RU2558464C1 - Method for determining foetal weight - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: pregnant women's pre-birth abdominal circumference at the level of a navel, an uterine fundus height, a pregnant woman's height, a foetal occipitofrontal head circumference are measured; Kettle's body weight index is determined in the first trimester of pregnancy. A foetal weight W is calculated by formula: $$W=UFH\times OFHC\times \left(\frac{UFH+AC}{20}+\frac{\mathrm{0,2}\text{Height}}{BWI}\right),$$

wherein UFH is the uterine fundus height (cm), AC is the pregnant woman's abdominal circumference (cm), Height is the pregnant woman's height (cm), OFHC is the foetal occipitofrontal head circumference (cm), BWI is the Kettle's body weight index in the first trimester of pregnancy.

EFFECT: method enables determining the pre-birth foetal weight in the pregnant women by assessing the anthropometric measures and constructing a mathematical model.

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Description

The invention relates to medicine, namely to obstetrics, and can be used to determine the mass of the fetus at the full term gestation.

One of the most important factors determining the frequency of intrapartum damage to the fetus is the imbalance between the size of the fetal head and the mother’s pelvis [10]. In such cases, two factors have a direct damaging effect on the fetus: mechanical, caused by an obstruction from the mother’s pelvis, and intrapartum hypoxia, associated with local and systemic circulatory disorders [1]. In the context of modern obstetric care, hypoxic lesions occurring as a result of local disturbances in cerebral hemodynamics due to the nature and degree of configuration of the fetal skull come to the fore [2]. An excessively pronounced configuration of the fetal head leads to compression of the main venous collector of the brain - the sagittal sinus and venous trunks of the cerebral hemispheres [3]. This is accompanied by difficulty or blockage of the venous outflow, progressive intracranial hypertension, hypoxia and cerebral ischemia [5]. Thus, an accurate determination of the fetal mass determines the probability of not only birth injury, but also intranatal damage to the central nervous system of the fetus.

A known method for determining the body weight of an intrauterine fetus with macrosomia at full term pregnancy [6], which is based on the determination of three parameters by ultrasonic fetometry: BDP (biparietal size of the fetal head, mm), DB (fetal femur, mm) and coolant (tummy circumference fetus, mm). By the sum of the products of these parameters by the coefficients, respectively: 16,980, 22,000, 0,007 determine the body weight of the fetus in grams (M). M - 16.980 × BPR + 22,000 × DB + 0.007 × Coolant ² . The method has the following disadvantages: the complexity of the method due to the need for ultrasonic fetometry.

A known method for determining the mass of the fetus V.N. Demidov et al. [4], which is based on ultrasound fetometry and includes several biometric indicators of the fetus: M = 186.6 × G-3490.3 × G ² + 43.9 × A-717.8 × A ² + 615 × C + 243.8 × D + 17849.0; where M is the body weight of the fetus, g; G - the size of the fetal head, cm; calculated by the formula G = (BPR + LZR) / 2; A is the diameter of the tummy of the fetus, cm; C is the transverse size of the heart, cm; D is the length of the femur, cm; BDP - biparietal size of the fetal head, cm; LZR - fronto-occipital size, see. The method has the following disadvantages: the complexity of the method due to the need for ultrasonic fetometry.

A known method of determining the mass of the fetus [7], which is based on measuring the circumference of the abdomen of a pregnant woman, the height of the uterine fundus above the womb, D. spinarum of the pelvis of a woman. Calculate the mass of the fetus before childbirth by the formula: M = -856.13 + 93.19 × A + 20.48 × B + 23.16 × C, where M is the mass of the fetus before childbirth, g; A - D.spinarum, cm; B - abdominal circumference, cm; C - the height of the bottom of the uterus, cm; 1856.13; 93.19; 20.48; 23.16 - digital prognostic factors. The method has the following disadvantages: insufficient accuracy of the method due to the fact that there is a large error in determining the mass of the fetus, which is 10-15% (± 350 g).

A known method of determining the mass of the fetus [8], taken as a prototype, which consists in the fact that to determine the mass of the fetus measure the length of the fetal ovoid, fronto-occipital size of the fetal head, the thickness of the skin fold of a pregnant woman at the intersection of the middle axillary line with the upper edge of the ilium and determine the mass of the fetus by the formula: X = (D + L + KZHS) × 100, where D is the length of the fetal ovoid, cm; L - frontal - occipital distance of the fetal head, cm; KZhS - thickness of the skin fold of a pregnant woman, see

However, the method has the following disadvantages: insufficient accuracy of the method due to the fact that there is a large error in determining the mass of the fetus, which is 12-15% (± 380 g).

