RU2593981C1 - Method for individual prediction of foetal death with subsequent selection of obstetric approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics and gynaecology, and can be used for individual prediction of antenatal fetus death in pregnant women and selection of optimised obstetric approach depending on prediction results. In pregnant women on 32 week of pregnancy the presence of factors influencing course and outcome of pregnancy are defined: social-biological factors, common and obstetric-gynaecologic anamnesis, extra-genital diseases, special aspects and complications of pregnancy, fetus condition, clinical-laboratory-instrumental findings, treatment-induced defects accompanying pregnancy. Define in points according to the prognostic table of fetus death their prognostic coefficients, denoted by sign "+" in case of aggressive nature factor and sign "-" in case of its protective nature. Derived prognostic coefficients are summed up. If total score is “+13 or more” antenatal fetus death is predicted. At such prognosis daily monitoring with the help of cardiotocography with estimation by W. Fisher scale is performed and biophysical profile by A.M scale is estimated twice a week. Vintzeleos. In case of normal and satisfactory condition of fetus pregnancy is prolonged and examination of fetus condition is continued in the same mode. In case of doubtful and poor condition of fetus patient is approved for labor by Cesarean section within 1-3 hours. If total score is “-13 or less”, absence of antenatal fetus death is predicted and pregnancy is prolonged. If total score is “more than -13 and less than +13” prognosis is considered to be uncertain. Note here that fetus condition is monitored two times a week using cardiotocography and fetus biophysical profile is estimated once a week. In case of normal and satisfactory condition of fetus pregnancy is prolonged and examination of fetus condition is continued in the same mode. In case of doubtful and poor condition of fetus patient is approved for labour by Cesarean section routinely.

EFFECT: method enables accurate, objective and effective individual prediction of fetus death during pregnancy, optimise obstetric approach due to integrated assessment and taking into account the most significant prognostic factors, as well as optimum mode of fetus monitoring.

1 cl, 1 dwg, 1 tbl, 4 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used for individual prediction of antenatal fetal death in pregnant women and the selection of rational obstetric tactics depending on the results of the forecast.

до

. Снижение ее происходило преимущественно за счет ранних неонатальных потерь при менее значительном снижении мертворождаемости, в частности антенатальной смертности, составлявшей 54% от всех перинатальных потерь (Демографический ежегодник России 2012. Статистический сборник. Федеральная служба государственной статистики. // Росстат. - М. - 2012. - С. 201-214, 516; Стародубов В.И., Суханова Л.П. Репродуктивные проблемы демографического развития России. - М.: ИД «Менеджер здравоохранения». - 2012. - С. 158). По последним данным РОССТАТА уровень ПС в 2012 г. в нашей стране повысился и составил

. При этом наблюдается рост всех ее компонентов и в первую очередь антенатальной смертности. Кроме того, в ближайшие годы в России прогнозируют снижение рождаемости, что обусловлено вступлением в репродуктивный возраст малочисленного поколения родившихся в 90-е годы. Таким образом, проблема репродуктивных потерь не только не теряет своей актуальности, а постоянно повышает к себе интерес отечественной научной общественности.In Russia, from 2001 to 2011, there was a downward trend in perinatal mortality (PS) with

before

. Its reduction occurred mainly due to early neonatal losses with a less significant decrease in stillbirth, in particular antenatal mortality, which accounted for 54% of all perinatal losses (Demographic Yearbook of Russia 2012. Statistical Bulletin. Federal State Statistics Service. // Rosstat. - M. - 2012 . - S. 201-214, 516; Starodubov V.I., Sukhanova L.P. Reproductive problems of the demographic development of Russia. - M .: Publishing House "Health Manager." - 2012. - P. 158). According to the latest ROSSTAT data, the PS level in 2012 in our country increased and amounted to

. At the same time, there is an increase in all its components and, in the first place, antenatal mortality. In addition, in the coming years, Russia is forecasting a decrease in the birth rate, which is due to the entry into the reproductive age of the small generation born in the 90s. Thus, the problem of reproductive losses not only does not lose its relevance, but constantly increases the interest of the domestic scientific community.

At the same time, the work of scientists is focused on identifying the causes and identifying the pathological mechanism of perinatal complications, improving existing and developing new methods for assessing reproductive potential, diagnosing perinatal pathologies, and searching for markers that predict the deterioration of the fetal health.

So there is a known method for predicting antenatal fetal death, proposed by Sagamonova K.Yu., Pogorelova T.N., Palieva N.V., Zamanskaya T.A., Evseeva 3.P., Kovpiy Yu.V., Melkonov E.U. , Klepikova A.A. (patent RU 2009140816, 2011), which consists in determining the blood serum of pregnant women (starting from 22-23 weeks of gestation) the level of D-dimer, with its value of 400-740 ng / ml, antenatal fetal death is predicted.

A significant drawback of the known method is the non-specificity of the proposed marker for predicting a specific variant of perinatal outcome - antenatal fetal death, due to the ability of the D-dimer to increase the serum of pregnant women with hypercoagulation complications of gestation, such as preeclampsia, premature placental abruption and extragenital diabetes of pregnant women ( kidney disease). In this regard, an increase in the level of D-dimer in the blood serum of pregnant women should be considered as a prognostic criterion for a possible threat of antenatal fetal death.

Thus, the use of modern medical technologies must be combined with the scientifically based multifactorial prognosis of perinatal pathology. This direction is very promising in obstetrics.

There are a number of scientific works based on the use of multivariate forecasting methods using computer technology (Ermoshenko B.G. Prediction of the course and outcome of pregnancy and childbirth: Dis ... Dr. med. Sciences. - St. Petersburg, 1991. - 189 p .; Zarubina E.N. Prediction of perinatal outcomes and the choice of delivery method: Abstract of thesis ... Dr. med. Sciences - Moscow, 1995. - 42 p .; Bashmakova N.V. Preclinical diagnosis and prognosis of perinatal pathology in a model of the population of pregnant women large industrial center: Author .dis ... doctor of medical sciences. - Moscow, 1999. - 53 pp .; Mamiev OB Prediction of the condition of the fetus and newborn in childbirth and the early neonatal period. - Astrakhan. - 2004. - 40 pp .; Mamiev O .B. Clinical and prognostic criteria for normal and impaired adaptation to birth stress in the mother and fetus: Abstract of thesis ... of a doctor of medical sciences. - Kazan, 2006. - 52 p.).

From the practice of medicine, methods for predicting perinatal pathology are known, which include summing the scoring equivalents of risk factors found in pregnant women.

The most widely used method L.S. Persianinova in the modification of O.G. Frolova and E.I. Nikolaeva. The universal scale for assessing perinatal risk factors developed at the same time was regulated by order of the USSR Ministry of Health No. 430 dated 04/22/81, “On the Approval of Guidelines for Organizing the Work of Women's Counseling”. However, in the context of the rapid progress of domestic science, the chronological correction of the epidemiology of diseases and pregnancy complications, changing working and living conditions, a number of factors, with their overall small numbers (72 factors), have become less significant at present. In this technique, there are no strictly delineated algorithms for dividing patients into risk groups, and therefore the boundaries of the choice of tactics for managing pregnancy and delivery do not look clear. All this contributed to a decrease in the prognostic significance of the OG scale. Frolova and E.I. Nikolaeva and led to its cancellation by order of the Ministry of Health of the Russian Federation of February 10, 2003 N 50 "On improving obstetric and gynecological care in outpatient facilities."

