RU2579421C1 - Method of predicting risk of progressive distress hypotrophic foetus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics and gynaecology, and can be used for prediction of risk of progressive distress hypotrophic foetus. In the gestational age is 18-21 weeks is Doppler monitoring of uterine arteries (UA) and Arteria umbilicalis (AU). Blood flow values UA and AU on the basis of pulsating index (PI) and taking into account the presence of chronic arterial hypertension (CHAG) in the mother. If PI UA ≥ 1.4 and the presence of CHAG; PI UA ≥ 2.20 and absence of CHAG; PI UA ≥ 1.40, but < 2.20 combined with PI at ≥ 1.37 and absence of CHAG, a risk of progressive distress hypotrophic foetus requiring delivery to 34 weeks.

EFFECT: method provides more accurate prediction of risk of progressive distress hypotrophic foetus by combined assessing Doppler UA and AU and availability in mother chronic arterial hypertension.

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Description

A method for predicting the risk of developing progressive distress of a hypotrophic fetus relates to medicine, namely to obstetrics and gynecology, and can be used to predict early to 34 weeks of progressive distress of a hypotrophic fetus.

Fetal growth retardation (PFR), caused by severe placental dysfunction, leading to the development of its critical conditions, requires early delivery as the only way to prevent perinatal losses. Delivery up to 34 weeks is accompanied by a high frequency of adverse perinatal outcomes as a result of a combination of hypoxic lesions of the central nervous system with severe respiratory distress of the newborn. Prediction of the development of PSA allows for timely diagnosis and dynamic monitoring of patients with the aim of choosing the optimal delivery time. The development of informative methods for predicting the progressive distress of a hypotrophic fetus, requiring delivery up to 34 weeks, is a key task in solving the problem of perinatal morbidity and mortality.

A known method for predicting the risk of developing progressive distress of a hypotrophic fetus, proposed by K. Harrington et al. using transvaginal dopplerometry of the uterine arteries (MA) and umbilical arteries (AP) in the interval from 12 to 16 weeks of pregnancy (Harrington K., Carpenter RG, Goldfrad C, Campbell S. Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation. Br. J. Obstet. Gynaecol. 1997; 104: 6: 674-81.) Pregnant women who subsequently developed progressive distress of the hypotrophic fetus had a significantly lower average blood flow velocity, lower volumetric blood flow and high indices of resistance in the studied vessels.

The disadvantage of this method is its complexity, because it requires transvaginal ultrasound and is used in non-screening periods up to 16 weeks of pregnancy, which is not suitable for widespread use at the stage of female consultation.

Closest to the technical result achieved is a method for predicting the risk of developing progressive distress of a hypotrophic fetus, proposed by C. De Paco et al. (De Paco, C, Ventura, W., Oliva, R., Miguel, M, Arteaga, Α., Nieto, A. and Delgado, JL (2014), Umbilical artery Doppler at 19 to 22 weeks of gestation in the prediction of adverse pregnancy outcomes. Prenat. Diagn., 34: 711-715. doi: 10.1002 / pd.4367), which consists in performing Dopplerometry MA and ΑΠ at 19-22 weeks of pregnancy, with subsequent determination of the risk of progressive distress of the hypotrophic fetus based on the combined assessment of dopplerometry and anamnestic data on maternal body mass index and smoking.

The disadvantage of this method is the inaccuracy of predicting early progressive distress of the hypotrophic fetus, since the method is carried out without taking into account the timing of the manifestation of this pregnancy complication, while the most severe outcomes occur when delivery is necessary up to 34 weeks.

The technical result of the proposed method is to increase the accuracy of predicting the risk of progressive distress of a hypotrophic fetus requiring delivery up to 34 weeks, based on a combined assessment of Dopplerometry MA and AP at 18-21 weeks of gestation and the presence of chronic arterial hypertension in the mother.

