RU2596719C1 - Method for increasing the accuracy of evaluating the state of fetus during the pregnancy, based on additional recording its hiccup-like movements during cardiotocography - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for assessing foetal state during pregnancy. Cardiotocography (CTG) is performed. Hiccup-like movements of the foetus are registered. If the foetus make hiccup-like movements, its state is considered normal.

EFFECT: method enables the precise evaluation of foetal condition, as well as reduces the time of examination ensured by registering hiccup-like movements of the foetus during cardiotocography.

1 cl, 5 dwg, 2 ex

Description

Reducing perinatal mortality is one of the most important public health problems. Therefore, the efforts of most economically developed countries are aimed at solving this problem. The introduction of various functional research methods into clinical practice in the 60-90s allowed in economically developed countries to reduce perinatal mortality by 3.5-5 times. This was mainly achieved through the widespread use of cardiotocography (CTG) [1].

However, as clinical observations show, lately, stabilization of perinatal mortality rates has begun, and even if it has decreased, this is mainly (by 40%) due to a significant improvement in the management of newborns [2, 3].

Literature data indicate that the main cause of perinatal mortality is acute and chronic fetal hypoxia during pregnancy and childbirth, which account for 40-70% of perinatal losses [4, 5, 6, 7]. It should be borne in mind that the adverse effect of hypoxia is not limited not only to perinatal mortality, but also in 60-80% of cases leads to impaired function of various organs and systems of the body [8].

One of the main manifestations of these disorders is intrauterine growth retardation, which, according to various authors [9, 10, 11], varies between 4.1-8%. It was found that in 32.5% of children born in a state of malnutrition, deviations in physical development persisted up to one year [12]. In 1/3 of the children, the mass deficit during this period varied in the range of 500–2000 g [13, 14]. Along with this, it was also noted that children with low anthropometric indicators in the first year of life often (in 59%) lagged behind in physical indicators and often in the first year of life (59%) lagged in physical and psychomotor development (31%) [ fifteen]. In one study [10], it was found that in 39% of children, the mass deficit (in the range of 8-12%) persisted until the end of the second year of life.

In addition to a delay in physical development in children undergoing chronic hypoxia, in connection with a violation of the immunological status in the first year of life, there was also a tendency to increased incidence of acute respiratory and intestinal infections, pneumonia, exudative diathesis, anemia, rickets. Late teething occurred in 45% of cases, and by the end of the first year of life their number was 29.4% less than normal [16].

ON. Millstone and M.M. Melnikov [17], as a result of a long study of the effect of hypoxia on the development of children, came to the conclusion that they have significant features of physical and sexual development between the ages of 10 and 17 years. Often revealed various skeletal imbalances, growth retardation, changes in the size of the pelvis, as well as significant deviations in the formation of the reproductive system. In this case, not only the sequence of the appearance of secondary sexual characteristics is violated, but also their severity. In girls, the frequency of menstrual dysfunction is observed more often than in the population.

Currently, the main method for diagnosing impaired functional state of the fetus is cardiotocography. In this case, in almost all serial devices, the classical CTG is recorded, which includes two curves. One of them displays the heart rate and the other uterine activity. However, the accuracy of determining the state assessment using this research method according to data obtained by American specialists is not large and varies between 36-78%. Moreover, it was also noted that the discrepancy in the interpretation of the same cardiotocograms by the same specialist, drawn after a certain period of time, can reach 28% [17].

In order to improve the accuracy of diagnosis of the fetal condition, in the late 80s of the last century the Sony Cade Antenatal Monitor (Great Britain) was developed and put into clinical practice, using which the CTG was interpreted automatically using a specially developed for this purpose computer program. However, the accuracy of the assessment of the state of the fetus during its use was not high and amounted to 67% [18].

