RU2237241C2 - Method for predicting postabortion complications in teenagers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in peripheral blood of pregnant teenagers at 6-12 wk gestation one should detect relative content of CD11b-positive lymphocytes and at its values being equal to 9.4% or below one should predict the development of postabortion hematometra at 76% accuracy. The present innovation gives a doctor the chance to prescribe necessary complex of curative-prophylactic measures and pay special attention to abortion technique.

EFFECT: higher efficiency of prediction.

3 ex, 1 tbl

Description

The invention relates to medicine, namely to gynecology, and can be used to predict complications after terminating an unwanted pregnancy by vacuum aspiration at 6-12 weeks of gestation in adolescents.

The relevance of the proposed method is determined by the high proportion of abortions in adolescents. This age group accounts for 10 to 25% of all abortions in the world. In the Russian Federation, abortion in adolescents is 11%. Due to such anatomical and physiological features as cervical rigidity, small diameter of the mouth of the fallopian tubes, imperfect regulation of the hypothalamic-pituitary system, complications after abortion in adolescents occur three times more often than women of reproductive age. So a hematometer develops in every sixth patient under 18 years of age [1]. In this regard, the development of informative criteria for predicting complications in the post-abortion period in adolescents will allow for the timely implementation of the necessary complex of medical and preventive measures.

A known method for predicting the complications of medical abortion based on a comprehensive assessment of risk factors according to the anamnesis, when the degree of risk of post-abortion complications is established in the form of high, medium or low. The average risk of complications is predicted if a woman has a history of uterine fibroids, cesarean section, foci of chronic infection (extragenital pathology), and a high risk of developing complications of abortion is predicted in pregnant women, in women who have only abortions as a result of pregnancy, a chronic history of infection ectopy of the cervix [2].

The disadvantages of the method:

1) the method is not designed to predict the development of complications in adolescents, since they do not have such anamnesis data;

2) the method does not allow to objectively assess the condition of a woman, since in an individual analysis, additional factors that are not considered by the authors may occur;

3) the degree of risk indicated by the authors is not always implemented into a specific complication;

4) the proportion of the probability of a sign (complication) is not known.

The closest technical solution to the claimed method is a method for predicting the development of complications of abortion in women with gestational age less than 63 days (6-7 weeks), the essence of which is that the content of chorionic gonadotropin (CH) in the serum of pregnant women and at high CG values in the range 27,722-200,000 predict failure of abortion (development of complications) within 15 days after abortion [3]. However, this method has several disadvantages:

1) the wide variability of indicators, the content of CG in the blood serum in the 1st trimester of pregnancy does not allow to establish the accuracy of the method [4];

2) the non-specificity of this indicator, since it is known that the content of CG increases in the blood with cystic drift, teratomas, chorionepitheliomas [4];

3) the method was not used to predict complications of abortion in adolescents;

4) the period indicated by the author (15 days) is remote, since during this period the patient could have acquired complications not related to abortion.

These disadvantages are proposed to eliminate in the present method.

The claimed technical result is achieved by the fact that before abortion in the peripheral blood of adolescents during pregnancy of 6-12 weeks, the relative content of CD11b-positive lymphocytes is determined and, with values of this indicator of 9.4% or less, the development of hematometers in the post-abortion period is predicted with an accuracy of 76%.

The novelty of the proposed method lies in the fact that for the first time it is proposed, prior to vacuum aspiration, the most gentle method for terminating pregnancy, to predict the development of hematometers after abortion in 6-12 weeks in adolescents by determining the relative content of CD11b-positive lymphocytes in peripheral venous blood.

A study of the level of CD11b + lymphocytes was previously carried out in the peripheral blood of pregnant women with gestosis at a gestational age of 34–40 weeks, and an increase in this indicator served as a diagnostic criterion for the development of fetal growth retardation syndrome [5]. To predict complications in the postabortion period in adolescents, this indicator is used for the first time.

It is known that the CD11b molecule is involved in the processes of intercellular interaction during the development of cytotoxicity reactions [6]. The decrease in the expression of the CD11b molecule is apparently associated with a violation of this type of immune response in adolescents, which results in the development of hematometers in the postabortion period.

The method is carried out according to the standard method as follows.

The selection of lymphocytes from peripheral venous blood is carried out according to standard methods [7].

Further, in accordance with the instructions of the company developing the monoclonal antibodies (OOO MedBioSpektr, Moscow, registration certificate No. 29/24070700 / 2013-01 dated June 14, 2001), 100 μl of lymphocytes at a concentration of 1x10 ⁶ cells / ml are incubated with 20 μl of FITC-labeled monoclonal anti-CD11b for 30 minutes at room temperature in the dark, after which the cells were washed 1 time with 1 ml of physiological saline by centrifugation at 1500 rpm for 2 minutes. Cells are resuspended in 500 μl of saline. The reaction is counted on a flow cytometer, determining the content of CD11b-positive cells in the lymphocyte gate.

Using the proposed method allows with high accuracy (76%) to predict the development of hematometers after abortion in 6-12 weeks of pregnancy in adolescents.

