RU2482797C1 - Method of predicting risk of formation of intrauterine fetus growth retardation (ifgr) at pregnancy stage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to diagnostics in obstetrics. Method includes analysis of anamnestic data in pregnancy period, starting from early terms. For this purpose presence of threat of abortion in previous pregnancies, IFGR in previous pregnancies are detected. Also detected are threat of miscarriage and ARVI in current pregnancy and presence of dysmenorrhoea. Presence of colds in anamnesis and diseases of respiratory organs in anamnesis are detected. Prognostic index (D) is calculated by formula. Prediction of IFGR is carried out taking into account obtained values D.

EFFECT: method detects GR at a stage of current pregnancy, starting with early terms, which makes it possible to identify risk groups and determine tactics of management for each patient.

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Description

Application area

The invention relates to medicine, namely to obstetrics and gynecology.

Description of the invention.

The essence of the problem. The diagnosis of IUGR is one of the most difficult in obstetrics. According to the literature, almost 60% of cases of IUGR are not detected by clinical methods [5, 9].

Despite a fairly wide range of etiological factors, a retrospective analysis suggests that in almost 50% of cases of IUGR, the risk factor cannot be identified [10, 11]. Of the variety of modern methods for studying the fetoplacental system, echography and dopplerography are most widely used.

[5] However, it should be borne in mind that the methods of functional diagnosis of the IUGR of the antenatal fetus are applicable more often from the second trimester of pregnancy, when the moment of prevention and correction of the pathological condition is missed. The use of these methods requires the use of special equipment and qualified specialists. The methods we developed for predicting the formation of IUGR in early pregnancy will allow us to distinguish from the general stream of patients those who really have a high risk of having children with IUGR. The method is based on the analysis of anamnestic data. Therefore, it can be widely used at the initial outpatient stage of the examination as a screening one to identify risk groups for the birth of children with IUGR, which are subject to mandatory examination by functional diagnostics at later stages of pregnancy.

State of the art

Analogs

1. The main role in the pathogenesis of IUGR is played by violations of the uteroplacental and fetal blood flow. For a comprehensive assessment of the status of the fetoplacental system in cases of suspected IUGR, it is necessary to use dopplerography. The study is conducted from 20-24 weeks. pregnancy [8, 3, 4].

2. In recent years, the study of venous blood flow in the venous duct, umbilical and inferior vena cava has been widely used. It has been established that impaired blood flow in the veins of the fetus has a greater prognostic value compared to the umbilical artery [1].

3. Diagnosis of IUGR during pregnancy by the method of dopplerometric assessment of hemodynamics in the vessels of the vertebro-basilar system of the fetus in the 2nd and 3rd trimesters of pregnancy [6, 2].

Prototype

A method for predicting fetal weight, developed on the basis of detailing the known constitutional options depending on the body weight at birth of parents (Huraseva AB Reproductive health of women born with polar values of body weight: dis. ... Dr. med. Sciences / A.B Khuraseva. - Kursk, 2010) [7].

SUMMARY OF THE INVENTION

The aim of the invention is to develop a method for predicting the formation of IUGR during pregnancy.

The method is as follows.

At the reception in the antenatal clinic, a woman applying for registration for monitoring the course of pregnancy carefully collects data from the obstetric and gynecological history, as well as the features of the course of this pregnancy. Find out the threat of termination in previous pregnancies, IUGR in previous pregnancies, the threat of miscarriage and SARS in a real pregnancy. Also find out the presence of dysmenorrhea, catarrhal diseases in the anamnesis and pathology of the respiratory system. Using the method of mathematical analysis of the selected features, a prognostic index D and the corresponding formula were generated.

D = 0.16 × X1 + 2.54 × X2 + 0.74 × X3 + 0.96 × X4 + 0.1 × X5 + 1.7 × X6 + 0.41 × X7-1.68,

where X1 is the threat of termination in previous pregnancies (if there is, then X1 = 1, if not, 0);

X2 - IUGR in previous pregnancies (if there is, then X2 = 1, if not, 0);

X3 - the threat of miscarriage during a real pregnancy (if there is, then X3 = 1, if not - 0);

X4 - SARS during pregnancy (if there is, then X4 = 1, if not, 0); X5 - dysmenorrhea (if there is, then X5 = 1, if not, 0); X6 - history of catarrhal diseases (if any, then X6 = 1, if not - 0);

X7 - pathology of the respiratory system (if there is, then X7 = 1, if not, 0)

and with D more than 0, a high probability of having a child with IUGR is predicted, and with D less than 0, the probable birth of a child with normal body weight is judged.

The effectiveness of the method is 80.77%;

The specificity of the method is 82.14%;

The sensitivity of the method is 79.17%.

Clinical examples.

1. Kolmakova GA, 27 years old, resident of the Sverdlovsk region. I applied to the antenatal clinic for registration on pregnancy in February 2008 for a period of 10 weeks. The analysis of anamnestic data is carried out. The signs necessary for predicting the risk of intrauterine growth retardation at the stage of a real pregnancy are identified: the threat of interruption in previous pregnancies, the birth of a child with IUGR in previous births by emergency caesarean section, the risk of miscarriage during this pregnancy, a history of dysmenorrhea, colds in history. The fourth pregnancy, the second birth is coming. We calculate the prognostic index D by the formula

D = 0.16 × 1 + 2.54 × 1 + 0.74 × 1 + 0.96 × 0 + 0.1x1 + 1.7 × 1 + 0.41 × 0-1.68 = 3.56

D> 0, therefore, this woman has a high probability of having a child with IUGR.

The history of childbirth No. 2226/236.

10/15/2008 Urgent operative delivery on an emergency basis in 38 weeks. Occipital presentation. A burdened obstetric history.