The technical result of the proposed method is achieved by the fact that dopplerometry is performed at a gestational age of 18-21 weeks, with an assessment of blood flow in MA and AP based on the pulsation index (PI) and taking into account the presence of chronic arterial hypertension (CAH) in the mother and PI MA> = 1.4 and the presence of HAT; PI MA> = 2.20 and the absence of CAH; PI MA> = 1.40, but <2.20 in combination with PI AP> = 1.37 and the absence of CAH, the risk of progressive distress of the hypotrophic fetus requiring delivery up to 34 weeks is predicted.

The method is as follows.

To illustrate the proposed method is given a figure in the form of a table.

The figure presents a statistical characteristic of the results of the examination of patients using the proposed method of progressive distress of the hypotrophic fetus, requiring delivery up to 34 weeks.

The claimed method uses equipment: ultrasound devices Voluson E8 (GE Healthcare) or any with the possibility of using convex transabdominal transducer with a frequency of 5 MHz, using seroscale imaging, pulse wave and color dopplerography.

When conducting a screening ultrasound examination (ultrasound) at 18-21 weeks of pregnancy in the patient’s position on the back with transabdominal access, dopplerometry of both uterine arteries and umbilical arteries is performed. In order to study blood flow in the uterine artery, the ultrasound probe is installed in the region of the lateral wall of the small pelvis, then bifurcation of the common iliac artery and the external iliac artery are determined during longitudinal scanning. After that, the sensor is moved medially to the lateral surface of the uterus to obtain an image of the uterine artery and registration of the characteristic blood flow velocity curves. Rating

blood flow in the umbilical arteries is carried out in the middle part at a sufficient distance from the place of entry into the placenta and the abdominal cavity of the fetus during apnea at a heart rate of 120 to 160 beats per minute. Dopplerometric blood flow indices in MA and AP are estimated on the basis of a pulsation index calculated automatically by an ultrasonic device as the ratio of the difference between the maximum systolic (C) and final diastolic (D) velocities to the average blood flow velocity (M): PI = (С-D) / M .

The risk of developing early progressive distress of the hypotrophic fetus is assessed based on the results of dopplerometry and the anamnestic features of the mother (the presence or absence of chronic hypertension).

With a PI MA> = 1.40 and a history of CAH, the patient is at high risk of developing progressive distress of the hypotrophic fetus, requiring delivery up to 34 weeks, and requires dynamic monitoring, including fetometry, dopplerometry of uteroplacental and fetal-placental blood flow every 2 weeks. In the absence of CAH, but PI MA> = 2.20, the patient also belongs to the high-risk group. In patients with no CAH and PI MA> = 1.40 <2.20, dopplerometry of the umbilical artery is performed, with PI AP> = 1.37; the patient is at risk. Patients with PI MA <1.40; as well as patients with PI MA> = 1.40 <2.20 with PI AP <1.37 and the absence of CAH belong to the low-risk group and do not need dynamic Doppler monitoring.

The essence of the proposed method is illustrated by the following examples:

 Clinical example 1.

Patient Ch., 33 years old (patient card No. 1349957), December 20, 2012 with ultrasound scan for 21 weeks, Dopplerometry of the uterine arteries (PI 2.41 and 1.94) and arteries were performed in the department of prenatal diagnosis of KGBU DTSAK

umbilical cord (PI 1.21). History of CAH has not been identified. Given the risk of developing progressive distress of the hypotrophic fetus, a dynamic observation was conducted with the control of fetometry and dopplerometry according to the claimed method. 03/01/2013 the patient was prematurely delivered operatively by combined indications from the mother and the fetus with a diagnosis of “Pregnancy 30 weeks. Severe preeclampsia on the background of extragenital pathology. Gestational diabetes. NDC according to the hypotonic type. Condition after surgical treatment of nodular thyrotoxic goiter. Chronic fetoplacental insufficiency subcompensated. Fetal growth retardation, asymmetric shape. Progressive distress of the hypotrophic fetus. " The weight of the newborn is 1260 g.; height - 42 cm. A newborn's assessment on the Apgar scale at 1 minute - 6 points, at 5 minutes - 7 points.