Distinctive features of the method are:

- a prognostic parameter was established for the relative content of CD11b + lymphocytes in the peripheral blood of adolescents who terminate pregnancy in the period of 6-12 weeks, with quantitative values of which 9.4% or less, the development of hematometers in the postabortion period is predicted. The essence of the proposed method is illustrated by the following examples.

Example 1. Patient M. 15 years. Asked about the delay of menstruation for 4 weeks. Sexual life from 15 years old, without contraception. Menses from 13 years, after 28 days to 5 days, moderate, painless. The last menstruation from November 4, 2001 to November 9, 2001, denies gynecological diseases.

When a vaginal examination: the vagina of a nulliparous, the cervix is cyanotic, conical, without visible mucosal defects, the external pharynx is closed. The body of the uterus is of a mild consistency, increased to 6-7 weeks of pregnancy, painless on palpation. The appendages are not enlarged, the vaults are free. Discharge mucous, moderate.

Clinical diagnosis: Pregnancy 6-7 weeks.

According to US data: the body of the uterus with an even contour, 64 × 40 × 54 mm in size, in the uterine cavity along the front wall closer to the bottom is an elongated fetal egg with a diameter of 28 mm with an embryo. KTR-10 mm, fetal heart rate is determined. Conclusion: 7 weeks pregnancy.

The patient asked to terminate the pregnancy.

After a clinical and laboratory examination, corresponding to order No. 242 of June 11, 1996 under the Ministry of Health of the Russian Federation, under aseptic conditions, under intravenous ketamine anesthesia, the cervix was taken on bullet forceps, the uterine cavity was probed, the length of the uterine cavity was 7 cm. The cervical canal was expanded to No. 10 expander Geghara. The fetal egg is destroyed and removed by a vacuum-exchleator.

According to the immunological examination according to the claimed method, the content of CD11b + lymphocytes in the peripheral blood was 12.4%, which is higher than the claimed parameter (9.4%).

Conclusion: the absence of complications in the postabortion period is predicted. When examining the patient after 10 days, the condition is satisfactory, no complaints. With a vaginal examination: the cervix without defects of the mucosa, the external pharynx is closed, the body of the uterus is normal in size, dense, mobile, painless, the appendages are not enlarged, the arches are free, the mucous discharge.

According to ultrasound: the body of the uterus is 50 × 23 × 50 mm, of a homogeneous structure, the uterine cavity is closed, there is no reflection from the endometrium. Appendages are not enlarged. Blood test Hb - 120 g / l, L - 8.5 g / l, ESR - 7 mm / h. The first menstruation after an abortion after 30 days, moderate, painless, for 5 days.

Thus, the prediction of the absence of postabortion complications by the claimed method was confirmed.

Example 2. Patient Sh., 16 years old. Asked about the delay of menstruation for 4 weeks. Sexual life from 14 years old, without contraception. Menses from 12 years, after 30 days for 6-7 days, moderate, painless. The last menstruation in the period from 11/27/2001 to 12/01/2001, Gynecological diseases denied.

When a vaginal examination: the vagina of a nulliparous, the cervix is cyanotic, conical, without visible defects of the mucosa. The body of the uterus is of a soft consistency, increased to 7 weeks of pregnancy, painless on palpation. The appendages are not enlarged, the vaults are free. Discharge mucous, moderate.

Clinical diagnosis: Pregnancy 7-8 weeks.

According to US data: the body of the uterus with a smooth contour, size 68 × 48 × 70 mm, in the uterine cavity 1 fetal egg in the middle section with a diameter of 20 mm with an embryo. KTR-10 mm, fetal heart rate is determined. Chorion on the front wall 11 mm thick. Conclusion: 8 weeks pregnancy.

The patient asked to terminate the pregnancy. After a clinical and laboratory examination, corresponding to order No. 242 of June 11, 1996, the Ministry of Health of the Russian Federation, under aseptic conditions, under intravenous ketamine anesthesia, the cervix was taken on bullet forceps, the uterine cavity was probed, the length of the uterine cavity was 8 cm. The cervical canal was expanded to No. 10 expander Geghara. The fetal egg is destroyed and removed by a vacuum-exchleator.

According to immunological examination according to the claimed method, the content of CD11b + lymphocytes was 4.9%, which is lower than the claimed parameter (9.4%).

Conclusion: the development of complications in the postabortion period is predicted.

After 2 days, the patient complained of pulling pains in the lower abdomen, an increase in body temperature to 37.6 degrees.

On examination, the cervix with traces of bullet forceps, conical, external pharynx closed. The body of the uterus is slightly larger than normal, painful in the study. Appendages on both sides are not determined, the vaults are free. Discharges are mucous-sacred, scanty.

Clinical diagnosis: Condition after medical abortion in the period of 7-8 weeks. Hematometer.

Prescribed treatment with antispasmodics (no-spa, suppositories with papaverine), anti-inflammatory treatment (trichopolum, doxycycline), antifungal drugs (nystatin) for 5 days. After the therapy, the condition improved, the pain syndrome stopped from the first day of prescribing, spotting appeared, which lasted 4 days.

