RU2764952C1 - Method for predicting the risk of uterine hypotension in the early postpartum period in women of different somatotypes - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, in particular to obstetrics and gynecology, and can be used to predict the risk of uterine hypotension in the early postpartum period. The anthropometric data of the examined women for a period of up to 10 weeks are determined. Also, the indicators of serum albumin and iron in the third trimester of pregnancy, the presence of preeclampsia in this pregnancy are determined. The calculation is carried out according to the stated formula of the probability of developing uterine hypotension in the early postpartum period in a particular subject.EFFECT: method makes it possible to predict the risk of uterine hypotension in the early postpartum period by evaluating the complex of the most significant indicators.1 cl, 3 tbl, 6 ex

Description

The invention relates to medicine, in particular to obstetrics and gynecology, and can be used to predict the risk of developing uterine hypotension in the early postpartum period.

The relevance of the problem of predicting and preventing uterine hypotension is beyond doubt. Hypotension of the uterus is an obstetric pathology in which the retraction of the myometrium is impaired. A decrease in uterine tone is a complication that can lead to blood loss, up to the death of a woman in labor, as well as to postpartum septic diseases. Hypotension of the uterus can turn into atony. As shown in various studies, it is quite difficult to stop atonic bleeding, a woman in labor can die from hemorrhagic shock. Uterine atony is a risk factor for hysterectomy. Despite the achievements of modern obstetrics, the frequency of uterine hypotension according to WHO does not tend to decrease. [Radzinsky V.E. obstetric aggression. - M.: Status Praesens Publishing House. - 2011. - 688 p.; Obstetrics: A National Guide. / Ed. Savelieva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E. - M.: GEOTAR-Media. - 2015. - 1078 p.; Veres I.A. Risk factors for the occurrence and clinical symptoms of postpartum endometritis due to uterine hypotension // Innovations in Science. - 2017. - No. 10(71). - S. 41-43.; Grebennikova I.P. Hysterectomy in modern obstetrics // Bulletin of Medical Internet Conferences. - 2016. - V. 6. - No. 6. - S. 1179].

Considering the above, domestic and foreign scientists are actively searching for adequate algorithms and programs available in routine obstetric practice for predicting uterine hypotension in the early postpartum period, which will allow timely prevention of the development of this pathology.

It should be noted that at present there is no computer program for predicting uterine hypotension in the early postpartum period in women of different somatotypes, which is highly informative.

In recent years, a large amount of material has been accumulated, indicating a person’s constitutional and genetic predisposition to certain diseases, the specifics of the clinical picture depending on the type of individual human constitution, and the differences in the course of the adaptation process when changing climatic and geographical regions in individuals with different somatotypes [Nikolaev V .G. The use of the anthropological approach in clinical medicine / V.G. Nikolaev, A.I. Kobezhikov, N.G. Kobileva // Actual problems of morphology: Sat. scientific work. - Krasnoyarsk: KrasGMA Publishing House, 2008. - S. 93-95; Sergeev B.C. Constitutional somatotypes: diagnostic and treatment-and-prophylactic aspects / V.N. Sergeev, I.A. Kournikova, V.I. Mikhailov et al. // Bulletin of Neurology, Psychiatry and Neurosurgery. - 2014. - No. 5. - S. 75-105.]. The modern constitutional approach in medicine makes it possible to improve the quality of diagnostics, taking into account the hereditary and genealogical background and ontogenetic dynamics of development, to increase the effectiveness of primary and secondary prevention of diseases and to provide a high-quality medical prognosis [Nikolaev V.G. Methodical approaches in modern clinical anthropology / V.G. Nikolaev // Biomedical and Biosocial Anthropology. - 2007. - No. 9. - S. 1-9.].

Known "Method for predicting hypotension and atony of the uterus in the postpartum period", described in the work of Herbert W.N.J., Cefalo R. "Tactics of postpartum hemorrhage" [Herbert W.N.J., Cefalo R. Management of postpartum hemorrhage // Clin Obstet Gynecol. 1984; 27: 139-147]. In the proposed method, the authors take into account such signs as post-term pregnancy, polyhydramnios, large fetus, chorionamnionitis, the use of tocolytics, induction of labor, uterine fibroids, many births in history. If the above signs are present in the examined woman, a high risk of developing hypotension or atony of the uterus in the postpartum period is predicted.

