RU2648031C2 - Method for premature birth prediction in second trimester of gestation associated with previous influenza a(h3n2) in first trimester of pregnancy complicated by retrochorial hematoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for premature birth prediction in the second trimester of gestation associated with previous influenza A(H3N2) in the first trimester of pregnancy complicated by retrochorial hematoma. In the first serum, the level of antibodies to the influenza virus A(H3N2) is determined (A). The concentration of interferon-γ (pg/ml) is established (B). The condition of the villous chorion in is assessed in points (C). The severity of the threat of miscarriage is determined in points (N). The prognosis for premature birth development is determined by the value of the discriminant function (D) with a boundary value of -22.36. At D equal to or greater than the boundary value, a normal course of pregnancy is predicted. At D less than the boundary value, premature birth in the second trimester of gestation is predicted.

EFFECT: method allows to accurately predict premature birth in the second trimester of gestation in women after the influenza in the first trimester of pregnancy, complicated by retrochorial hematoma due to assessment of the most meaningful indicators.

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Description

The invention relates to medicine, namely to obstetrics. One of the urgent tasks of practical healthcare is the prevention of preterm labor in women with infectious diseases in the early stages of gestation [5, 6, 7, 8]. Ultrasound imaging of retrochorial hematoma in patients at early gestation is often accompanied by an increase in the activity of natural killers (CD56 + 16 +) [4], as well as the level of proinflammatory cytokines, which lead to the development of immune vasculitis and amputation of decidual vessels, which play an important role in the pathogenesis of villous x-ray detachment [6].

Viral infection with the development of the threat of miscarriage in the first trimester of pregnancy leads to an increase in the level of pro-inflammatory cytokines, in particular, interferon-γ, which can inhibit the growth and metabolic activity of trophoblast, stimulate apoptosis of cellular elements, the development of endothelial pathology [1], and also increase the risk of development premature birth [5, 8]. With influenza A (H3N2) in the early stages of gestation, complicated by the threat of miscarriage, the content of interferon-γ increases [1]. Therefore, predicting preterm labor in the second trimester of gestation in women who have had influenza A (H3N2) associated with retrochorial hematoma in the first trimester of pregnancy is important for public health.

A known method for predicting threatening preterm birth in women with the threat of miscarriage early [7].

The disadvantage of this method is:

it does not allow predicting premature birth in the second trimester of gestation during the period of the height of influenza A (H3N2) in women in the first trimester of pregnancy complicated by a retrochorial hematoma;

does not take into account the level of influenza immunity and the severity of retrochorial hematoma.

The aim of the invention is to enable the prediction of preterm birth in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy, complicated by retrochorial hematoma.

The goal is achieved in that the prediction of preterm labor in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy complicated by retrochorial hematoma is carried out by determining the level of antibodies to influenza A (H3N2) virus (A), establishing the concentration of interferon γ (pg / ml) (B), scores of the ultrasonic state of the villous chorion in points (1 point - normal echostructure of the villous chorion; 2 points - single retrochorial hematoma; 3 points - multiple retrochorial hematomas) (C) , determining the severity of the risk of miscarriage in points (1 point - aching pain in the lower abdomen for 1-3 days; 2 points - aching or cramping pains in the lower abdomen and spotting spotting from the genital tract from 1-3 days; 3 points - aching or cramping pains in the lower abdomen and spotting spotting from the genital tract for more than 3 days) (N), and then determine the prognosis of fetal loss syndrome using the discriminant equation: D = -0.171 × A-0.268 × B-3.357 × C-0.803 × N, where

D is a discriminant function with a boundary value equal to 22.36;

when D is equal to or greater than the boundary value, the normal course of pregnancy is predicted for women who have had influenza A (H3N2) in the first trimester of pregnancy complicated by a retrochorial hematoma, and when D is less than the boundary value, premature birth is predicted for women who have had influenza A (H3N2) first trimester of pregnancy complicated by retrochorial hematoma.

The probability of a correct forecast is 87.7%.

The essence of the method is to determine in women with influenza A (H3N2) during the height of the disease in the first trimester of pregnancy, complicated by a retrochorial hematoma, discriminant function (D), in relation to which the boundary value of the discriminant function predicts the development of premature birth.

