RU2374984C1 - Method of diagnosing threat of abortion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics, and can be used for diagnosing threat of abortion. For this purpose in gestation terms of 22-36 weeks electrothermometric measurements of superficial temperature of anterior abdominal wall is carried out in 10 points: in epigastric region in two points, each 5 cm sideward from abdomen white line, in mesogastric region in two points, each 5 cm sideward from navel, and in two points each 10 cm sideward from navel, in hypogastric region in two points each 2 cm higher and 5 cm sideward from abdomen white line, and in two points on the middle of distance between the latter and previous points. After that mean temperature value is calculated and if mean value is equal or is higher than 32.3°C, threat of abortion is diagnosed.

EFFECT: method allows to extend arsenal of diagnostics of threat of abortion, has high accuracy, sensitivity, specificity, is simple and available in application, non-invasive.

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Description

The invention relates to medicine, namely to obstetrics, and can be used to diagnose the threat of abortion in women in the period 22-36 weeks of gestation.

The relevance of the developed method is determined by the high frequency of preterm birth (from 4.5 to 5%) [1]. Preterm birth is one of the main causes of perinatal morbidity and mortality [1, 2]. There are many diagnostic criteria for the development of threatening preterm birth [2, 3, 4]. However, hardware techniques to diagnose the threat of abortion are few. The development of new diagnostic criteria for threatening preterm labor would reduce the risk of maternal and fetal pathology.

A known method for diagnosing a threatening state of pregnancy, which consists in the fact that in the III trimester of pregnancy, a mechano-hysterographic study is carried out, which consists in synchronous recording of contractile activity of symmetric sections of the right and left uterine halves. In the presence of bilateral uterine contractions - threatening preterm birth is diagnosed (patent No. 2021754, Russian Federation, A method for diagnosing a threatening condition of pregnancy / Botasheva T.L., Poroshenko A.B., Kovtunova L.G., Chernositova A.V. // Bull. - 1994. - No. 20. - P.38). The disadvantages of the method: between the mechanometric sensor and the wall of the uterus is the skin, subcutaneous fat, aponeurosis, muscles of the anterior abdominal wall, peritoneum with preperitoneal fat. Each of these layers has different mechanical, including damper, properties that can affect the magnitude of the pressure force vector on the sensor, so the technique does not provide a reliable picture of the myometrium potential, which determines the severity of the threat of termination of pregnancy.

The closest technical solution to the claimed method is a method of reflex diagnostics of the threat of termination of pregnancy, which consists in the fact that they measure the electrical resistance at the acupuncture points of paired meridians located at the base of the phalanx of the fingers and toes, calculate the average value of the electrical skin resistance for the right and left arms and legs. With an increase in electrical resistance of the hands 4 times more than legs, the threat of abortion is diagnosed (patent for invention No. 2187242, RF, Method for reflex diagnosis of the threat of abortion / Pomaskin R.V., Zharkin NA. // Bull. - 2002. - No. 23, 4.2. - P.306).

The disadvantages of the method: the presence of vegetovascular disorders, which are often found in pregnant women, can lead to a distorted result during the examination.

The claimed technical result is achieved by measuring the temperature at ten points of the anterior abdominal wall in women during pregnancy at 22-36 weeks and with an average temperature of the anterior abdominal wall equal to or more than 32.3 ° C, they diagnose the threat of termination of pregnancy with an accuracy of 77 , 53%.

The method is as follows. The temperature of the anterior abdominal wall is measured using an electrothermometer (thermal sensor of the Poly-Spectrum computer multifunctional complex, NeuroSoft LLC (Ivanovo), registration certificate No. 02262006 / 4136-06 dated December 25, 2006, valid until December 25, 2010; certificate of conformity No. 8022132, valid from 13.04.2008 to 13.04.2011) with an accuracy of 0.1 ° C in conditions of functional rest in the position of a pregnant woman lying on her back. Temperature measurement is carried out at 10 points of the anterior abdominal wall (diagram). In the epigastric region - 1 and 2 points are located 5 cm to each side of the white line of the abdomen. In the mesogastric region 3 and 4 points are located, retreating 5 cm to the sides of the navel, and 5 and 6 points to 10 cm to the sides of the navel. In the hypogastric region 9 and 10, the points of temperature measurement are located 2 cm above the womb and 5 cm to the sides of the white line of the abdomen, and the temperature was measured at 7 and 8 points in the middle of the distance between the last two and the previous two. The calculation of the average value of the skin temperature is carried out and when the average value is 32.3 ° C or more, the threat of termination of pregnancy is diagnosed.