Disadvantages of the known method: the authors of the work do not take into account anthropometric data, the somatotype of women, do not calculate the individual prognosis for the development of uterine hypotension in the postpartum period in women.

Known "Method for predicting atony and hypotension of the uterus", which consists in the fact that in the postpartum period determine the level of serum uric acid. With an increase in the level of serum uric acid, a high risk of atony and hypotension of the uterus is predicted. [Kovacheva VP, Soens MA, Tsen LC. Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery // Int J Obstet Anesth. 2013; 22(3): 200-208. doi: 10.1016/j.ijoa.2013.04.005].

The disadvantages of this method: the work did not take into account anthropometric data, the somatotype of women, did not calculate the individual prognosis for the development of uterine hypotension in the postpartum period in women.

Closest to the claimed invention is the "Method for predicting uterine subinvolution in the postpartum period", which consists in the fact that an ultrasound measurement of the anteroposterior size of the uterus and the thickness of the endometrium is performed 2 hours and 3 days after birth and the coefficient of involution (Kin) of the uterus is calculated by the formula: Kin \u003d A-B / a-b, where A is the anteroposterior size of the uterus (mm) 2 hours after birth, B is the thickness M - echo (mm) 2 hours after birth, a is the anteroposterior size of the uterus (mm) by 3 the th day of the postpartum period, b is the thickness of the M-echo (mm) on the 3rd day of the postpartum period, and with a Kin value of less than 1.3, subinvolution of the uterus is determined. [Ustyuzhanina N.V., Grebenkin B.E. A method for diagnosing subinvolution of the uterus in the postpartum period. Patent for invention RU 2431445].

The disadvantages of the known method: the authors of the work do not take into account anthropometric data, the somatotype of women.

In the studied scientific, medical and patent literature, no method was found for individual prediction of the risk of developing uterine hypotension in the early postpartum period in women of different somatotypes, therefore, the proposed method meets the criterion of novelty.

The aim of the invention is to develop a method for predicting the risk of developing uterine hypotension in the early postpartum period in women of different somatotypes.

This goal is achieved by the fact that in the proposed method, express diagnostics of the somatotype of women is carried out with an assessment of the body mass index.

Somatometry and somatotyping according to R.N. Dorokhov in women in early pregnancy (up to 10 weeks of gestation) [Dorokhov R.N. Experience in using the original metric scheme of somatotyping in sports and morphological studies. // Theor. and pract. physical cult. - 1991. - No. 1. - S. 14-20.; Petrukhin V.G. Sports morphology as an applied science. / V.G. Petrukhin, R.N. Dorokhov - M.: SportAcademPress. - 2001. - 163 p.].

When determining the somatotype, the following anthropometric indicators are used: 1) body weight, kg; 2) body length, cm; 3) the thickness of the skin-fat fold (SCF) on the shoulder in front, mm; 4) thickness of the LCL on the shoulder at the back, mm; 5) thickness of the CLJ on the forearm, mm; 6) thickness of the CL on the back, mm; 7) thickness of the CLJ on the abdomen, mm; 8) thickness of the CLJ on the thigh, mm; 9) thickness of the CLJ on the lower leg, mm; 10) shoulder girth, cm; 11) forearm girth, cm; 12) thigh girth, cm; 13) shin girth, see

Anthropometric measurements are carried out according to generally accepted rules and methods. Body length is measured by a medical stadiometer (with an accuracy of 0.5 cm), body weight - on a medical scale (with an accuracy of 100 g), longitudinal dimensions of the body - with an anthropometer (with an accuracy of 1 mm), girth measurements of the body - with a centimeter tape (with accurate to 0.5 cm). The thickness of the skin-fat folds (SCF) is determined by a caliper with a specially calibrated spring, which produces a pressure on the fold of 10 g per 1 sq. mm [Brozhek I. Determination of the components of the human body / I. Brozhek // Vopr. anthropology. - 1960. - Issue. 5. - S. 31-57].

