RU2235499C2 - Method for predicting delivery discoordination in risk-group pregnant women - Google Patents

Abstract

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: in risk-group pregnant women from 37 wk of gestation one should register heart rate (HR) fluctuations. Registration should be carried out in low frequencies (LF) and high frequencies (HF). Discoordination of delivery activity should be predicted by LF and HF values. The method is noninvasive, simple and provides the opportunity to conduct early prediction.

EFFECT: higher efficiency of prediction.

3 ex, 1 tbl

Description

The invention relates to medicine, namely to obstetrics, and can be used to predict the development of discoordination of labor in pregnant women at risk.

The relevance of the development is due to an increase in the frequency of labor anomalies (ARD) to 17-30% (1, 3), of which discoordination is up to 3% (2, 3). The pathology of uterine contractility leads to an increase in the duration of labor, the number of surgical interventions, the frequency of obstetric injuries, pathological blood loss, and fetal hypoxia. Perinatal mortality and stillbirth increase sharply (4).

A significant number of diagnostic and prognostic tests used to predict the course of childbirth (clinical, anamnestic, hysterography, hormonal, genetic, anthropometric, etc.) are uninformative and only determine the degree of risk of developing pathology of labor, and with regard to individual characteristics, women do not provide a forecast .

There is a method for predicting the discoordination of labor by determining the activity of adenosine deaminase in the blood from the cervix and, when it is increased relative to the norm, discoordination of labor is predicted (5).

The disadvantages of the method:

1) the adenosine deaminase enzyme has a pronounced age dynamics and depends on immunodeficiency states, extragenital pathology, polyhydramnios, etc .;

2) the reaction requires mandatory control to determine non-specific phosphatase, which in pregnant women has an initially altered level;

3) may contribute to the development of inflammatory complications;

4) is invasive;

5) the method is traumatic;

6) lack of data on the accuracy of the method.

Closest to the technical solution to the claimed method is a method for predicting anomalies of labor on the eve of childbirth by ultrasound ultrasound of the uterine body at the border with the lower segment. When a hyperechoic line is detected against the background of hypoechogenic myometrium, ARD is predicted (6).

The disadvantages of the method:

1) the subjectivity of the assessment of the result, a high probability of error (30%);

2) late prognosis - on the eve of childbirth;

3) to perform the method requires expensive ultrasound equipment and a trained specialist - ultrasound diagnostics doctor;

4) lack of data on the accuracy of the method.

These disadvantages can be eliminated in the proposed method.

The technical result of the method is predicting the discoordination of labor in pregnant women at risk based on the determination from 37 weeks of gestation according to spectral analysis of heart rate indicators that reflect fluctuations in heart rate at low frequencies (LF norm) * (* LF norm reflects fluctuations in heart rate in low frequencies from 0.04 to 0.15 Hz.) and at high frequencies (HF norm) ** (** HF norm reflects fluctuations in heart rate in high frequencies from 0.15 to 0.40 Hz (9)), expressed as a percentage, and when The values LF norm, equal to 53.9% or less, and the HF norm, equal to 46.1% or more generic activity diskoordinirovannuyu predict with accuracy 87.8%.

Previously, a spectral analysis of heart rate variability was used in cardiology for the diagnosis of cardiac arrhythmias, pathology of the coronary arteries, and was also used as a method of formalized choice of drug exposure in therapeutic patients (7, 8). For the spectral analysis of heart rate variability, various computer programs were used (we took the Polyspectrum program, registration certificate No. 29/02020300 / 1987-01 of July 27, 2001, Neurosoft, Ivanovo). Spectral analysis reveals and quantifies the periodic changes in the frequency of the sinus rhythm (7, 9).

The novelty of the proposed method

The relationship of indicators reflecting fluctuations in heart rate at low frequencies (LF norm) and at high frequencies (FTF norm), with the development of discoordination of labor activity was established for the first time.

Distinctive features of the method

The prognostic parameters of indicators reflecting fluctuations in heart rate at low frequencies (LF norm) and at high frequencies (HF norm) were established in pregnant women at risk of developing ARD at 37 weeks of gestation: with LF norm values of 53.9% or less and with HF norm equal to 46.1% or more, the development of discoordination of labor is predicted with an accuracy of 87.8%.

The method is as follows.

The initial data for calculating the LF norm and HF norm indicators was an electrocardiogram (ECG), which was standardly recorded in 6 leads (I, II, III standard, aUR, aVL, aVF) at rest in a lying position, in the morning on an empty stomach, after 10 minutes recreation. The duration of the ECG recording was 5 minutes. ECG data was entered into a computer and calculated in accordance with the Polyspectrum program (registration certificate No. 29/02020300 / 1987-01 of July 27, 2001, Neurosoft, Ivanovo), intended for cardiac research. The data obtained was expressed as a percentage.

The essence of the proposed method is illustrated by the following examples.