A known method of assessing risk factors for pregnancy and upcoming birth using the monitoring scale of pregnant women at risk is proposed by A. Fayzullin. (patent RU 2335236, 2008) and which consists in determining a pregnant woman with a subsequent assessment in terms of socio-biological factors, obstetric and gynecological history, extragenital diseases, pregnancy complications and the condition of the fetus. Then the points are summed up and, on the basis of the amount received, the course and outcome of pregnancy is estimated as follows: less than 30 points are favorable (further monitoring and delivery are carried out in obstetric institutions of the central district or city hospital); 31-49 points - doubtful (the tactics of further pregnancy and delivery are determined in the inter-district perinatal center or city maternity hospital); 51-99 points - unfavorable (the tactics of further pregnancy and delivery are determined in the republican perinatal center or regional or regional maternity hospital); 101 or more points are extremely unfavorable (with emergency hospitalization at the nearest obstetric care institution for intensive care of the existing pathology, calling a specialized team "for yourself" and the need to resolve the issue of the advisability of prolonging pregnancy). During the gestational period, the risk group is assessed three times: 1 - when a pregnant woman is registered with a antenatal clinic, 2 - at 20-24, 3 - at 30-34 weeks of pregnancy.

The disadvantages of the proposed method are:

- the lack of accounting for the retrospective result of the pregnancy outcome for the puerpera and the newborn and the related lack of correlation between the specific prognostic weight of each risk factor in the prenatal period and the outcome of the pregnancy outcome, which does not allow a comprehensive and objective assessment of the degree of pregnancy risk;

- the use of obsolete terminology and classification of gestosis, which was changed in accordance with ICD X revision in accordance with the order of the Ministry of Health of the Russian Federation No. 170 dated 05/27/1997 “On the transition of organs and healthcare institutions of the Russian Federation to the International Statistical Classification of Diseases and Problems Related to Health X review (as amended on January 12, 1998) ”, the relevant clinical protocols for the provision of medical care were adopted (2012), federal clinical recommendations were given (2013);

- interpretation of antenatal fetal death - one of the options for perinatal outcome as a risk factor for the condition of the fetus, which does not correspond to the main purpose of the proposed method - predicting the outcome of pregnancy, the use of a differentiated algorithm of actions in the process of pregnancy and a decrease in maternal and perinatal losses;

- the lack of consideration among the risk factors of the group of complications induced by medical staff during pregnancy and childbirth (iatrogenic factor) (Savelyeva G.M., 2007, Radzinsky V.E., 2011), which reduces the possibility of an objective forecast and the effectiveness of treatment and preventive measures, undertaken in connection with its results;

- a distorted assessment of the absence of a risk factor: in the absence of a risk factor, its score is equal to zero instead of determining a numerical value with a "-" sign ("minus"), which does not correspond to the method used by the authors A.A. Genkina and E.V. Gubler (EV Gubler. Computer science in pathology, clinical medicine and pediatrics. - L .: Medicine - 1990. - P. 44-99) and reduces the objectivity of the prognosis, artificially inflating the integrative assessment of perinatal risk.

A known method proposed by Knyazev S.A., Orazmuradov A.A., Radzinsky V.E., Kuzmina N.V., Gagaev Ch.G., Zlatovratskaya T.V., Galina T.V. in 2009, aimed at improving the accuracy of predicting perinatal morbidity and taking into account the perinatal transition (Radzinsky V.E., Kostin I.N. Obstetric risk. Maximum information minimum risk for mother and baby. - M .: Eskmo. - 2009. - S. 75-186). The specified method consists in determining the presence of anamnestic factors: socio-biological risk factors, obstetric-gynecological anamnesis factors, extragenital diseases of the mother and pregnancy factors: pregnancy complications, assessment of the fetus. The authors also conduct additional laboratory and instrumental examination. The identified factors are assigned scores using the “Modified Perinatal Disease Prediction Scale”, then the identified scores are summarized and, with a score of up to 15, a low degree of risk of perinatal morbidity is predicted, with a score of 15 to 25 an average degree, with a score of more than 25 a high degree (patent RU 2369331, 2009).

The disadvantages of this method, requiring further improvement, are:

- the use of obsolete terminology and classification of gestosis;

- the complexity and material cost of conducting some biochemical studies in droves.

In addition, all the above methods of multifactorial forecasting are united by one key feature that affects the practical significance and applicability of these techniques, a clear tendency to the abstractness of the purpose of the invention. Prediction of “perinatal pathology”, “perinatal morbidity” and “assessment of the degree of individual risk of possible complications of the gestational period and upcoming birth” using the created or modified risk scales, although it increases the physician’s alertness for specific patients with the subsequent determination of the level of medical care and the basics of tactical and preventive measures in accordance with the forecast, still does not contribute to the necessary orientation of the obstetrician-gynecologist in the time of onset and the spectrum of expected complications. Using known methods, the doctor, unfortunately, cannot predict which complications, what severity and when (during gestation, childbirth or in the early neonatal period) will occur.

Antenatal losses inflict significant social (decreasing life expectancy by 1-2 years) and economic (decreasing the participation of each generation in the process of social production by 2-3%) losses (Denisova TG Ways to improve management of the prophylaxis process of antenatal and intranatal losses at the regional level (based on the materials of the Chuvash Republic): Author's abstract of thesis ... Dr. med. sciences. - Kazan, 2008. - 43 p.). This is especially important, since today the preservation of every viable fetus and newborn has acquired strategic importance for society. Meanwhile, neither in the patent, nor in the scientific medical literature, as well as in the medical practice of forecasting, it is unknown about the existence of a method that allows simultaneously differentially predicting antenatal fetal death and preventing it by rational obstetric tactical measures.

The aim of the present invention is to improve the accuracy and objectivity of predicting fetal death during pregnancy, optimizing and individualizing obstetric tactics aimed at reducing the likelihood of an unfavorable prognosis.

