RU2618403C1 - Method for abortion threat prediction in the second trimester for women with chorion location anomalies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: following is recorded for pregnant women: the distance from the internal uterus os to the lower chorion edge in centimeters at the first screening, the age of the pregnant woman in years, age of the first sex, history of uterine fibroids, adenomyosis, chorionic localization option - mostly on the front or the rear wall, presence of bacterial vaginosis, chlamydia and herpes infection, level of hemoglobin, red blood cells, thrombin, eosinophil, band neutrophils, thrombin time. Then the individual prediction factor of abortion threat probability (Kab) is calculated by the formula. If Kab is less than or equal to 0.48, there is no threat of miscarriage in the second trimester; if Kab in the range of 0.49 to 0.87, one episode of abortion threat is predicted; in the range of 0.88 to 1.42 - two episodes; more than 1.43 - three episodes.

EFFECT: improved prediction accuracy for the number of miscarriage threat episodes for pregnant women with abnormal chorion location.

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Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to predict the number of episodes of the threat of termination of pregnancy in pregnant women with anomalies in the location of the chorion.

Among the problems that have a negative effect on maternal and perinatal mortality are the abnormal location of the chorion (APC) and, subsequently, the placenta: presentation and its low location. In the early stages, pregnancy with this pathology can end with its spontaneous abortion [Protopopova T.A. The condition of the fetus and newborn in women with an abnormality of the placenta // Obstetrics and gynecology. 2007. - No. 1. - S. 58-61]. Predicting the likelihood of an interruption threat that allows you to take preventive measures in a timely manner is an important task for obstetrician-gynecologists.

A known method for predicting the threat of termination of pregnancy from an early gestation (application RU No. 2005101186 from 01/19/2005). For its implementation, the concentration of specific hormones of the placenta is determined: estriol, placental lactogen, the level of interleukin 6 and the diagnostic indicator (D) is calculated by the formula:

D = X1 • K1 + X2 • K 2 + X3 • K3 + const, where X1 is the concentration of estriol, ng / ml; X2 - level of interleukin 6, pg / ml; X3 - the amount of placental lactogen, mg / l; K 1 = 0.05; K2 = 0.07; K3 = -0.18; const = -0.37. When D is less than 0, a conclusion is drawn about the absence of laboratory signs of the development of a threat of termination of pregnancy, and with D more than 0, the presence of laboratory signs characteristic of the development of this pathology is diagnosed.

The disadvantages of the method: the authors propose to use only current laboratory indicators, anamnestic data are not taken into account.

A known method for diagnosing the threat of termination of pregnancy (application RU No. 2007105843 from 02.16.2007). The authors propose to determine the content of prostaglandins E2 and F2α and with a value of E2 493 pg / ml or more and F2 α 235.5 pg / ml diagnose the threat of termination of pregnancy.

A known method for predicting the threat of abortion (application RU No. 2407015), where the authors propose to determine the content of epidermal growth factor (EGF) in the blood serum of a woman in the second trimester of pregnancy. With an EGF of 463 pg / ml or higher in women with a male fetus, a threat of abortion is predicted. Using the method allows to increase the accuracy of forecasting the threat of interruption and to carry out the timely formation of high-risk groups.

The disadvantages of the above two methods - it is proposed to draw conclusions about the presence of threats to terminate a pregnancy on the basis of only one indicator, which cannot objectively reflect the state of the body as a whole.

A known method for predicting the threat of termination of pregnancy with genital infection (application RU No. 2008102175 from 01/21/2008). The method includes recording the stiffness index of large arteries (SI) using a photoplethysmograph, characterized in that, with SI indices of basal more than 7.65 and SI for a sample with salbutamol greater than 7.15, a high risk of termination of pregnancy is concluded, and with SI indices of basal 6.23 to 7.65 and SI for a sample with salbutamol from 5.88 to 7.15 diagnose an average risk of pregnancy loss.

