RU2802667C1 - Method of predicting the risk of developing hypoxic ischemic encephalopathy in newborns from women of different somatotypes - Google Patents

Abstract

FIELD: medicine; obstetrics and gynecology.

SUBSTANCE: invention can be used to predict the risk of developing hypoxic ischemic encephalopathy in newborns. At a gestational age of up to 10 weeks, the examined woman measures the weight and length of the body. The somatotype is determined by the method of R.N. Dorokhov. Bioimpedance analysis is conducted. The fat and skeletal muscle mass of the pregnant woman is calculated. After 32 weeks of pregnancy, fetal cardiotocography is performed. The frequency of oscillations in 1 minute and the amplitude of the oscillations are calculated. According to Dopplerography of uteroplacental and fetal-placental blood flow, the severity of blood flow disturbance in the mother-placenta-fetus system is calculated. Then, according to the developed mathematical formula, the probability of developing hypoxic ischemic encephalopathy in newborns from women of different somatotypes is calculated, in %. According to the result obtained, of 60% a high risk of developing hypoxic ischemic encephalopathy in newborns from women of different somatotypes is predicted.

EFFECT: invention makes it possible to identify pregnant women with a high risk of developing hypoxic ischemic encephalopathy in newborns long before delivery and to carry out therapeutic and preventive measures in a timely manner in this category of patients.

1 cl, 6 ex, 5 tbl

Description

The invention relates to medicine, in particular to obstetrics and gynecology, human anatomy, neonatology, pediatrics, and can be used to predict the risk of developing hypoxic ischemic encephalopathy in newborns.

The relevance of the problem of predicting and preventing hypoxic ischemic encephalopathy in newborns is beyond doubt, since this pathology is widespread. The costs of treatment and care for newborns with hypoxic ischemic encephalopathy cause significant economic damage not only to the child’s family, but to the country’s budget as a whole. In the structure of causes of infant mortality, hypoxic ischemic encephalopathy occupies one of the leading places. Despite the achievements of modern medicine, the incidence of hypoxic ischemic encephalopathy in newborns, according to WHO, does not tend to decrease. [Pediatrics. National leadership. Brief edition / ed. A.A. Baranova. - M.: GEOTAR-Media, 2015. - 768 pp.; Neonatology. National leadership. Brief edition / Ed. N.N. Volodina. - M.: GEOTAR-Media, 2019. - 896 p.].

Considering the above, domestic and foreign scientists are actively searching for adequate and accessible algorithms and programs for predicting the risk of developing hypoxic ischemic encephalopathy in newborns, which will allow timely prevention of the development of this pathology.

In recent years, a large amount of material has been accumulated indicating a person’s constitutional and genetic predisposition to certain diseases, the specificity of the clinical picture depending on the type of individual constitution of a person, the differences in the course of the adaptation process when changing the climatic and geographical region in individuals with different somatotypes [Nikolaev V .G. Using the anthropological approach in clinical medicine / V.G. Nikolaev, A.I. Kobezhikov, N.G. Kobileva // Current problems of morphology: collection. scientific work. - Krasnoyarsk: KrasSMA Publishing House, 2008. - P. 93-95; Sergeev B.S. Constitutional somatotypes: diagnostic and treatment-and-prophylactic aspects / V.N. Sergeev, I.A. Kournikova, V.I. Mikhailov and others // Bulletin of neurology, psychiatry and neurosurgery. - 2014. - No. 5. - pp. 75-105; Tomaeva K.G., Gaidukov S.N., Komissarova E.N. A method for predicting the risk of developing preeclampsia in women of different somatotypes. - Patent RU 2679111. - 2019.; Tomaeva K.G., Gaidukov S.N., Komissarova E.N. A method for predicting the risk of developing weakness of labor in women of different somatotypes. - Patent RU 2723596. - 2020; Tomaeva K.G., Gaidukov S.N., Komissarova E.N. et al. A method for predicting the risk of premature birth in women of different somatotypes. - Patent RU 2747592. - 2021.; Tomaeva K.G., Gaidukov S.N., Komissarova E.N. A method for predicting the risk of developing placental insufficiency in pregnant women of different somatotypes. - Patent RU 2731608. - 2020; Tomaeva K.G., Gaidukov S.N., Komissarova E.N. et al. A method for predicting the risk of developing uterine hypotension in the early postpartum period in women of different somatotypes. - Patent RU 2764952. - 2022.].