The novelty of the proposed method lies in the fact that for the first time it is proposed to diagnose the development of the threat of abortion by determining the average temperature of the skin. Previously, this method of diagnosing the threat of abortion was not offered.

In recent years, interest in the study of the autonomic link of regulation during pregnancy has increased significantly. This is due to the introduction of computer technology to assess the state of the vegetative link of regulation. A number of authors [5, 6, 7] note that in the second and third trimesters of pregnancy, the activity of the sympathetic part of the autonomic nervous system is higher than in non-pregnant women. The question of the reasons for the increase in the sympathetic part of the autonomic nervous system during pregnancy has not yet been fully studied. The authors believe that an increase in activity occurs under the influence of chronic stress, which is considered pregnancy [8, 9, 10]. Other scientists regard this as compensation in response to systemic vasodilation arising under the influence of NO, the production of which increases significantly during pregnancy [11]. A significant increase in the dynamics of nitric oxide production in women with the threat of abortion reflects a compensatory reaction of the body to prolong pregnancy, affecting the relaxation of the uterine muscles and the restoration of placental circulation.

We suggest that systemic relaxation of blood vessels with the threat of abortion leads to an increase in blood flow and blood vessels in the skin, which, in turn, determines an increase in surface temperature. Thus, when measuring the average temperature of the skin of the anterior abdominal wall, the threat of abortion can be diagnosed.

Using the proposed method allows with a high degree of accuracy (77.53%) to diagnose the threat of termination of pregnancy in the period 22-36 weeks of gestation.

Distinctive features of the method are: during gestation periods of 22-36 weeks, an electrothermometric measurement of the surface temperature of the skin of the anterior abdominal wall is carried out at 10 points: in the epigastric region at two points by 5 cm to the sides of the white line of the abdomen, in the mesogastric region at two points by 5 cm apart from the navel and at two points 10 cm away from the navel, in the hypogastric region at two points 2 cm above the womb and 5 cm away from the white line of the abdomen and at two points in the middle of the distance between the last and previous points (figure 1), then calculate the average temperature and when the average value is equal to or more than 32.3 ° C, the threat of termination of pregnancy is diagnosed.

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

Example 1

Pregnant R., born in 1978, is inpatient treatment at the hospital for obstetric care II obstetric clinic with a diagnosis of

Pregnancy is 35-36 weeks. Head presentation of the fetus.

Intrauterine infection (ureaplasmosis), treated. Chronic gastritis without exacerbation.

Anamnesis. Of the diseases in childhood - chickenpox, mumps. Of the diseases in adulthood - ARI, influenza, viral hepatitis A, chronic gastritis, tonsillitis.

Of the transferred gynecological diseases - cervical erosion, candidal vulvovaginitis.

Menarche is 13 years old. Menstrual function is not impaired. Contraception: hormonal, barrier methods (condom). Beginning of sexual activity at the age of 19. This pregnancy is the first, desired in a registered marriage.

I trimester - the threat of miscarriage at 12 weeks, received preservation therapy (duphaston). II trimester - an intrauterine infection was detected (ureaplasmosis) - took rovamycin. Regarding placentitis, fetoplacental insufficiency, I received treatment aimed at improving uteroplacental blood flow.

Status praesens. General condition is satisfactory. Complaints of pulling discomfort in the lower abdomen, appearing after minor physical exertion. No headache. Clear vision. Pulse 74 beats per minute, rhythmic, moderate filling and tension. A / D on the right and left hand 120/80 mm Hg The uterus in normal tone, upon examination, is slightly excitable, painless in all departments. The fetal movement feels good. The position of the fetus is longitudinal, the head of the fetus is presented, pressed to the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic, up to 148 beats per minute. Stool, urination without features. No swelling.

Vaginal examination. The external genitalia are developed correctly. The vagina does not give birth. The cervix without visible defects, 2.5 cm long, is located along the conductive axis of the pelvis, is unevenly softened. The cervical canal is freely passable for 1 transverse finger. The crease of the transition is moderate. The fetal bladder is intact, the head lies, is pressed to the entrance to the small pelvis. Bone pelvis without features. Discharge mucous in a small amount.