The specified technical result is achieved by the fact that pregnant women at 32 weeks of gestation reveal the presence of factors that influence the course and outcome of pregnancy and determine their prognostic factors in points, indicated by a “+” sign in the case of an aggressive nature of the factor and a “-” sign in case of protective nature (table No. 1), namely socio-biological factors: age at the time of this pregnancy 15-19 years as +5.7, age at the time of this pregnancy 20-24 years as -2.9, age at the time of this pregnancy 25-29 years as -1.5, age at the time of this pregnancy 30 years and older as +4.8, unregistered marriage as +3.7, registered marriage as -1.9, primary education as +2.7, secondary - as +2.2, secondary education - as -0.6, higher - as -1.5, housewife as +1.6, studying as +12.7, working as -1.5, smoking as +11.3 , does not smoke like -1.3, suffers from alcoholism as +14.7, does not suffer - like -0.3, uses drugs like +10.5, does not use - like -0.1; general anamnesis: the anamnesis is aggravated by allergic diseases as +7.8, not aggravated as -0.5, the anamnesis is aggravated by blood transfusion as +10.5, not aggravated as -0.1, diseases of the cardiovascular system were as +2, 7, there wasn’t like -0.5, diseases of the respiratory system were like +3.5, there wasn’t like -7.6, viral hepatitis was like +2.7, it wasn’t like -0.1, pyelonephritis was like +2 was not like -0.2; obstetric and gynecological history: menarche at the age of 11-15 years as -0.2, at the age of 16 and more years as +1.5, meager menstrual flow as +6.5, moderate as -0.4, copious as +1, the onset of sexual activity before 18 years old as +0.5, after 18 years old as -0.4, inflammatory diseases of the genitals were like +3, there wasn’t like -3.1, sexually transmitted infections were like +9 , 4, it was not like -1.7, infertility of 5 years or more was like +8.7, it was not like -0.1, the age at the time of the first pregnancy was 15-19 years old as +0.4, age at the time the onset of the first pregnancy of 20-24 years as -0.7, during growing at the time of the first pregnancy of 25-29 years as +0.5, age at the time of the first pregnancy of 30 years and older as +2.7, two or more pregnancies in history as +1.6, one pregnancy - as -2 , the absence of pregnancies - as -1, two or more births in the anamnesis as +3.4, some births - as -2, the absence of births - as +0.4, the birth of children weighing less than 2.5 kg as +17.5, the birth of children weighing from 2.5 to 4 kg as -0.5, the birth of children weighing more than 4 kg as +8.7, the antenatal loss of the fetus in the anamnesis is as +11.7, not as -0.2, the death of a child in early neonatal period in I have a history of being like +1.7, not like -0.1, spontaneous miscarriages in a nulliparous were like +6, there wasn’t like -0.3, anomalies in children were like +8.7, there wasn’t like -0.1 , artificial abortions were like +2.4, there wasn’t like -1.6, artificial abortions before real pregnancy were like +1.3, there wasn’t like -0.5; extragenital diseases: vegetative-vascular dystonia by hypertonic type is as +3.5, not as -0.1, vegetative-vascular dystonia by hypotonic type is as +1.2, not as -0.1, varicose disease is like + 2.1, no like -0.2, thyroid disease is like + 6.1, no like -0.3, diabetes is like +8.7, no like -0.1, obesity is like +7.2 , body mass deficit as +2.4, normal weight as -0.7, anemia of 2-3 degrees is as +1.7, not as -0.2, high myopia is as +8.7, not as - 0.1; features and complications of a real pregnancy: unwanted pregnancy as +23, desired as -2.4, conception season - spring as -1.8, summer as -3.5, autumn as +6, winter as +10.8, setting registration in the antenatal clinic up to 20 weeks as -3, after 20 weeks as +15.6, was not registered as +1.4, visits to the antenatal clinic as regular as -2.4, irregular as +6.2, acute respiratory viral infection with fever is like + 4.8, not like -1.8, gestational pyelonephritis is like + 2.5, not like -0.3, early toxicosis is like +2, not like -0.3, caused by pregnancy edema is as +2.5, not as -0.4, pregnancy-induced hypertension without significant proteinuria is as +7.8, not as -0.5, severe preeclampsia is as +10.5, not as -0.1 , Rhesus sensitization is like +8.7, not like -0.1, polyhydramnios like +7.5, low water like +2, normal amount of water like -1.5, pelvic presentation is like +8.3, not like -0.6, the threat of abortion before 20 weeks is like +0.5, not like -0.1, the threat of abortion after 20 weeks is like +7.8, not like -1, the recurring threat of abortion is like + 2.7, no like -0.3, parade ground There are ents like +10.5, no like -0.1, premature detachment of a normally located placenta is like +8, no like -0.4, uterine rupture is like +11.7, no like -0.1, umbilical cord pathology there is like +12, no like -1.7, chronic placental insufficiency is like +7.3, no like -2.8, inflammatory diseases of the genitals are like +7, no like -4.4, sexually transmitted infections, during pregnancy, it’s like +12.7, no like -2, mixed infection is like +7.5, no like -0.4, chorioamnionitis is like +17, no like -0.5, uterine fibroids are like +2, 7, no as -0.1, induced pregnancy is ka 20, there is as -1; the fetus and its condition: male as +1.5, female as -1.8, fetal growth retardation syndrome is as +8.4, not as -1.2, acute fetal hypoxia is as +6.5, not as -0.3, chronic fetal hypoxia is as +8.6, not as -1.3, congenital malformations of the fetus are as +7.2, not as -0.4; the results of clinical, laboratory and instrumental examination of pregnant women: the blood group of the pregnant woman is the first as -0.4, the second as -0.8, the third as +1.2, the fourth as +3.5, height 155 cm and less as +7, height 156-170 cm as -1, height 171 cm and more as +3.5, pregnancy gain 6 kg or less as +4, pregnancy gain 7-12 kg as -2.3, pregnancy gain 13 kg or more as +6.2, d. spinarum 24 cm or less as +1.4, d. spinarum 25 cm or more as -0.7, d. cristarum 26 cm or less as +3, d. cristarum 27-28 cm as -2, d. cristarum 29 cm or more as +3, d. trochanterica 29 cm and less as +4.8, d. trochanterica 30-33 cm as -0.9, d. trochanterica 34 cm and more as +2.1, c. externa 19 cm and less as +3, c. externa 20 cm or more as -0.6, the number of red blood cells in the blood 4 × 10 ¹² and less as +0.9, the number of red blood cells in the blood 4.1 × 10 ¹² and more as -4.5, hemoglobin 109 g / l and less than +2, hemoglobin 110 g / l or more as -1, color index 0.99 or less as +1.5, color index 1 or more as -6.2, white blood cell count 7.9 × 10 ⁹ and less as +4.6, the number of white blood cells in the blood 8-9.9 × 10 ⁹ as -4, the number of white blood cells in the blood 10 × 10 ⁹ or more as +3.6, the recalcification time of 90 seconds or more as +1 , 6, recalcification time 89 sec or less as -1, heparin time 31-45 sec as -1, heparin time 46-50 sec as +2.4, platelets 219 × 10 ⁹ and less as +3, platelets 220 × 10 ⁹ and more as -1.5, fibrinogen A 3.59 g / l and less as +2, fibrinogen A 3.60 - 4.79 g / l as -2.6, prothrombin index (IPT) 90% or less as +3.7, prothrombin index 91-95% as -3.7, prothrombin index 96% or more as +4, 4, the level of plasma tolerance to heparin 6 min 59 sec or less as +9.5, the level of plasma tolerance to heparin 7 min or more as -0.1, proteinuria is as +5.2, not as -1.4, bacteriuria there is like +6.8, no like -0.4, leukocyturia is like +4.5, no like -0.5, hematuria is like +6.8, no like -0.4, the number of white blood cells in a smear from the vagina of 25 or more in the field of view as +3.9, less than 25 in the field of view as -0.2, the epithelium in the smear from the vagina "layer" as +5.6, the epithelium of 25 or less in the field of view as -1 , 1, cocci in the vaginal smear are “moderately” and “much” like +4.7, “little” like -6.6, yeast in the smear from the vagina is like +0.3, not like -0.4, key cells in the smear from the vagina there is +3.3, not as -0.2, intrauterine infection markers according to the results of ultrasound examination are as +5.5, not as -1.1, short fetal heart rate variability according to the results of cardiotocography 5 ms. and less than +10, more than 5 ms. as -2.8, the assessment of the condition of the fetus according to Fischer according to the results of cardiotocography of 7 points and less as +9, the assessment of the condition of the fetus according to Fisher according to the results of cardiotocography of 8 points or more as -2; iatrogenic defects in the management of this pregnancy and delivery: untimely diagnosis of pregnancy complications in the antenatal clinic, the absence of an appropriate examination plan and patient management is as +11.5, not as -2.2, the patient has not been examined for sexually transmitted infections, there is how +7, no as -1.3, the consultant's recommendations have not been implemented, there are +8.7, no as -0.1, operative delivery has not been performed; if there is evidence, there is +12.7, no as -0.2, received prognostic coefficients summarize and with sum e predictive coefficients equal to "13" or more points predict fetal death, with such prediction performed daily fetal monitoring via CTG with the evaluation scale W. Fisher and twice weekly evaluate biophysical

A.M. fetal profile Vintzeleos (Figure 1), when assessing the condition of the fetus equal to "8 or more" points, according to the results of cardiotocography and / or achieving a short heart rate variability of the fetus "more than 5" milliseconds and / or biophysical profile of the fetus equal to "8 or more" points, which corresponds to a normal and satisfactory condition of the fetus, the pregnancy is prolonged, continuing to examine the condition of the fetus in the same mode, and when assessing the condition of the fetus equal to "7 or less" points, according to the results of cardiotocography and / or short heart rate variability LfTetanus rhythm fruit "is 5 or less" milliseconds, and / or fetal biophysical profile equal to "7 or less" points that corresponds questionable and unsatisfactory fetal condition, the patient rodorazreshayut by cesarean section for 1-3 hours; with the sum of prognostic factors equal to "-13 or less" points, the absence of antenatal death of the fetus is predicted, and pregnancy is prolonged; with the sum of prognostic factors equal to a value in the range of "greater than -13 and less than +13" points, the prognosis is considered uncertain, and therefore the fetus is monitored twice a week using cardiotocography with a rating on the W. Fisher scale and one once a week evaluate the biophysical profile of the fetus on an AM scale Vintzeleos, when assessing the condition of the fetus equal to "8 or more" points, according to the results of cardiotocography and / or achieving a short variability of the fetal heart rate of "more than 5" milliseconds and / or the biophysical profile of the fetus equal to "8 or more" points, which corresponds to normal and a satisfactory condition of the fetus, pregnancy is prolonged, continuing to examine the condition of the fetus in the same mode, and when assessing the condition of the fetus equal to "7 or less" points, according to the results of cardiotocography and / or achievement of short heart rate variability the fetus is "5 or less" milliseconds and / or the biophysical profile of the fetus is equal to "7 or less" points, which corresponds to the doubtful and unsatisfactory condition of the fetus, the patient is delivered by cesarean section in a planned manner.

