RU2626302C1 - Method for time of day determination for caesarean section - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: preliminary stage, conducted according to general rules and supplemented by an ultrasound evaluation of fetal adaptation to repeated intrauterine hypoxia, is performed. In addition, body temperature of the pregnant woman is monitored for at least 2 consecutive days. Time of the day with the minimum temperature value is determined. At that, assessment of fetal adaptation to hypoxia is carried out during this period of the daily rhythm of woman's body temperature. With poor fetal adaptation to hypoxia, the indicated time period of the day is selected for the planned Caesarean section.

EFFECT: increased accuracy of selection of the optimal time of day for the Caesarean section, in which no meconium is present in the amniotic fluid, no fetus aspiration with amniotic fluid, no cyanosis of its skin and a long period of apnea in the newborn baby.

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Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to prepare pregnant women for a planned Caesarean section.

A well-known methodology for conducting programmed childbirth, including a preliminary stage in which ultrasound is performed, cardiotocography, determination of cervical maturity and amnioscopy, stage of obstetrics, including an enema at 7:00, a soul, a woman is transferred to the birth block, at 8:00 amniotomy and cardiotocography, intravenous drip at 9.00 oxytocin 5 IU in 500 ml of isotonic sodium chloride solution and stage of labor, including cardiotocography, pudental anesthesia, analgesia, delivery in weekdays and during working hours (found on the Internet 13.02.2016, URL: http://ilive.com.ua/family/programirovannye-rody_68795il5934.html).

The disadvantage of this method is the low accuracy and safety, because it does not provide a determination of the dynamics of the temperature in the body of a pregnant woman during the day and an assessment of the resistance of the fetus to intrauterine hypoxia, taking into account the temperature of the body of the pregnant woman at a certain time of the day. In addition, the method does not provide delivery at a time of day with a minimum body temperature of a pregnant woman and with the highest fetal resistance to hypoxia. The fact is that the intensity of aerobic metabolism, the need for oxygen and the temperature of the body of a pregnant woman and the fetus change every day. Moreover, these changes are wave-like in nature with a wavelength of 24 hours, that is, cyclic fluctuations in body temperature and fetal oxygen demand have a daily rhythm. It was previously shown that in all mammals with a daytime lifestyle, body temperature, the intensity of aerobic metabolism in the daytime is higher than at night (A. Urakov, Recipe for temperature. Science and life. 1989. No. 9. P. 38 -42).

In addition, the intensity of aerobic metabolism, tissue oxygen demand and the temperature of the body of a pregnant woman and her fetus are determined by the intensity of inflammation, which can develop in a woman's body as a universal protective and adaptive reaction in response to the influence of various stress factors. Stress factors that increase body temperature include pathogens of infectious diseases, their toxins, soft tissue bruises, bone fractures, incised, puncture wounds and injection infiltrates that occur at the injection site of drug solutions (Urakov A.L., Nikityuk D.B. ., Urakova N.A., Soykher M.I., Soykher M.G., Reshetnikov A.P. Types and dynamics of local skin lesions of patients in places where drugs are injected. Doctor. 2014. No. 7. P. 56-60; Urakov A. .., Urakova NA Post-injection bruising. What is this, a secret disease, traces of of crimes or an overprotective reaction of an organism? International Journal of Applied and Basic Research, 2015. No. 5 (Part 2), pp. 233-237; Urakov AL, Ammer K., Urakova NA, Chernova LV, Fisher EL Infrared thermography can discriminate the cause of skin discolourations. Thermology international. 2015. Vol. 25. N. 4. P. 209-215).

Any of these stressors can interfere with the health status of a pregnant woman before birth by chance. A special place among the known stress factors is occupied by aggressor drugs. In particular, it was previously shown that injections of drugs with irritating, hyperthermic and pyrogenic effects can change body temperature (Urakov A.L. et al. Bin Newton as a “formula” for the development of medical pharmacology. - Izhevsk: Publishing House of the Institute of Applied Mechanics Ural Branch of the Russian Academy of Sciences. - 2007, - 192 p .; Urakov AL, Urakova NA Temperature of the site of injection in subjects with suspected "injection's disease". Thermology International. 2014. N 2. P. 63-64).

In this regard, the injection of high-quality solutions of drugs produced in the vein of a woman in labor before childbirth can also change the body temperature of a woman and her fetus. Moreover, one part of the medication can cause inflammation with hyperthermia and / or a pyrogenic reaction, and the other part of the medication can cause an allergic reaction, collapse, acrocyanosis, sweating and hypothermia. At the same time, an increase in body temperature increases the need of tissues for oxygen, therefore, reduces the body's resistance to hypoxia, and hypothermia lowers the need for tissues in oxygen, therefore, increases the resistance of tissues to hypoxia and ischemia (A. Urakov, N. A. Urakova, L. Chernova B. The effect of temperature, atmospheric pressure, antihypoxants and the chemical “oxygen accumulator” on the viability of fish in water without air access. International Journal of Applied and Basic Research. 2014. No. 8-2. P. 48-52).