, где В ДМ - высота дна матки (см), ОЖ - окружность живота беременной (см). Рост - рост беременной (см), ЛЗР - лобно-затылочный размер головки плода (см), ИМТ - индекс массы тела женщины по Кетле в первом триместре беременности.To improve the accuracy of the method for determining the weight of the fetus in pregnant women on the eve of childbirth, measure the abdominal circumference, height of the bottom of the uterus, the height of the pregnant woman, the fronto-occipital size of the fetal head, find out the body mass index of a woman according to Ketle in the first trimester of pregnancy and calculate the weight of the fetus M according to the formula: $$M=\mathrm{AT}DM\times L3R\times \left(\frac{\mathrm{AT}DM+\mathrm{ABOUT}F}{\mathrm{twenty}}+\frac{0.2R\mathrm{about}\mathrm{from}t}{\mathrm{AND}MT}\right)$$

where In DM - the height of the bottom of the uterus (cm), coolant - the circumference of the pregnant abdomen (cm). Growth - growth of a pregnant woman (cm), LZR - fronto-occipital size of the fetal head (cm), BMI - body mass index of a woman according to Kettle in the first trimester of pregnancy.

The selection of criteria for determining the mass of the fetus was carried out on the basis of assessing the influence of anthropometric features on determining the mass of the fetus according to the construction of a mathematical model based on the methods of regression analysis [9].

The method is as follows: when a pregnant woman enters a hospital for prenatal hospitalization, measure with a centimeter tape the circumference of the abdomen at the navel in the supine position, the height of the uterine fundus over the womb with the centimeter tape in the supine position, the growth of the pregnant stadiometer in the supine position, the fronto-occipital size of the fetal head from nadapryazheniya to the occipital protuberance through the anterior abdominal wall of a woman with a tazomer in the supine position, find out the body mass index of a woman according to Ketle in the first trimester of pregnancy and calculate the mass M ode by the formula:

, где ВДМ - высота дна матки (см), ОЖ - окружность живота беременной (см). Рост - рост беременной (см), ЛЗР - лобно-затылочный размер головки плода (см), ИМТ - индекс массы тела женщины по Кетле в первом триместре беременности. $$M=\mathrm{AT}DM\times L3R\times \left(\frac{\mathrm{AT}DM+\mathrm{ABOUT}F}{\mathrm{twenty}}+\frac{0.2R\mathrm{about}\mathrm{from}t}{\mathrm{AND}MT}\right)$$

where VDM is the height of the uterine fundus (cm), coolant is the pregnant woman’s abdominal circumference (cm). Growth - growth of a pregnant woman (cm), LZR - fronto-occipital size of the fetal head (cm), BMI - body mass index of a woman according to Kettle in the first trimester of pregnancy.

Example 1. Pregnant J., primogenous 17 years old, was admitted on April 17, 13 to the Department of Pregnancy Pathology with a diagnosis of Chronic placental insufficiency, subcompensated form at 39 weeks of gestation. Chronic intrauterine hypoxia of the fetus. Young primiparous. Mild gestational anemia. Nonspecific vaginitis.

When a pregnant woman enters a hospital: abdominal circumference = 92 cm, uterine fundus height = 36 cm, pregnant woman’s height = 162 cm, frontal-occipital size of the fetal head = 11.5, Kettle’s woman’s body mass index in the first trimester of pregnancy = 19.5 . The mass of the fetus M is calculated by the formula:

Conclusion: The body weight of the fetus corresponds to the gestational age, conservative management of labor is planned.

04/23/13, through a natural birth canal was born a live full-term boy without injuries and deformities, weighing 3370 g, height 50 cm, with an Apgar score of 10-10 points.

The diagnosis is final:

Delivery at term (39-40 weeks of pregnancy) in a young primiparous. Chronic placental insufficiency, subcompensated form. Chronic intrauterine hypoxia of the fetus. Mild gestational anemia. Nonspecific vaginitis.

Epidural anesthesia

Example 2. Pregnant N., repetitive for 28 years, was admitted on 01/27/13 to the Department of Pregnancy Pathology with a diagnosis of Pregnant edema at 38-39 weeks of pregnancy. Large fruit. Gestational diabetes mellitus, target Hbalc level less than 6%. Rh-negative blood without At. Hypertension I tbsp., 1 tbsp., Risk 2. N ₀ . Chronic pyelonephritis, in remission. CKBPo. Mild gestational anemia.