In 1991, in our country, the Unikos company (Moscow), together with the Scientific Center for Obstetrics, Gynecology and Perinatology, developed and launched into serial production a fully automated and computerized device - the “Fetal Condition Analyzer”. The main distinctive ability of this device was that when it was used, in addition to the heart rate, fast fetal movements were recorded and analyzed. All this made it possible to significantly increase the accuracy of diagnosis of the fetus, which averaged 89.6% [19]. The main advantages of this monitor, in comparison with other devices of the same type, are as follows [19]:

- higher (by 20-25%) information content compared to traditional methods of analysis of CTG;

- the possibility of a differentiated assessment of the state of the fetus in the 4th, and not in 2 groups (norm, initial, pronounced and pronounced violations);

- full automation of the processing of information received;

- unification of results and lack of subjectivity in the analysis of CTG;

- almost complete elimination of the influence of fetal sleep on the final result;

- automatic determination of the duration of the study;

- taking into account the motor activity of the fetus;

- the establishment of the fact of registration of heart rate from the aorta of a woman with the simultaneous absence of registration of her cardiac activity;

- unlimited long storage of a large amount of information with its reproduction at any moment of time;

- the ability to print the received data and monitor curves on ordinary writing paper, which leads to significant cost savings;

- use in any obstetric institution, including at home, without the direct participation of medical personnel;

- accelerating the process of training specialists in decoding CTG;

- the ability to use the device as a regular computer.

However, in order to further improve the accuracy of assessing the state of the fetus, we decided to evaluate the possibility of using its hiccup movements for these purposes.

According to modern views [20], hiccups are clinical cramps of the diaphragm, as well as the motor part of the respiratory apparatus. Convulsions are accompanied by a jerky protrusion of the abdomen with a narrowed glottis. It has been established that this phenomenon can occur reflexively in perfectly healthy individuals and very often for no apparent reason. Such a random hiccup does not last long, does not cause any complaints and has no clinical significance.

Our analysis of the literature showed that at present there is practically no data on the issue of fetal motions of the fetus. In the domestic scientific literature, we were not able to meet a single message devoted to the study of this physiological phenomenon. In foreign literary sources, we also did not find reports on instrumental recording and analysis of this physiological process. Among doctors, according to the Internet, there are opinions that the fetal movements of the fetus occur in the second half of pregnancy. The frequency of their appearance increases with increasing gestational age and continues until the birth of the fetus. Moreover, only in one of the works known to us [21], an attempt was made to find out the possibility of the most pregnant woman to differentiate various types of fetal movements. As a result of this study, it was found that 90.8% of women perceive them only as a general movement of the body, 86% as an isolated movement of the limbs and only 36.6% as hiccupic movements.

In order to clarify the clinical significance of hiccups, we used the Unikos serial analyzer of fetal status. Hiccup-like movements were recorded with the same sensor as the heart rate and its motor activity. To differentiate between fast and hiccup-like movements, a special computer program was developed. At the same time, for their difference on the monitor screen, fast movements were shown in red, and hiccups were shown in green. A distinctive feature of the hiccup-like movements of the fetus from fast movements was the fact that the first of them were recorded in separate groups, while the second were single and chaotic. The number of hiccup-like movements was calculated automatically and their digital values were displayed on the monitor screen [Fig. one].

To obtain the necessary information, we examined 1,400 healthy women with a physiologically occurring pregnancy in periods of 28 to 41 weeks, which, as it was found, subsequently gave birth to healthy children. As a result of a survey of patients, it was found that in most women hiccup movements occurred once a day, in some cases their number could reach up to two times a day. In single observations, they arose after three or even four days. At the same time, it was noteworthy that a significant part of women (45%) could not distinguish hiccupic movements from fetal movements. According to the pregnant women, the duration of the hiccup movements varied from 3 to 15 minutes. However, in most fruits (58%), their duration was 5-10 minutes.

At the time of cardiotocography, hiccup movements were recorded in 105 pregnant women, which amounted to 7.5% of the total number of all examined women. On the monitor screen they were displayed in the form of closely spaced thin vertical linear stripes (Fig. 1) in most cases of approximately the same amplitude. Usually they were recorded at regular intervals of 2-3 seconds. The duration of the hiccup movements varied over a rather wide range from 2 to 17 minutes and was generally 5-12 minutes. During registration, hiccup-like movements appeared at different times. In twelve cases, they were recorded immediately from the moment the recording began (Fig. 2), and in eight cases an hour or more, that is, after the automatic extension of the study (Fig. 3). In other cases, they occurred within an hour of examination.

In the vast majority of cases, hiccupic movements were combined with normal cardiotocograms. In five cases, they were recorded in the presence of initial signs of impaired fetal status. However, subsequently at birth, these children did not show any signs of hypoxia. At the same time, out of 22 observations, where, using instrumental research methods, fetal hypoxia of varying severity was established, which was then confirmed after the birth of the child, hiccup movements were not recorded in any of them.