Calculate the absolute and relative content of the main components of the body (fat and muscle tissue) according to the following formulas J. Mateigka [Kliorin A.I., Readers V.P. Biological problems of the doctrine of human constitutions. / A.I. Kliorin, V.P. Readers - L.: Nauka, 1979. - 164 p.; Matiegka J. The testing of physical efficiency / J. Matiegka // Amer. J Phys. Anthropol. - 1921. - Vol.4, No. 3. - P. 125-134.]:

a) Muscle mass is determined by the formula:

where M is absolute muscle mass (in kg); L - body length (in cm); r - the average value of the radii of the shoulder, thigh in places of greatest muscle development, without subcutaneous fat and skin on these parts of the body; k is a constant equal to 6.5.

b) The fat component of body weight is determined by the formula:

where D is the total amount of fat (in kg); k is a constant equal to 1.3; d is the average thickness of subcutaneous fat along with the skin (in mm); s is the surface of the body (in m ² ).

The surface of the body is determined by the formula B.A. Issakson (1958) [Issakson V.A. A simple formula for the arithmetry of the human body surface area / B.A. Issakson // Scand. J.Clin. Lab. Invest. - 1958. - Vol. 10. - P. 283-289]:

where S is the surface of the body (in m ² ); W - body weight (in kg); L - body length (in cm); Δ L - deviation of the height of the subject's body from 160 cm, indicating the plus sign (+) or minus sign (-).

c) the absolute content of bone tissue (in kg) is determined by the formula:

where K is the absolute content of bone tissue (in kg); L - body length (in cm); O - square of the average value of the transverse diameters of the distal parts of the shoulder, forearm, thigh and lower leg (in cm); k is a constant equal to 1.2.

The relative content of the main components of the body is determined by the formula:

The body mass index of the examined women is calculated using the formula:

where I - body mass index (in kg / m ² ), m - body weight (in kg), h - height (in m).

The somatic type is calculated from the dimensional variation according to R.N. Dorokhov (1991, 1994).

The assessment of the overall level of variation (GUV) is made according to the length and weight of the body, which are converted separately into conventional units using special tables [Dorokhov R.N. Experience in using the original metric scheme of somatotyping in sports and morphological studies. / R.N. Dorokhov // Teor. and pract. physical cult. - 1991. - No. 1. - S. 14-20.; Dorokhov R.N., Levchenkov V.A. Computer somatotyping. / R.N. Dorokhov, V.A. Levchenkov - Smolensk, 1993. - 36 p.].

First, conventional units of length and body weight are obtained according to the following formulas:

a) conv. units

- условные единицы длины тела,

- длина тела обследованных женщин (в см), С и D - коэффициенты, рассчитанные для длины тела, взятые из специальных таблиц (Дорохов Р.Н., 1991, 1993);where conv. units

- arbitrary units of body length,

- body length of the examined women (in cm), C and D - coefficients calculated for body length, taken from special tables (Dorokhov R.N., 1991, 1993);

b) conv. units

where conv. units m - conditional units of body weight, m - body weight of the examined women (in kg), C and D - coefficients calculated for body weight, taken from special tables (Dorokhov R.N., 1991, 1993).

Based on the obtained conventional units of length and body weight, somatotype scores are calculated:

which are entered into the somatotyping triangle and determine the somatic type by dimensional variation (Dorokhov R.N., 1991, 1993).

It is advisable to single out five main and two transitional somatic types, considering them not as discrete somatic types, but as fragments of a continuous series of variation. The following main somatic types are distinguished:

наносомный (НаС) тип - менее 0,200 баллов,

nanosomal (NaS) type - less than 0.200 points,

микросомный (МиС) тип - от 0,200 до 0,386 баллов,

microsomal (MiS) type - from 0.200 to 0.386 points,

мезосомный (МеС) тип - от 0,466 до 0,534 баллов,

mesosomal (MeS) type - from 0.466 to 0.534 points,

макросомный (МаС) тип - от 0,614 до 0,800 баллов,

macrosomal (MaS) type - from 0.614 to 0.800 points,

мегалосомный (МегС) тип - более 0,800 баллов, а также переходные соматические типы:

megalosomal (MegC) type - more than 0.800 points, as well as transitional somatic types:

микромезосомный (МиМеС) тип - от 0,386 до 0,466 баллов,

micromesosomal (MiMeS) type - from 0.386 to 0.466 points,

макромезосомный (МаМеС) тип - от 0,534 до 0,614 баллов.

macromesosomal (MaMeS) type - from 0.534 to 0.614 points.

