RU2547256C1 - Method of predicting development of acute foetus hypoxia in labour - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics and gynaecology. After anamnesis analysis, the presence of the foetoplacental failure of a compensated form, oligohydramnios are identified. The day before labour cardiotocographic (CTG) examination is carried out, its results are evaluated, and the index STV is determined. Foetal monitoring is carried out, during which the sum of areas of decelerates in the active phase of I period of labour is determined with the external CTG and STV index with direct CTG after 1 hour of monitoring. The obtained data are processed with the calculation of a prognostic index. On the basis of the obtained index value the development of acute foetus hypoxia is predicted.

EFFECT: method makes it possible to predict the development of acute foetus hypoxia in labour, which makes it possible to determine further obstetric tactics of labour management in due time.

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Description

Application area

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

The most important task of modern obstetrics is to reduce perinatal morbidity and mortality. Currently, the problem of hypoxic conditions of the fetus in childbirth has not lost its relevance. In the structure of perinatal mortality, fetal and newborn hypoxia occupy one of the leading places (30%). The frequency of fetal hypoxia is 4-6%, and in the structure of perinatal morbidity - 21-45%. Intrauterine hypoxia leads to damage to the central nervous system, increases the frequency of somatic and infectious diseases, reduces the adaptation of newborns in the early neonatal period, causes impaired psychomotor and intellectual development of children [1, 9, 10, 11, 12, 13, 14].

One of the leading causes of perinatal morbidity and mortality is hypoxic damage to the fetus in the intrapartum period. Hypoxic-ischemic lesions of the central nervous system occupy one of the leading places in the structure of the causes of high mortality and disability of newborn children. Thus, the proportion of hypoxic-ischemic lesions of the central nervous system ranges from 20 to 50% in the structure of causes of perinatal mortality and up to 60-70% in the structure of causes of childhood disability [1, 2, 3]. Perinatal brain injuries determine a high mortality rate in the neonatal period, lead to the development of neurological complications and determine the further unfavorable prognosis and quality of life of the child [4, 5, 8, 9, 10, 11, 12, 13, 14].

The reduction in perinatal mortality was made possible largely due to intensive monitoring of the fetus during pregnancy and childbirth using modern research methods based on an analysis of its cardiac activity [6, 7].

State of the art

Analogs

1. Prediction of impaired fetal status in childbirth is based on an analysis of a number of anamnestic signs: the mother has extragenital diseases, complicated pregnancy (preeclampsia, fetoplacental insufficiency, permanent threat of termination of pregnancy, pregnancy prolongation, immunological incompatibility of mother and fetal blood, fetal infection) [ fifteen].

2. Assessment of the condition of the fetus in childbirth is based on ultrasound dopplerography of the fetal vessels, umbilical arteries and uterine arteries [17].

3. Diagnosis of acute fetal hypoxia during childbirth is carried out using blood sampling from the skin of the fetal head to determine the pH in it [18].

Prototype

Prediction of the development of acute fetal hypoxia in childbirth is based on data from intranatal cardiotocography (CTG) [16]. The disadvantage of this method is the difficulty in interpreting monitor curves. Certain subjectivity in the analysis of cardiotocograms, which entirely depends on the experience and skills of a specialist, often leads to an incorrect interpretation of monitor curves and, therefore, incorrect tactical decisions that threaten the life and health of the child.

SUMMARY OF THE INVENTION

The aim of the invention is to develop a method for predicting acute intrapartum hypoxia of the fetus based on the analysis of various types of fetal monitoring to improve perinatal outcomes.

The method is as follows. Anamnestic data is carefully collected from a patient arriving at a full-term pregnancy in the maternity ward, namely, the presence of chronic fetoplacental insufficiency (CKDF), lack of water, the result of CTG performed on the eve of childbirth, STV (short-term variation - short-term variability) ) according to CTG performed on the eve of childbirth. When conducting fetal intranatal monitoring in real time, an indicator of the sum of the areas of deletions in the active phase I of the labor period with external CTG and an STV with direct CTG after 1 hour of fetal monitoring are obtained.