Therefore, the value of body temperature, metabolic rate and tissue demand for oxygen in the body of a pregnant woman and her fetus are not stable throughout the day. Most often, the dynamics of body temperature, the intensity of aerobic metabolism and tissue oxygen demand is wave-like and their cyclical changes are associated with the daily rhythm of a pregnant woman. Regardless of the wave-like change in body temperature with a wavelength of 24 hours, the body temperature of a pregnant woman can suddenly rise or fall in any part of the day due to inflammation of an allergic or non-allergic nature in response to a variety of stress factors. In particular, inflammation may occur in response to the administration of a drug solution. Moreover, such a medicine can be administered to a pregnant woman in the birth block before the very beginning of the Caesarean section.

In this regard, the determination of delivery time without taking into account the time of day and body temperature of a pregnant woman reduces the accuracy and safety of the method. Therefore, the known method allows the appearance of meconium in the amniotic fluid, aspiration of the amniotic fluid by the fetus, cyanosis of the skin of the fetus and a prolonged apnea period in the born baby.

There is a method of prenatal assessment of fetal adaptation to repeated hypoxia according to N.A. Urakova, during the implementation of which from the period of 36 weeks of pregnancy for many days, at least every 7 days, assess the condition of the fetus, including determining the time of the onset of the act of respiratory movements of its ribs during a series of successive periods of short-term and reversible hypoxia, modeling it by holding a breath by a pregnant woman several times every 2 minutes until the time interval of the onset of the act of respiratory movements of the ribs of the fetus is stabilized, the dynamics of the time interval between the onset of the act of respiratory movements of the ribs in the fetus and the subsequent analysis of the results obtained, assess the fetus's adaptation to repeated hypoxia as poor if the period of time remains short during repeated hypoxia, decreases or increases, but does not reach 15 seconds, as satisfactory or good if time increases and exceeds 15 or 30 s, the final conclusion is issued and the method of delivery is chosen according to the results of the last assessment (RU 2529377).

The disadvantage of this method is the low accuracy and safety, since the method does not provide a determination of the dynamics of temperature in the body of a pregnant woman during the day, an assessment of the fetus's resistance to intrauterine hypoxia, taking into account the time of day and body temperature of the pregnant woman, and also does not ensure delivery during the time of day with a minimum body temperature of a pregnant woman and with the highest resistance of the fetus to hypoxia. The fact is that the dynamics of the intensity of aerobic metabolism, oxygen demand and the body temperature of a pregnant woman and the fetus has a wave-like character with a wavelength of 24 hours. It was shown that in all mammals with a daytime lifestyle, body temperature, the intensity of aerobic metabolism in the daytime is higher than at night (A. Urakov. Recipe for temperature. Izhevsk: Udmurtia. 1988. - 80 p.).

In addition, the oxygen demand and the temperature of the human body are determined by the intensity of inflammation, which is the universal protective and adaptive reaction of the body to many stress factors. Stress factors, including inflammation (a universal protective and adaptive reaction), are infectious agents (pathogens, their toxins), injuries, bruises, cuts, punctures of hard and soft tissues, as well as aggressor drugs (drugs with local irritant effect or general pyrogenic effect) (Urakov A.L., Urakova N.A. Postinjection bruising, infiltrates, necrosis and abscesses can cause drugs due to the lack of control of their physico-chemical aggressiveness. Modern problems of science and education. 2012. No. 5; S. 5-7; URL: www.science-education.ru/105-6812; Urakova N.A., Urakov A.L. Injection skin disease. Current problems of science and education. 2013. No. 1. URL: http: //www.science-education.ru/107-8171; AA Kasatkin, AL Urakov, IA Lukoyanov. Nonsteroidal anti-inflammatory drugs causing local inflammation of tissue at the site of injection. Journal of Pharmacology and Pharmacotherapeutics. 2016. V. 7 . (1). (Http://www.jpharmacol.com/).

Therefore, body temperature and tissue need for oxygen in a pregnant woman and her fetus change throughout the day. It is shown that these changes are cyclical in nature with the daily rhythm of a pregnant woman. In this regard, the determination of fetal resistance to hypoxia without taking into account the time of day and the body temperature of a pregnant woman reduces the accuracy of the method. The fact is that delivery through physiological delivery or a Caesarean section threatens the health of the fetus due to aggravation of intrauterine hypoxia. Therefore, an inaccurate assessment of the resistance of the fetus to hypoxia before delivery increases the risk of meconium in the amniotic fluid, aspiration of the fetus with amniotic fluid, cyanosis of its skin, apnea period in the born baby and hypoxic damage to the cells of the cerebral cortex.