A known method for predicting the threat of termination of pregnancy in the first trimester (US Pat. RU No. 2255339 from 03.25.2004). According to the method, the ratios of the ratio of the content of lactobacilli to the conditionally pathogenic flora in scrapings taken after removal of mucus from the surface of the posterior fornix of the vagina and cervical canal are determined, and when they are reduced by at least 2 times with respect to the norm, a conclusion is drawn about the risk of termination of pregnancy.

A known method for diagnosing the threat of abortion (US Pat. RU No. 2390022, publ. 05/20/2010). The method is carried out by evaluating the microbiocenosis of the mucous membranes of the genital and digestive tracts. To achieve this goal, they use the relationship of indicators of microbiocenosis and factors of local humoral immunity of the vagina and intestines. The threat of termination of pregnancy occurs when the content of opportunistic microflora in the vagina is more than 3.0 lg CFU / g with a concentration in the vaginal wash of IgG less than 7 μg / ml, the content of opportunistic microflora in feces more than 4.0 lg CFU / g concentrations in IgA coprofiltrates of less than 4 μg / ml, sIgA of less than 4 μg / ml and sc of less than 3 μg / ml.

A known method for predicting miscarriage of early infectious genesis (US Pat. RU No. 2444734 publ. 10.03.2012).

The authors propose determining the level of the soluble form of the sFlt-1 receptor in the blood serum of a pregnant woman in the first trimester. With its value equal to 0.389 ng / ml or lower, pregnancy termination is predicted. The method allows to reduce the threat of perinatal losses due to the timely identification of pregnant risk groups and the beginning of adequate therapeutic measures.

There is a non-invasive method for predicting the threat of termination of pregnancy in the first trimester (US Pat. RU No. 2469331) by examining the biological fluid, where pregnant women are preliminarily determined indicators of lateral behavioral phenotype and, if multidirectional sensory-motor and motor parameters of the phenotype are detected, the level of melatonin in morning and evening urine is additionally examined. and, if the difference between melatonin is 30% or less, a high risk of termination of pregnancy in the first trimester is predicted e.

The disadvantages of the above methods - their implementation requires the use of additional laboratory equipment and expensive reagents.

EFFECT: development of a method for predicting threats of abortion in the second trimester in patients with anomalies in the location of the chorion, based on the consideration of individual anamnestic data and the results of laboratory diagnostic tests during initial registration of pregnant women. The method does not require additional costs of financial and human resources, allows you to timely begin the implementation of preventive measures.

The technical result is achieved as follows. Clinical observations of 117 pregnant women were performed, in which, upon initial registration, registration revealed anomalies in the location of the chorion (APC). These anomalies included the regional and central presentation of the chorion - the lower edge of the chorion was in the region of the internal pharynx or overlapped it or the low location of the chorion - the distance between the lower edge of the chorion and the internal pharynx of the cervix is less than 2 cm.

An obligatory criterion for inclusion in the study was an early appearance in a antenatal clinic with registration for pregnancy up to 8 weeks of gestation.

Patients recorded data somatic and gynecological history

At the first stage, using the correlation analysis, the indicators measured during the registration period that had statistically significant relationships with episodes of threatened abortion were selected as influencing. The set included: the distance from the internal uterus of the uterus to the lower edge of the chorion in centimeters at the first screening, the age of the pregnant woman in years, the age of the onset of sexual activity, the presence of a history of uterine fibroids, adenomyosis, the option of localization of the chorion in the uterus - mainly along the anterior or posterior wall, the presence of bacterial vaginosis, chlamydial and herpes infections, the level of hemoglobin, erythrocytes, thrombin, eosinophils, stab neutrophils, thrombin time.

