RU2472438C1 - Method of predicting perinatal pathology in newborn babies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to obstetrics and perinatology. Examination of women is performed in the third trimester of pregnancy complicated by gestosis. Sample with ischemia/reperfusion is included into examination. If oxygenation of forearm tissues in phase of reperfusion increases in comparison with initial value, development of perinatal pathology is predicted.

EFFECT: method makes it possible to increase reliability of diagnosing perinatal pathology in newborn babies.

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Description

The invention relates to medicine, namely to obstetrics and perinatology, and can be used to predict the development of perinatal pathology in newborn children born to mothers with gestosis of varying severity.

The main cause of perinatal pathology and mortality remains gestosis and ranges from 10 to 30 ‰ (Savelyeva G.M. Some urgent issues of obstetrics. Modern approaches // Mother and child: proceedings of the VII Russian forum. - M., 2005. - P.222- 223. Savelyeva GM The problem of gestosis in modern obstetrics // Materials of the 36th annual congress of the International Society for the Study of Pathophysiology of Pregnancy. - M .; 2004. - p.194-196). The problem of perinatal pathology in newborns remains relevant due to the high frequency and great importance for the further life of a person (Barashnev Yu.I., Bessonova Yu.V. Indicators of perinatal damage to the brain of the fetus and newborn // Akush. And gin. - 1997. - No. 2. - S.28-33). Predicting perinatal pathology in newborn babies born to mothers with gestosis presents a complex clinical problem.

A known method for predicting perinatal pathology in newborns by examining the immunogenetic status of the body. In the peripheral blood of a pregnant woman, the ability of leukocytes to produce γ-interferon, the number of antibodies to γ-interferon, autoantibodies to OBM and S-100 proteins and with a decrease in the production of γ-interferon less than 16 IU / ml, autoantibodies to OBM and S-100 proteins are determined (-) 40 conventional units and increased antibodies to γ-interferon more than 20 conventional units predict perinatal pathology. The accuracy of the method is unknown (Patent No. 2256914, Russia, IPC 7 G01N 33/49. A method for predicting perinatal pathology in pregnant women with chronic infectious and inflammatory diseases. / Tareeva T.G., Tkacheva I.I., etc. // Inventions. Useful models. - 2005. - No. 20).

The method has disadvantages:

- peripheral venous blood is examined, the procedure is invasive and can have a number of serious complications;

- the method requires the determination of several parameters for predicting perinatal pathology;

- the method requires expensive equipment and reagents.

A known method for predicting perinatal morbidity by determining the presence of anamnestic factors: socio-biological risk factors, obstetric and gynecological anamnesis, extragenital diseases of the mother, as well as pregnancy factors: pregnancy complications, assessment of the fetus. The identified factors are assigned scores, then they are summarized and, with a score of up to 15, a low risk of perinatal morbidity is predicted, with a score of 15 to 25, a medium degree, with a score of more than 25, a high degree (Patent No. 2369331, Russia, IPC A61B 10 / 00. A method for predicting perinatal morbidity. / Knyazev SA, Orazmuradov AA and others // Inventions. Useful models. - 2009. - No. 28).

The method has disadvantages:

- calculations are made according to very complex formulas;

- this method is not without subjectivity;

- the accuracy of the method is unknown.

The closest in technical solution is a method for predicting perinatal hypoxic lesions of the central nervous system in newborns by immunological examination of the peripheral venous blood of a pregnant woman from 35 weeks gestation complicated by gestosis, the content of interleukin-1β is determined and, with its value> 40 pcg / l, the development of perinatal hypoxic lesions is predicted CNS (Patent No. 2313095, Russia, IPC G01N 33/68, G01N 33/53. A method for predicting perinatal hypoxic lesions of the central nervous system systems in newborns / Borzova N.Yu., Sotnikova N.Yu. et al. // Inventions. Useful models. - 2007. - No. 35).

This method is selected as a prototype.

The method has disadvantages:

- this method is associated with venous blood sampling, it is an invasive procedure that has a number of serious complications;

- to determine the immunological indicator requires expensive equipment and reagents;

- the accuracy of the method of 78.4%.

