RU2336527C1 - Method of pre-clinical prediction of placental insufficiency in second trimester of pregnancy associated with previous influenza a(h3n2) in first trimester of gestation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics. Substance of method of pre-clinical prediction of placental insufficiency in the second trimester of gestation associated with previous influenza A(H3N2) in the first trimester of pregnancy implies counting of days during which pregnant woman suffering from influenza A (H3N2) had temperature above 37.4° (A), evaluation of maximum temperature registered within the first 4 days of disease (B), level of antibodies to influenza A in binate bloods serum, at that indicator is level of antibodies in the second serum (C), detection of intoxication clinical symptoms number (N). Placental insufficiency development is predicted by solution of discriminant equation, where D is discriminant function with boundary value equal to 187.69. If D is equal or greater than boundary value, placental insufficiency development is predicted in the second trimester of pregnancy. D lower than boundary value indicates normal current of the second trimester of gestation. Method application provides higher accuracy and simplification of prediction method of placental insufficiency in the second trimester of gestation in women with previous influenza A (H3N2) in the first trimester of pregnancy.

EFFECT: provided higher accuracy and simplification of prediction method of placental insufficiency.

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Description

The invention relates to medicine, namely to obstetrics.

There is a method of preclinical prediction of placental insufficiency based on the determination of the content of medium-weight molecules in the serum of peripheral blood, the concentration of which in women in the first trimester of gestation is more than 0.220 conventional units, in the second trimester - more than 0.230 conventional units and in the third trimester - more than 0.240 conventional units placental insufficiency is predicted [1].

The disadvantages of this method are:

1. The complexity of the biochemical assessment of intoxication syndrome.

2. The need to use expensive equipment, namely a spectrophotometer, which increases the economic component of the method.

3. This method does not take into account the significant role of the level of specific immunity to influenza A (H3N2) in the development of placental insufficiency.

The aim of the invention is to improve the accuracy and simplification of the method for predicting placental insufficiency in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy.

The goal is achieved in that the prediction of placental insufficiency in the second trimester of pregnancy in women who have had influenza A (H3N2) in the first trimester of gestation is carried out by determining the number of days during which an increase in body temperature above 37.4 ° (A) is recorded, note the value the maximum temperature, which is measured during the first 4 days of the disease (B); establish the value of antibodies to influenza A (H3N2) in the second blood serum (C), determine the number of clinical symptoms of intoxication (temperature, headache, dizziness, photophobia, sweating, chills, weakness and adynamia) (N). Then, using the discriminant equation, including defined indicators, the development of placental insufficiency is predicted.

The essence of the method is to determine in women who have had influenza A (H3N2) in the first trimester of pregnancy, discriminant function (D), in relation to which the boundary value of discriminant function predicts the development of placental insufficiency.

The method contains the following techniques:

1. Determine the number of days during which a temperature is observed above 37.4 °;

2. Record the maximum temperature during the first 4 days;

3. Through the reaction of inhibition of hemagglutination (RTGA) determine the value of antibodies to influenza A (H3N2) in paired blood serum [2];

4. Count the number of symptoms of intoxication;

5. Using the discriminant equation determine the value of the discriminant function:

D = + 4.251 × A + 4.428 × B + 0.002 × C + 1.099 × N, where the boundary value is 187.69.

6. The development of placental insufficiency is predicted: when D is equal to or greater than the boundary value of the discriminant function, the development of placental insufficiency is predicted, and when D is less than the boundary value, the normal course of the gestational process is predicted.

The probability of a correct forecast is 88.3%.

