Method of predicting development of acute foetus hypoxia in labour

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics and gynaecology. After anamnesis analysis, the presence of the foetoplacental failure of a compensated form, oligohydramnios are identified. The day before labour cardiotocographic (CTG) examination is carried out, its results are evaluated, and the index STV is determined. Foetal monitoring is carried out, during which the sum of areas of decelerates in the active phase of I period of labour is determined with the external CTG and STV index with direct CTG after 1 hour of monitoring. The obtained data are processed with the calculation of a prognostic index. On the basis of the obtained index value the development of acute foetus hypoxia is predicted.

EFFECT: method makes it possible to predict the development of acute foetus hypoxia in labour, which makes it possible to determine further obstetric tactics of labour management in due time.

2 ex

 

Scope

The invention relates to medicine, namely to obstetrics and gynecology.

The most important task of modern obstetrics is to reduce perinatal morbidity and mortality. At present the problem of hypoxic States of the fetus during labor has not lost its relevance. In the structure of perinatal mortality hypoxia of the fetus and newborn is one of the leading places (30%). The frequency of fetal hypoxia is 4-6%, and in the structure of perinatal morbidity - 21-45%. Intrauterine hypoxia leads to damage of the Central nervous system, increases the frequency of somatic and infectious diseases, reduces the adaptation of the newborn in the early neonatal period, causing impaired psychomotor and intellectual development of children[1, 9, 10, 11, 12, 13, 14].

One of the leading causes of perinatal morbidity and mortality are hypoxic damage to the fetus during the intrapartum period. Hypoxic-ischemic lesion of the Central nervous system are one of the leading places in the structure of causes of high mortality and disability in infants. Thus, the proportion of hypoxic-ischemic lesion of the Central nervous system is 20 to 50% in the structure of perinatal mortality and up to 60-70% in the structure of causes of childhood disability [1, 2, 3]. Perinatal damaged�I the brain are responsible for the high mortality in the neonatal period, lead to the development of neurological complications and further define poor prognosis and quality of life of the child[4, 5, 8, 9, 10, 11, 12, 13, 14].

Reducing perinatal mortality in many respects it became possible thanks to the intensive monitoring of the fetus during pregnancy and childbirth with the help of modern research methods based on the analysis of cardiac activity [6, 7].

The level of technology

Analogs

1. Prediction of abnormal fetus during labor is performed based on the analysis of a number of anamnestic characteristics: the presence of the mother of extragenital diseases, complications of pregnancy (preeclampsia, placental insufficiency, permanent threat of termination of pregnancy, multiple pregnancy, immunologic incompatibility of blood mother and the fetus, infection of the fetus) [15].

2. Assessment of fetal condition during labor is performed on the basis of ultrasonic vascular Doppler fetal, umbilical artery and uterine arteries [17].

3. Diagnosis of acute fetal hypoxia during labor is done using a blood sample from the skin of the fetal head to determine her pH [18].

Prototype

Predicting the development of acute hypoxia of the fetus during childbirth based on the data intrapartum cardiotocography (CTG) [16]. The disadvantage of this method is the difficulty �interpretatie monitor curves. A certain subjectivity in the analysis of cardiotocogram, completely depending on the experience and specialist skills, often leads to incorrect interpretation of monitor curves and therefore to incorrect tactical decisions that threaten the life and health of the child.

Summary of the invention

The aim of the invention is to develop a method of prognosis of acute intrapartum fetal hypoxia based on the analysis of different types of fetal monitoring to improve perinatal outcomes.

The method is as follows. The patient coming to give birth at full-term pregnancy in a generic office, carefully collect anamnestic data, specify the presence of chronic placental insufficiency (hfpn), oligohydramnios, the result CTG conducted the day before the birth, the rate of STV (short-term variation - variability of short pieces) according to the CTG held the day before the birth. When conducting intrapartum fetal monitoring in real time get the index of the sum of squares of decelerate the active phase of the first stage of labor when the outer CTG and indicator STV with direct CTG 1 hour fetal monitoring.

The method of mathematical analysis of the selected features was established prognostic index D and the corresponding formula:

D=2,87×X1+1,69×x2-2,03×X3-0,11×X4-0,003×X5-0,09×X6+1,30, DG�:

X1 - oligohydramnios (presence - 1, no - 0);

X2 - hfpn, compensated form (available - 1, no - 0);

X3 - normal CTG birth (presence - 1, no - 0);

X4 - indicator STV birth (msec);

X5 is an indicator of the sum of squares of decelerate the active phase of the first stage of labor when the outer CTG 1 hour fetal monitoring (mm2);

X6 - indicator STV with direct CTG 1 hour fetal monitoring (msec);

onst=1,30.

If D>0, predict a high risk of acute fetal hypoxia during labor.

If D<0, predicts the birth of a healthy child.

The sensitivity of the decision rule 88%.

The specificity of 77%.

Efficiency 89%.

Clinical examples

1. Maslennikov O. B., age 27, resident of the city of Yekaterinburg. He entered the ancestral branch for delivery in pregnancy 40-41 weeks. The analysis of anamnestic data. The patient history was revealed hfpn, compensated form and oligohydramnios by ultrasound (ultrasound). CTG is within normal limits, according to cardiotocography, held the day before the birth, the rate of STV was 9.7 msec. During intrapartum fetal monitoring indicator is the sum of the squares of decelerate the active phase of the first stage of labor when the outer CTG was 50 mm2indicator STV when you direct the CTG was 4.9 msec.

The calculated prognostic index D according to the formula:

D=2,87×1+1,69×1-2,03×1-0,11×9,7-0,003×50-0,09×4,9+1,30=1,82

D>0, hence in mothers predict a high risk of acute fetal hypoxia during labor.

