RU2422087C1 - Methods of diagnosing asynclitism by scull changes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to pathologic anatomy, forensic medicine and obstetrics. In order to diagnose asyncli8tism degree borders of periostal stagfnation area (PSA). In dead children degree of asynclitism is determined by calculating degree ofdisplacement of area of dome of cranium periosteal stagnation (PSA) by formula

where X is degree of transversal displacement of PSA from longitudinal suture to extreme PSA border, L1 is larger distance in millimeters from longitudinal suture to extreme PSA border, L2 is shorter distance from longitudinal suture to extreme PSA border. Degree of transversal PSA displacement from longitudinal suture (X) more than 15 mm is considered to be pathologic asynclitism, less than 15 mm - physiologic asynclitism.

EFFECT: method increases accuracy of asynclitism degree diagnostrics by scull changes.

Description

The present invention relates to medicine, namely to such specialties as pathological anatomy, forensic medicine and obstetrics. It can be used in the diagnosis of the nature of insertion of the head in deceased children and, therefore, in a retrospective assessment of the course of childbirth according to objective data obtained in sectional studies.

Known methods for determining the nature of the insertion of the head into the small pelvis during childbirth: with vaginal examination by determining the location of sutures and fontanelles relative to the main anatomical landmarks (cape, pubic joint) [1, 2] and using ultrasound to vertically displace the eye sockets relative to each other [3, 4]. However, we have not found any methods of diagnosing asynclitism in deceased children in the literature.

At the same time, there is an objective need to evaluate the birth process based on objective morphological data. The history of childbirth does not always fully reflect the objective picture of the birth process, obstetricians often record in them after childbirth, and ultrasound is rarely performed in childbirth. Vaginal examination is very subjective and inaccurate, increases the risk of purulent-septic diseases in childbirth and allows only an approximate assessment of the degree of asynclitism. However, asynclitism plays an important role in the occurrence of birth traumatic injuries of the central nervous system, cerebellar rupture breakdowns [4].

In pathological and forensic practice, there is often a need to assess the importance of childbirth in the occurrence of a birth injury to the skull. Such an assessment is important for determining the quality of medical care for women in labor.

What morphological substrate or phenomenon can underlie such a diagnosis? We came to the conclusion that such is the "area of periosteal stagnation" (SCR), which was first clearly defined and formulated by the authors [5]. Previously, many wrote about pathological changes in the periosteum in children, hemorrhages, edema, stagnation, and cephalohematomas, however, they did not describe SCR as a morphological phenomenon, did not attach importance to its borders, and did not perform any measurements [6, 7 and 8].

The closest solution to the proposed invention is a diagnostic method, including determining the boundaries of the area of periosteal stagnation (SCR) [5].

OPZ is an area of periosteal stagnation that has borders, with plethora of veins under the periosteum, edema and hemorrhages of various sizes. SCR is formed below the contact belt of the head in the birth canal of the mother. The birth tumor on the head is formed as a result of a similar mechanism, but does not have clear boundaries, quickly disappears (1-2 days) and is even able to “migrate” or shift after birth, depending on the position of the head. Therefore, it cannot be a reliable criterion for inserting a head. OPZ does not shift after birth, usually has clear boundaries and does not disappear for a long time (7 days or more, depending on the severity of concomitant hemorrhages).

The main task to be solved by the invention is to increase the accuracy of the diagnosis of asynclitism by changes in the skull, change the tactics of labor and reduce birth injury and perinatal mortality of children.

The problem is achieved using the proposed method for diagnosing the degree of asynclitism by changes in the skull, which, like the prototype, includes determining the boundaries of the area of periosteal stagnation (SCR).

, гдеIn contrast to the prototype in the proposed method, the degree of asynclitism is determined by changes in the skull in deceased children by calculating the degree of displacement of the area of periosteal stagnation (SCR) of the skull roof according to the formula

where

X is the degree of transverse displacement of the SCR from the swept seam, L1 is the greater distance in millimeters from the swept seam to the extreme border of the SCR, L2 is the smaller distance from the swept seam to the extreme border of the SCR, in which a deviation of more than 15 mm is considered pathological asynclitism, and less than 15 mm - physiological asynclitism.

