RU2669730C1 - Method for predicting the risk of developing ischemic-cervical insufficiency in single-pregnancy, which resulted from assisted reproductive technologies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to obstetrics. Method consists in the fact that during the setting up for a clinical check-up, an anamnesis is collected and the prognostic index D is calculated from the formula D=2.311X1-2.509X2-5.612X3-3.102X4-5.821X5-4.468X6-3.984X7+const, where X1 – factor of infertility: if the patient has a tubal-peritoneal factor of infertility, then X1 = 1, if not, then X1 = 0; X2 – parity: if a patient with a history of obstetrical and gynecological history: medical abortions, regressing pregnancies, miscarriages in the anamnesis and she will have the first birth, then X2 = 1, if the patient is first-bred as a result of ART, then X2 = 0; X3 – the presence of history of ischemic-cervical (IC) insufficiency in the anamnesis: if the patient's previous pregnancies ended with late spontaneous miscarriages or early premature births or in previous pregnancies IC deficiency was detected, then X3 = 1, if not, then X3 = 0; X4 – the presence of gram-negative microflora in the bacteriological study of the lower part of the genital tract: if so, then X4 = 1, if not, then X4 = 0; X5 – an indication of the treated inflammatory diseases of the lower part of the genito-urinary tract caused by the ureaplasma and/or mycoplasma when preparing for the ART protocol: if so, X5 = 1, if not, then X5 = 0; X6 – presence in the patient of chronic diseases of ENT organs: if yes, then X6 = 1, if not, then X6 = 0; X7 – presence in the patient of an anamnesis of chronic inflammatory diseases of the appendages: if yes, then X7 = 1, if not, then X7 = 0; const = +1.906, and if the value of the obtained index D is less than zero, then a high risk of developing an IC of insufficiency is predicted, and if the value of D is greater than or equal to zero, then a conclusion is made about the absence of this risk in a pregnant woman.

EFFECT: method ensures timely detection in pregnant women of the risk group for the formation of IC deficiency, more careful observation and timely correction of this complication of pregnancy to reduce the frequency of late spontaneous miscarriages and early premature births.

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Description

The invention relates to medicine, namely to obstetrics, and relates to a method for predicting the formation of isthmic-cervical insufficiency in a single pregnancy, resulting from assisted reproductive technologies.

The tasks of solving reproductive problems in pairs are at the peak of relevance. Assisted reproductive technologies (ART) come to the fore in the system of assisting infertile couples. According to the reports of the Russian Association of Human Reproduction, in 2015 765 cycles of ART were performed per 1 million people, while in 2014 - 665 cycles [Register of ART. Report for 2015 Russian Association of Human Reproduction. Available at: http://www.rahr.ru/d_registr_otchet/RegistrVRT_2015.pdf (accessed October 10, 2017)]. The number of couples who have resorted to ART techniques is growing worldwide.

Pregnancies following the use of various assisted reproduction methods are more frequent than spontaneous (miscarriage, premature birth [Assisted reproductive technology and the risk of preterm birth among primiparas / Dunietz GL, Holzman C, McKane P, Li C, Boulet SL, Todem D. [et al]. // Fertil Steril. - 2015. - Apr; 103 (4): 974-979.e1. Doi: 10.1016 / j. Fertnstert. 2015.01.15]).

Miscarriage in the second trimester and early premature birth can be directly related to the time of undiagnosed and uncorrected ischemic-cervical insufficiency (ICI). According to domestic authors, the incidence of ICI during pregnancy after IVF is 20.6%, while after spontaneous pregnancy it is 4.4% [Zhukova E.V., Trifonova N.S., Aleksandrov L.S., Ishenko A.I. ., Borisova N.I., Nikonov A.P., Grineva AM Comparative evaluation of the frequency and structure of preterm labor in women after in vitro fertilization with donor and their own oocytes. Questions of gynecology, obstetrics and perinatology. 2017; 16 (3): 24-30. DOI: 10.20953 / 1726-1678-2017-3-24-30].

It is believed that the pathogenesis of ICN in each individual case is individual and often there is a combination of several factors. Pregnant women as a result of ART are a risk group for the formation of CPI. In this category of patients, it is especially important and necessary to predict this complication in time and take the necessary measures to correct it in order to bear and give birth to healthy children and improve the “take home baby” indicators.

There are various methods for predicting the formation of ICN. One of the common diagnostic methods for ICN is ultrasound cervicometry [Mancuso MS, Szychowski JM, Owen J, et al. Vaginal Ultrasound Trial Consortium. Cervical tunneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women. Am J Obstet Gynecol. 2010; 203: 259.e1-5]. A modern way to assess the condition of the cervix and predict ICI is the ultrasound elastography technique [Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation: a prospective observational study / S. Wozniak [et al.] // Ginekol. Pol. - 2015 .-- Vol.86. - P. 442-447].