Next, a regression equation was constructed in which the number of episodes of abortion in the second trimester was the predicted sign. The equation was:

CRC = 2.84306 - 0.223738 * F_01 + 0.0962419 * F_02 + 0.0588445 * F_03 + 0.0700054 * F_04 - 0.252256 * F_05 - 0.00926101 * F_06 + 0.348514 * F_07 + 0, 112354 * F_08 + 0.40114 * F_09 - 0.736193 * F_10 - 0.131657 * F_11 + 2.23443 * F_12,

where F_01 is the distance from the lower edge of the chorion to the internal pharynx at the first screening, measured in centimeters; F_02 - the age of the pregnant woman at the time of treatment in years; F_03 - age of onset of sexual activity in years; F_04 - the presence in the history of fibroids, endometriosis - absence is indicated by the number "0", the presence of one or both diseases is indicated by the number "1"; F_05 - a variant of the location of the chorion relative to the uterine wall: the location on the front wall is ten points "10", other options are twenty points "20"; F_06 - the presence of bacterial vaginosis: absence is indicated by the number "0", the presence of the number "1"; F_07 - the presence of chlamydial infection: absence is indicated by the number "0", the presence of the number "1"; F_08 - the presence of herpetic infection: absence is indicated by the number "0", the presence of the number "1"; F_09 - hemoglobin level during the initial examination: values within the normal range for the first trimester of pregnancy are indicated by the number “0”, deviations from the norm by the number “1”; F_10 - the number of red blood cells during the initial examination: quantity, 10 ¹² / _liter ; F_11 - the number of eosinophils during the initial examination: the quantity, measured as a percentage of the number of all leukocytes; F_12 - the number of stab neutrophils during the initial examination: the quantity, measured as a percentage of the number of all leukocytes.

Next, we calculated the average values of the prediction coefficients of the probability of a threat of termination of pregnancy in patients, having previously grouped them by the number of episodes. The results are presented in the table.

Table

Average values of the prognosis coefficient of episodes of threatened abortion in patients with chorion attachment abnormalities

The number of episodes of the threat of abortion The average value of the coefficient of probability of occurrence of the threat of termination of pregnancy (CRC) did not have 0.48 ± 0.047 one episode 0.87 ± 0.055 two episodes 1.42 ± 0.012 three episodes 1.61 ± 0.089

Thus, according to the results of our studies, we can formulate the following rule: if the value of CRC calculated by the above formula is less than or equal to 0.48, the patient has no threat of abortion in the second trimester; if the CRC value lies in the range from 0.49 to 0.87, one episode of the threat of termination of pregnancy is predicted; in the range from 0.88 to 1.42 - two episodes; more than 1.43 - three episodes.

The application of the method is illustrated by the following clinical examples.

Example 1

Patient K.V.A. Date of birth: 12/07/1986, age at the time of registration: 27 years.

Gynecological history: menarche from 11 years to 5 days after 30 days, the beginning of sexual activity from 16 years.

4 pregnancies, of which independent births were 1 in 2009, two abortions, one spontaneous miscarriage in a period of 5 weeks with curettage of the uterine cavity in 2007.

Gynecological diseases: cicatricial deformity of the cervix.

Somatic diseases: Vegetative-vascular dystonia of the hypotonic type, chronic pyelonephritis, chronic cystitis, obesity of 2 degrees.

Blood Type: 0 (I)

Rhesus factor: (+) positive

General blood analysis indicators Er Hb CPU Tr Le E P FROM L M ESR 3.92 118 0.9 283 7 3 one 56 36 four 22

General urine analysis indicators color specific weight transparency protein leukocyte. flat epithelium slime salt bacteria light. yellow 1020 transparent no 2.5 a lot of 0 0 0

Blood chemistry indicators glucose total protein bilirubin ALAT ASAT urea iron thymol test 4.02 67 8.4 24 twenty 2.92 19.23 0.2

Vaginal purity: 3. Determination of sexually transmitted infections by PCR: no infections were detected.

Cervical canal inoculation: E. Coli massive growth

ELISA for toxoplasmosis: + (IgG detected)

Pharyngeal swab for staphylococcus: (-) negative

Deviation in a smear on the flora (trimester, indicator): 1 trimester, an increase in white blood cells

Ultrasound examination for 12-14 weeks - 1 screening: the location of the chorion along the back wall, the distance of the lower edge of the chorion / placenta relative to the internal pharynx 1.6 cm.