Using the method of mathematical analysis of the selected features, a prognostic index D and the corresponding formula were formed:

D = 2.87 × X1 + 1.69 × X2-2.03 × X3-0.11 × X4-0.003 × X5-0.09 × X6 + 1.30, where:

X1 - low water (presence - 1, absence - 0);

X2 - HFPN, compensated form (presence - 1, absence - 0);

X3 - normal CTG on the eve of childbirth (presence - 1, absence - 0);

X4 - STV indicator on the eve of childbirth (ms);

X5 - an indicator of the sum of the areas of deletions in the active phase of the first stage of labor with external CTG after 1 hour of fetal monitoring (mm ² );

X6 - STV in direct CTG after 1 hour of fetal monitoring (ms);

const = 1.30.

If D> 0, a high risk of developing acute fetal hypoxia in labor is predicted.

If D <0, predict the birth of a healthy baby.

The sensitivity of the decision rule is 88%.

The specificity of 77%.

Efficiency 89%.

Clinical examples

1. Maslennikova OB, 27 years old, a resident of the city of Yekaterinburg. Received in the maternity ward for delivery during pregnancy 40-41 weeks. The analysis of anamnestic data is carried out. The patient had a history of CKDF, a compensated form and water deficiency according to ultrasound (ultrasound). CTG within normal limits, according to cardiotocography performed on the eve of childbirth, the STV was 9.7 ms. During intranatal fetal monitoring, the indicator of the sum of the areas of decelerations in the active phase of the first stage of labor with external CTG was 50 mm ² , the STV with direct CTG was 4.9 ms.

We calculate the prognostic index D by the formula:

D = 2.87 × 1 + 1.69 × 1-2.03 × 1-0.11 × 9.7-0.003 × 50-0.09 × 4.9 + 1.30 = 1.82

D> 0, therefore, women in labor expect a high risk of developing acute fetal hypoxia during childbirth.

Medical card number 1859. In childbirth, vacuum was used - extraction of the fetus. A live full-term baby was born weighing 3530 grams, with an Apgar rating of 6/7 points, umbilical cord blood pH 7.19. For 6 days he was in the intensive care ward, diagnosed with ischemic-hypoxic damage to the central nervous system and spinal cord of 1-2 degrees.

2. Kozlova OM, 28 years old, a resident of the city of Yekaterinburg. Received in the maternity ward for delivery in pregnancy 39-40 weeks. The analysis of anamnestic data is carried out. The patient had no history of CKDF, compensated form and low water according to ultrasound. CTG within normal limits, according to cardiotocography performed on the eve of childbirth, the STV was 9.3 ms. During intranatal fetal monitoring, the indicator of the sum of the areas of decelerations in the active phase of the first stage of labor with external CTG was 100 mm ² , the STV with direct CTG was 15.5 ms.

We calculate the prognostic index D by the formula:

D = 2.87 × 0 + 1.69 × 0-2.03 × 1-0.11 × 9.3-0.003 × 100-0.09 × 15.5 + 1.30 = -4.44

D <0, therefore, in a woman in labor, the birth of a healthy child is predicted.

Medical card number 1932. The birth was conservative. A live full-term baby was born weighing 2890 grams, with an Apgar score of 7/8 points, umbilical cord blood pH 7.27. Discharged on the 5th day from a maternity hospital with a diagnosis of healthy.

Thus, the proposed method allows to predict acute intrapartum hypoxia of the fetus, which makes it possible to timely determine the further obstetric tactics of labor and to prevent the birth of children in serious condition.

Sources of information taken into account during the examination

1. Tsidvintseva L.N. Determination of the information content of automated CTG in assessing the condition of the fetus during childbirth. Abstract. dis. Ph.D. - M. 2007.P.3.