The objective of the invention is to improve the accuracy and safety by preliminary determining the daily dynamics of the mother’s body temperature, identifying the time of day with a minimum value of body temperature, maximum resistance of the fetus to hypoxia and conducting a planned Cesarean section at this time of day.

The technical result consists in the absence of meconium in the amniotic fluid, aspiration of the fetus by the amniotic fluid, cyanosis of its skin and a long period of apnea in the born baby.

The essence of the method for planning a Cesarean section, including the preliminary stage, carried out according to the general rules and supplemented by an ultrasound evaluation of the fetus's adaptation to repeated intrauterine hypoxia, analysis of the results, issuing an opinion on the choice of the Cesarean section and the stage of surgical obstetrics performed in the birth unit at a specific time of the day, consists in that previously, at least 2 days in a row, they monitor the body temperature of a pregnant woman, determine the period of the day with a minimum of temperature, assessment of fetal adaptation to hypoxia is carried out at this time of day at this woman’s body temperature, if the fetus is poorly adapted to hypoxia, they plan a surgical delivery at this time of the day, 30 minutes before the planned start of surgical delivery, a woman’s body temperature is monitored, and Cesarean section carried out at a temperature corresponding to the minimum value in the daily rhythm.

In the proposed method, due to the preliminary implementation of continuous thermometry of the body of a pregnant woman for at least 2 consecutive days, the accuracy of the method is increased, since temperature monitoring provides a determination of the dynamics of daily fluctuations in body temperature of a pregnant woman. Moreover, the determination of temperature dynamics for less than 2 days does not provide for the identification of patterns of the wave temperature curve, therefore, does not provide high accuracy of the method. In turn, monitoring the woman’s body temperature for 48 hours ensures the identification of the laws of the temperature curve, since this curve has a daily rhythm (her wavelength is 24 hours). Moreover, monitoring body temperature for more than 2 days in a row increases the accuracy of the method, but higher accuracy is not needed to select the time of day for the purpose of safe for the health of the Caesarean section. The fact is that the purpose of monitoring is to identify the period of time of the day with a minimum body temperature of a pregnant woman. At the same time, this period of time of the day is always calculated in tens of minutes and even hours, while the duration of the period from the beginning of the Caesarean section to the removal of the fetus from the womb takes several minutes.

By evaluating the adaptation of the fetus to repeated hypoxia during the time of day, when the body temperature of the pregnant woman has a minimum value in the daily rhythm, the accuracy and efficiency of the method are increased. The fact is that a decrease in the body temperature of a pregnant woman lowers the fetal body temperature. Periodic daily occurring general physiological hypothermia reduces the consumption of oxygen by the organs and tissues of the body of the mother and her fetus under conditions of a decrease in the frequency and depth of pulmonary respiration in a pregnant woman and the functional activity of the cardiovascular system, which makes the outcome of providing the fetus with oxygen in every pregnant woman unpredictable due to possible pathology of organs and systems of her body. Therefore, different periods of time of the day can have different effects on the resistance of the fetus to repeated hypoxia. An assessment of the adaptation of the fetus to repeated hypoxia, carried out during the time period of the day, characterized by the minimum daily body temperature of the pregnant woman, reveals the hidden reserves of adaptation of the mother and her fetus to repeated hypoxia and establishes the most favorable time of the day for the fetus to carry out the planned Cesarean section. The fact is that delivery at a time of day, characterized by an increase in fetal resistance to hypoxia, reduces the risk of hypoxic damage to fetal cortex brain cells during delivery, and reduces the likelihood of signs of fetal asphyxiation and signs of encephalopathy in a newborn.

In this regard, in the presence of symptoms of pulmonary heart failure and / or fetoplacental insufficiency and poor fetal resistance to acute hypoxia, planning a Cesarean section during the time of day, characterized by an increase in fetal resistance to hypoxia, increases the accuracy and safety of the method.

The start of monitoring the temperature of the woman in labor of the woman in labor 30 minutes before the planned start of the surgical delivery increases the accuracy, safety and efficiency of the method, since it eliminates the uncontrolled, non-wave and unexpected (unplanned) increase in the temperature of the woman in labor. The fact is that the body temperature of a woman in labor can change not only because of the expected undulating daily rhythm, but also because of the sudden development of inflammation and fever in response, for example, to the influence of stress factors such as pathogens and their toxins, hyperthermic and pyrogenic drugs, inflammatory mediators that appear in a surgical wound due to surgical damage to the soft tissues of the woman's body. At the same time, the beginning of monitoring the body temperature of a woman in labor 30 minutes before the planned start of surgical delivery is optimal, since a longer monitoring period is not advisable due to the fact that with a planned Caesarean section, a pregnant woman appears in the birth block no earlier than 30 minutes before the operation. Beginning of monitoring body temperature less than 30 minutes before the planned start of surgical delivery reduces the safety of the method, since already in the first minute after the appearance of a pregnant woman in the birth block, she may begin a pyrogenic reaction to antiseptic vapors and / or a hyperthermic reaction in response to an unexpected start of labor activation uterus.