The essence of the invention lies in the fact that it became possible to diagnose physiological and pathological asynclitism without taking into account the history of childbirth, that is, on the basis of only a posthumous study of the head of a deceased fetus or newborn, which is important for fulfilling the most important function of pathologists - monitoring the quality of clinical diagnosis. This is also important for forensic doctors examining the corpses of children without anamnestic data. The use of this invention in the practice of pathologists will target obstetricians to introduce the latest methods for the diagnosis of asynclitism, which will contribute to a change in the management of childbirth, reduce birth injury and perinatal mortality.

The proposed method is as follows.

,A study was conducted of 154 deaths in childbirth and newborns born with head presentation. At the same time, the SCR, its boundaries were investigated. Using a ruler, the SCR offset with respect to the swept seam was measured. The distance (in millimeters) from the most distant lateral edges of the SCR to the swept seam was measured, then the smaller was calculated from the larger length and divided by two. The degree of displacement of the SCR with respect to the swept seam was determined by the formula:

,

where X is the degree of transverse displacement of the SCR from the swept seam, L1 is the greater distance in millimeters from the swept seam to the extreme border of the SCR, L2 is the smaller distance from the swept seam to the extreme border of the SCR, in which a deviation of more than 15 mm is considered pathological asynclitism, and less than 15 mm - physiological asynclitism.

The division of asynclitism into physiological and pathological is made on the basis of changes in the cerebellar tent, since asynclitism increases the tension of one of the halves of the tenth, leading to intradural hemorrhages, tears and tears. It was found that with a deviation of 15 mm or more in deceased children, unilateral or large intradural hemorrhages, tears and ruptures of the cerebellar tent are determined on one side. In the histories of childbirth, with rare exceptions, there were no indications of asynclitism. Ultrasound examination of the head in childbirth was not conducted.

Thus, the use of the proposed invention in the practice of pathologists will target obstetricians to introduce the latest methods for the diagnosis of asynclitism, which will contribute to a change in the management of childbirth, reduction in birth injury and perinatal mortality.

The present invention can be used in clinical practice, if using ultrasound to learn to determine the SCR and the nature of its displacements in living children. The principle underlying the invention can be used for diagnosis in living children.

Information sources

1. Ailamazyan E.K., Novikov B.N., Pavlova L.P. and other Obstetrics. 4th edition, St. Petersburg, 2003.

2. Bodyazhina V.I., Zhmakin K.N. Obstetrics. M., 1979. - 534 p.

3. Vlasyuk V.V. Morphological criteria for assessing the pathogenesis of birth trauma and dyscirculatory lesions of the central nervous system (CNS) in the perinatal period. Arch. Pathology, 1991, No. 12, pp. 14-20.

4. Russian Federation patent No. 2140196, IPC: 6 A61B 8/00, 10.27.1999.

5. Vlasyuk VV, Lobzin Yu.V., Nesmeyanov A.A. Periostal congestion of the roof of the skull as a criterion for assessing the biomechanism of childbirth and intracranial lesions in newborns. Bulletin of the International Academy of MAISU, 2009, No. 9, pp. 58-61 - prototype.

6. Gurevich P.S., Sorokin A.F. Perinatal pathology. - In the book: Pathological anatomy of diseases of the fetus and child. Manual in 2 volumes, v. 1. Ed. T.E. Ivanovskaya and L.V. Leonova. M., 1989, p. 38-121.

7. Rabtsevich T.S. Kefalogematoma and its significance as an indicator of the severity of a birth injury to the skull. Akush. Gynec., 1961, No. 3, p. 68-71.

8. Schwartz P. Birth injuries of the newborn. Jena: Springer Verlag, 1964.

Claims (1)

A method for diagnosing the degree of asynclitism by changes in the skull, including determining the boundaries of the area of periosteal stagnation (SCR), characterized in that the degree of asynclitism is determined in deceased children by calculating the degree of displacement of the area of periosteal stagnation (SCR) of the skull roof according to the formula

,
where X is the degree of transverse displacement of the SCR from the swept seam;
L1 is the greater distance in millimeters from the swept seam to the extreme boundary of the SCR;
L2 - a shorter distance from the swept seam to the extreme border of the SCR, at which a deviation of more than 15 mm is considered pathological asynclitism, and less than 15 mm - physiological asynclitism.