Survey The pregnant woman measured the temperature of the anterior abdominal wall. The average value of the surface temperature of the skin was + 33.3 ° C. Conclusion: Threatening preterm birth during pregnancy 35-36 weeks.

Inpatient treatment: motherwort tincture, MgSO ₄ v / m, ginipral, verapamil, actovegin, glucose.

Pregnancy outcome: I preterm birth during pregnancy of 36 weeks in fetal presentation of the head. Prenatal discharge of amniotic fluid. Acute fetal hypoxia during childbirth. Cross suprapubic laparotomy, cesarean section in the lower uterine segment by transverse section. The boy was removed for the operation, weighing 2450, height - 46 cm, Apgar score - 7-8 points, Downsu - 4 points. The postoperative period was uneventful.

Example 2

Pregnant V., born in 1978, is under the supervision of 9 antenatal clinics.

Diagnosis during examination: Pregnancy 22-23 weeks. Head presentation of the fetus. A burdened obstetric and gynecological history (cervical erosion - diathermocoagulation, colpitis).

Anamnesis. From childhood illnesses - chickenpox, measles rubella. Of the diseases in adulthood - acute respiratory infections, influenza, chronic tonsillitis.

Of the transferred gynecological diseases - cervical erosion, candidal vulvovaginitis.

Menarche is 13 years old. Menstrual function is not impaired. Contraception: barrier methods (condom). Beginning of sexual activity from the age of 19. This pregnancy is the second, desired in a registered marriage. The first pregnancy in 2000 ended in childbirth, a girl was born, weighing 3,000 g. Childbirth proceeded without complications.

The course of this pregnancy. I trimester - without features.

Status praesens. General condition is satisfactory. No complaints. No headache. Clear vision. Pulse 72 beats per minute, rhythmic, moderate filling and tension. A / D on the right and left hand 110/70 mm Hg The uterus is in a normal tone, upon examination it is not excitable, painless in all departments. The fetal movement feels good. The position of the fetus is longitudinal, the head of the fetus is presented, pressed to the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic up to 150 beats per minute. The night slept quietly. Stool, urination without features. No swelling.

Survey The pregnant woman measured the temperature of the anterior abdominal wall. The average value of the surface temperature of the skin was + 31.3 ° C. Conclusion: no threat of abortion.

Pregnancy outcome: II timely delivery during pregnancy of 39-40 weeks in the head presentation of the fetus.

There are no complications in childbirth and the postpartum period. A newborn child is a girl weighing 3000 g, height - 51 cm, Apgar score - 8-9 points.

Example 3

Pregnant R., born in 1977, is hospitalized in the hospital for obstetric surgery of the 3rd obstetric clinic with a diagnosis of Pregnancy 30 - 31 weeks. Head presentation of the fetus.

A burdened obstetric and gynecological history (cervical erosion, primary infertility for 3 years). Chronic pyelonephritis without exacerbation.

Anamnesis. From childhood illnesses - chickenpox. Of the diseases in adulthood: acute respiratory infections, flu, tonsillitis. Currently suffering from chronic pyelonephritis.

Of the transferred gynecological diseases - cervical erosion (treated), candida vulvovaginitis.

Menarche is 13 years old. Menstrual function is not impaired. Contraception: not protected. Beginning of sexual activity from 25 years. This pregnancy is the first, desired in a registered marriage.

I trimester - the threat of miscarriage at 12 weeks, received preservation therapy (duphaston).

II trimester - anemia of the 1st degree, threatening premature birth.

Hospitalized. Treated, discharged with improvement.

Status praesens. General condition is satisfactory. Complaints of pulling discomfort in the lower abdomen, appearing after minor physical exertion. No headache. Clear vision. Pulse 78 beats per minute, rhythmic, moderate filling and tension. A / D on the right and left hand 110/70 mm Hg The uterus in normal tone, upon examination, is slightly excitable, painless in all departments. The fetal movement feels good. The position of the fetus is longitudinal, the fetal head is presented, above the entrance to the small pelvis. The fetal heartbeat is clear, rhythmic, up to 150 beats per minute. Stool, urination without features. No swelling.

Vaginal examination. The external genitalia are developed correctly. The vagina is nulliparous. The cervix without visible defects, 2.5 cm long, is rejected to the sacrum, unevenly softened. The external pharynx passes the tip of the finger. Through the anterior arch, the underlying part is determined - the fetal head, above the entrance to the small pelvis. Bone pelvis without features. Discharge mucous in a small amount.