The technical result is to increase the accuracy of predicting perinatal pathology in newborns.

The technical result is achieved by conducting a test with ischemia / reperfusion and, with an increase in oxygenation of the forearm tissues in the reperfusion phase relative to the initial value, the development of perinatal pathology is predicted.

The novelty of the proposed method lies in the fact that for the first time it is proposed to predict the development of perinatal pathology in newborn babies born to mothers whose pregnancy was complicated by gestosis by the increase in the level of oxygenation of the forearm tissues during the test with ischemia / reperfusion. A test with ischemia / reperfusion is used in oncology to determine the indications for radiation therapy (Patent RU No. 2341306 Russia, IPC A61K 31/02, A61K 31/573. Method for the treatment of cancer patients / P.Yu. Polyakov, O. A. Bychenkov, D . A. Rogatkin // Inventions. Utility Models. - 2008. - No. 35).

One of the main pathogenetic mechanisms of gestosis is generalized vasospasm. Generalized vascular spasm leads to impaired microcirculation, increased peripheral vascular resistance and permeability of the vascular wall, changes in water-electrolyte metabolism, which leads to uteroplacental insufficiency, these processes have an adverse effect on the fetus, causing the development of perinatal pathology.

Studies like this have not been done before.

The method is as follows.

The examination is carried out using a non-invasive spectrophotometric complex for monitoring the level of oxygenation of soft biological tissues "Spectrotest" (manufacturer of the Federal State Institution "Scientific-Production Enterprise" Cyclone-Test ").

Recording of indicators is carried out in a sitting position, the forearm is at the level of the heart. The ambient temperature is +20 + 22 ° C. Before fixing the sensor, the test subject put on a shoulder cuff from a standard tonometer without pressure. The indicators are recorded using a basic test for 180 seconds in order to register the initial level of tissue oxygenation of the forearm tissues (the level of oxygenation of the forearm tissues is measured in relative units). Then, in the shoulder area using the tonometer cuff, a positive additional pressure is created that is more than systolic by 40-50 mm Hg. With continuous recording of indicators, arterial occlusion was maintained for 180 seconds. Data on the change in oxygenation of the forearm tissue is displayed on a computer monitor. With an increase in the oxygenation index of the forearm tissues relative to the initial level, the development of perinatal pathology in the newborn is predicted.

Distinctive features of the method

A new prognostic parameter of the level of oxygenation of the forearm tissues was established during a test with ischemia / reperfusion. With an increase in the level of tissue oxygenation in the reperfusion phase relative to the initial value, the development of perinatal pathology is predicted.

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

Example 1. Pregnant A., 29 years old. This pregnancy is the 3rd. Registered in the antenatal clinic from 7 weeks of pregnancy. At gestational age of 30 weeks, gestosis develops in the form of nephropathy. At a gestational age of 33-34 weeks, a woman was hospitalized in the clinic for gestosis. Diagnosed with pregnancy 33-34 weeks. Nephropathy II degree. When examining the claimed method at rest, the level of oxygenation of the forearm tissues was 0.64 ± 0.05 relative units, during the reperfusion phase during the test with ischemia / reperfusion, an increase in tissue oxygenation is recorded to 0.70 ± 0.05 relative units and the development of perinatal pathology. In a gestational age of 35 weeks, a woman is delivered by cesarean section. A live premature boy was born weighing 1480 g, growing 35 cm, with an Apgar scale rating of 5/6 points, Downs 4 points. Based on the clinical picture and the results of the examination, the diagnosis was made: respiratory distress syndrome of newborns, respiratory failure of the II stage, cerebral ischemia of the II stage. Conclusion: the forecast for the claimed method was confirmed.