Example 1. Pregnant K., 28 years old. Obstetric and gynecological history is burdened. The first pregnancy ended with a medical abortion in the period of 10 weeks, the second with a miscarriage during pregnancy of 8-9 weeks of pregnancy, the third and fourth with mini-abortions. Real pregnancy is the fifth, desirable, married. A woman is assigned to a high risk group for the development of labor abnormalities. Was admitted to the department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. Nephropathy I degree. OASA (burdened obstetric and gynecological history). Immature cervix.

Survey data according to the claimed method: when assessing heart rate variability, the LF norm was 48.2%, which is lower than the stated parameter, HF norm is 51.8%, which is higher than the declared parameter. Discoordination of labor is predicted. Pregnancy ended in timely delivery, which was complicated by the discoordination of labor. A full-term baby was born with a body weight of 3200 g, a growth of 50 cm, an Apgar score of 6-7 points. Conclusion: the forecast for the claimed method was confirmed.

Example 2. Pregnant T., 26 years old. Gynecological history burdened. Real pregnancy is the first. In the history of gynecological diseases, there is a violation of menstrual function: menstruation from 17 years old, irregular, with delays of up to 3-4 months, about which she was repeatedly examined in the gynecological department, treatment was carried out without effect. A woman is assigned to a high risk group for the development of labor abnormalities. Was admitted to the department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. Polyhydramnios. A burdened gynecological history. Mature cervix.

The survey data according to the claimed method: when assessing heart rate variability, the LF norm was 53.9%, HF norm - 46.1%. Discoordination of labor is predicted.

Pregnancy ended in timely delivery at 39 weeks. In childbirth, antispasmodic drugs were used to prevent discoordinated labor, with a positive effect - discoordination of labor did not develop. A full-term baby was born with a body weight of 3400 g, a growth of 50 cm, with an Apgar score of 7-8 points. Conclusion: the forecast for the claimed method was not confirmed in connection with timely prevention.

Example 3. Pregnant J., 28 years old. Obstetric and gynecological history is burdened. Real pregnancy is the third, desirable, married. A history of two medical abortions without complications. Of the gynecological diseases, cervical erosion is noted, about which the woman underwent diathermoelectrocoagulation, chronic adnexitis. A woman is assigned to a high risk group for the development of labor abnormalities. Was admitted to the department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. ZVRP. OASA. Coagulated neck syndrome. Ripening cervix.

The survey data according to the claimed method: when assessing heart rate variability, the LF norm was 64.5%, which is higher than the declared parameters, the HF norm is 35.5%, which is lower than the declared parameters. Normal labor is predicted.

Pregnancy ended in timely delivery at 40 weeks. Childbirth proceeded without complications. A full-term baby was born with a body weight of 2600 g, a height of 51 cm, with an Apgar score of 8-9 points. Conclusion: the forecast for the claimed method was confirmed - the anomaly of labor did not develop.

In this way, 142 pregnant women at risk of developing ARD were examined. Research data are given in the table.

The advantages of the proposed method:

1. The possibility of an early prognosis from 37 weeks of pregnancy, which will allow for preventive measures.

2. The method is simple to implement, has high accuracy.

3. The method is non-invasive.

4. The method is objective.

5. The duration of the methodology and calculation of indicators is 15 minutes.

6. The method does not require expensive equipment.

BIBLIOGRAPHY

1. Abramchenko V.V. Active management of childbirth. St. Petersburg: Special Literature, 1997.

2. Sidorova I.S. Physiology and pathology of labor. - M .: MEDpress, 2000 .-- 318 p.

3. Chernukha EA The birth block. - M .: “Triad-X”, 1999. - p.181-222.

4. Kulakov V.I., Serov V.N. and others. Anesthesia of childbirth. - M.: “Triad-X”, 1998. - 152 p.

5. Orlov V.I., Pogorelova T.N., Drukker N.A., Yurovsky S.L. A method for predicting discoordination of labor. // Official Bulletin “Discoveries. Inventions. ”- 1991. - No. 18. - p. 17. // A.S. No. 1648346.

6. Glushko A.A., Fedorova M.V., Kotov Yu.B., Tumanyan E.E. A method for predicting anomalies of labor on the eve of childbirth. // Bulletin “Inventions”. - 1999. - No. 22. part 2. - p. 390. // Patent No. 2134418.

7. Ryabykina G.V., Sobolev A.V. Heart rate variability. - M.: Publishing House "Star Co.", 1998. - 200 p.

8. Ryabykina G.V., Sobolev A.V. Heart rate variability analysis. //Cardiology. - 1996. - T. 36. - No. 10, p. 87-97.

9. Heart rate variability. Standards for measuring physiological interpretation and clinical use. Recommendations // Bulletin of arrhythmology. - 1999. - No. 11. - p. 53-78.

Claims (1)

A method for predicting the development of discoordinated labor in pregnant women at risk by the method of functional diagnostics, characterized in that for women from 37 weeks of gestation they determine indicators of fluctuations in heart rate at low and high frequencies and at low frequencies of 53.9% or less, and high frequencies equal to 46.1% or more predict the development of discoordination of labor.