The method contains the following techniques:

1. Determine the titer of antiviral antibodies in the first serum during the peak of influenza A (H3N2) on days 2-4 of the disease (A) [1, 2];

2. Investigate the level of interferon-γ (pg / ml) in the first blood serum during the peak of influenza A (H3N2) on the 2-4th day of the disease, for example, using reagents from the Protein circuit company of St. Petersburg (B);

3. Evaluate the ultrasonic state of the villous chorion in points (1 point is the normal echostructure of the villous chorion; 2 points are a single retrochorial hematoma; 3 points are multiple retrochorial hematomas), for example, using the apparatus "Aloka SSD - 1700" (Japan) (C) ;

4. Determine the severity of the risk of miscarriage in points (1 point - aching pain in the lower abdomen for 1-3 days; 2 points - aching or cramping pains in the lower abdomen and spotting spotting from the genital tract from 1-3 days; 3 points - aching or cramping pains in the lower abdomen and spotting spotting from the genital tract for more than 3 days) (N);

5. Using the discriminant equation, determine the value of the discriminant function D:

D = -0.171 × A-0.268 × B-3.357 × C-0.803 × N, where D is the boundary value of the discriminant function equal to -22.36;

6. Predict the development of preterm labor in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy complicated by retrochorial hematoma: if D is greater than or equal to the boundary value, normal pregnancy is predicted, and if D is less than the boundary value of the discriminant function, development is predicted preterm birth in the second trimester of gestation in women who have had influenza A (H3N2) in the first trimester of pregnancy complicated by a retrochorial hematoma.

The probability of a correct forecast is 87.7%.

Example 1. Patient Z., 24 years old, came to the polyclinic at the Center for Phytosanitary Diseases with complaints of headache, dizziness, photophobia, sweating, chills, sore throat, runny nose and cough with a moderate amount of mucous sputum for 2 days and weakness. There was an increase in body temperature to 37.8 ° for 2 days. The titer of antiviral antibodies in blood serum obtained on day 2 was 1: 8 (A), the content of IFN-γ was 23.5 pg / ml (B), and a single retrochorial hematoma was determined by ultrasound analysis (2 points) (C) , and the woman complained of aching and cramping pains in the lower abdomen, spotting spotting from the genital tract for 2 days (2 points) (hC). Sonographically, the size of the uterus and embryo corresponded to the 9th week of gestation. Clinical diagnosis: Pregnancy 9 weeks. Influenza A (H3N2). Acute nasopharyngitis. The threat of miscarriage.

After introducing the above parameters into the discriminant equation, the following value of the discriminant function is established:

D = -0.171 × 8-0.268 × 23.5-3.357 × 2-0.803 × 2 = -15.99, i.e. more than the boundary value of the discriminant function equal to - 22.36.

The normal course of pregnancy was predicted in women who had influenza A (H3N2) in the first trimester of pregnancy, complicated by a retrochorial hematoma.

In the process of dynamic monitoring of the patient, normal development of the fetus before the term of childbirth was noted.

Example 2. Patient S., 25 years old, came to the polyclinic of the Dagestan Scientific Center for FPD with complaints of fever, headache, dizziness, photophobia, sweating, sore throat, runny nose, cough with a moderate amount of mucous sputum for 3 days and weakness. The titer of antiviral antibodies in serum obtained on day 3 was 1:32 (A), the IFN-γ level was 27.0 pg / ml (B), and multiple retrochorial hematomas were determined by ultrasound analysis (3 points) (C) , the woman complained of aching and cramping pains in the lower abdomen, spotting spotting from the genital tract for 2 days (2 points) (N). Sonographically, the size of the uterus and embryo corresponded to the 8th week of gestation.

Clinical diagnosis: Pregnancy 8 weeks. Influenza A (H3N2). Acute nasopharyngitis. The threat of miscarriage. Multiple retrochorial hematomas.

When the above parameters are introduced into the discriminant equation, the following value of the discriminant function is obtained:

D = -0.171 × 32-0.268 × 27.0-3.357 × 3-0.803 × 2 = -24.38, i.e. less than the boundary value of -22.36.

The development of preterm labor in the second trimester of gestation was predicted in women who had influenza A (H3N2) in the first trimester of pregnancy complicated by retrochorial hematoma.

During dynamic monitoring of a patient who had influenza A (H3N2) in the first trimester of gestation, complicated by retrochorial hematoma, premature birth was diagnosed at 22 weeks of gestation.