When a pregnant woman enters the hospital: abdominal circumference = 108 cm, the height of the uterine fundus = 40 cm, the height of the pregnant woman = 159 cm, the fronto-occipital size of the fetal head = 12.5, the Kettle body mass index of a woman in the first trimester of pregnancy = 28.2 . The mass of the fetus M is calculated by the formula:

Conclusion: The body weight of the fetus corresponds to a large fetus for a given gestation period, conservative delivery is planned with a clinical evaluation of the woman’s pelvis at the end of the first stage of labor, and if signs of clinical mismatch are detected, it is recommended that the delivery be completed by cesarean section. 02/01/13, the birth was complicated by the development of clinical inconsistency and was completed by cesarean section, during which a live full-term girl without injuries and deformities was weighed, weighing 4270 g, height 56 cm, with an Apgar score of 9-9 points.

The diagnosis is final:

Surgical delivery at term (39 weeks of gestation) by a large fetus. Edema of the pregnant. Gestational diabetes mellitus, target Hbalc level less than 6%. Rh (-) negative blood without At. Hypertension I tbsp., 1 tbsp., Risk 2. N ₀ . Chronic pyelonephritis, in remission. CKD ₀ . Mild gestational anemia.

Premature discharge of amniotic fluid. Clinically narrow basin.

Papannenstiel laparotomy. A caesarean section in the lower segment of the uterus is a transverse section.

Example 3. Pregnant E., repetitive 29 years old, was admitted on 05.21.13 to the delivery room with a diagnosis of I stage of labor at 37 weeks gestation. OAA Chronic placental insufficiency, subcompensated form. Fetal growth retardation syndrome I degree. Chronic intrauterine hypoxia of the fetus. Low water. Syndrome of connective tissue dysplasia. Prolapse of the mitral valve of the I degree, mitral insufficiency of the I degree. Chronic obstructive pulmonary disease, bronchitis, moderate course, remission. DN ₀ .

When a woman in labor is admitted to the hospital: abdominal circumference = 87 cm, uterine fundus height = 30 cm, pregnant height = 162 cm, frontal-occipital size of the fetal head = 10.5, Kettle's body mass index of a woman in the first trimester of pregnancy = 20.3 . The mass of the fetus M is calculated by the formula:

Conclusion: The body weight of the fetus corresponds to the first degree of fetal growth retardation syndrome for a given gestation period, conservative management of labor is planned, if the condition of the fetus worsens, it is recommended that the delivery be completed by cesarean section.

05/21/13, through a natural birth canal, a live full-term boy was born with signs of stunted growth, without injuries and deformities, weighing 2400 g, height 48 cm, with an Apgar score of 8-8 points.

The diagnosis is final:

Delivery on time (37 weeks of pregnancy). OAA Chronic placental insufficiency, subcompensated form. Fetal growth retardation syndrome I degree. Chronic intrauterine hypoxia of the fetus. Low water. Syndrome of connective tissue dysplasia. Prolapse of the mitral valve of the I degree, mitral insufficiency of the I degree. Chronic obstructive pulmonary disease, bronchitis, moderate course, remission. DN ₀ .

Amniotomy. Epidural anesthesia

Example 4. Pregnant A., repetitive 40 years old, was admitted on 01.27.13 to the Department of Pregnancy Pathology with a diagnosis of Chronic placental insufficiency, subcompensated form at a gestational age of 39 weeks. Chronic intrauterine hypoxia of the fetus. Chronic polyhydramnios. Large fruit. Hypertension I tbsp., 1 tbsp., Risk 2. N ₀ . Chronic pyelonephritis, in the stage of latent inflammation. CKD ₀ . Alimentary-constitutional obesity III tbsp. Nonspecific vaginitis.

When a pregnant woman enters a hospital: abdominal circumference = 126 cm, uterine fundus = 41 cm, fronto-occipital size of the fetal head = 12.3, pregnant height = 158 cm, Kettle’s woman’s body mass index in the first trimester of pregnancy = 43.8 . The mass of the fetus M is calculated by the formula:

Conclusion: The body weight of the fetus corresponds to a large fetus for a given gestation period, conservative delivery is planned with a clinical assessment of the woman’s pelvis at the end of the first stage of labor, if signs of clinical mismatch are detected, it is recommended that the delivery be completed by cesarean section, if signs of perineal rupture are detected by an old scar recommend midline lateral episiotomy.

01/30/13, through a natural birth canal a lively full-term boy was born, without injuries and deformities, weighing 4350 g, height 56 cm, with an Apgar score of 8-9 points.