In order to concretize the sign “consultant's recommendations have not been implemented”, it should be noted that the consultants in the clinical institution are the professor, teachers and researchers of the university (research institute) located on the basis of this institution, who conduct scheduled visits, advise patients and determine plans and tactics for their further examination and treatment in accordance with the order of the Ministry of Health of the Russian Federation dated September 29, 1993 No. 228 “On approval of the Regulations on the clinical treatment and prevention institution” (Appendix 1, paragraph 4.7, subparagraph 4.7.1.). The consultant's recommendations are individual in nature, depending on the specific clinical situation and must be implemented by medical staff.

The probability of coincidence of the prediction of antenatal losses with their real results is 95%.

The proposed method is developed as follows. A total of 184 patients were examined. The examination was carried out by a continuous retrospective study of 134 birth histories (study form No. 096 / y) of patients with antenatal fetal death (main group), 134 medical certificates of perinatal death (study form No. 106-2 / у-08) and randomly 50 selected childbirth histories (study form No. 096 / y) of patients with a favorable outcome for the fetus, the birth of a live baby and the subsequent satisfactory condition of the newborn (control group).

The authors analyzed socio-biological factors, data on a general and obstetric-gynecological history, extragenital diseases, features and complications of a real pregnancy, the condition of the fetus, the results of clinical, laboratory and instrumental examination of pregnant women, iatrogenic defects in the management of a real pregnancy. The total number of factors studied is 400. At the same time, qualitative factors were considered in a binary (dichotomous) aspect ("yes", "no", "was", "was not"). Those factors that are more common in the main group are aggressive, the so-called "risk factors" of antenatal fetal death. Protective factors prevailed in the control group. Based on the data obtained, in accordance with Wald's sequential procedure, the prognostic factors coefficients were calculated. A variant of Bayes formula was used in which the probability ratios of the probability of an event multiplied by 5 decimal logarithms were used in the presence of a certain attribute in the two compared groups (E.V. Gubler. Computer Science in Pathology, Clinical Medicine and Pediatrics. - L .: Medicine. - 1990. - 176 p.). Groups differ among themselves in the presence of the main characteristic (antenatal fetal death):

PC (x _ij ) - the value of the prognostic coefficient in the presence of the sign of x _ij ;

P (x _ij / A ₂ ) is the probability of event A in the presence of the sign of x _ij in group 2;

P (x _ij / A ₁ ) is the probability of event A in the presence of the attribute x _ij in group 1.

Risk factors have prognostic factors with a + sign, and protective ones with a - sign.

The selection of the most information-significant (valuable) features included in the prognostic table was carried out according to the formula of divergence of the statistical distributions of Kullback:

R (x _ij ) - the value of the information content of the sign x _ij ,

P (x _ij / A ₂ ) is the probability of event A in the presence of the sign of x _ij in group 2,

P (x _ij / A ₁ ) is the probability of event A when there is a sign of x _ij in group 1.

Of the 400 factors, 231 factors turned out to be information-significant (table No. 1).

Based on modern protocols for the provision of obstetric and gynecological care, taking into account theoretical and practical knowledge, we differentiated obstetric tactics depending on the outcome of the prognosis of antenatal fetal death (Figure 1), which allows the use of modern and common methods and scales for functional assessment of the fetus (cardiotocography, biophysical fetal profile).

The described method differs from the previous ones both by the specific objective of the invention, aimed at predicting fetal death during pregnancy, and by the main technique that takes into account all factors (aggressive and protective) that affect the outcome of pregnancy, which significantly increases the objectivity and resolution of the prognosis.

In addition, for the first time in obstetrics and perinatology, the issue of multifactorial prognosis of the fetus and pregnancy outcome for the fetus was approached differentially, proposing a method that allows both predicting antenatal fetal death and choosing a rational obstetric tactic taking into account the prognosis results. Neither in the patent, nor in the scientific medical literature, as well as in medical practice, it is unknown about the existence of a method identical to the claimed one. Hence, the conclusion about the conformity of the proposed solution to the criterion of "novelty", which is necessary for the recognition of the solution by the invention, is valid.

The above set of essential features (significant differences) is necessary and sufficient to achieve the objectives of the invention. Based on this, it is completely legitimate to conclude that the claimed technical solution meets the criterion of “inventive step”, presented for recognition of the decision by the invention.

The proposed method with its combination of essential features can be implemented in practice repeatedly with the receipt of the same technical result. Hence, the conclusion about the conformity of the proposed solution to the criterion necessary for the recognition of the invention is “industrial applicability”.

In addition, this prognostic table is quite simple to use and does not require material costs, and the obstetric tactics algorithm is based on the use of modern and common methods for assessing the condition of the fetus, implemented both in the hospital and in the antenatal clinic.

The method proposed as an invention has been tested under conditions of a female consultation at the Astrakhan City Budgetary Healthcare Institution, Astrakhan Consulting and Diagnostic Center, OPC GBUZ JSC Astrakhan, pregnancy pathology departments and maternity wards of the Astrakhan City Public Health Center, Astrakhan City Public Health Institution.

The following are the results of testing the method.

