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Method for prediction of anembryonic pregnancy

Method for prediction of anembryonic pregnancy
IPC classes for russian patent Method for prediction of anembryonic pregnancy (RU 2540499):
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FIELD: medicine.

SUBSTANCE: method involves dropping a supernatant of uterine fluid aspirate or menstrual fluid in an amount of 0.2 ml on a slide surface, drying at room temperature for one day, and microscoping the prepared samples (phases). The presence of a complex of morphological elements, including toxic plaques, wedge and disk-shaped structures enables predicting a high risk of anembryonic pregnancy.

EFFECT: simplifying and providing higher sensitivity of the method for the prediction of anembryonic pregnancy and enables predicting the clinical course and outcome of a pregnancy within a short time and with a small amount of the biological material available.

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The invention relates to medicine, namely to laboratory methods, and can be used to predict non-developing pregnancy.

In the last decade among the most important problems of practical obstetrics and gynecology, one of the first places is the issue of miscarriage (C. M. Sidelnikov, Was So Dry. Miscarriage: a Guide for practitioners. - M.: OOO " Medical information Agency, 2010, - 536 S.).

According to the classification of T. Y. Bastrikova (1994), non-developing pregnancy (NB) is considered one of the pathogenetic variants of miscarriage (So Yu Pestrikov. Miscarriage: spontaneous abortion, premature birth, non-developing pregnancy. The management of pregnancy and childbirth high risk. M: Relax, 1994). In recent years among cases of spontaneous abortions in the early stages, the frequency of this disease has increased from 10-20% to 45-88,6% (C. E. Radzinsky, V. I. Dimitrov, I. Yu Myskova. Non-developing pregnancy - M.: GEOTAR - Media, 2009. - 200 C.), which forces you to consider the NB as the current health and socio significant problem.

One approach to solving this problem when planning a pregnancy is to assess the risk of UXO at the stage pregravidarnoy training (Century. who. Radzinsky, V. I. Dimitrov, I. Yu Myskova. Non-developing pregnancy - M.: GEOTAR - Media, 2009 - 200 C.).

Thus, modern medicine requires new ways of forecasting NB in order to identify risk groups for its development on pregravidarnoy stage of preparation.

For screening of patients with NB on stage pregravidarnoy preparation used sonohysterography and transvaginal sonography (B. S. Demidov. The clinical significance of abnormal Doppler waveforms in the diagnosis and prediction of placental insufficiency in the second and third trimesters of pregnancy: author. dis. ...candles. the honey. Sciences. M, 2000). Using these methods it is possible to predict NB. But these methods have significant drawbacks:

- require the presence of expensive equipment;

the fact of the presence of UXO;

- high frequency of false-positive results in the early stages;

it is impossible early preclinical prediction of non-developing pregnancy.

The most common is the method of forecasting NB, based on histological examination remote tissue (M Burston. The histochemistry of enzymes, Per. s angl.. M., 1965; R. Lilly. Histopathological technique and practical histochemistry, Per. s angl., M., 1969; E. Pearce. The histochemistry, Per. s angl., M, 1962; Principles and methods histologische anal is for in pathology, Ed. by A. P. Auzina etc., L., 1971; O. I. topchieva, C. A. Pryanishnikova, H. P. zemkova. Endometrial biopsy - M.: Medicine. - 1978).

Disadvantages histological method are:

- establishing possible causes NB only after diagnostic procedures;

- the complexity of technical performance;

- the need for a specially equipped premises;

- the need to use expensive equipment;

- the duration of the study before issuing the final report (10-14 days).

A special place in forecasting NB is the method of determining the level of β - human chorionic gonadotropin (HCG) (instructions for use of the test system enzyme immunoassay for the quantitative determination of human chorionic gonadotropin "HCG-IVF-test", produced by LLC "Diatech-EM").

The disadvantages of the method are:

- use of special test systems;

- high frequency of false-positive results (increased levels of HGH can occur when the number of gynecological diseases - USSR tumor, dysgerminoma);

it is impossible early preclinical prediction of non-developing pregnancy.

A method for predicting NB in the level of growth factor, placenta serum with 5 weeks of pregnancy (A. Y. Ponomarev, Century, Ph.D, I. I., Krukier and others - "the Way the prognosis is non-developing pregnancy" - Patent for invention No. 2313793. - UHF Rostov scientific research Institute of obstetrics and Pediatrics of the Federal Agency for healthcare and social development, 2006) has several disadvantages, namely:

- forecasting of NB in the period of 5 weeks or more;

- the need for expensive test systems;

- inefficient use of on pregravidarnoy stage of preparation.

After the implantation process peripheral trophoblast cells invade the endometrium mother and trigger mechanism of the immune response, resulting in embryo receives embryo tropic autoantibodies (N.T. Haha, 2003; S. C. Apresyan, 2003; Centuries Misnik, 2005). To assess their impact on the formation of the chorion and the prediction of the development of NB was proposed ELI-P - the test (ELISA-detected Probability of pathology in Pregnancy, 1998 (A. B. Poletaev, N. To. Vabishchevich, S., Morozov. Method of screening women of childbearing age using the test system ELI-P to forecast the development of the embryo and fetus and the birth of healthy or abnormal child. RF patent for the invention №2107913 of 27 March 1998).