Using the formula for predicting the threat of termination of pregnancy, we calculate:

F_01 (distance from the lower edge of the chorion to the internal pharynx at the first screening, measured in centimeters) - 1.6;

F_02 (the age of the pregnant at the time of treatment) - 27;

F_03 (age of onset of sexual activity) - 16;

F_04 (presence of a history of fibroids, endometriosis) - 0;

F_05 (a variant of the location of the chorion relative to the wall of the uterus) - along the back wall 20;

F_06 (the presence of bacterial vaginosis) - 0;

F_07 (presence of chlamydial infection) - 0;

F_08 (the presence of herpes infection) - 0;

F_09 (hemoglobin level) 118 norm (no pathology) - 0;

F_10 (the number of red blood cells) - 3.92 * 10 ¹² / _liter ;

F_11 (the number of eosinophils) - 3;

F_12 (the number of stab neutrophils) - 1.

Kpr1 = 2.84306 - 0.223738 * 1.6 + 0.0962419 * 27 + 0.0588445 * 16 + 0.0700054 * 0 -0.252256 * 20 - 0.00926101 * 0 + 0.348514 * 0 + 0.112354 * 0 + 0.40114 * 0-0.736193 * 3.92-0.131657 * 3 + 2.23443 * 1

Kpr1 = 2.84306 -0.3579808 2.5985313 0.941512 0 -5.04512 0 0 0 0 -2.88587656 -0.394971 2.23443

Kpr1 = -0.06641506

The obtained CRC value is less than 0.48, which corresponds to the absence of threats of abortion in the second trimester. Further observation of the patient showed that there were no episodes of threatened abortion in the second trimester.

Delivery: urgent, independent delivery, the color of the amniotic fluid is light, partial tight attachment of the placenta was absent. Condition of the newborn: Apgar points for 1 and 5 min: 7 - 7, weight 3700 g, height 52 cm.

Condition of newborn at discharge: adaptation period.

Example 2

Patient D.S.E. Date of birth: 11/01/1982, age at the time of registration: 30 years.

Gynecological history: Gynecological history: menarche from 14 years to 3-4 days after 30 days, the onset of sexual activity from 18 years.

Pregnancy - 1, childbirth alone in 2007, delivery by cesarean section. The presence of gynecological diseases is denied.

Somatic diseases: mixed-type vegetovascular dystonia, chronic cystitis.

Blood Type: B (III)

Rhesus factor: (+) positive

General blood analysis indicators Er Hb CPU Tr Le E P FROM L M ESR 3,5 113 0.97 217 6.4 2 one 55 40 2 fifteen

General urine analysis indicators color specific weight transparency protein leukocyte. flat epithelium slime salt bacteria light. yellow 1010 transparent 0 1,5 few 0 0 0

Blood chemistry indicators glucose total protein bilirubin ALAT ASAT urea iron thymol test 4.02 67 8.4 24 twenty 2.92 19.23 0.2

A smear on the flora: candidiasis, leukocytosis, degree of purity of the vagina: 3. Determination of sexually transmitted infections by PCR: mycoplasma hominis, ureaplasma urealitikum.

Cervical Canal Inoculation: Enterococcus Medium

ELISA for toxoplasmosis: - (not detected)

Pharyngeal swab for staphylococcus: (-) negative

Deviation in a smear on the flora (trimester, indicator): 1 trimester - candidiasis, leukocytosis at 9-10 and 13 weeks

Treatment: The duration of treatment for STIs is 25 weeks.

Ultrasound examination for 12-14 weeks - 1 screening: the location of the chorion along the front wall, the distance of the lower edge of the chorion / placenta relative to the internal pharynx is 0.1 cm.

Using the formula for predicting the threat of termination of pregnancy, we calculate:

F_01 (distance from the lower edge of the chorion to the internal pharynx at the first screening, measured in centimeters) - 0.1;

F_02 (the age of the pregnant woman at the time of treatment) - 30;

F_03 (age of onset of sexual activity) - 18;

F_04 (presence of a history of fibroids, endometriosis) - 0;

F_05 (a variant of the location of the chorion relative to the wall of the uterus) - along the front wall 10;

F_06 (the presence of bacterial vaginosis) - 0;

F_07 (presence of chlamydial infection) - 0;

F_08 (the presence of herpes infection) - 0;

F_09 (hemoglobin level) 113 normal (no pathology) - 0;

F_10 (the number of red blood cells) - 3.5 * 10 ¹² / _liter ;

F_11 (the number of eosinophils) - 2;

F_12 (the number of stab neutrophils) - 1.

