RU2306564C1 - Method for predicting chronic fetoplacental insufficiency - Google Patents

Abstract

FIELD: medicine, perinatology.

SUBSTANCE: a smear should be treated due to Betke's cytochemical technique, the quantity of fetal erythrocytes in the smear should be calculated by Cisnetsky's technique, in case of 1.74 value of fetal erythrocytes in visual field one should diagnose chronic fetoplacental insufficiency. The innovation enables to improve the quality of diagnostics at earlier stages of pregnancy and shortens the terms of prediction.

EFFECT: higher accuracy of diagnostics.

2 ex, 3 tbl

Description

The invention relates to medicine, namely to perinatology, neonatology, obstetrics, and can be used in the practice of perinatologists, neonatologists and obstetrician-gynecologists for the diagnosis of chronic placental insufficiency.

A known method for the diagnosis of chronic fetoplacental insufficiency, based on ultrasound (ultrasound) of the fetoplacental complex [2, 3]. The disadvantages of this method are: the ability to diagnose chronic placental insufficiency by morphological signs of the condition of the placental complex, which does not allow to identify this pathology in early pregnancy.

The objective of the invention is the advancing deadlines and improving the accuracy of diagnosis of chronic placental insufficiency.

The task is achieved due to the fact that the smear is subjected to treatment with the Betke cytochemical method, the number of fetal red blood cells in the smear is calculated according to the Tsisnetsky technique, with indicators of fetal red blood cells in the field of view of more than 1.74, chronic fetoplacental insufficiency is diagnosed.

The method is as follows.

In a pregnant woman, following the rules of blood sampling, they take blood from a finger, as this is the most common and less painful way to get venous blood, which allows you to prepare a blood smear from a stele from 1-2 drops. For light microscopy of a smear in order to count fruit erythrocytes, the Betke cytochemical method is used [1]. The smear is fixed in 80% ethanol, kept in citrate-phosphate buffer, stained in a 1% aqueous solution of methylene violet. The calculation of the number of fetal red blood cells in a smear is carried out according to the method of Tsisnetsky [4]. In 50 fields of view, with a magnification of 600 times, the number of fetal red blood cells is calculated and the average number of fetal red blood cells in one field of view is calculated. With indicators of fetal erythrocytes in the field of view of more than 1.74, chronic fetoplacental insufficiency is diagnosed.

The object of the study was 31 pregnant women. All women at the end of pregnancy were conditionally divided into two groups. Group I included women whose pregnancy proceeded without chronic placental insufficiency. Group II consisted of women with chronic placental insufficiency.

Study volume: women of both groups underwent ultrasound examination of the placental complex in order to diagnose chronic placental insufficiency. Examination terms: 22-24 and 32-34 weeks. Additionally, the determination of the number of fetal red blood cells in a blood smear was performed.

The results of ultrasound of pregnant women in comparison groups are presented in table 1.

Table 1 Ultrasound results in the control period of pregnancy. Criteria for chronic placental insufficiency Comparison groups I (n = 17) II (n = 14) one 2 3 Pregnancy 22-24 weeks Premature maturation of the placenta,% 0 0 Intrauterine growth retardation,% 0 0 Low water,% 0 0 Hemodynamic disturbances in the uteroplacental blood flow,% 0 0 Pregnancy 32-34 weeks Premature maturation of the placenta,% 0 71,4 Intrauterine growth retardation,% 0 21,4 Low water,% 0 42.9 Hemodynamic disturbances in the uteroplacental blood flow,% 0 7.1

Thus, according to the results of ultrasound, chronic fetoplacental insufficiency in 22-24 weeks of pregnancy was not detected in any of the women of group II. At 32-34 weeks using ultrasound in women of this group, signs of chronic placental insufficiency were revealed: premature maturation of the placenta, intrauterine growth retardation, oligohydramnios, hemodynamic disturbances in the uteroplacental blood flow. A combination of all four signs was not observed in any of the women. The combination of three signs was observed in 1 woman (7.1%), two signs - in 4 women (28.6%). One sign of chronic placental insufficiency was detected in 9 women of group II, which accounted for 64.3% of cases of observation.

The results of determining the number of fetal red blood cells in maternal blood are presented in table 2.

This analysis is possible from 14-16 weeks of gestation when the formation of the placenta ends. But since its permeability to fetal erythrocytes during these periods is negligible, they were not determined in the mother’s blood, i.e. their number was 0.00 ± 0.00 in women of both groups.

table 2 The number of fetal red blood cells in the blood of pregnant women during the study period of pregnancy. Gestational age Comparison groups I (n = 17) II (n = 14) 22-24 weeks, M ± m 0.64 ± 0.18 2.38 ± 0.64 ** 32-34 weeks, M ± m 1.00 ± 0.16 2.76 ± 0.64 **

Legend: ** - significance of differences at p≤0.01 compared with group I.