Survey The pregnant woman measured the temperature of the anterior abdominal wall. The average value of the surface temperature of the skin was + 32.4 ° C. Conclusion: Threatening preterm birth during pregnancy 30-31 weeks.

Inpatient treatment: motherwort tincture, ginipral, verapamil, actovegin, glucose, piracetam, multivitamins, thermopulse.

Pregnancy outcome: I premature birth during pregnancy 36-37 weeks in the fetal presentation of the fetus on 01/22/2008. Prenatal discharge of amniotic fluid. Acute fetal hypoxia during childbirth. Cross suprapubic laparotomy, cesarean section in the lower uterine segment by transverse section. A boy was removed for the operation, weighing 2900, height - 49 cm, Apgar score - 7-8 points.

The postoperative period was uneventful.

The advantages of the proposed method:

- high accuracy - 76.7%, sensitivity - 84.2%, specificity - 63.6%;

- non-invasiveness of the technique;

- technical simplicity and accessibility of the technique (the study can be carried out by paramedical personnel);

- short time of the procedure (time spent - 10 minutes).

The research data are shown in table 1.

Table 1. Indicator The number of examined Total women 90 True positive result 48 False positive result 12 True negative result 21 False negative result 9

The accuracy of the proposed method: 76.7%

The sensitivity of the proposed method: 84.2%

The specificity of the proposed method: 63.6%

The calculation of the accuracy, sensitivity and specificity of the method was carried out in accordance with methodological recommendations ("Assessment of the diagnostic information content of laboratory tests" // Clinical laboratory diagnostics. - 1992. - No. 1-2. - S.49-58).

Information sources

1. Kulakov V.I., Prilepskaya V.N., Radzinsky V.E. Guidelines for outpatient care in obstetrics and gynecology. -M .: Publishing group "GEOTAR-Media", 2007. - S.120-176.

2. Sidelnikova V.M., Antonov A.G. Premature birth. Premature baby. - M .: Publishing group "GEOTAR-Media", 2006. - 447 p.

3. Sidelnikova V.M. Threatening preterm birth - management tactics // Obstetrics and gynecology. - 2006. - No. 4. - S.66-68.

4. Sidelnikova V.M. Habitual loss of pregnancy. - M .: Publishing house "Triad-X", 2002. - P.27-109.

5. Bayevsky P.M. Prediction of conditions on the verge of norm and pathology. - M .: Medicine, 1979. - 298 p.

6. Baevsky P.M., Berseneva A.P. Assessment of the adaptive capabilities of the body and the risk of developing diseases. - M., 1997 .-- 127 p.

7. Khlybova S.V., Tsirkin V.I. Sympathetic activity (according to cardiointervalography) in women with physiological and complicated pregnancy // Russian Journal of Obstetrician-Gynecologist. - 2007. - No. 1. - S.7-10.

8. Kushnir S.M., Antonova L.K. Vegetative dysfunction and autonomic dystonia. - Tver, 2007 .-- 214 p.

9. Benediktov I.I., Sysoeva D.A., Salnikov L.V. Features of the adaptive process of the autonomic nervous system in pregnant women with vegetovascular dystonia // Bulletin of the Russian Association of Obstetricians and Gynecologists. - 1998. - No. 4. - S. - 20-24.

10. Gudkov GV, Pomortsev AV, Fedorovich OK Comprehensive study of the functional state of the autonomic nervous system in pregnant women with gestosis // Obstetrics and gynecology. - 2001. No. 3. - C. 45-50.

11. VanMook W, Peeters L. Curr Opm Crit Care, 2005, 11: 5: 430-434.

Claims (1)

A method for diagnosing the threat of termination of pregnancy by electrophysiological examination of women, characterized in that during gestation of 22-36 weeks they conduct electrothermometric measurement of the surface temperature of the skin of the anterior abdominal wall at 10 points: in the epigastric region at two points each 5 cm away from the white line of the abdomen , in the mesogastric region at two points 5 cm to the side of the navel, and at two points 10 cm to the side of the navel, in the hypogastric region at two points 2 cm above the womb and 5 cm away from white ii abdomen, and two points midway between the last and previous points, then calculate the average temperature value and the value of the average value equal to or more than 32,3 ° C, diagnose threatening abortion.

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