Kpr2 = 2.84306 - 0.223738 * 0.01 + 0.0962419 * 30 + 0.0588445 * 18 + 0.0700054 * 0 - 0.252256 * 10 - 0.00926101 * 0 + 0.348514 * 0 + 0.112354 * 0 + 0.40114 * 0 - 0.736193 * 3.5 - 0.131657 * 2 + 2.23443 * 1

Kpr2 = 3.65916112

The obtained value is more than 1.43; according to the forecast, there are three possible episodes of threats of abortion in the second trimester.

According to the pregnant observation card, 3 episodes of the threat of interruption in 2 trimesters were recorded: at 14 weeks, at 18-19 weeks and 22 weeks.

Delivery: urgent independent birth, there was no prenatal outflow of amniotic fluid. The color of the amniotic fluid is light, partial tight attachment of the placenta was absent.

Condition of the newborn: Apgar points for 1 and 5 min: 7 - 8, weight 3190 g, height 54 cm. Condition of the newborn at discharge: adaptation period.

Thus, the formula for predicting the threat of abortion that we developed allows us to timely identify clinical distress, orient the patient to the need to comply with the medical and protective regimen, and prescribe antispasmodic therapy.

Claims (3)

A method for predicting the threat of abortion in the second trimester in patients with anomalies in the location of the chorion with an assessment of eight to ten weeks of gestation during the gestation period: the distance from the internal pharynx of the uterus to the lower edge of the chorion in centimeters, the age of the pregnant woman in years, the age of onset of sexual activity, the presence of history of uterine fibroids, adenomyosis, localization of the chorion in the uterus - mainly along the anterior or posterior wall, the presence of bacterial vaginosis, chlamydial and herpetic infections, the level of hemo globin, red blood cells, eosinophils, stab neutrophils, characterized in that they calculate the individual coefficient of prediction of the probability of threatened abortion (CRC) by the formula: CRC = 2.84306 - 0.223738 * F_01 + 0.0962419 * F_02 + 0.0588445 * F_03 + 0.0700054 * F_04 - 0.252256 * F_05 - 0.00926101 * F_06 + 0.348514 * F_07 + 0, 112354 * F_08 + 0.40114 * F_09 - 0.736193 * F_10 - 0.131657 * F_11 + 2.23443 * F_12, where F_01 is the distance from the lower edge of the chorion to the internal pharynx at the first screening in centimeters; F_02 - the age of the pregnant woman at the time of treatment in years; F_03 - age of onset of sexual activity in years; F_04 - the presence in the history of fibroids, endometriosis - absence is indicated by the number "0", the presence of one or both diseases is indicated by the number "1"; F_05 - a variant of the location of the chorion relative to the uterine wall: the location on the front wall is ten points "10", other options are twenty points "20"; F_06 - the presence of bacterial vaginosis: absence is indicated by the number "0", the presence of the number "1"; F_07 - the presence of chlamydial infection: absence is indicated by the number "0", the presence of the number "1"; F_08 - the presence of herpetic infection: absence is indicated by the number "0", the presence of the number "1"; F_09 - hemoglobin level: values within normal limits for the first trimester of pregnancy are indicated by the number "0", deviations from the norm by the number "1"; F_10 - the number of red blood cells, 10 ¹² / _liter ; F_11 - the number of eosinophils, measured as a percentage of all leukocytes; F_12 - the number of stab neutrophils, measured as a percentage of the number of all leukocytes; if the CRC value is less than or equal to 0.48 - the patient has no threat of abortion in the second trimester; if the CRC value lies in the range from 0.49 to 0.87, one episode of the threat of termination of pregnancy is predicted; if CRC in the range from 0.88 to 1.42 - two episodes; if the CRC value is more than 1.43 - three episodes of threats of abortion in the second trimester.