The diagnosis is final:

Delivery at term (39-40 weeks of gestation) large fetus. Chronic placental insufficiency, subcompensated form. Chronic intrauterine hypoxia of the fetus. Chronic polyhydramnios. Hypertension I tbsp., 1 tbsp., Risk 2. N ₀ . Chronic pyelonephritis, in the stage of latent inflammation. CKD ₀ . Alimentary-constitutional obesity III tbsp.

Nonspecific vaginitis.

The threat of rupture of the perineum in the old scar.

Episiotomy, episiorography.

This method was used to determine the weight of the fetus at the full term gestation in 500 pregnant women and women in labor. The error was 5% (± 250 g). The results are presented in the table.

The effectiveness of the method for determining the mass of the fetus Way Common Methods for Determining Fetal Mass The method of determining the mass of the fetus The method of determining the mass of the fetus according to Jordan The method of determining the mass of the fetus according to Johnson The method for determining the mass of the fetus according to Lankowitz The method for determining the mass of the fetus according to Yakubova Formula for Estimated Fetal Mass

Coolant + VDM (VDM-11) × 155 (Coolant + VDM + height + mass) × 10

Error ± 250 g ± 700 g ± 550 g ± 650 g ± 1000 g Efficiency 95% 82% 86% 84% 75%

Bibliography

1. Barashnev Yu.I. Key problems of perinatal neurology / Yu.I. Barashnev // Obstetrics and gynecology. - 2007. - No. 5. - S. 51-54.

2. Vlasyuk V.V. Birth injury and perinatal disorders of cerebral circulation / V.V. Vlasyuk. - St. Petersburg: Nestor-Istoriya, 2009 .-- 252 p.

3. Gulchenko OV, Nikiforovsky NK, Pokusaeva VN, Stas L.I. Obstetric and perinatal outcomes with a large fetus // Russian Bulletin of the Obstetrician-Gynecologist. - 2010. - T. 10. - No. 1. - S. 55-58.

4. Demidov V.N., Bychkova P.A., Logvinenko A.V. Possibilities of using ultrasonic fetometry in determining the weight of the fetus in the III trimester of pregnancy // Vopr. Ohr Mat. - 1987. - No. 6. - S. 45-47.

5. Kravchenko E.N. Birth injury: obstetric and perinatal aspects / E.N. Kravchenko. - M.: GEOTAR-Media, 2009 - 240 p.

6. Patent No. 2132800, Russian Federation, IPC АВВ 8/00. A method for determining the body weight of an intrauterine fetus with macrosomia in the term of full-term pregnancy / T.V. Slabinskaya, O.Yu. Sevostyanova; Applicant and patent holder of the Ural Research Institute. protection of motherhood and infancy - No. 98104359/14; declared 03/11/1998; publ. 09/27/1999, Bull. Number 17. - 3 p.

7. Patent No. 2361515, Russian Federation, IPC А61В 5/107. The method of determining the mass of the fetus / N.V. Lazareva, Yu.L. Minaev; applicant and patent holder State educational institution of Higher professional education Samara Military Medical Institute - No. 2007127157/14; declared 07/16/2007; publ. 07/20/2009, Bull. No. 20. - 3 p.

8. Patent No. 1732937, Union of Soviet Socialist Republics, IPC А61В 10/00. The method for determining the mass of the fetus / G.A. Lukashevich, A.N. Shilko; Applicant and patent holder of the Belarusian Research Institute for the Protection of Motherhood and Childhood - No. 4739924/14; declared 09/25/1989; publ. 05/15/1992, Bull. Number 18. - 3 p.

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Claims (1)

A method for determining the mass of the fetus, including an anthropometric study of a pregnant woman on the eve of childbirth, characterized in that they measure the circumference of the abdomen, the height of the uterus, the height of the pregnant woman, the fronto-occipital size of the fetal head, find out the body mass index of the woman according to Ketle in the first trimester of pregnancy and calculate the mass fetus M according to the formula:
$$M=\mathrm{AT}DM\times L3R\times \left(\frac{\mathrm{AT}DM+\mathrm{ABOUT}F}{\mathrm{twenty}}+\frac{0.2R\mathrm{about}\mathrm{from}t}{\mathrm{AND}MT}\right)$$

where In DM - the height of the bottom of the uterus (cm), coolant - the circumference of the pregnant abdomen (cm). Growth - growth of a pregnant woman (cm), LZR - fronto-occipital size of the fetal head (cm), BMI - body mass index of a woman according to Kettle in the first trimester of pregnancy.