The modern constitutional approach in medicine makes it possible to improve the quality of diagnosis, 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 ensure a high-quality medical prognosis [Nikolaev V.G. Methodological approaches in modern clinical anthropology // BiomedicalandBiosocialAnthropology. - 2007. - No. 9. - P. 1-9.].

There is a known method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns, described in the work of Krukier I.I. [Krukier I.I. A method for predicting neonatal encephalopathy. - Patent RU 2254573. - 2005.]. In the proposed method, the authors, at the final stage of labor after separation of the placenta, take tissue samples (500 mg), prepare a 10% homogenate, in which NADPH oxidase activity is determined. The reaction results are taken into account spectrophotometrically at a wavelength of 600 nm. And with a value equal to 13.5 units. Optical density and higher predict the development of encephalopathy in a newborn.

Disadvantages of the known method: The method is inaccurate, the study is carried out after the birth of the child and does not allow timely prediction of the risk of developing hypoxic-ischemic encephalopathy in the newborn; making a 10% placenta homogenate requires additional time and reagents.

There is a known method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns, described in the work of Dzhumagaziev A.A., Rakhimova L.R., Goldenberg O.P. [Dzhumagaziev A.A., Rakhimova L.R., Goldenberg O.P. A method for predicting perinatal hypoxic-ischemic encephalopathy in newborns. - Patent RU 2157534. - 2000.]. In the proposed method, the authors determine the antigens of the A, B, DR loci of the HLA system in umbilical cord blood, and in the presence of one of the antigens A32, B8, B27, DR3 or a combination thereof, they predict perinatal hypoxic-ischemic encephalopathy in newborns.

Disadvantages of the known method: The method is inaccurate, the study is carried out after the birth of the child and does not allow timely prediction of the risk of developing hypoxic-ischemic encephalopathy in the newborn; to perform the method, a highly qualified immunologist is required; expensive equipment and reagents are required.

The closest to the claimed invention is a method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns, described in the work of Sayutina S.B., Shprakh V.V., Protopopova N.V., Maksimova O.G., Rozhkova N.Yu. [Sayutina S.B., Shprakh V.V., Protopopova N.V., Maksimova O.G., Rozhkova N.Yu. A method for predicting the development of hypoxic-ischemic encephalopathy in full-term newborns. - Patent RU 2167608. - 2001.]. In the proposed method, the authors conduct a clinical examination of the pregnant woman, ultrasound examination of the uterine arteries, umbilical artery and middle cerebral artery of the fetus, identify risk factors, analyze ultrasound indicators and risk factors, determine their gradations and numerical values and calculate predictive coefficients F1 and F2 using the formulas :

where a1, 2…14 - gradations and numerical values of risk factors (RF), ultrasound indicators: a1 - age; a2 - chronic psycho-emotional stress; a3 - hypertension or vegetative-vascular dystonia; a4 - menstrual dysfunction; a5 - smoking during pregnancy; a6 - number of abortions more than three; a7 - threat of miscarriage in the second half of pregnancy; a8 - chronic fetoplacental insufficiency; a9 - chronic intrauterine fetal hypoxia; a10 - intrauterine growth retardation syndrome; a11 - OPG-preeclampsia lasting 4 weeks or more; a12 - systole-diastolic ratio of the umbilical cord artery; a13 - systole-diastolic ratio of the uterine arteries; a14 is the systole-diastolic ratio of the middle cerebral artery of the fetus, and with the value of predictive coefficients F1≥F2, the development of hypoxic-ischemic encephalopathy is predicted in a full-term newborn who will be born to the examined woman.

Disadvantages of the known method: calculations are made using very complex cumbersome formulas; It is impossible to say in advance with certainty whether the woman being examined will have a full-term baby, and in the case of premature birth, the prediction method is not used.

In the studied scientific, medical and patent literature, no method was found for individually predicting the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes. It should be noted that at present there is no computer program for predicting the risk of developing hypoxic ischemic encephalopathy in newborns that has high information content

The purpose of the invention is to develop a method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes.

This goal is achieved by the fact that in the proposed method, rapid diagnostics of the somatotype of women is carried out.

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

Anthropometric measurements are carried out according to generally accepted rules and methods. Body length is measured with a medical stadiometer (with an accuracy of 0.5 cm), body weight - on a medical scale (with an accuracy of 100 g).

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

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

First, standard units of body length and weight are obtained using the following formulas:

where conventional units - conventional 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);

where conventional units m - conventional 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 included in the somatotyping triangle and determine the somatic type by dimensional variation (Dorokhov R.N., 1991, 1993).

It is advisable to distinguish five main and two transitional somatic types, considering them not as discrete somatic types, but as fragments of a continuous series of variations.