We illustrate the data obtained with a few examples.

Pregnant H.V.A., 31 years old. Received at the center for a period of 34 weeks. pregnancy for a planned cardiotocographic study. Real pregnancy is the second. The first pregnancy 3.5 years ago ended in a normal and timely birth. From the anamnesis it is known that a pregnant woman is somatically healthy, she denies gynecological diseases. My husband is 35 years old. Heredity among spouses is not burdened. In the early stages, pregnancy proceeded with toxicosis. In 7 weeks. slight bleeding was observed due to chorionic detachment. Further pregnancy proceeded without complications. An ultrasound and dopplerographic study conducted at 33 weeks did not show any abnormalities on the part of the fetus. CTGgraphy data showed that during the first hour of the examination, the PSP was 1.82, which indicated the initial impairment of the fetal condition, and therefore the study was automatically extended for another 30 minutes. As a result of this, the PSP amounted to 0.93, which testified to the normal condition of the fetus. At the same time, it can be seen from the first graph that hiccup movements occurred in 21 minutes and lasted 2.5 minutes. Therefore, in this case, taking into account the hiccup-like movements, the study should have been completed 66.5 minutes earlier with the same final result in relation to the assessment of the fetal health. CTG data (Fig. 4) were subsequently fully confirmed after the birth of the baby. Delivery occurred at 39 weeks. pregnancy. A healthy boy was born weighing 3633 g, height 52 cm. Apgar score of 9 points. Discharged in good condition on the 4th day after birth.

Pregnant D.N.V., 37 years old. Received in the center in 33 weeks. pregnancy to assess the condition of the fetus. Real pregnancy is the third. The first pregnancy at 26 weeks. ended with normal birth and the second at the age of 28 years with an ectopic pregnancy. This marriage is second. My husband is 35 years old. Spouses are somatically healthy, heredity is not burdened. For 5 years, the patient suffered from infertility. Real pregnancy occurred after a course of physiotherapy. The first half proceeded with the threat of abortion. When conducting ultrasound and Dopplerographic studies of the pathology from the fetus was not detected. Cardiotocography data (Fig. 5) excluding hiccup-like movements are the initial fetal disturbances (PSP - 1.45). After their accounting, PSP - 0.90 (norm). It can be seen from the presented data that, in the above observation, taking into account hiccup-like movements, firstly, made it possible to clarify the condition of the fetus and, secondly, to reduce the study time by 20 minutes For 37 weeks. a healthy boy was born, weight 2747 g and height 49 cm. Apgar score of 8 points. Discharged on the 7th day after birth in good condition.

From the data presented by us, it follows that hiccup-like movements are a fairly reliable sign indicating the absence of a violation of the fetus. This is evidenced by the fact that in all cases where there were hiccupic movements, the children were born in good condition, while their absence did not exclude a violation of the state of the fetus. Since hiccup-like movements on the monitor curves in a significant number of observations appeared rather early, their presence allowed in such cases to reduce the study time by an average of 21 minutes, while usually it lasted an average of 32 minutes. Therefore, these data indicate that taking into account hiccup-like movements can slightly increase the throughput of the equipment used.

Thus, the conducted studies indicate that hiccup-like movements are a fairly reliable sign, allowing to slightly increase the accuracy of the diagnosis of the fetus and reduce the time of the study, and this fact must be taken into account both by manufacturers of medical equipment and by doctors working in the field of practical healthcare.

SIGNATURES TO FIGURES

FIG. 1 On CTG, in addition to heart rate and fast movements, hiccup-like movements are recorded, with standard detection of CTG, the initial disturbances in the fetal state, when taking into account hiccup-like movements, is the norm.

FIG. 2 CTG. Early appearance of hiccups.

FIG. 3 CTG. The late appearance of hiccup movements.

FIG. 4 CTG. Excluding hiccup-like movements, the initial violations of the fetus (PSP - 1.82). After taking them into account - the norm (PSP - 0.93).

FIG. 5 CTG. Excluding hiccup-like movements, the initial violations of the fetus (PSP - 1.45). After taking them into account - the norm (PSP - 0.90).

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Claims (1)

A method for assessing the condition of the fetus during pregnancy, including cardiotocography (CTG), characterized in that during cardiotocography, the hiccupal movements of the fetus are recorded, and when detected, the condition of the fetus is assessed as normal.

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