Example 2. Pregnant B., 25 years. This pregnancy is 2nd. Registered in the antenatal clinic from 11 weeks of pregnancy. At a gestational age of 33 weeks, gestosis develops in the form of nephropathy. During pregnancy of 35 weeks, a woman is hospitalized in the clinic for gestosis. Diagnosed with pregnancy 34-35 weeks. Nephropathy I degree. When examining the claimed method at rest, the level of tissue oxygenation was 0.57 ± 0.02 relative units, during the reperfusion phase during the test with ischemia / reperfusion, tissue oxygenation was recorded to increase to 0.62 ± 0.02 relative units and the development of perinatal pathology was predicted in a newborn. At 38 weeks of gestation, a woman is delivered by cesarean section. A live full-term boy was born weighing 2750 g, height 50 cm, with a rating on the Apgar scale of 7/8 points. Based on the clinical picture and the results of the examination, the diagnosis was made: cerebral ischemia of the 1st stage, conjugation jaundice. Conclusion: the forecast for the claimed method was confirmed.

Example 3. Pregnant C., 38 years old. This pregnancy is the 5th. Registered in the antenatal clinic from 7-8 weeks of pregnancy. At gestational age 31 weeks, gestosis develops in the form of nephropathy. During pregnancy 32 weeks, a woman is hospitalized in the clinic for gestosis. Diagnosed with pregnancy 32 weeks. Nephropathy of the III degree. When examining the claimed method at rest, the level of oxygenation of the forearm tissues was 0.69 ± 0.03 relative units, during the reperfusion phase during the test with ischemia / reperfusion, the level of oxygenation of the forearm tissues was 0.75 ± 0.02, an increase in tissue oxygenation was recorded and the development of perinatal pathology is predicted. In a gestational age of 34-35 weeks, a woman is delivered by cesarean section for an increase in gestosis. A live premature girl was born weighing 1900 g, 47 cm tall, with an Apgar score of 4/6 points, Downs 4 points. Based on the clinical picture and the results of the examination, the diagnosis was made: intraventricular hemorrhage, II tbsp. left, convulsive syndrome, respiratory distress syndrome of newborns, respiratory failure I-II art. Conclusion: the forecast for the claimed method was confirmed.

Example 4. Pregnant G., 26 years old. This pregnancy is 2nd. Registered in the antenatal clinic from 10-11 weeks of pregnancy. At a gestational age of 35 weeks, gestosis develops in the form of nephropathy. In the gestational age of 35-36 weeks, a woman is hospitalized in the clinic for gestosis. Diagnosed with pregnancy 35-36 weeks. Nephropathy I degree. When examining the claimed method at rest, the level of oxygenation of the forearm tissues was 0.65 ± 0.02 relative units, during the reperfusion phase during the test with ischemia / reperfusion, the level of oxygenation of the forearm tissues was 0.63 ± 0.03. Tissue oxygenation is recorded and perinatal pathology is not predicted. In the period of pregnancy 39-40 weeks, timely delivery occurred. A live full-term girl was born weighing 3,500 g, height 52 cm, with a rating on the Apgar scale of 8/9 points. Taking into account the clinical picture and the results of the examination, the diagnosis was made: conjugation jaundice.

This method examined 60 pregnant women with preeclampsia.

The research results are presented in table 1

Table 1 Indicator The number of examined Total women 60 True positive result 19 False positive one True negative result 10 False negative result thirty Total: Predictive value of a positive result - 95.0% The sensitivity of the proposed method is 38.8 The specificity of the proposed method is 91.0%

The predictive value of a positive result is 95.0%

The advantages of the proposed method:

1) simplicity and accessibility of the methodology;

2) expensive reagents are not required to perform the procedure;

3) non-invasiveness of the method;

4) high accuracy (95.0%) and specificity (90.9%) of the method;

5) the duration of the methodology is 9 minutes;

6) the method does not require special training and can be performed by paramedical personnel;

7) the method can be performed in any obstetric institution.

Thus, the claimed method is simple to implement and allows us to accurately predict the development of perinatal pathology in newborn babies born to mothers with gestosis of varying severity, which makes it possible to choose the right tactics for pregnant women in the third trimester of gestation and the method of delivery. Timely taken measures will help to reduce the frequency of perinatal pathology in newborns and at the same time will reduce the economic costs of their treatment.

Claims (1)

A method for predicting perinatal pathology in newborns by examining women in the 3rd trimester of pregnancy complicated by gestosis, characterized in that they carry out a test with ischemia / reperfusion and, with an increase in oxygenation of the forearm tissues in the reperfusion phase, the development of perinatal pathology is predicted relative to the initial value.