Example 1. Patient M., 34 years old. At 32 weeks of gestation, the presence of the following factors was revealed and, in accordance with the prognostic table of antenatal fetal death, their prognostic factors were determined: socio-biological factors (age 34 years (+ 4.8), unregistered marriage (+3.7), secondary education (- 0.6), a housewife (+1.6), does not smoke (-1.3), does not suffer from alcoholism (-0.3), does not use drugs (-0.1)); the general history is not burdened with allergic diseases (-0.5), blood transfusion (-0.1), diseases of the cardiovascular system were (+2.7), respiratory diseases were (+3.5), and there was no viral hepatitis ( -0.1), pyelonephritis was not (-0.2)); obstetric and gynecological history (menarche at the age of 13 years (-0.2), moderate menstrual flow (-0.4), the onset of sexual activity under 18 years (+0.5), inflammatory diseases of the genitals were (+3), infections there were no sexually transmitted infections (-1.7), infertility for 5 years or more was not (-0.1), the age at the time of the first pregnancy was 34 years (+2.7), there was no history of pregnancies (- 1), there were no births (+0.4), antenatal loss of the fetus (-0.2) and early neonatal death of the child in the anamnesis is not (-0.1), spontaneous miscarriages in the nulliparous were not (-0.3), develop anomalies tions in children has not been (-0.1), induced abortion was not (1,6), (0,5)); extragenital diseases (vegetative-vascular dystonia according to the hypertonic type is (+3.5), according to the hypotonic type it is not (-0.1), there is no varicose disease (-0.2), there are no thyroid diseases (-0.3) , there is no diabetes mellitus (-0.1), normal weight (-0.7), anemia of 2-3 degrees is not (-0.2), high myopia is not (-0.1)); features and complications of a real pregnancy (pregnancy desired (-2.4), conception season - summer (-3.5), registration up to 20 weeks (-3), attendance at an antenatal clinic irregular (+6.2), acute respiratory there is a viral infection with fever (+4.8), no gestational pyelonephritis (-0.3), early toxicosis (+2), edema caused by pregnancy, there is (+2.5) pregnancy-induced hypertension without significant proteinuria (gestational arterial hypertension) no (-0.5), severe preeclampsia no (-0.1), rhesus sensitization no (-0.1), many gadfly (+7.5), pelvic presentation not observed (-0.6), there is no threat of termination of pregnancy up to 20 weeks (-0.1), there is no threat of termination of pregnancy after 20 weeks (-1), there is no recurring threat of termination of pregnancy (-0.3), placenta previa was not detected (-0.1), premature detachment of a normally located placenta is not (-0.4), chronic placental insufficiency is (+7.3), inflammatory genital diseases are (+7) , no sexually transmitted infections during pregnancy (-2), no mixed infection (-0.4), no chorioamnionitis (-0.5), during pregnancy revealed a myomatous node (+2.7), located in the area of localization of the placenta, pregnancy is not induced (-1)); fetal condition (male child’s gender (+1.5), fetal growth retardation syndrome is not (-1.2), there is no acute fetal hypoxia (-0.3), fetal chronic hypoxia is (+8.6), congenital malformations no fetus (-0.4)); results of clinical, laboratory and instrumental examination (second blood group of the pregnant woman (-0.8), height 167 cm (-1), pregnancy gain 12 kg (-2.3), d. spinarum 25 cm (-0.7) , d. cristarum 29 cm (+3), d. trochanterica 33 cm (-0.9), c. externa 21 cm (-0.6), the number of red blood cells in the blood 4 × 10 ¹² (+0.9), hemoglobin 105 g / l (+2), color index 0.99 (+1.5), white blood cell count 9.2 × 10 ⁹ (-4), recalcification time 88 sec (-1), heparin time 38 sec (-1), platelets 223 × 10 ⁹ (-1.5), fibrinogen A 3.85 g / l (-2.6), IPI 96% (-3.7), plasma heparin tolerance level of 8 minutes ( -0.1), no proteinuria (-1.4), no bacteriuria (-0, 4), there is no leukocyturia (-0.5), no hematuria (-0.4), the number of leukocytes in the vaginal smear is 25-30 in the field of view (+3.9), the epithelium in the smear from the vagina is “stratum” (+5 , 6), cocci in the smear “a lot” (+4.7), yeast in the smear is (+0.3), no key cells were found (-0.2), there are no markers of intrauterine infection according to the results of ultrasound examination (-1 , 1), short variability of the fetal heart rate according to the results of cardiotocography 7 ms. (-2.8), Fisher score (cardiotocography) 8 points (-2)); there are no iatrogenic defects in the management of pregnancy (-2.2), (-1.3), (-0.1), (-0.2). The sum of prognostic coefficients according to the prognostic table for antenatal fetal death is "+36.1", that is, with a probability of 95% predicted antenatal fetal death, in connection with which the condition of the fetus was monitored daily using cardiotocography with a rating on the W. Fisher scale and twice in weekly, the biophysical profile of the fetus was evaluated on the AM Vintzeleos scale. For four weeks, according to the results of cardiotocography, the fetus was evaluated at least 8 points, the short variability of the fetal heart rate was above 5 milliseconds, the biophysical profile of the fetus did not fall below 8 points, which corresponds to the normal and satisfactory condition of the fetus, according to the algorithm of obstetric tactics, the pregnancy was prolonged, continuing to examine the condition of the fetus. At 36 weeks of gestation, when assessing the condition of the fetus equal to 6 points, according to the results of cardiotocography, short variability of the fetal heart rate of 4 milliseconds, the biophysical profile of the fetus equal to 7 points, which corresponds to the dubious condition of the fetus, the patient was delivered by cesarean section for 2 hours. Moreover, the patient was diagnosed with a progressive premature detachment of a normally located placenta. As a result of the operation, a live child was extracted with an Apgar score of 6/7 points.

Example 2. Patient B., 23 years old. At 32 weeks of gestation, the presence of the following factors was revealed and, in accordance with the prognostic table of antenatal fetal death, their prognostic factors were determined: socio-biological factors (age 22 years (-2.9), registered marriage (-1.9), higher education (- 1.5), studies (+12.7), does not smoke (-1.3), does not suffer from alcoholism (-0.3), does not use drugs (-0.1)); the general history is not burdened with allergic diseases (-0.5), blood transfusion (-0.1), there were no diseases of the cardiovascular system (-0.5), diseases of the respiratory system were (+3.5), there was no viral hepatitis (-0.1), pyelonephritis was not (-0.2)); obstetric and gynecological history (menarche at the age of 14 years (-0.2), heavy menstrual flow (+1), the onset of sexual activity under 18 years of age (+0.5), there were no inflammatory diseases of the genitals (-3.1), there were no sexually transmitted infections (-1.7), infertility for 5 years or more was not (-0.1), the age at the time of the first pregnancy was 19 years (+0.4), a history of 1 pregnancy ( -2), there was no history of childbirth (+0.4), antenatal loss of the fetus (-0.2) and an early neonatal death of the child in the anamnesis (-0.1), one spontaneous miscarriage in a nulliparous (+6), anomalies times children had no vitia (-0.1), artificial abortions were not (-1.6), (-0.5)); extragenital diseases (vegetative-vascular dystonia according to the hypotonic type is (+1.2), according to the hypertonic type it is not (-0.1), there is no varicose disease (-0.2), there are no thyroid diseases (-0.3) , there is no diabetes mellitus (-0.1), lack of body weight (+2.4), anemia of the 2nd to 3rd degree is not (-0.2), a high degree of myopia is not (-0.1)); features and complications of a real pregnancy (desired pregnancy (-2.4), conception season - winter (+10.8), registration up to 20 weeks (-3), regular attendance at a antenatal clinic (-2.4), acute respiratory there is no viral infection with fever (-1.8), no gestational pyelonephritis (-0.3), no early toxicosis (-0.3), edema caused by pregnancy, no (-0.4) pregnancy-induced hypertension without significant proteinuria (gestational arterial hypertension) no (-0.5), severe preeclampsia no (-0.1), rhesus - no sensitization (-0.1), normal the total amount of water (-1.5), pelvic presentation (+8.3), there is no threat of termination of pregnancy up to 20 weeks (-0.1), there is a threat of termination of pregnancy after 20 weeks (+7.8), a recurring threat of termination there is no pregnancy (-0.3), placenta previa is not detected (-0.1), premature detachment of a normally located placenta is not (-0.4), there is no chronic placental insufficiency (-2.8), there are no inflammatory diseases of the genitals (- 4.4), sexually transmitted infections during pregnancy, no (-2), no mixed infection (-0.4), no chorioamnionitis (-0.5), fibroids m heel during pregnancy is not detected (-0.1), pregnancy uninduced (-1)); fetal condition (female child’s gender (-1.8), fetal developmental delay syndrome not (-1.2), there is no acute fetal hypoxia (-0.3), fetal chronic hypoxia is not (-1.3), congenital malformations no fetus (-0.4)); results of clinical, laboratory and instrumental examination (first blood group of the pregnant woman (-0.4), height 169 cm (-1), pregnancy gain 10 kg (-2.3), d. spinarum 25 cm (-0.7) , d. cristarum 28 cm (-2), d. trochanterica 30 cm (-0.9), c. externa 21 cm (-0.6), the number of red blood cells in the blood 4 × 10 ¹² (+0.9), hemoglobin 106 g / l (+2), color index 0.99 (+1.5), white blood cell count 7.9 × 10 ⁹ (+4.6), recalcification time 88 sec (-1), heparin time 40 sec (-1), platelets 223 × 10 ⁹ (-1.5), fibrinogen A 3.85 g / l (-2.6), IPI 93% (-3.7), plasma tolerance to heparin 8 minutes (-0.1), no proteinuria (-1.4), no bacteriuria (-0 , 4), there is no leukocyturia (-0.5), no hematuria (-0.4), the number of leukocytes in the vaginal smear 25 in the field of view (+3.9), the epithelium in the smear from the vagina 25 in the field of view (-1 , 1), moderate cocci in the smear (+4.7), no yeast in the smear (-0.4), no key cells (-0.2), no intrauterine infection markers according to the results of ultrasound examination (-1.1 ), short variability of the fetal heart rate according to the results of cardiotocography 15 ms. (-2.8), Fisher score (cardiotocography) 8 points (-2)); there are no iatrogenic defects in the management of pregnancy (-2.2), (-1.3), (-0.1), (-0.2). The sum of prognostic coefficients according to the prognostic table for antenatal fetal death is "-9.8", that is, the prognosis is uncertain, and therefore the fetus was monitored twice a week using cardiotocography with a W. Fisher rating and once a week assessed the biophysical profile of the fetus according to the AM Vintzeleos scale. Within seven weeks, according to the results of cardiotocography, the fetus was evaluated at least 8 points, the short variability of the fetal heart rate was above 5 milliseconds, the biophysical profile of the fetus did not fall below 8 points, which corresponds to the normal and satisfactory condition of the fetus, according to the algorithm of obstetric tactics, the pregnancy was prolonged, continuing to examine the condition of the fetus. At the 39th week of pregnancy, the patient developed regular labor, culminating in the birth of a live baby with an Apgar score of 8/8 points.

