uterine-placental complex within normal limits.

The baby was born alive, Mature, male, weight 3450, height 50 cm Estimation on Apgar scale in the first minute 8 points in the fifth minute of 8 points. Carrying out timely preventive measures helped to prevent the development sdfd.

Thus, the proposed method is easy to use and vasocontriction, the sensitivity of the method is quite high and exceeds similar ways. The claimed invention allows the prediction of MO and selection of patients for prophylactic therapy using specific criteria. The use of this invention will contribute to a more objective forecasting MO and will reduce the cost of treatment for women with low risk.

A method for predicting placental insufficiency, characterized in that in the first trimester of pregnancy to determine the level of microalbuminuria and its value is equal to and more than 45 mg / l, predict placental insufficiency.



 

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