The disadvantages of this method are:

- the need for expensive test systems, cytogenetic laboratory;

- if NB can meet all three types of immunoreactivity, the method is not specific;

the influence of somatic pathology test results - shifts of immunoreactivity,projected at extragenital diseases (N. T. Haha, 2003).

There is a method of assessing the level glycodelin in menstrual blood for prediction of NB in women with hormonal disorders in history (Y. C. the Balkan mountains via pipelines. "Restore functional ability of the endometrium in women with miscarriage". - Abstract. dis. ...candles. the honey. Sciences. - Perm, 2009).

The disadvantages of this method are:

- the need for expensive reagents and technical complexity of the process;

strict specificity of the method (informative only for prediction NB hormonal dysfunction);

- change level glycodelin can occur at various pathology of the endometrium that is not connected with pregnancy;

Our invention is directed to simplifying and improving the sensitivity of the method for predicting NB.

The technical result of the invention is achieved in that the supernatant aspiration of fluid from the uterine cavity or menstrual discharge in the amount of 0.2 ml applied to the surface of the glass in the form of drops, dried at room temperature overnight, after which the samples (facies) mikroskopiruyut and in the presence of complex morphological elements, including: toxic plaques, language and the disc-shaped patterns, predict a high risk of development of underdeveloped take is nasty.

Summary of the invention is illustrated by drawings, where:

figure 1 is a fragment of facies supernatant aspiration of fluid from the uterine cavity in women with advancing pregnancy;

figure 2 is a fragment of facies supernatant menstrual blood of healthy women;

figure 3 is a fragment of facies supernatant aspiration of fluid from the uterine cavity in women with non-developing pregnancy, where:

1. azkabanu patterns

2. disc-shaped patterns

3. toxic plaques.

The proposed method was successfully tested in gynaecological OA the establishment of health care Clinical maternity hospital" , Astrakhan, JSC the establishment of health care, AMARB, Astrakhan, women's consultation Clinical maternity hospital" , Astrakhan in 2012-2013

Surveyed 80 women aged from 16 to 43 years, 30 (40%) women diagnosed with NB, the control group consisted of 50 (60%) women with normal pregnancy in the period from 5 to 12 weeks with no signs of threat, applying for abortion on request in gynecologic hospitals, Astrakhan. All investigated along with traditional clinical and laboratory examinations were performed ultrasound, pelvic transvaginal access, mammary glands, Cytology endo - ectocervical and morphostructural analysis of facies studied biological fluids Obtained results were compared with clinical data, histological findings pregnancies and morphological pattern obtained facies.

The results of testing are described below.

Example 1

Pregnant M., born in 1989, № history 3495, was admitted to the gynecological Department 23/12/12, with a diagnosis of pregnancy in the period of 5 weeks of gestation (artifactual abortion).

Complaints upon receipt does not show.

Menstrual and reproductive function: menstruation of 14 to 4 days, regular, moderate, cycle 30 days. The last menstrual period, 2/11/12

History: birth - 2, abortion - 2.

Comorbidities: chronic adnexitis, remission.

Somatic history is not burdened.

Objectively:

P. V. External genitals are developed correctly, the vaginal mucosa is not changed. The body of the uterus is increased to 5 weeks of pregnancy, soft, painless. Appendages on both sides without features. Parametrium free.

Selection - whites.

Ultrasound from 21.12.12, - uterus size 54×46×48 mm, up to 5 weeks of pregnancy, contours precise, equal, heterogeneous structure. M-echo of 0.9 mm In the uterus, the fertilized egg KTR - 0.45 mm, VDS - 15 mm, the heartbeat of the fetus is determined. The right ovary 30×21 mm, left ovary 18×25 mm Fence material: after exploring women on the mirrors in aseptic conditions produced by vacuum aspiration of the uterus. Received ASPIRA the ionic liquid from the cavity of the uterus was centrifuged for 15 minutes with a frequency of 3000 rpm The supernatant aspiration fluid used for further work.

Semi-dropper-dispenser supernatant aspiration of fluid from the uterine cavity in the amount of 0.2 ml in the form of drops caused on the surface of pre-prepared slides. After 24 hours the samples (facies) mikroskopiruyut in transmitted light, and evaluate the morphological picture obtained facies.

Morphological picture of facies aspiration of fluid from the uterine cavity: the symmetrical arrangement of cracks, clear rectangular individually, small round nodules, abnormal patterns is not detected. Conclusion: the morphological pattern characteristic of progressive uterine pregnancy (see Fig.1).

The result of histological examination No. 0967-67: decidual tissue, chorionic villi, is characteristic of progressive uterine pregnancy.

Example # 2

Patient F., born in 1980, no history 8831, appealed to the antenatal clinic Clinical maternity hospital" 18/12/12, with the aim of planning a pregnancy.

Complaints upon receipt does not show.