Example 3. Patient K., 25 years old. At 32 weeks of gestation, the presence of the following factors was revealed and, in accordance with the prognostic table of antenatal fetal death, their prognostic factors were determined: socio-biological factors (age 25 years (-1.5), registered marriage (-1.9), secondary education (+ 2.2), works (-1.5), does not smoke (-1.3), does not suffer from alcoholism (-0.3), does not use drugs (-0.1)); the general history is not burdened with allergic diseases (-0.5), blood transfusion (-0.1), there were no diseases of the cardiovascular system (-0.5), diseases of the respiratory system were (+3.5), there was no viral hepatitis (-0.1), pyelonephritis was not (-0.2)); obstetric and gynecological history (menarche at the age of 13 years (-0.2), moderate menstrual flow (-0.4), the onset of sexual activity after 18 years (-0.4), inflammatory diseases of the genitals were (+3), infections there were no sexually transmitted infections (-1.7), infertility for 5 years or more was not (-0.1), age at the time of the first pregnancy was 20 years (-0.7), a history of 1 pregnancy (- 2), there was no history of childbirth (+0.4), antenatal loss of the fetus (-0.2) and an early neonatal death of the child in the anamnesis (-0.1), spontaneous miscarriages in the nulliparous were not (-0.3 ), anom ly development in children has not been (-0.1), one abortion in history, before the current pregnancy (2.4), (1.3)); extragenital diseases (there is no hypotonic vegetative-vascular dystonia (-0.1), hypertonic type (+3.5), no varicose veins (-0.2), no thyroid disease (-0.3) , there is no diabetes mellitus (-0.1), normal weight (-0.7), anemia of 2-3 degrees is not (-0.2), high myopia is not (-0.1)); features and complications of a real pregnancy (pregnancy desired (-2.4), conception season - summer (-3.5), registration after 20 weeks (+15.6), attendance at an antenatal clinic irregular (+6.2), there is no acute respiratory viral infection with fever (-1.8), no gestational pyelonephritis (-0.3), no early toxicosis (-0.3), edema caused by pregnancy, no (-0.4) caused by pregnancy there is no hypertension without significant proteinuria (gestational arterial hypertension) (-0.5), severe preeclampsia is not (-0.1), rhesus sensitization is not (-0, 1), oligohydramnios (+2), no pelvic presentation (-0.6), no threat of termination of pregnancy up to 20 weeks, no (-0.1), no threat of termination of pregnancy after 20 weeks, no (-1), no recurring threat of termination of pregnancy (-0.3), placenta previa was not found (-0.1), premature detachment of a normally located placenta is not (-0.4), there is no chronic placental insufficiency (-2.8), inflammatory diseases of the genitals are (+7) , sexually transmitted infections during pregnancy are (+12.7) (primary genital herpes), no mixed infection (-0.4), chorio mnionita not (-0.5), uterine fibroids is not revealed in the (-0.1) during pregnancy, pregnancy uninduced (-1)); fetal condition (female child’s gender (-1.8), fetal developmental delay syndrome not (-1.2), there is no acute fetal hypoxia (-0.3), fetal chronic hypoxia is not (-1.3), congenital malformations no fetus (-0.4)); results of clinical, laboratory and instrumental examination (second blood group of a pregnant woman (-0.8), height 165 cm (-1), pregnancy gain 8 kg (-2.3), d. spinarum 25 cm (-0.7) , d. cristarum 27 cm (-2), d. trochanterica 30 cm (-0.9), c. externa 20 cm (-0.6), the number of red blood cells in the blood 4.5 × 10 ¹² (-4.5 ), hemoglobin 115 g / l (-1), color index 1 (-6.2), white blood cell count 10 × 10 ⁹ (+3.6), recalcification time 88 sec (-1), heparin time 42 sec (-1) × 225 platelets September ¹⁰ (-1.5), fibrinogen A 4.0 g / l (-2,6), PB 95% (-3.7), plasma levels of tolerance to heparin 8 minutes 10 seconds (-0.1), no proteinuria (-1.4), bacteriuri and no (-0.4), no leukocyturia (-0.5), no hematuria (-0.4), the number of leukocytes in the vaginal smear 35 in the field of view (+3.9), the epithelium in the smear from the vagina "layer ”(+5.6), cocci in the smear“ a lot ”(+4.7), no yeast in the smear (-0.4), no key cells were found (-0.2), intrauterine infection markers were detected by ultrasound studies (+5.5), short variability of the fetal heart rate according to the results of cardiotocography 8 ms. (-2.8), Fisher score (cardiotocography) 8 points (-2)); there are no iatrogenic defects in the management of pregnancy (-2.2), (-1.3), (-0.1), (-0.2). The sum of prognostic factors according to the prognostic table of antenatal fetal death is "+3.7", that is, the prognosis is uncertain, and therefore the fetus was monitored twice a week using cardiotocography with a W. Fisher rating and once a week assessed the biophysical profile of the fetus according to the AM Vintzeleos scale. Within five weeks, according to the results of cardiotocography, the fetus was evaluated at least 8 points, the short variability of the fetal heart rate was above 5 milliseconds, the biophysical profile of the fetus did not fall below 8 points, which corresponds to the normal and satisfactory condition of the fetus, according to the algorithm of obstetric tactics, the pregnancy was prolonged, continuing to examine the condition of the fetus. At 37 weeks of gestation, against the background of developing chronic fetal hypoxia, the assessment of his condition according to the results of cardiotocography was 7 points, and the short variability of the fetal heart rate was 5 milliseconds, the biophysical profile of the fetus reached 7 points, which corresponds to the doubtful condition of the fetus, the patient was delivered by cesarean section in as planned at 39 weeks gestation. As a result of the operation, a live child was extracted with an Apgar score of 7/7 points.