The forecasting method has passed clinical testing on the basis of DPC FPD. Using the proposed method, the prognosis of threatening preterm birth in 54 women who had influenza A (H3N2) in the first trimester of pregnancy complicated by a retrochorial hematoma was made.

Based on the observation of this category of patients, the sensitivity, specificity, and accuracy [3] of predicting preterm labor in women who had influenza A (H3N2) in the first trimester of pregnancy complicated by a retrochorial hematoma were calculated. True negative results were found in 25, true positive in 20, false positive in 4, false negative in 5. The sensitivity of the proposed method was 87.0%, specificity 86.2%, accuracy 86.5%.

Information sources used

1. Gorikov I.N., Lutsenko M.T., Andrievskaya I.A. Ultrasonic signs of primary placental insufficiency and a systemic inflammatory response in case of influenza A (H3N2) in women in the first trimester of pregnancy // Bull. fiziol. and patol. breathing. - 2016. - Issue. 59. - S. 44-48.

2. Influenza: A Guide for Physicians / Ed. Acad. RANS, prof. G.I. Karpukhin. - St. Petersburg: Hippocrates, 2001 .-- 360 p.

3. Karmazanovsky G. G. Assessment of the diagnostic significance of the method ("sensitivity", "specificity", "general accuracy") // Annals of surgical hepatology. - 1997. - T 2. - S. 139-142.

4. Kiryushchenkov P.A., Belousov D.M., Alexandrina O.S. Pathogenetic substantiation of the tactics of conducting chorionic and placental detachment in early pregnancy // Gynecology. - 2010. - T. 12, No. 1. - S. 36-39.

4. Kulavsky V.A., Syrtlanov I.R., Frolov A.L. Peculiarities of the course of pregnancy in women with a history of undeveloped pregnancies and fetal death at different gestational periods // Journal of Obstetrics and Women's Diseases. - 2007.- T. 56, Vol. 3. - S. 107-112.

5. Systemic syndromes in obstetric and gynecological practice: a Guide for physicians / Ed. HELL. Makatsaria. - M .: Medical Information Agency LLC, 2010. - S. 711-714.

6. Solovova L.D., Lineva O.I., Artyukh Yu.A., Kazakova A.V., Berdnikova I.A. Retrochorial hematoma: principles of complex therapy // Journal of Obstetrics and Women's Diseases. - 2012. - T 61, Iss. 4. - S. 104-107.

7. A method for predicting threatening preterm birth in women with the threat of early miscarriage: US Pat. 2344424 Ros. Federation: IPC G01N 33/53 / N.Yu. Borzova, N.Yu. Sotnikova, N.V. Kroshkina, I.B. Lepilova; applicant and patentee of the Federal State Institution Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkova. - No. 2007126889/15; declared 07/16/2007; publ. 01/20. 2009, Bull. No. 2.

8. Teturashvili N.K., Sidelnikova V.M., Veryasov V.N., Sukhikh G.T. The role of the cytokine system in the pathogenesis of habitual miscarriage and premature birth // Bulletin of the Association of Obstetricians and Gynecologists. - 1999. - No. 3. - S. 37-45.

Claims (4)

A method for predicting preterm birth in the second trimester of gestation, characterized in that the prediction is carried out in women who have had influenza A (H3N2) in the first trimester of pregnancy complicated by retrochorial hematoma, for which the level of antibodies to influenza A virus (H3N2) is determined in the first blood serum ( A) establish the concentration of interferon-γ in pg / ml (B), evaluate the state of the villous chorion in points: as 1 point with a normal echostructure of the villous chorion; as 2 points for hyperechoic villous chorion, 3 points for retrochorial hematoma (C), determine the severity of the threat of miscarriage in points: as 1 point in the presence of aching pains in the lower abdomen for 1-3 days, as 2 points in the presence of aching or cramping pain in the lower abdomen and spotting spotting from the genital tract for 1 to 3 days, as 3 points in the presence of aching or cramping pain in the lower abdomen and spotting spotting from the genital tract for more than 3 days (N), and then determine the prognosis zhdevremennyh delivery using discriminant equation: D = -0.171 × A-0.268 × B-3.357 × C-0.803 × N, where D is the discriminant function with a boundary value equal to "-22.36"; with D equal to or more than the boundary value, normal pregnancy is predicted, and with D less than the boundary value, premature birth is predicted in the second trimester of pregnancy in women who have the flu A (H3N2) in the first trimester of pregnancy complicated by a retrochorial hematoma.