Thus, the number of fetal erythrocytes in the blood of women whose pregnancy proceeded with the development of chronic fetoplacental insufficiency was increased at 22-24 and 32-34 weeks of pregnancy compared to women whose pregnancy proceeded without chronic fetoplacental insufficiency.

Therefore, it is possible to diagnose chronic fetoplacental insufficiency at a gestational age of 22-24 weeks. The range of variability of the number of fetal red blood cells in the blood of women of group II was 1.74-3.02 (2.38 ± 0.64) units / field of view. Given that the upper limit of the range of the content of fetal red blood cells in the blood of women of group I for this period of pregnancy was 0.82 (0.64 + 0.18) units / field of view, i.e. did not reach the lower limit of the range of fetal erythrocytes in the blood of women of group II (1.74 fetal erythrocytes in the field of view), then 1.74 fetal erythrocytes in the field of view should be taken as a threshold criterion for the diagnosis of chronic placental insufficiency.

Table 3 summarizes the percentage of diagnosis of chronic placental insufficiency (CKDF) during the study period of pregnancy according to ultrasound and the number of fetal red blood cells in a smear of maternal blood.

Table 3 Criteria for chronic placental insufficiency Comparison groups I (n = 17) II (n = 14) Pregnancy 22-24 weeks The number of women with a high content of fetal red blood cells,% 0 one hundred The number of women with signs of CKD detected by ultrasound,% 0 0 Pregnancy 32-34 weeks The number of women with a high content of fetal red blood cells,% 0 one hundred The number of women with signs of CKD detected by ultrasound,% 0 one hundred

Therefore, the determination of fetal erythrocytes in the blood of pregnant women is a more accurate way to diagnose chronic placental insufficiency compared to ultrasound, allows you to diagnose chronic placental insufficiency in earlier pregnancy and prevent severe complications from the fetus.

Example 1. Patient L., 24 years old, was admitted to the maternity hospital No. 5 on August 9, 2004 with a diagnosis of Pregnancy 22-24 weeks, the threat of termination of pregnancy. Cervical erosion. Cytomegalovirus (CMV) -, herpes simplex virus (HSV) - infection. Chronic pyelonephritis, remission.

Examination in a maternity hospital revealed:

1. Blood test: no features.

2. Urinalysis: no features.

3. Ultrasound from 10.08.04: Biparietal size (BDP) 54.6 mm, fronto-occipital size (LZR) 71.1 mm, head circumference (OG) 199 mm, abdominal circumference (OJ) 179 mm, hip length 37, 9 mm, shoulder length 35.6 mm. The amount of amniotic fluid is normal. Placenta: localization - the front wall of the uterus. The umbilical cord has 3 vessels. Conclusion: pregnancy 22-24 weeks.

4. Dopplerometry from 08/10/04: No hemodynamic disturbances were detected.

5. CTG from 08/10/04: Normal type.

When determining the number of fetal red blood cells in a blood smear taken from a finger, the number of fetal red blood cells in the field of view was 2.33, which indicates increased placental permeability.

The patient was prescribed conservative therapy aimed at maintaining pregnancy.

During the control ultrasound and dopplerometry at 33-34 weeks of pregnancy, the following were revealed: BDP 84.8 mm, LZR 109 mm, exhaust gas 312 mm, coolant 272 mm, hip length 67.8 mm, shoulder length 60.0 mm. The amount of amniotic fluid is normal. Placenta: localization - the anterior wall of the uterus, maturity III. The umbilical cord has 3 vessels, visualized near the neck with a possible entanglement. Conclusion: 34-week pregnancy, ZVRP, asymmetric form, premature maturation of the placenta. Hemodynamic disturbances of Ia degree. CTG from 10/18/04: Normal type.

The patient was re-hospitalized on October 18, 2004 in maternity hospital No. 5 with a diagnosis of Pregnancy 34 weeks, premature maturation of the placenta, ZVRP, asymmetric form. Chronic fetoplacental insufficiency. Cervical erosion. CMV -, HSV - infection. Chronic pyelonephritis, remission.

When determining the number of fetal red blood cells in a blood smear taken from a finger, the number of fetal red blood cells in the field of view was 2.67, which confirms the presence of chronic fetoplacental insufficiency.

In order to treat chronic fetoplacental insufficiency, the patient was prescribed metabolic therapy and therapy that improves uteroplacental blood flow. During the control ultrasound, hemodynamic disorders were not detected.