Pyelonephritis. Anemia. Gestosis of moderate severity. HFPN, subcompensated form. ZVUR

Girl, weight = 2540 g, length = 47 cm, head circumference = 32 cm, chest circumference = 32 cm. Apgar score 2/4 points. Transferred to PIN.

Discharged on the 7th day with a diagnosis of Intrauterine malnutrition.

Chronic hypoxia Ischemic-hypoxic damage to the central nervous system,

intracranial hypertension, myatonic syndrome.

2. Velikanova N.A., 33 years old, the city of Yekaterinburg. I applied to the antenatal clinic for registration on pregnancy in June 2007 at a period of 11-12 weeks. The analysis of anamnestic data is carried out.

The signs necessary for predicting the risk of intrauterine growth retardation at the stage of a real pregnancy are identified. All of the listed symptoms were absent, that is, equal to 0. Pregnancy is the second, the first birth is coming.

We calculate the prognostic index D by the formula

D = 0.16 × 0 + 2.54x0 + 0.74 × 0 + 0.96 × 0 + 0.1 × 0 + 1.7 × 0 + 0.41 × 0-1.68 = -1.68

D <0, therefore, this woman has a high probability of having a baby with normal body weight.

History of childbirth No. 46/87.

01/09/2008 Urgent independent birth at 39 weeks with premature discharge of amniotic fluid. Occipital presentation. Mild gestosis. Chronic fetal hypoxia.

Girl, weight = 3580 g, length = 50 cm, head circumference = 36 cm, chest circumference = 35 cm. Apgar score 7/8 points. At birth, mild asphyxia. Translated to a joint stay mother and child. Discharged on the 7th day with a diagnosis of Healthy.

Thus, the proposed method allows us to identify the possibility of giving birth to children with IUGR at the stage of a real pregnancy, starting from an early date, which makes it possible in a timely manner, without using invasive methods and unnecessary material costs, to identify risk groups that must be examined by functional diagnostics at a later date pregnancy, and determine the management tactics of the patient, can be widely used in the primary outpatient phase of the examination as a screening.

Information sources

1. Barkova S.N., Medvedev M.V. Doppler study of hemodynamics in the veins of the fetus. // Ultrasound. the diagnosis 1998. No. 1. S.24-34.

2. Bunin A.T., Strizhakov A.N., Medvedev M.V., Grigoryan G.A. Features of the cerebral circulation of the fetus are normal and with a syndrome of a delay in its development. // Q. Ohr mat. children 1990. No. 2. S.43-47.

3. Gorbunov A.L., Medvedev M.V. The importance of echocardiography and dopplerometry in assessing fetal hemodynamics in developmental delay syndrome. // Actual issues of antenatal protection of the fetus. M., 1986. S. 130-132.

4. Medvedev M.V. Doppler study of the uteroplacental and fetal blood flow. // Clinical Guide to Ultrasound Diagnostics. / Ed. Mitkova V.V., Medvedeva M.B. T.II. M .: Vidar. 1996. S. 256-279.

5. Medvedev M.V., Yudina E.V. Intrauterine growth retardation. M .: 1998. 205 p.

6. Strizhakov A.N., Ignatko I.V., Gasangadzhieva G.A., Efimov M.S., Vatolin K.V. Dopplerometric assessment of hemodynamics in the vessels of the vertebro-basilar system of the fetus during physiological and aggravated pregnancy. / Issues of gynecology, obstetrics and perinatology, 2007 - No. 1. - S.5-13.

7. Khuraseva A.B. Reproductive health of women born with polar values of body weight: dis ... d-pa honey. sciences. / A.B. Khurasev. - Kursk, 2010 .-- 235 p.

8. Fouron G.C., Teyssier G., Maroto E. Et al. Diastolic circulatory. dynamics of elevated placental resistance: pathological correlation. // Brit. J. Obstet. Gynaecol. 1985. V. 92. P.31-38.

9. Hepbum M., Rosenberg K. An audit of the detection and management of small for gestational age babies. // Brit. J. Obstet. Gynaecol. 1986. V. 93. P.212-216.

10. Moodley S.J. Intrauterine Growth Restriction IUGR. // Essentils of Maternal Fetal Medicine. / Ed. Ashmead G.B. NY: International Thomson Publ. 1997. P. 81-93.

11. Scott A., Moar V., Ounsted M. The relative contributions of different maternal factors in small-for-gestational age pregnancies. // Eur. J. Obstet. Gynecol. 1981. V.12. P.157-161.

Claims (1)

A method for predicting the risk of intrauterine growth retardation (IUGR) at the stage of pregnancy by analyzing anamnestic data, characterized in that a woman who is pregnant, from an early date, reveals the threat of termination in previous pregnancies, IUGR in previous pregnancies, the risk of miscarriage and SARS in real pregnancy, they also detect the presence of dysmenorrhea, a history of catarrhal diseases, and respiratory diseases and calculate the prognostic index D using the formula
D = 0.16 × X1 + 2.54 × X2 + 0.74 × X3 + 0.96 × X4 + 0.1 × X5 + 1.7 × X6 + 0.41 × X7-1.68,
where X1 is the threat of termination in previous pregnancies, if there is, then 1, if not, 0;
X2 - IUGR in previous pregnancies, if there is, then - 1, if not - 0;
X3-threatened miscarriage during real pregnancy, if there is, then - 1, if not - 0;
X4 - SARS during pregnancy, if there is, then - 1, if not - 0;
X5 - dysmenorrhea, if there is, then - 1, if not - 0;
X6 - history of catarrhal diseases, if any, then - 1, if not - 0;
X7 - respiratory diseases, if any, then 1, if not, 0,
having D more than 0 predict a high probability of giving birth to a child with IUGR, and with D less than 0 they judge the probable birth of a child with normal body weight.