Medical card No. 1859. In childbirth were applied to vacuum extraction of the fetus. Born live, full-term baby weighing 3530 g, estimation on Apgar scale 6/7 scores, cord blood pH of 7.19. For 6 days was in intensive observation, diagnosed with ischemic-hypoxic lesions of the Central nervous system and spinal cord of 1-2 degrees.

2. Kozlova O. M., 28 years old, a resident of the city of Yekaterinburg. He entered the ancestral branch for delivery in pregnancy 39-40 weeks. The analysis of anamnestic data. The patient history was not revealed hfpn, compensated form and oligohydramnios by ultrasound. CTG is within normal limits, according to cardiotocography, held the day before the birth, the rate of STV was 9.3 msec. During intrapartum fetal monitoring indicator is the sum of the squares of decelerate the active phase of the first stage of labor when the outer CTG was 100 mm2indicator STV when you direct the CTG was 15.5 msec.

The calculated prognostic index D according to the formula:

D=2,87×0+1,69×0-2,03×1-0,11×9,3-0,003×100-0,09×15,5+1,30=-4,44

D<0, and therefore, in mothers predicts the birth of a healthy child.

Medical �art No. 1932. Childbirth was conducted conservatively. Born live, full-term child weight of 2890 g, estimation on Apgar scale 7/8 points, pH of umbilical cord blood 7,27. Was discharged on the 5th day home from the hospital with a diagnosis of healthy.

Thus, the proposed method allows to predict acute intrapartum fetal hypoxia, which gives the opportunity to define future obstetric tactics of childbirth and to prevent the birth of children in serious condition.

Sources of information taken into account in the examination

1. Chigvintsev L. N. The definition of informativeness automated CTG to assess fetal condition during labor. Author. dis. MD - M. 2007. C. 3.

2. Ageeva M. I. Doppler study in obstetric practice. - M. 2000. P. 112.

3. Barashnev Y. I. Hypoxic encephalopathy: the hypothesis of the pathogenesis of cerebral disorders and the search for methods of drug therapy. The Russian Bulletin of Perinatology and Pediatrics; No. 1 2002. Pp. 6-9.

4. Zubarev, E. A. Integrated perinatal ultrasound assessment of cerebrovascular disorders in children the first year of life. Author. dis. M. D. M. 2006. P. 49.

5. Chernukha E. A. the Generic unit. - M. 2005. Pp. 138-153.

6. Demidov V. N., Sigizbaeva I. K., O. Y. Ogai, etc. Automated antenatal and intrapartum cardiotocography. Health and medical technologies. 2005; No. 9. P. 52-53.

7. IIR�low A., H. Thunell R. Clinical guidelines for asphyxia of the fetus and newborn. - SPb. 2001. P. 144.

8. Savelyeva G. M. Obstetrics. - M. 2000. P. 449.

9. Badalyan L. O. Protection of the developing brain is the most important task of perinatal medicine. Tashkent, 1989.

10. Barashnev Y. I. Akush. and gynecologist. 1993. No. 1. Pp. 14-18.

11. Barashnev Y. I., Y. V. Bessonova Obstetrics and gynecology. 1997. No. 2. Pp. 28-33.

12. Savelyeva G. M., L. G. Sichinava Russian Federation).. Vestn. Perinatology. and a pediatrician. 1995. No. 3. P. 19-23.

13. Yatsyk G. V. Preterm infants. - M. 1989.

14. Sautin S. B., The All-New V. V., Rozhkova N. Yu., Pokrovskaya S. A., Shestakova N. G. Risk factors and predict the development of perinatal hypoxic-ischemic lesions of the nervous system in newborns. ROS. Vestn. women. and a pediatrician. 2001. No. 1. P. 31-32.

15. Savelyeva G. M. Handbook of obstetrics, gynecology and Perinatology. - M. 2006. P. 126-127.

16. Makarov I. O., Yudina E. V. Cardiotocography in pregnancy and childbirth. - M. 2012. P. 52-53.

17. Orlov V. I. Cardiotocography and Doppler in modern obstetrics / V. I. Orlov, T. L. botcheva, V. F. Kuzin and others - M.: UNC RAS, 2007. - P. 113-114. P. 238-239.

18. Saling E. A new method for examination of the child during labor. Introduction, teaching and princi pies / E. Saling // Arch Gynakol. - 1962. - Vol.197. - P. 108.

Method predict the occurrence of acute fetal hypoxia during labor, characterized in that set in the history of the presence of placental insufficiency compensated�Oh form, drought, the result set cardiotocography (CTG) and the indicator of STV, according to the CTG, held just before the birth, intrapartum fetal monitoring to determine the sum of squares of decelerate the active phase of the first stage of labor when the outer CTG and indicator STV with direct CTG 1 hour monitor and calculate the prognostic index D according to the formula:
D=2,87×X1+1,69×X2-2,03×X3-0,11×X4-0,003×X5-0,09×X6+1,30
where:
X1 - oligohydramnios: presence 1, absence 0;
X2 - chronic fetoplacental insufficiency, compensated form: presence 1, absence 0;
X3 - normal CTG birth: presence 1, absence 0;
X4 - indicator STV before the birth, MS;
X5 is an indicator of the sum of squares of decelerate the active phase of the first stage of labor when the outer CTG 1 hour fetal monitoring, mm2;
X6 - indicator STV with direct CTG 1 hour fetal monitoring, MS;
const=1,30;
and when D is more than 0 predict the occurrence of acute hypoxia of the fetus,
when D less than 0 is judged about the lack of risk of acute hypoxia of the fetus during labor.



 

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