The disadvantages of the known methods

1. Factors of obstetric, gynecological, somatic history of a pregnant woman are not taken into account.

2. All the above methods take into account the condition of the cervix, its shortening or softening, which already indicates the formation of ICN.

3. These methods do not allow the prevention of ICI, predicting it before the development of clinical manifestations.

A known method for predicting the development of isthmic-cervical insufficiency and premature birth [N. Linchenko, M. Andreeva, E. Shevtsova Premature birth and isthmic-cervical insufficiency. Prediction and prevention // Mlt and Child in Kuzbass - 2015. - No. 2 (61) - P.66-69], in which the obstetric history (multiple pregnancies, late pregnancy losses) was retrospectively analyzed; gynecological (chronic inflammatory diseases of the uterine appendages, PCOS, infertility, abnormalities of the uterus, infertility), somatic history of patients (obesity, congenital hyperplasia of the adrenal cortex) and the most significant data were singled out using non-parametric statistics.

The disadvantages of this method

4. The microbiological background of the course of pregnancy is not taken into account.

5. A prognostic formula has not been created based on risk factors for the formation of CPI.

6. The method does not take into account the specifics of pregnancy resulting from ART.

The problem to which the invention is directed, is to develop a method for predicting the risk of the formation of ischemic-cervical insufficiency in a single pregnancy, resulting from assisted reproductive technologies.

EFFECT: timely identification of pregnant risk groups for the formation of isthmic-cervical insufficiency, more careful monitoring and timely correction of this pregnancy complication in order to reduce the frequency of late spontaneous miscarriages and early premature births.

The claimed technical result is achieved by the fact that in women, when registering for a dispensary, an anamnesis is collected, patient parity, infertility genesis, indications of treated inflammatory diseases of the lower genitourinary tract caused by ureaplasma and / or mycoplasma in preparation for the ART protocol are established. are there indications of ischemic-cervical insufficiency in previous pregnancies, the presence of a history of inflammatory diseases of the uterine appendages, are there chronic inflammatory diseases of the ENT organs, is there a gram-negative microflora in the bacteriological study of the lower genital tract. Given these informative features, the prognostic index D is calculated by the formula:

D = 2,311X1-2,509X2-5,612X3-3,102X4-5,821X5-4,468X6-3,984X7 + const,

where X1 is the infertility factor: if the patient has tubal-peritoneal infertility factor, then X1 = 1, if not, then X1 = 0;

X2 - parity: if the patient has a burdened obstetric and gynecological history (medical abortions, regressing pregnancies, spontaneous miscarriages in the anamnesis) and she has the first birth, then X2 = 1, if the patient is still pregnant as a result of ART, then X2 = 0;

X3 - history of ischemic-cervical insufficiency: if the patient had previous pregnancies ended in late spontaneous miscarriages or premature premature births or during previous pregnancies was revealed isthmic-cervical insufficiency, then X3 = 1, if not, then X3 = 0;

X4 - the presence of gram-negative microflora in the bacteriological study of the lower genital tract: if so, then X4 = 1, if not, then X4 = 0;

X5 - an indication of the treated inflammatory diseases of the lower urinary tract caused by ureaplasma and / or mycoplasma in preparation for the ART protocol: if yes, then X5 = 1, if not, then X5 = 0;

X6 - the patient has chronic diseases of ENT organs: if yes, then X6 = 1, if not, then X6 = 0;

X7 - the patient has a history of chronic inflammatory diseases of the appendages: if yes, then X7 = 1, if not, then X7 = 0;

const = + 1,906,

and if the value of the obtained index D is less than zero, then a high risk of developing ischemic-cervical insufficiency is predicted, and if the value of D is greater than or equal to zero, then a conclusion is made about the absence of this risk in a pregnant woman.

The specificity of the method is 91.9%, sensitivity - 75.8%, efficiency - 84.3%.

Clinical examples of the implementation of the method for predicting the risk of the formation of isthmic-cervical insufficiency in a singleton pregnancy resulting from assisted reproductive technologies

Example 1. Patient P., 41 years old, re-pregnant, primiparous, who had a history of 1 medical abortion, 2 ectopic pregnancies. This pregnancy occurred after an episode of secondary infertility, tubal peritoneal origin. In the gynecological history, an indication of chronic inflammatory diseases of the uterine appendages deserves attention, however, there were no indications of treated inflammatory diseases of the lower urinary tract caused by ureaplasma and / or mycoplasma in preparation for the ART protocol. There was no indication of a chronic illness of ENT organs in a somatic history. In a bacteriological study of the contents of the cervical canal, a gram-negative flora (Escherichia coli 10 ^ 6) was sown.