Example 4. Patient A., 32 years old. At 32 weeks of gestation, the presence of the following factors was revealed and, in accordance with the prognostic table of antenatal fetal death, their prognostic factors were determined: socio-biological factors (age 32 years (+4.8), unregistered marriage (+3.7), higher education (- 1.5), works (-1.5), does not smoke (-1.3), does not suffer from alcoholism (-0.3), does not use drugs (-0.1)); the general history is not burdened with allergic diseases (-0.5), blood transfusion (-0.1), diseases of the cardiovascular system were (+2.7), there were no diseases of the respiratory system (-7.6), there was no viral hepatitis (-0.1), pyelonephritis was not (-0.2)); obstetric and gynecological history (menarche at the age of 13 years (-0.2), moderate menstrual flow (-0.4), the onset of sexual activity under 18 years of age (+0.5), there were no inflammatory diseases of the genitals (-3.1 ), there were no sexually transmitted infections (-1.7), infertility for 5 years or more was not (-0.1), the age at the time of the first pregnancy was 21 years (-0.7), a history of 6 pregnancy (+1.6), two births in the anamnesis (+3.4), birth of children weighing from 2.5 to 4 kg (-0.5), antenatal loss of the fetus (-0.2) and early neonatal death of the child a history of no (-0.1) spontaneous there were no idioms (-0.3), children had no developmental abnormalities (-0.1), four had a history of abortions (+2.4), two of them before a real pregnancy (+1.3)); extragenital diseases (vegetative-vascular dystonia by the hypotonic type is (+1.2), by the hypertonic type - not (-0.1), varicose veins are not (-0.2), thyroid diseases are not (-0.3) , there is no diabetes mellitus (-0.1), normal weight (-0.7), anemia of the 2nd or 3rd degree is not (-0.2), a high degree of myopia is not (-0.1)); features and complications of a real pregnancy (desired pregnancy (-2.4), conception season - spring (-1.8), registration up to 20 weeks (-3), regular attendance at a antenatal clinic (-2.4), acute respiratory there is a viral infection with fever (+4.8), no gestational pyelonephritis (-0.3), no early toxicosis (-0.3), edema caused by pregnancy, no (-0.4) pregnancy-induced hypertension without significant proteinuria (gestational arterial hypertension) is not (-0.5), severe preeclampsia is not (-0.1), rhesus sensitization is not (-0.1), but a small amount of water (-1.5), pelvic presentation is not observed (-0.6), there is no threat of termination of pregnancy up to 20 weeks (-0.1), there is no threat of termination of pregnancy after 20 weeks (-1), a recurring threat of termination there is no pregnancy (-0.3), placenta previa is not detected (-0.1), premature detachment of a normally located placenta is not (-0.4), there is no chronic placental insufficiency (-2.8), there are no inflammatory diseases of the genitals (- 4.4), sexually transmitted infections during pregnancy, no (-2), no mixed infection (-0.4), chorioamnionitis n et (-0.5), uterine fibroids during pregnancy were not detected (-0.1), pregnancy is not induced (-1)); fetal condition (female child’s gender (-1.8), fetal developmental delay syndrome not (-1.2), there is no acute fetal hypoxia (-0.3), fetal chronic hypoxia is not (-1.3), congenital malformations no fetus (-0.4)); the results of clinical, laboratory and instrumental examination (pregnant woman’s first blood group (-0.4), height 169 cm (-1), pregnancy gain 10 kg (-2.3), d. spinarum 27 cm (-0.7) , d. cristarum 30 cm (+3), d. trochanterica 33 cm (-0,9), c. externa 21 cm (0.6), the number of red blood cells 4 × ¹⁰ December (0.9) hemoglobin 90 g / l (+2), color index 0.99 (+1.5), white blood cell count 7.5 × 10 ⁹ (+4.6), recalcification time 88 sec (-1), heparin time 38 sec (-1), platelets 221 × 10 ⁹ (-1.5), fibrinogen A 3.85 g / l (-2.6), IPI 92% (-3.7), plasma heparin tolerance level 8 minutes (-0.1), no proteinuria (-1.4), no bacteriuria (-0 , 4), there is no leukocyturia (-0.5), no hematuria (-0.4), the number of leukocytes in the vaginal smear is 20 in the field of view (-0.2), the epithelium in the smear from the vagina is “plast” (+5, 6), cocci in the smear are “many” (+4.7), there is no yeast in the smear (-0.4), no key cells were found (-0.2), there are no markers of intrauterine infection according to the results of ultrasound examination (-1, 1), short variability of the fetal heart rate according to the results of cardiotocography 20 ms. (-2.8), Fisher score (cardiotocography) 8 points (-2)); there are no iatrogenic defects in the management of pregnancy (-2.2), (-1.3), (-0.1), (-0.2). The sum of prognostic coefficients according to the prognostic table for antenatal fetal death is "-34.1", that is, with a probability of 95% predicted the absence of antenatal fetal death, pregnancy was prolonged in accordance with the algorithm for choosing obstetric tactics. A patient at the 40th week of gestation gave birth to a live child with an Apgar score of 8/9 points.

Thus, the obtained research results allow us to assume that the proposed method achieves accurate, objective and effective individual prediction of antenatal fetal death, maximizes optimization of obstetric tactics and reduces the likelihood of an unfavorable prognosis.

Claims (1)