Clinical example 2.

Patient G., 33 years old (patient card No. 923465) with hypertension, 12/14/2012 with an ultrasound scan of 20 weeks, dopplerometry of the uterine arteries (PI 2.12 and 2.51) and umbilical arteries were performed at the Department of Prenatal Diagnosis PI 1.62). Given the risk of developing progressive distress of the hypotrophic fetus, a dynamic observation was conducted with the control of fetometry and dopplerometry according to the claimed method. 01/24/13 the patient was prematurely delivered operatively for progressive distress of the hypotrophic fetus in KGBUZ "PC (k) AK." The final diagnosis: "Pregnancy 27-28 weeks. Hypertension 1, risk 2. Chronic pyelonephritis, remission. Chronic fetoplacental insufficiency decompensated with critical circulatory failure. Fetal growth retardation, symmetrical shape. Progressive distress of the hypotrophic fetus." The weight of the newborn is 700 g; height - 30 cm. Assessment

a newborn on the Apgar scale at 1 minute - 6 points, at 5 minutes - 6 points.

Clinical example 3.

Patient K., 29 years old (patient card No. 2650666), with hypertension, on July 10, 2013, for a period of 21 weeks, an ultrasound scan was performed at the prenatal diagnosis department of the Diagnostic Center of Altai Krai. When conducting dopplerometry, the uterine artery PI indicators were 2.35 and 1.38; PI of the umbilical artery - 0.99. Despite the high risk of developing progressive distress of the hypotrophic fetus, no dynamic observation was conducted. 09.24.2013 the patient was admitted to the Department of Pregnancy Pathology of KGUZ "Perinatal Center (Clinical) of the Altai Territory" with a diagnosis of Pregnancy 32-33 weeks. Severe preeclampsia against the background of hypertension. Chronic fetoplacental insufficiency decompensated. Fetal growth retardation, asymmetric shape. Progressive distress of the hypotrophic fetus. " Against the background of preparation for delivery, antenatal fetal death occurred. Induced childbirth by a dead fetus was performed. The weight of the fetus is 1450 g.; height - 41 cm. The final pathological diagnosis: "Antenatal asphyxia of the fetus."

The inventive method examined 564 pregnant women at 18-21 weeks of gestation, including 178 patients subsequently delivered up to 34 weeks of pregnancy due to progressive distress of the hypotrophic fetus, and 186 patients with spontaneous preterm delivery through the natural birth canal for up to 34 weeks with no signs intrauterine suffering of the fetus (FIG.). A truly positive result was obtained in 123 patients; a false positive result in 13 patients, a truly negative result in 173 patients, a false negative result in 55 patients.

The inventive method has high accuracy of 81.3%; sensitivity - 69.1%; specificity - 93.0%; the study of PI MA and AP, followed by a combined assessment based on the presence / absence of CAH, allows for the early preclinical prediction of progressive distress of the hypotrophic fetus, dynamic monitoring for timely diagnosis and selection of the optimal delivery time.

The inventive method has non-invasiveness, simplicity and accessibility of the method; the possibility of conducting a screening examination of pregnant women at 18-21 weeks, which is suitable for widespread use at the stage of female consultation.

Claims (1)

A method for predicting the risk of developing progressive distress of a hypotrophic fetus, including dopplerometry of the uterine arteries (MA) and umbilical arteries (AP), characterized in that dopplerometry is performed at a gestational age of 18-21 weeks, with an assessment of blood flow in MA and AP based on the pulsation index (PI) and taking into account the presence of chronic arterial hypertension (CAH) in the mother and with PI MA ≥ 1.4 and the presence of CAH; PI MA ≥ 2.20 and in the absence of CAH; PI MA ≥ 1.40, but <2.20 in combination with PI AP ≥ 1.37 and the absence of CAH predict the risk of progressive distress of the hypotrophic fetus, requiring delivery up to 34 weeks.

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