2. Ageeva M.I. Dopplerometric studies in obstetric practice. - M. 2000.P.112.

3. Barashnev Yu.I. Hypoxic encephalopathy: hypotheses of the pathogenesis of cerebral disorders and the search for drug therapy methods. Russian Bulletin of Perinatology and Pediatrics; No. 1 2002. P.6-9.

4. Zubareva EA Comprehensive ultrasound evaluation of perinatal cerebrovascular disorders in children of the first year of life. Abstract. dis. doctor of medical sciences - M. 2006. S. 49.

5. Chernukha EA The birth block. - M. 2005. S.138-153.

6. Demidov V.N., Sigizbaeva I.K., Ogay O.Yu. and others. Automated antenatal and intrapartum cardiotocography. Health and medical technology. 2005; No. 9. S.52-53.

7. Mikhailov A., Tunell R. Clinical guidelines for asphyxiation of the fetus and newborn. - SPb. 2001. P.144.

8. Savelyeva G.M. Obstetrics. - M. 2000.P.449.

9. Badalyan L.O. Protecting the developing brain is the most important task of perinatal medicine. Tashkent, 1989.

10. Barashnev Yu.I. Akush. and gynecologist. 1993. No. 1. S.14-18.

11. Barashnev Yu.I., Bessonova Yu.V. Obstetrics and gynecology. 1997. No2. S.28-33.

12. Savelyeva G.M., Sichinava L.G. Russian Vestn. perinatologist. and pediatrician. 1995. No3. S.19-23.

13. Yatsyk G.V. Premature babies. - M. 1989.

14. Sayutina S.B., Shprakh V.V., Rozhkova N.Yu., Pokrovskaya S.A., Shestakova N.G. Risk factors and prediction of the development of perinatal hypoxic-ischemic lesions of the nervous system in newborns. Grew up. Vestn. perinatol. and pediatrician. 2001. No1. S.31-32.

15. Savelyeva G.M. Handbook of Obstetrics, Gynecology and Perinatology. - M. 2006. S.126-127.

16. Makarov I.O., Yudina E.V. Cardiotocography during pregnancy and childbirth. - M. 2012. S. 52-53.

17. Orlov V.I. Cardiotocography and Dopplerometry in modern obstetrics / V.I. Orlov, T.L. Botasheva, V.F. Kuzin et al. - M.: JRC RAS, 2007. - P.113-114. S.238-239.

18. Saling E. A new method for examination of the child during labor. Introduction, teaching and princi pies / E. Saling // Arch Gynakol. - 1962. - Vol.197. - P.108.

Claims (1)

A method for predicting the occurrence of acute fetal hypoxia in childbirth, characterized in that a history of compensated fetoplacental insufficiency is established, oligohydramnios, the result of cardiotocography (CTG) and the STV value are determined according to CTG performed on the eve of childbirth, when fetal intranatal monitoring determines the sum of the areas of deceleration in the active phase I of the delivery period with external CTG and the STV indicator with direct CTG after 1 hour of monitoring and calculate the prognostic index D by the formula:
D = 2.87 × X1 + 1.69 × X2-2.03 × X3-0.11 × X4-0.003 × X5-0.09 × X6 + 1.30,
Where:
X1 - oligohydramnios: presence - 1, absence - 0;
X2 - chronic fetoplacental insufficiency, compensated form: presence - 1, absence - 0;
X3 - normal CTG on the eve of childbirth: presence - 1, absence - 0;
X4 - STV on the eve of childbirth, ms;
X5 - an indicator of the sum of the areas of deletions in the active phase of the first stage of labor with external CTG after 1 hour of fetal monitoring, mm ² ;
X6 - STV in direct CTG after 1 hour of fetal monitoring, ms;
const = 1.30;
and with D greater than 0, the occurrence of acute fetal hypoxia is predicted,
and with D less than 0, the absence of a risk of acute fetal hypoxia during childbirth is judged.