The level of serum albumin (in g/l) and serum iron (in µmol/l) is determined on the Abbott biochemical analyzer in pregnant women in all trimesters of gestation according to well-known methods [Kamyshnikov B.C. Clinical and biochemical laboratory diagnostics: a Handbook. In 2 volumes - Minsk: Interpressservis, 2003. - T. 1: 495 p. T. 2: 463 s].

The data obtained from the examined women are entered into the SPSS statistical program. Correlation-regression analysis revealed a statistically significant relationship between uterine hypotension in the early postpartum period and fat (r=0.77; p<0.05), muscle mass (r=-0.81; p<0.05), somatotype of women (r=-0.79; p<0.05), serum albumin level in the third trimester of pregnancy (r=-0.88; p<0.05), serum iron level in the third trimester of pregnancy (r=- 0.84; p<0.05), and with the presence of preeclampsia in this pregnancy (r=0.73; p<0.05). Given the relationship between the above indicators (signs), in the course of multiple regression analysis, a regression equation (formula) is obtained for prognostic models that predict the development of uterine hypotension in the early postpartum period in women of different somatotypes:

VRGM \u003d - 1.82 - (79.86 × A) + (0.34 × B) + (1.39 × C) - (1.36 × D) + (1.89 × E) + (98, 23×F),

where VRGM is the probability of developing uterine hypotension in the early postpartum period (in %),

A - somatotyping scores,

B - fat mass of a woman (in%),

C - muscle mass of a woman (in%),

D - the level of albumin in the blood serum in the third trimester of pregnancy (in g / l),

E - the level of iron in the blood serum in the third trimester of pregnancy (in µmol / l),

F - the presence of preeclampsia in this pregnancy (1 - yes, 0 - no)

According to generally accepted scales [Aleksandrovich Yu.S., Gordeev V.I. Evaluation and prognostic scales in critical care medicine. - Publishing house "Sothis". - 2007. - 140 p.] the risk of developing a pathological process is divided into low, moderate and high. Upon receipt of the value of VRHF within less than 30%, the risk of developing uterine hypotension in the early postpartum period is low, within more than 60% - high. When obtaining a value of VRHF in the range from 30% to 60%, a moderate degree of risk of developing pathology is implied. This means that the closer the result is to 60%, the higher the likelihood of developing a pathological process (hypotonia of the uterus in the early postpartum period), and the closer the result is to 30%, the lower the likelihood of developing a pathological process (hypotension of the uterus in the early postpartum period).

Due to the lack of a significant relationship between bone mass and uterine hypotension in the early postpartum period, this component of body weight was not taken into account when obtaining the regression equation (formula). The data of the examined woman are substituted into the obtained formula, and according to the result obtained, the probability of developing uterine hypotension in the early postpartum period in a particular subject is judged.

Statistical research methods

Statistical processing of the data of the study presented by us was carried out using the application package STATGRAPHICS Plus 5.0 for Windows and SPSS 15.0 for Windows. Standard statistical methods were used [Gubler E.V. Computational methods for the analysis and recognition of pathological processes. - L .: Medicine. - 1978. - 294], including the calculation of arithmetic means, standard deviations, standard errors of the mean, multiple regression analysis. The significance of differences in groups was assessed using parametric methods (Student's t-test), for relative values, Pearson's ^{χ 2 -test was used.} Differences at a significance level of p<0.05 were regarded as significant.

Results. Characteristics of study groups

390 women were examined. Of the examined women, HO people were of macrosomatic body type, 173 were of mesosomatic body type, and 107 were of microsomatic body type. Of these, 233 (59.7%) women were nulliparous, and 157 (40.3%) were multiparous. The age of the examined women ranged from 18 to 38 years (mean age was 27.5±2.8 years).