At the end of treatment, Нb - 125 g / l, L - 6.2 g / l, ESR - 10 mm / h.

USG on the 10th day after the abortion: the uterus is 42 × 26 × 47 mm of the usual structure. The cavity is closed, there is no reflection from the endometrium. Ovaries of normal size, structure.

The first menstruation after abortion after 38 days, moderate, painless, for 6 days.

Thus, the forecast for the occurrence of hematometers in the postabortion period by the claimed method was confirmed,

Example 3. Patient K, 18 years old. Asked about the delay of menstruation for 5 weeks. Sexual life from 17 years old, without contraception. Menses from 13 years, after 26 days to 5 days, moderate, painful. The last menstruation from 02/17/2002 to 02/21/2002 denies gynecological diseases.

With vaginal examination: the vagina of the nulliparous, the cervix is cyanotic, conical, without visible mucosal defects, the external pharynx is closed. The body of the uterus is of a soft consistency, increased to 8 weeks of pregnancy, painless on palpation. The appendages are not enlarged, the vaults are free. Discharge mucous, moderate.

Clinical diagnosis: Pregnancy 7-8 weeks.

According to US data: the body of the uterus with a smooth contour, dimensions 69x45x56 mm, 1 fetal egg in the middle section is determined in the uterine cavity, with a diameter of 19 mm with an embryo. KTR-18 mm, fetal heart rate is determined. Conclusion: pregnancy 8 weeks, 5 days.

The patient asked to terminate the pregnancy. After a clinical and laboratory examination corresponding to order No. 242 of June 11, 1996, the Ministry of Health of the Russian Federation, under aseptic conditions, under intravenous ketamine anesthesia, the cervix was taken on bullet forceps, the uterine cavity was probed, the length of the uterine cavity was 9 cm. The cervical canal was expanded to No. 10 expander Geghara. The fetal egg is destroyed and removed by a vacuum-exchleator.

According to immunological examination, the content of CD11b + lymphocytes was 9.3%.

Conclusion: the development of complications in the postabortion period is predicted.

Upon examination of the patient after 10 days, the condition is satisfactory, no complaints.

When examining the vagina of a nulliparous cervix, without mucosal defects, the external pharynx is closed, the body of the uterus is normal in size, dense, mobile, painless during examination. The appendages are not enlarged, the vaults are free. Discharge mucous, moderate.

Blood test total Hb - 135 g / l, L - 7.2 g / l, ESR - 12 mm / h.

According to ultrasound, the uterus is of a normal structure, 50 × 44 × 55 mm, the uterine cavity is closed, there is no reflection from the endometrium. No appendages were detected.

The first menstruation after an abortion after 28 days, moderate, painless, within 5 days.

Thus, the prognosis of the development of complications by the claimed method was not confirmed. Apparently, this is due to the fact that 6 months before this abortion, the patient had a medical abortion in the late period, when a significant expansion of the cervical canal was performed.

This method examined 33 adolescents during pregnancy of 6-12 weeks. Research data are given in the table.

The advantages of the proposed method:

1. Allows predicting its complication, the hematometer, prior to an abortion.

2. It has high accuracy - 76%, sensitivity - 64%, specificity - 82%.

3. The duration of the methodology for determining CD11b + lymphocytes does not exceed 1 hour 30 minutes.

LIST OF REFERENCES

1. Gurkin Yu.A. Gynecology of adolescents. A guide for doctors. - SPb, 1998, - p. 79-81, 393-402.

2. Trubina TB A comprehensive assessment of risk factors in predicting the complications of medical abortion // Bulletin of the Russian Association A and G. -2000, - No. 2, - p.24.

3. Rorbye S., Norgaard M., Vestermark V., Nilas L. Medical abortion - defining success and optimization follow-up // XXXIII congress of the Nordic Federation of Societies of Obstetricians and Gynecologists (NFOG): Programm and Abstracts. Umea, Sweden, 1-4 June 2002. - Sweden, 2002, - p. 116.

4. Govallo V.I. Immunology of reproduction M .: Medicine, 1987, - 159 p.

5. Patent No. 2188427 A method for diagnosing intrauterine growth retardation in women with gestosis / Kudryashova A. V., Panova I. A., Sotnikova N.Yu. et al. // Inventions. Useful models. - 2002, - No. 24, part 2, - p.357.

6. Finger M.A., Ivanov A.A. Cell-cell interactions M .: Medicine, 1995, - c.224.

7. Boyum A. Isolation of mononuclear cell and granulocytes from human blood and bone marrow // Scand. J. Clin. Lab. Invest - 1968 - v.21 - No. 97 - p.77.

Claims (1)

A method for predicting postabortion complications in the study of peripheral venous blood, characterized in that in adolescents before termination of pregnancy at a gestational age of 6-12 weeks, the level of CD11b-positive lymphocytes is determined and, with their indices equal to 9.4% or less, the development of hematometers is predicted.