A method for individual prediction of antenatal fetal death, followed by the choice of obstetric tactics, which consists in the fact that pregnant women at 32 weeks of gestation identify the presence of factors that influence the course and outcome of pregnancy, and determine their prognostic factors in points, indicated by a + sign in the case of the aggressive nature of the factor and the sign “-” - in the case of its protective nature, namely socio-biological factors: age at the time of this pregnancy is 15-19 years old as +5.7, age at the moment is pregnancy of 20-24 years as -2.9, age at the time of this pregnancy 25-29 years as -1.5, age at the time of this pregnancy 30 years and older as +4.8, unregistered marriage as +3.7, registered marriage as -1.9, primary education as +2.7, secondary as +2.2, secondary as as -0.6, higher as -1.5, housewife as +1.6, studying as + 12.7, works like -1.5, smokes like +11.3, doesn't smoke like -1.3, suffers from alcoholism like +14.7, doesn't suffer like -0.3, uses drugs like +10.5 , does not use - as -0.1; general anamnesis: the anamnesis is aggravated by allergic diseases as +7.8, not aggravated as -0.5, the anamnesis is aggravated by blood transfusion as +10.5, not aggravated as -0.1, diseases of the cardiovascular system were as +2, 7, there wasn’t like -0.5, diseases of the respiratory system were like +3.5, there wasn’t like -7.6, viral hepatitis was like +2.7, it wasn’t like -0.1, pyelonephritis was like +2 was not like -0.2; obstetric and gynecological history: menarche at the age of 11-15 years as -0.2, at the age of 16 and more years as +1.5, meager menstrual flow as +6.5, moderate as -0.4, copious as +1, the onset of sexual activity before 18 years old as +0.5, after 18 years old as -0.4, inflammatory diseases of the genitals were like +3, there wasn’t like -3.1, sexually transmitted infections were like +9 , 4, it was not like -1.7, infertility of 5 years or more was like +8.7, it was not like -0.1, the age at the time of the first pregnancy was 15-19 years old as +0.4, age at the time the onset of the first pregnancy of 20-24 years as -0.7, during growing at the time of the first pregnancy of 25-29 years as +0.5, age at the time of the first pregnancy of 30 years and older as +2.7, two or more pregnancies in history as +1.6, one pregnancy - as -2 , the absence of pregnancies - as -1, two or more births in the anamnesis as +3.4, some births - as -2, the absence of births - as +0.4, the birth of children weighing less than 2.5 kg as +17.5, the birth of children weighing from 2.5 to 4 kg as -0.5, the birth of children weighing more than 4 kg as +8.7, the antenatal loss of the fetus in the anamnesis is as +11.7, not as -0.2, the death of a child in early neonatal period in I have a history of +1.7, no like -0.1, spontaneous miscarriages in a nulliparous were like +6, there wasn’t like -0.3, developmental abnormalities in children were like +8.7, there wasn’t like -0.1 , artificial abortions were like +2.4, there wasn’t like -1.6, artificial abortions before real pregnancy were like +1.3, there wasn’t like -0.5; extragenital diseases: vegetative-vascular dystonia by hypertonic type is as +3.5, not as -0.1, vegetative-vascular dystonia by hypotonic type is as +1.2, not as -0.1, varicose disease is like + 2.1, no like -0.2, thyroid disease is like + 6.1, no like -0.3, diabetes is like +8.7, no like -0.1, obesity is like +7.2 , body mass deficit as +2.4, normal weight as -0.7, anemia of 2-3 degrees is as +1.7, not as -0.2, high myopia is as +8.7, not as - 0.1; features and complications of a real pregnancy: unwanted pregnancy as +23, desired as -2.4, conception season - spring as -1.8, summer as -3.5, autumn as +6, winter as +10.8, setting registration in the antenatal clinic up to 20 weeks as -3, after 20 weeks as +15.6, was not registered as +1.4, visits to the antenatal clinic as regular as -2.4, irregular as +6.2, acute respiratory viral infection with fever is like + 4.8, not like -1.8, gestational pyelonephritis is like + 2.5, not like -0.3, early toxicosis is like +2, not like -0.3, caused by pregnancy edema is as +2.5, not as -0.4, pregnancy-induced hypertension without significant proteinuria is as +7.8, not as -0.5, severe preeclampsia is as +10.5, not as -0.1 , Rhesus sensitization is like +8.7, not like -0.1, polyhydramnios like +7.5, low water like +2, normal amount of water like -1.5, pelvic presentation is like +8.3, not like -0.6, the threat of abortion before 20 weeks is like +0.5, not like -0.1, the threat of abortion after 20 weeks is like +7.8, not like -1, the recurring threat of abortion is like + 2.7, no like -0.3, parade ground There are ents like +10.5, no like -0.1, premature detachment of a normally located placenta is like +8, no like -0.4, uterine rupture is like +11.7, no like -0.1, umbilical cord pathology there is like +12, no like -1.7, chronic placental insufficiency is like +7.3, no like -2.8, inflammatory diseases of the genitals are like +7, no like -4.4, sexually transmitted infections, during pregnancy, it’s like +12.7, no like -2, mixed infection is like +7.5, no like -0.4, chorioamnionitis is like +17, no like -0.5, uterine fibroids are like +2, 7, no as -0.1, induced pregnancy is ka 20, there is as -1; the fetus and its condition: male as +1.5, female as -1.8, fetal growth retardation syndrome is as +8.4, not as -1.2, acute fetal hypoxia is as +6.5, not as -0.3, chronic fetal hypoxia is as +8.6, not as -1.3, congenital malformations of the fetus are as +7.2, not as -0.4; the results of clinical, laboratory and instrumental examination of pregnant women: the blood group of the pregnant woman is the first as -0.4, the second as -0.8, the third as +1.2, the fourth as +3.5, height 155 cm and less as +7, height 156-170 cm as -1, height 171 cm and more as +3.5, pregnancy gain 6 kg and less as +4, pregnancy gain 7-12 kg. as -2.3, pregnancy gain 13 kg or more as +6.2, d. spinarum 24 cm or less as +1.4, d. spinarum 25 cm or more as -0.7, d. cristarum 26 cm or less as +3, d. cristarum 27-28 cm as -2, d. cristarum 29 cm or more as +3, d. trochanterica 29 cm and less as +4.8, d. trochanterica 30-33 cm as -0.9, d. trochanterica 34 cm and more as +2.1, c. externa 19 cm and less as +3, c. externa 20 cm or more as -0.6, the number of red blood cells in the blood 4 × 10 ¹² and less as +0.9, the number of red blood cells in the blood 4.1 × 10 ¹² and more as -4.5, hemoglobin 109 g / l and less than +2, hemoglobin 110 g / l or more as -1, color index 0.99 or less as +1.5, color index 1 or more as -6.2, white blood cell count 7.9 × 10 ⁹ and less as +4.6, the number of white blood cells in the blood 8-9.9 × 10 ⁹ as -4, the number of white blood cells in the blood 10 × 10 ⁹ or more as +3.6, the recalcification time of 90 seconds or more as +1 , 6, recalcification time 89 sec or less as -1, heparin time 31-45 sec as -1, heparin time 46-50 sec as +2.4, platelets 219 × 10 ⁹ and less as +3, platelets 220 × 10 ⁹ and more as -1.5, fibrinogen A 3.59 g / l and less as +2, fibrinogen A 3.60 - 4.79 g / l as -2.6, prothrombin index 90% or less as +3.7, prothrombin index 91-95% as -3.7, prothrombin index 96% or more as +4.4, level plasma tolerance to heparin 6 min 59 sec or less as +9.5, plasma tolerance to heparin 7 min or more as -0.1, proteinuria is as +5.2, not as -1.4, bacteriuria is as + 6.8, no as -0.4, leukocyturia as +4.5, no as -0.5, hematuria as +6.8, no as -0.4, white blood cell count f from the vagina 25 or more in the field of view as +3.9, less than 25 in the field of view as -0.2, the epithelium in the smear from the vagina by the “layer” as +5.6, the epithelium 25 and less in the field of view as -1 , 1, cocci in the vaginal smear are “moderately” and “much” like +4.7, “little” like -6.6, yeast in the smear from the vagina is like +0.3, not like -0.4, key cells in the smear from the vagina there is +3.3, not as -0.2, intrauterine infection markers according to the results of ultrasound examination are as +5.5, not as -1.1, short fetal heart rate variability according to the results of cardiotocography 5 ms and less than +10, more than 5 ms as -2.8, Fiscal condition of the fetus according to the results of cardiotocography of 7 points and less than +9, Fiscal condition of the fetus according to the results of cardiotocography of 8 points and more as -2; iatrogenic defects in the management of this pregnancy and delivery: untimely diagnosis of pregnancy complications in the antenatal clinic, the absence of an appropriate examination plan and patient management is as +11.5, not as -2.2, the patient has not been examined for sexually transmitted infections, there is how +7, no as -1.3, the recommendations of the consultant are not fulfilled, there are +8.7, no as -0.1, operative delivery is not performed; if there is evidence, there is +12.7, no as -0.2; the obtained prognostic coefficients are summarized and, with the sum of prognostic factors equal to "+13 or more" points, antenatal fetal death is predicted, with this prognosis, fetal condition is monitored daily using cardiotocography with a rating on the W. Fisher scale and the fetal biophysical profile is evaluated twice a week. according to the AM Vintzeleos scale, when assessing the condition of the fetus equal to "8 or more" points, according to the results of cardiotocography and / or achieving a short heart rate variability of the fetus "more than 5" milliseconds and / or biophysi a fetal profile equal to "8 or more" points, which corresponds to a normal and satisfactory condition of the fetus, prolong pregnancy by continuing to examine the condition of the fetus in the same mode, and when assessing the condition of the fetus equal to "7 or less" points, according to the results of cardiotocography and / or achieving a short variability of the fetal heart rate of "5 or less" milliseconds and / or a biophysical profile of the fetus equal to "7 or less" points, which corresponds to a doubtful and unsatisfactory condition of the fetus, the patient is delivered I have caesarean section for 1-3 hours; with the sum of prognostic factors equal to "-13 or less" points, the absence of antenatal death of the fetus is predicted, and pregnancy is prolonged; with the sum of prognostic factors equal to a value in the range of "greater than -13 and less than +13" points, the prognosis is considered uncertain, and therefore the fetus is monitored twice a week using cardiotocography with a rating on the W. Fisher scale and one once a week, the fetal biophysical profile is assessed according to the AM Vintzeleos scale, when assessing the fetal condition equal to "8 or more" points, according to the results of cardiotocography and / or achieving a short heart rate variability of the fetus "more than 5" milliseconds and / or biophysical profile yes, equal to "8 or more" points, which corresponds to a normal and satisfactory condition of the fetus, pregnancy is prolonged, continuing to examine the condition of the fetus in the same mode, and when assessing the condition of the fetus equal to "7 or less" points, according to the results of cardiotocography and / or achieving a short variability of the fetal heart rate of “5 or less” milliseconds and / or a biophysical profile of the fetus equal to “7 or less” points, which corresponds to a doubtful and unsatisfactory condition of the fetus, the patient is delivered by means of cesarean surgery va-section in a planned manner.

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