The criterion for inclusion of women in the study was the absence of a history of severe somatic pathology, the gestational age of up to 9-10 weeks at the time of inclusion in the study, singleton pregnancy, the absence of anomalies in the development of the uterus, the absence of genital infantilism, the absence of a scar on the uterus.

We found that uterine hypotension in the early postpartum period (Table 1) was significantly more common in representatives of the macro- and microsomatic body types, compared with women with mesosomatotypes (p<0.05).

The levels of albumin and iron in the blood serum in all trimesters of pregnancy in the examined women are presented in Table 2. As can be seen from the data obtained, there were significant differences in all parameters in the examined groups (p<0.05). Thus, the level of albumin and iron in the blood serum was significantly lower in the group of women with subsequent uterine hypotension in the early postpartum period (p<0.05), and this trend was observed already from the first trimester of pregnancy.

Table 3 presents anthropometric indicators in the examined groups. The C and D coefficients for body length and body weight for women aged 18 to 38 years who are not involved in professional sports were: for body length C=135.42 and D=59.71, and for body weight C=8 .78 and D=107.74.

Examples of specific implementation of the method.

Example 1. Woman B., 27 years old, at 6-7 weeks of gestation, was carried out express diagnostics of the human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 49 kg; 2. body length - 159 cm; 3. body mass index (BMI) - 19.4 kg / m ² ; 4. body surface area - 1.49 m ² ; 5. thickness of the CLJ on the shoulder in front - 8 mm; 6. Thickness of the LCL on the shoulder at the back - 12 mm; 7. thickness of the CLJ on the forearm - 7.2 mm; 8. The thickness of the CLJ on the back is 13 mm; 9. thickness of the CLJ on the abdomen -16.5 mm; 10. thickness of the CLJ on the thigh - 17 mm; 11. thickness of the CLJ on the lower leg - 12.7 mm; 12. adipose tissue - 11.8 kg; 13. adipose tissue - 24.7%; 14. shoulder girth - 23 cm; 15. forearm girth - 20 cm; 16. thigh girth - 50.5 cm; 17. leg girth - 29 cm; 18. muscle tissue - 19.82 kg; 19. muscle tissue - 41%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined B. had a microsomatic type (0.38 points). At the gestational age of 28-29 weeks, the level of serum albumin was 38.3 g/l, the level of serum iron was 25.7 µmol/l. This pregnancy proceeded without signs of preeclampsia. VRGM according to the obtained formula was 31%.

The patient was delivered vaginally at 39 weeks' gestation. In the postpartum woman, the early postpartum period proceeded without signs of uterine hypotension, i.e. the actual data corresponded to the forecast for the proposed method.

Example 2. A woman T., 25 years old, at 6 weeks of gestation, underwent express diagnostics of a human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 44.5 kg; 2. body length - 156 cm; 3. body mass index (BMI) - 18.3 kg / m ² ; 4. body surface area - 1.46 m ² ; 5. thickness of the CL on the shoulder in front - 9 mm; 6. Thickness of the LCL on the shoulder at the back - 13.7 mm; 7. thickness of the CLJ on the forearm - 9 mm; 8. The thickness of the CLJ on the back is 14.7 mm; 9. thickness of the CLJ on the abdomen -17.6 mm; 10. Thickness of the FCL on the thigh - 18 mm; 11. thickness of the CLJ on the lower leg -14.4 mm; 12. adipose tissue - 12.47 kg; 13. adipose tissue - 28.5%; 14. shoulder girth - 21 cm; 15. forearm girth - 18 cm; 16. thigh girth - 47.5 cm; 17. leg girth - 26.5 cm; 18. muscle tissue - 15.8 kg; 19. muscle tissue - 35.5%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined T. had a microsomatic type (0.34 points). At 28-29 weeks' gestation, the serum albumin level was 30.5 g/l, the serum iron level was 6.1 µmol/l. This pregnancy proceeded against the background of preeclampsia. VRGM according to the obtained formula was 98.2%.

The patient was delivered through the natural birth canal at a gestational age of 38-39 weeks. The puerperal in the early postpartum period was observed hypotension of the uterus, ie. the actual data corresponded to the forecast for the proposed method.