Example 1: Patient A, 26 years old, history no. 256, was examined twice in the obstetric department of pregnant women’s pathology at the Department of Pediatric Surgery, Center for Phytotherapy and Diseases. Upon admission, the patient presented the following complaints: headache, dizziness, photophobia, sweating, chills, weakness, adynamia, runny nose and cough with a moderate amount of sputum mucosa for 3 days. An increase in temperature in a woman was recorded within 4 days, the maximum temperature was 39 ° (the number of symptoms of intoxication was 8); the value of antibodies to influenza A virus (H3N2) in the second serum was 1: 128 (in the first serum 1:32). Sonographically, the size of the embryo corresponds to 8 weeks of gestation. Clinical diagnosis: Pregnancy 8 weeks. Influenza A (H3N2). Acute rhinopharyngitis. After introducing the above signs of influenza infection into the discriminant equation, the following value of the discriminant function is established:

D = + 4.251 × 4 + 4.428 × 39 + 0.002 × 128 + 1.099 × 8 = 198.744 (D is greater than the boundary value).

Thus, a pregnant woman with influenza infection was predicted to develop chronic placental insufficiency in the second trimester of gestation. When re-examining this patient at 22 weeks of pregnancy, she was diagnosed with chronic placental insufficiency (by ultrasound analysis, the placenta thickness was 27.5 mm (normal - 22.8), a Dopplerometric study of blood flow in the mother-placenta-fetus system with the definition of systolic-diastolic relations in the right uterine artery - 2.2 (normal for this period - 1.92), and in the umbilical artery - 3.9 (normal - 3.26).

Example 2. Patient A, 24 years old, history No. 287, was examined twice in the obstetric department of pregnancy pathology, GU DSC FPD SB RAMS. At the first admission, the woman complained of the following complaints: temperature, headache, feeling of chills; within 1 day, a temperature of 37.2-37.5 ° was recorded with a maximum temperature of 37.5 ° (the number of intoxication symptoms was 3); in the second blood serum, antibodies to influenza A virus (H3N2) were 1:64 (in the first serum 1:16). After examining the obstetric status, ultrasound parameters of the uterus, chorion and embryo, as well as analyzing the course of acute respiratory viral infection, a clinical diagnosis was made: Pregnancy 9 weeks. Influenza A (H3N2). Acute catarrhal rhinopharyngitis. When the above signs of influenza were introduced into the discriminant equation, the following value of the discriminant function was obtained:

D = + 4.251 × 1 + 4.428 × 37.5 + 0.002 × 64 + 1.099 × 3 = 173.726 (less than the boundary value of D). In women, a normal course of the second trimester of gestation was predicted.

Repeated examination of this patient at 23 weeks of gestation did not reveal deviations from the normal course of the gestational process. Ultrasound examination revealed placental thickness 22.7 mm (normal - 22.8), Dopplerometric blood flow analysis in the mother-placenta-fetus system with determination of systolic-diastolic ratio in the right uterine artery - 1.94 (normal for this period - 1.92), and in the umbilical artery - 3.3 (normal - 3.26).

The method was tested on 56 cases.

The correct forecast was confirmed in 88.3% of cases.

Information sources

1. Smirenina I.V., Pestrikova T.Yu. Method for preclinical prediction of placental insufficiency RU (11) 2148256 (13) C1 / (51) 7 G01N 33/49, G01N 33/48.

2. Influenza: A Guide for Physicians. / Ed. Acad. RANS, prof. G.I.Karpukhina. - St. Petersburg: Hippocrates, 2001 .-- 360 p.

Claims (1)

A method for preclinical prediction of placental insufficiency in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy, characterized in that they determine the number of days during which body temperature is recorded above 37.4 ° (A), the maximum temperature in during the first 4 days of illness (B), the level of antibodies to influenza A virus in paired blood serums is determined, while the level of antibodies in the second serum (C) is used as an indicator, the number of clinical symptoms is detected intoxication in (N), and then determine the prognosis of placental insufficiency using the discriminant equation D = + 4,251 · A + 4,428 · B + 0,002 · C + 1,099 · N, where D is a discriminant function with a boundary value equal to 187.69, when D is equal to or greater than the boundary value, the development of placental insufficiency in women in the second trimester of pregnancy is predicted, and when D is less than the boundary value, the normal course of the second trimester of gestation is predicted.