She received prenatal hospitalization on November 29, 2004. On December 6, during a gestational age of 39 weeks, a cesarean section was performed. A boy was born weighing 2700 g, height 50 cm, with an Apgar rating of 1 min 7b, 5 min 9b, without asphyxia, with signs of fetal malnutrition I degree. The posterior amniotic fluid was green. Placenta: weight 430 g, size 21 · 15 · 2.5 cm, all in petrificates.

Final diagnosis: Urgent delivery I. Premature maturation of the placenta. Chronic fetoplacental insufficiency. Hypotrophy of the fetus I degree. Chronic fetal hypoxia. Cervical erosion. CMV -, HSV - infection. Chronic pyelonephritis, remission.

Operations: Laparotomy for Pfannestil. Cesarean section in the lower uterine segment by transverse section, sutures on the uterus according to Utkin.

The above example proves the diagnostic significance of the proposed method. Identification of an increased number of fetal red blood cells at 22-24 weeks of gestation and the timely conduct of a course of metabolic therapy would improve uteroplacental blood flow, avoid the development of chronic placental insufficiency and the occurrence of complications from the fetus.

Example 2. Patient F., 26 years old. The results of the control ultrasound and dopplerometry at 22-24 weeks of gestation: BPR 55.2 mm, LZR 71.8 mm, GO 203 mm, coolant 184 mm, hip length 38.5 mm, shoulder length 36.1 mm. The amount of amniotic fluid is normal. Placenta: localization - the posterior wall of the uterus, high above the internal pharynx. The umbilical cord has 3 vessels. Conclusion: pregnancy 22-24 weeks. Hemodynamic disorders were not detected. CTG from 06/16/04: Normal type.

The result of determining the number of fetal red blood cells: 0.67 fetal red blood cells in the field of view, which is normal.

During the control ultrasound and dopplerometry at 32-33 weeks of pregnancy, the following were revealed: BDP 80 mm, LPR 108 mm, exhaust gas 298 mm, coolant 281 mm, hip length 61 mm, shoulder length 54.0 mm. The amount of amniotic fluid is normal. Placenta: localization - posterior wall of the uterus, degree of maturity II. The umbilical cord has 3 vessels. Conclusion: pregnancy 32-33 weeks. Hemodynamic disorders were not detected. CTG from 08.25.04: Normal type.

When determining the number of fetal red blood cells in a blood smear taken from a finger, the number of fetal red blood cells in the field of view was 0.94, which also corresponds to the norm.

On October 11, 2004 she gave birth to a girl weighing 3300 g, height 53 cm, with an Apgar rating of 1 min 8b, 5 min 9b, without asphyxiation. Placenta: weight 453 g, size 25 × 24 × 2.5 cm.

Final diagnosis: Urgent delivery II. Cervical erosion. Myopia of the I degree. Rupture of the mucosa of the posterior commissure, vagina.

Operations: Amniotomy, suturing of the gap with catgut.

This example indicates that during pregnancy without the development of chronic placental insufficiency, the number of fetal red blood cells in maternal blood remains within normal limits. An increase in the rate of fetal red blood cells in the field of view from 0.67 in 22-24 weeks to 0.94 in 32-33 weeks indicates a physiological increase in placental permeability during pregnancy.

Thus, the proposed method for determining fetal red blood cells in maternal blood can improve the quality of diagnosis of chronic placental insufficiency in early pregnancy.

The advantages of this method include advancing the timing of diagnosis of chronic placental insufficiency, accuracy, simplicity, accessibility.

Information sources

1. Menshikov V.V., Delektorskaya L.N., Zolotnitskaya R.P. and other laboratory research methods in the clinic. Ed. V.V. Menshikov. - M .: Medicine, 1987 .-- p.106, 121-122.

2. Savelyeva G.M., Fedorova M.V., Klimenko P.A., Sichinova L.G. Placental insufficiency. - M .: Medicine, 1991.- p. 114-115, 130, 148-150, 168.

3. Strizhakov A.N., Bunin A.T., Medvedev M.V. Ultrasound diagnostics in the obstetric clinic. - M .: Medicine, 1990. - p. 95, 172-177.

4. Tsisnetskiy V.V. Determination of fetal red blood cells in the bloodstream of the mother with late toxicosis of pregnant women // 3rd Congress rep. scientific Society of Laboratory Assistants: Abstracts. doc. - Uzhgorod, 1983.- p. 482-483.

Claims (1)

A method for diagnosing chronic fetoplacental insufficiency, including taking blood from a finger in pregnant women, preparing a blood smear, characterized in that the smear is subjected to the Betke cytochemical method, the number of fetal red blood cells in the smear is calculated according to the Tsisnetsky method, with indicators of fetal red blood cells in the field of view of more than 1, 74 diagnose chronic placental insufficiency.