D = 2,311 * 1-2,509 * 1-5,612 * 0-3,102 * 1-5,821 * 0-4,468 * 0-3,984 * 1 + l, 906

D <0

Therefore, this patient has a high risk of ICI formation. At 23 weeks, the patient was diagnosed with isthmic-cervical insufficiency, an obstetric pessary was installed. The patient was delivered at 37 weeks with a live full-term boy weighing 2690 g, 49 cm long, 6/7 points on the Apgar scale.

Example 2. Patient S. 37 years old, multiparous. This pregnancy occurred after an episode of secondary infertility of tubal-peritoneal origin. In the gynecological history, an indication of chronic inflammatory diseases of the uterine appendages, and treated cervicitis caused by ureaplasma deserves attention. There was no indication of a chronic illness of ENT organs in a somatic history. In a bacteriological study of the contents of the cervical canal, a gram-negative flora (Klebsiella pneumoniae 10 ^ 4) was sown.

D = 2,311 * 1 -2,509 * 0-5,612 * 0-3,102 * 1 -5,821 * 1 -4,468 * 0-3,984 * 0 + 1,906

D <0

Therefore, this patient has a high risk of ICI formation.

At 24 weeks, she is diagnosed with isthmic-cervical insufficiency, correction is performed by an obstetric pessary. The patient was delivered at 37 weeks with a live full-term boy weighing 3180 g, 49 cm long, 7/8 points on the Apgar scale.

Example 3. Patient K., 31 years old, first pregnant. This pregnancy occurred after an episode of primary infertility, tubo-peritoneal genesis. In the gynecological history, there were no indications of chronic inflammatory diseases of the uterine appendages and treated inflammatory diseases of the lower genitourinary tract caused by ureaplasma and / or mycoplasma in preparation for the ART protocol. There was no indication of a chronic illness of ENT organs in a somatic history. In a bacteriological study of the contents of the cervical canal, lactobacilli were seeded.

D = 2,311 * 1-2,509 * 0-5,612 * 0-3,102 * 0-5,821 * 0-4,468 * 0-3,984 * 0 + 1,906 D> 0

Therefore, this patient has a low risk of developing isthmic-cervical insufficiency.

During ultrasound cervicometry, there was no significant shortening of the length of the cervix, i.e. There were no data for the CPI. The patient was delivered at 39 weeks with a live healthy girl weighing 3340 g, length 50 cm, 7/8 points on the Apgar scale.

Thus, the proposed method for predicting the risk of formation of ischemic-cervical insufficiency in a single pregnancy resulting from assisted reproductive technologies allows the doctor to timely identify pregnant risk groups for the formation of ischemic-cervical insufficiency, to conduct more careful monitoring and timely correction of this pregnancy complication to reduce the frequency late spontaneous miscarriages and early premature births.

Claims (11)

A method for predicting the risk of development of ischemic-cervical insufficiency in a single pregnancy, resulting from assisted reproductive technologies, which consists in the fact that when enrolling in a dispensary, an anamnesis is collected and the prognostic index D is calculated by the formula: D = 2,311X1-2,509X2-5,612X3-3,102X4-5,821X5-4,468X6-3,984X7 + const, where X1 is the infertility factor: if the patient has tubal-peritoneal infertility factor, then X1 = 1, if not, then X1 = 0; X2 - parity: if the patient has a burdened obstetric and gynecological history: medical abortions, regressing pregnancies, spontaneous miscarriages in the anamnesis and she will have the first birth, then X2 = 1, if the patient is still pregnant as a result of ART, then X2 = 0; X3 - history of ischemic-cervical insufficiency: if the patient had previous pregnancies ended in late spontaneous miscarriages or premature premature births or during previous pregnancies was revealed isthmic-cervical insufficiency, then X3 = 1, if not, then X3 = 0; X4 - the presence of gram-negative microflora in the bacteriological study of the lower genital tract: if so, then X4 = 1, if not, then X4 = 0; X5 - an indication of the treated inflammatory diseases of the lower urinary tract caused by ureaplasma and / or mycoplasma in preparation for the ART protocol: if yes, then X5 = 1, if not, then X5 = 0; X6 - the patient has chronic diseases of ENT organs: if yes, then X6 = 1, if not, then X6 = 0; X7 - the patient has a history of chronic inflammatory diseases of the appendages: if yes, then X7 = 1, if not, then X7 = 0; const = + 1,906, and if the value of the obtained index D is less than zero, then a high risk of developing ischemic-cervical insufficiency is predicted, and if the value of D is greater than or equal to zero, then a conclusion is made about the absence of this risk in a pregnant woman.