Example 3. A 25-year-old woman K., at 7 weeks of gestation, underwent express diagnostics of a human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 62 kg; 2. body length - 169 cm; 3. body mass index (BMI) - 21.7 kg / m ² ; 4. body surface area - 1.7 m ² ; 5. thickness of the CL on the shoulder in front - 9 mm; 6. Thickness of the CLJ on the shoulder at the back - 14 mm; 7. thickness of the CLJ on the forearm - 9 mm; 8. Thickness of the LCL on the back - 15 mm; 9. the thickness of the CL on the abdomen - 18 mm; 10. Thickness of the FCL on the thigh - 18 mm; 11. thickness of the CLJ on the lower leg - 15 mm; 12. adipose tissue - 15.57 kg; 13. adipose tissue - 25.1%; 14. shoulder girth - 27 cm; 15. forearm girth - 24 cm; 16. thigh girth - 54.2 cm; 17. leg girth - 33 cm; 18. muscle tissue - 26.73 kg; 19. muscle tissue - 43%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined K. had a mesosomatic type (0.52 points). At the gestational age of 28-29 weeks, the level of serum albumin was 47.1 g/l, the level of serum iron was 21.2 µmol/l. This pregnancy proceeded without signs of preeclampsia. VRGM according to the obtained formula was 1.1%.

The patient was delivered vaginally at 38 weeks' gestation. In the postpartum woman, the early postpartum period proceeded without signs of uterine hypotension, i.e. the actual data corresponded to the forecast for the proposed method.

Example 4. A woman R., aged 24, at 7 weeks of gestation, underwent express diagnostics of the human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 74 kg; 2. body length - 178 cm; 3. body mass index (BMI) - 23.4 kg / m ² ; 4. body surface area - 1.89 m ² ; 5. the thickness of the CLJ on the shoulder in front - 10 mm; 6. Thickness of the KZhS on the shoulder at the back - 16 mm; 7. thickness of the CLJ on the forearm - 9 mm; 8. thickness of the CL on the back - 16.4 mm; 9. thickness of the CLJ on the abdomen - 21.7 mm; 10. Thickness of the CLJ on the thigh - 21 mm; 11. thickness of the CLJ on the lower leg - 15.3 mm; 12. adipose tissue - 19.4 kg; 13. adipose tissue - 26.1%; 14. shoulder girth - 29 cm; 15. forearm girth - 24.5 cm; 16. thigh girth - 58 cm; 17. leg girth - 36 cm; 18. muscle tissue - 31.87 kg; 19. muscle tissue - 43%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined R. had a macrosomatic type (0.64 points). At the gestational age of 28-29 weeks, the level of serum albumin was 42.2 g/l, the level of serum iron was 24.3 µmol/l. This pregnancy proceeded without signs of preeclampsia. VRGM according to the obtained formula was 4.3%.

The patient was delivered through the natural birth canal at 40 weeks' gestation. In the postpartum woman, the early postpartum period proceeded without signs of uterine hypotension, i.e. the actual data corresponded to the forecast for the proposed method.

Example 5. A woman N., 26 years old, at a 7-week gestation period, underwent express diagnostics of a human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 86 kg; 2. body length - 177 cm; 3. body mass index (BMI) - 27.5 kg / m ² ; 4. body surface area - 1.99 m ² ; 5. Thickness of the KZhS on the shoulder in front - 14 mm; 6. Thickness of the LCL on the shoulder at the back -22.5 mm; 7. thickness of the CLJ on the forearm - 10 mm; 8. Thickness of the FCL on the back - 20 mm; 9. the thickness of the CLJ on the abdomen - 27 mm; 10. thickness of the CLJ on the thigh - 26 mm; 11. thickness of the CLJ on the lower leg - 20 mm; 12. adipose tissue - 26.72 kg; 13. adipose tissue - 31%; 14. shoulder girth - 31 cm; 15. forearm girth - 26 cm; 16. thigh girth - 62 cm; 17. leg girth - 38 cm; 18. muscle tissue - 33.8 kg; 19. muscle tissue - 39%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined N. had a macrosomatic type (0.686 points). At the gestational age of 28-29 weeks, the level of serum albumin was 39.7 g/l, the level of serum iron was 4.2 µmol/l. This pregnancy proceeded against the background of preeclampsia. VRGM according to the obtained formula was 59%.