Performing a Cesarean section with a minimum value of the body temperature of the woman in childbirth in a physiological daily rhythm increases the accuracy and safety of the method, since it reduces tissue oxygen demand, the risk of intrauterine hypoxia, and extends the survival period of fetal cortex cells under conditions of oxygen deficiency.

The method is as follows. Preliminarily, a conventional method is used to continuously monitor the body temperature of a pregnant woman for at least 2 consecutive days. The period of time of the day is determined with the body temperature corresponding to the minimum value in the daily wave-like change. Then, the adaptation of the fetus to repeated hypoxia is assessed at this time of day at a woman's body temperature corresponding to the minimum value in the daily rhythm. With poor adaptation of the fetus to hypoxia, a Caesarean section is planned, which is carried out during this period of time of the day. 30 minutes before the planned start of surgical delivery, monitoring the body temperature of a pregnant woman begins. When detecting body temperature corresponding to its minimum value in the physiological daily rhythm of this woman, a Caesarean section is performed.

Example. A pregnant woman of B. at the age of 26 years old with a gestational age of 38 weeks, with an abnormality of the uterus, with signs of fetoplacental insufficiency and with poor fetal resistance to repeated intrauterine hypoxia (the fetal resistance to repeated hypoxia is 7 seconds), identified in noon in the conditions of the antenatal clinic on the eve of hospitalization of the woman in the maternity hospital. For planning surgical delivery with the exception of fetal asphyxiation of the fetus and with a high probability of having a healthy baby, it was decided to use the claimed method.

To do this, from the first day of hospitalization, they began to carry out continuous monitoring of a woman’s body temperature using an electrothermometer, the sensor of which was installed in the right axillary hollow. After 2 days, we analyzed the thermogram and determined that the minimum value of the woman’s body temperature in the daily rhythm was 36.3 ° C and that the period of the day with the minimum body temperature was between 4 hours 30 minutes and 5 hours 30 minutes (Fig. 1).

After that, on the next day at 5 hours 00 minutes the woman’s body temperature was measured. The woman’s body temperature turned out to be 36.3 ° C, that is, the value of the pregnant woman’s body temperature turned out to be equal to her minimum value in a daily wave-like temperature change. Therefore, they immediately evaluated the adaptation of the fetus to repeated hypoxia and found that the value of the sample was 9 seconds. These results indicated poor fetal adaptation to hypoxia. Based on the results, it was decided to perform a Caesarean section the next day between 4 hours 30 minutes and 5 hours 30 minutes. After receiving the woman’s voluntary informed consent for delivery by Caesarean section, at 4:30 the next day she was transferred to the birth unit, where she immediately began monitoring her body temperature using the ARGUS LCM multifunction monitor (SCHILLER, Switzerland). In the period from 4 hours 30 minutes to 5 hours 00 minutes, the woman's body temperature was + 36.3 ° C, which corresponded to her minimum daily value. At the same time at 5 hours 00 minutes began the implementation of spinal anesthesia. At 5 hours 10 minutes, sufficient anesthesia efficacy was detected and Caesarean section started. At 5 hours 17 minutes, a fetus was removed, the skin of which turned out to be a physiological pink color. On examination, it turned out that a girl was born. At 5 hours 18 minutes a clamp was placed on the umbilical cord and dissected. Assessment of the girl’s health showed her lack of cyanosis of the skin, decreased muscle tone, and aspiration of amniotic fluid. 3 seconds after birth, the girl screamed, after which she began to breathe on her own. Inspection of the poured amniotic fluid showed the absence of meconium in them. Subsequent monitoring of the born girl showed her lack of symptoms of encephalopathy.

Thus, the proposed method, by preliminary determining the daily dynamics of the mother’s body temperature, identifying the time of day with the minimum body temperature and maximum resistance of the fetus to hypoxia, improves the accuracy of determining the optimal time of day for the planned Cesarean section, safe for the fetus.

Claims (1)

A Caesarean section planning method, including a preliminary stage carried out according to the general rules and supplemented with an ultrasound assessment of the fetus's adaptation to repeated intrauterine hypoxia, analysis of the results obtained and issuing a conclusion, characterized in that the pregnant woman’s body temperature is monitored for at least 2 consecutive days women, determine the period of time of the day with the minimum value of its temperature, assess the adaptation of the fetus to hypoxia during this period of the circadian rhythm of the woman’s body temperature, When a bad adaptation to fetal hypoxia selected specified time of day to elective caesarean section.

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