Menstrual and reproductive function: menstruation with 13 years 4 days, regular, moderate, cycle 30 days. Last menstrual period 17/12/12,

History: birth - 2, abortion - 2.

Comorbidities: chronic adnexitis, Remy is this

Somatic history is not burdened.

Objectively:

P. V. External genitals are developed correctly, the vaginal mucosa is not changed. The body of the uterus is not enlarged, soft, painless. Appendages on both sides without features. Parametrium free. Selection - bloody (2nd day of menstruation).

Ultrasound from 18.12.12, - uterus size 42×40×34 mm, contours precise, equal, heterogeneous structure. M-echo of 0.8 mm Right ovary 28×25 mm, left ovary 34×29 mm

The sampling was carried out similarly, see example No. 1.

Morphological study of menstrual blood from the uterus: a symmetric type of cracks, clear rectangular separately, rounded nodules, the absence of abnormal structures.

Morphological picture of facies menstrual blood: the symmetrical arrangement of cracks, clear rectangular individually, small round nodules, abnormal patterns not found.

Conclusion: the morphological pattern corresponds to the normal (see Fig.2).

The result of histological examination No. 0965-89: proliferative endometrium.

Example # 3

Pregnant L., born in 1978, № history 41935, was admitted to the gynecological Department 11/03/13 was diagnosed with non-developing pregnancy in the period of 6 weeks of gestation according to the type of death of the embryo.

Complaints received at a delay of menstruation, blood is discharge from the genital tract during the day.

Menstrual and reproductive function: menstruation from 15 years to 5 days, regular, moderate, cycle of 25 days. Date of last menstruation 30213-year history: 1 abortion. In 2008 laparotomy, a cystectomy.

Medical history: iron deficiency anemia is mild.

Objectively:

P. V. External genitals are developed correctly, the vaginal mucosa is not changed. The body of the uterus is increased to 5 weeks, soft, painless. Appendages on both sides without features. Parametrium free. Selection - blood.

Ultrasound of the pelvic organs from 10.03.13, - uterus size 62×52×52 mm, up to 5 weeks of pregnancy, contours precise, equal, heterogeneous structure. M-echo 12 mm In the uterine cavity deformed gestational SAC KTR - 4,7 mm, VDS - 3 mm, the heartbeat of the fetus is not defined. The right ovary 37×31 mm, left ovary 24×20 mm

The sampling was carried out similarly, see example No. 1.

Morphological picture of facies aspiration of fluid from the uterine cavity: asymmetric location of large cracks, the presence of complex morphological elements, including toxic plaques, language and disk-like structure (see figure 3).

Conclusion: the morphological picture is typical for non-developing pregnancy.

The result of histological examination No. 0197709: decidual tissue, chorionic villi with impozitareconsulting, lost fertilized egg

Example No. 4

Pregnant T., born in 1978, № history 41435, appealed to the antenatal clinic Clinical maternity hospital" 20/02/13 to plan pregnancy.

Complaints at admission does not show.

Menstrual and reproductive function: menstruation 13 years and 5 days, regular, moderate, cycle 28 days. Last menstrual period 18/02/13, history: 1 abortion, 1 birth, 1 non-developing pregnancy

Comorbidities: chronic adnexitis, remission.

Medical history: chronic gastroduodenitis remission, impaired fat metabolism 2 degrees.

Objectively:

P. V. External genitals are developed correctly, the vaginal mucosa is not changed. The body of the uterus is not enlarged, soft, painless. Appendages on both sides without features. Parametrium free. Selection - bloody, moderate (3rd day of menstruation).

Ultrasound from 18.02.13, the uterus dimensions 35×49×36 mm, M-echo 10 mm, contours fuzzy, uneven structure of the endometrium with heterogeneous single hyperechoic inclusions. The structure of the heterogeneous myometrium, echo is reduced. Advanced vessels arcuatula plexus. The right ovary 23×34 mm, left ovary 27×31 mm Conclusion: signs of chronic MetroEthernet in remission.

The sampling was carried out similarly, see example No. 1.

Morphol the ecological study of menstrual blood from the uterus: asymmetric location of the radial cracks, the presence of toxic plaques, language and disk-like structures (see Fig.3).

Conclusion: the morphological pattern indicates a high risk of developing NB.

The result of histological examination No. 065564-77: proliferative endometrium with leukocyte infiltration.

Thus, the present invention is aimed at simplifying and improving the sensitivity of the method for predicting non-developing pregnancy. Investigation of the features of morphological patterns aspiration of fluid or menstrual blood allows in a short time, a small volume of biological material to predict the course and outcome of pregnancy.

The inventive method is characterized by low invasiveness, technical simplicity, availability, execution conditions, antenatal clinics, hospitals.

A method for predicting non-developing pregnancy by studies of biological fluids, namely, that of the supernatant aspiration of fluid from the uterine cavity or menstrual discharge in the amount of 0.2 ml applied to the surface of the glass in the form of drops, dried at room temperature overnight, after which the samples (facies) mikroskopiruyut and in the presence of complex morphological elements, including: toxic plaques, language and disco is brassie patterns, predict a high risk of non-developing pregnancy.

 

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