The patient was delivered vaginally at 39 weeks' gestation. The puerperal in the early postpartum period was observed hypotension of the uterus, ie. the actual data corresponded to the forecast for the proposed method.

Example 6. The woman S., 25 years old, at the gestational age of 6-7 weeks, was carried out express diagnostics of the human somatotype according to R.N. Dorokhov with an assessment of the body mass index.

Anthropometric measurements according to generally accepted rules and methods gave the following results: 1. body weight - 80 kg; 2. body length - 175 cm; 3. body mass index (BMI) - 26.1 kg / m ² ; 4. body surface area - 1.95 m ² ; 5. thickness of the CLJ on the shoulder in front - 12.5 mm; 6. Thickness of the CLJ on the shoulder at the back - 20.5 mm; 7. thickness of the CLJ on the forearm - 10 mm; 8. Thickness of the FCL on the back - 18 mm; 9. the thickness of the CLJ on the abdomen - 25 mm; 10. thickness of the CLJ on the thigh - 24.5 mm; 11. thickness of the CLJ on the lower leg - 18 mm; 12. adipose tissue - 23.61 kg; 13. adipose tissue - 29.5%; 14. shoulder girth - 30 cm; 15. forearm girth - 25 cm; 16. thigh girth - 60 cm; 17. leg girth - 37.5 cm; 18. muscle tissue - 32.14 kg; 19. muscle tissue - 40%.

The resulting conventional units of length and body weight were entered into the somatotyping triangle and the somatic type was determined by dimensional variation. The examined S. had a macrosomatic type (0.64 points). At the gestational age of 28-29 weeks, the level of serum albumin was 32.7 g/l, the level of serum iron was 8.1 µmol/l. This pregnancy proceeded against the background of preeclampsia. VRGM according to the obtained formula was 81.7%.

The patient was delivered through the natural birth canal at a gestational age of 38-39 weeks. The puerperal in the early postpartum period was observed hypotension of the uterus, ie. the actual data corresponded to the forecast for the proposed method.

Thus, carrying out calculations according to the above formula, which can be performed using a calculator or Microsoft Excel, makes it possible to predict with sufficient accuracy the prognosis of uterine hypotension in the early postpartum period, and also makes it possible to form high-risk groups for the development of this disease among patients for a long time. before delivery, which will contribute to a more effective implementation of therapeutic and preventive measures to prevent the development of uterine hypotension in the early postpartum period. The method in comparison with the known has the advantage that it is simple to implement and allows you to calculate an individual prognosis for the development of the disease.

Claims (10)

A method for predicting the risk of developing uterine hypotension in the early postpartum period in women of different somatotypes, including calculating the prognostic index of uterine hypotension in the postpartum period according to the formula, characterized in that anthropometric indicators are measured in the examined woman in the gestation period up to 10 weeks: body weight and length, thickness skin-fat folds on the shoulder in front, on the shoulder behind, on the forearm, on the back, on the abdomen, on the thigh, on the lower leg, the girth of the shoulder, forearm, thigh and lower leg, with the help of which the fat and muscle mass of the body is calculated according to the J. Mateigka formula , determine the somatotype according to the method of R.N. Dorohova, and then in the third trimester of pregnancy, the level of albumin and iron in the blood serum is determined, the presence of preeclampsia during this pregnancy is detected, the data obtained are entered into the formula VRGM \u003d -1.82 - (79.86 × A) + (0.34 × B) + (1.39 × C) - (1.36 × D) + (1.89 × E) + (98, 23×F), where VRGM is the probability of developing uterine hypotension in the early postpartum period, in%, A - somatotyping scores, B - fat mass of a woman, in%, C - muscle mass of a woman, in%, D - the level of albumin in the blood serum in the third trimester of pregnancy, in g / l, E - the level of iron in the blood serum in the third trimester of pregnancy, in µmol / l, F - the presence of preeclampsia in this pregnancy: 1 - yes, 0 - no, and according to the result obtained, from 60% to 100% predict a high risk of developing uterine hypotension in the early postpartum period.