The following main somatic types are distinguished:

nanosomal (NaS) type - less than 0.200 points,

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

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

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

megalosomic (MegS) type - more than 0.800 points,

as well as transitional somatic types:

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

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

Next, a woman in the early stages of pregnancy (up to 10 weeks of gestation) undergoes a bioimpedance analysis on a portable bioimpedance analyzer “MEDASS ABC-01”, with a built-in computer program. Bioimpedance analysis is carried out according to the analyzer manufacturer's instructions. The measurement is carried out 2 hours after eating, 24 hours after any physical activity. The values of length, body weight, and age of the woman are entered into the program. The woman being examined is placed on a horizontal surface, on her back, on a medical couch at least 80 cm wide, without contact with the metal parts of the couch or the wall. There should be no contact between the arms and torso, as well as between the legs. Two electrodes are located on the arm and on the leg. The potential (proximal) electrode is installed in the middle above the interosseous gap of the ankle or ankle. The current electrodes are placed distally, at least 2.5 cm from the potential electrodes. The ends of the electrodes, free from the adhesive gel, are oriented towards the location of the device. The red terminals are connected to the distal electrodes (which are closer to the fingers), and the black terminal is connected to the proximal electrodes. During the study, the data obtained is displayed on a computer and the built-in computer program automatically calculates the absolute and relative content of the main body components: fat and skeletal muscle mass.

Fetal cardiotocography (non-stress test) is performed in pregnant women from 33 weeks of gestation using well-known methods, the duration of the study is 40-60 minutes. To assess fetal cardiac activity, the W. Fischer scale (1976), modified by G.M., is used. Savelyeva [Obstetrics: national guide / Ed. E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva. - M.: GEOTAR-Media, 2014. - 1200 p.]. Determine the frequency of oscillations per minute and the amplitude of oscillations (in beats per minute).

Dopplerography of uteroplacental and fetal placental blood flow is performed in the third trimester of pregnancy using well-known methods. To assess the state of blood flow in the “mother-placenta-fetus” system, the classification of disorders of uteroplacental and fetal-placental blood flow by A.N. Strizhakov is used. et al. (1989) [Obstetrics: a national guide / Ed. E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva. - M.: GEOTAR-Media, 2014. - 1200 p.].

The obtained data from the examined women are entered into the SPSS statistical program. Using correlation-regression analysis, a statistically significant relationship was revealed between hypoxic ischemic encephalopathy in newborns and maternal body fat mass (r=0.8; p<0.05), maternal skeletal muscle mass (r=-0.78; p< 0.05), maternal somatotype (r=-0.82; p<0.05), amplitude of oscillations in gestation after 32 weeks (r=-0.92; p<0.05), frequency of oscillations per minute in the gestation period after 32 weeks (r=-0.74; p<0.05), the severity of the disturbance of uteroplacental and fetal-placental blood flow in the third trimester of gestation (r=0.88; p<0.05). Taking into account the presence of a connection between the above indicators (signs), in the course of multiple regression analysis, a regression equation (formula) is obtained for prognostic models, which is used to predict the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes:

VRGIEN=85.21+(9.38×A)+(1.21×B)-(2.02×C)-(0.85×D)-(0.66×E)+(10.17 ×F),

where VRGIEN is the probability of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes, in%,

A - maternal somatotyping scores,

B - maternal body fat mass, in%,

C - skeletal muscle mass of the mother’s body, in%,

D - amplitude of oscillations in gestation after 32 weeks, in beats per minute,

E - frequency of oscillations per minute in gestation after 32 weeks.

F - severity of Dopplerographic disturbance of uteroplacental and fetal-placental blood flow in the third trimester of gestation, where 0 - absence of blood flow disturbance, 1 - IA severity of blood flow disturbance, 2 - IB severity of blood flow disturbance, 3 - II severity of blood flow disturbance, 4 - III degree of severity of blood flow disturbance.

According to generally accepted scales [Aleksandrovich Yu.S., Gordeev V.I. Rating and prognostic scales in critical care medicine. - Sotis Publishing House. - 2007. - 140 p.] the risk of developing a pathological process is divided into low, moderate and high. When receiving a VRGIEN value of less than 30%, the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes is low, and if it is more than 60%, it is high. When obtaining a VRGIEN value ranging 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 (hypoxic ischemic encephalopathy in newborns born to women of different somatotypes), and the closer the result is to 30%, the lower the likelihood of developing a pathological process (hypoxic ischemic encephalopathy in newborns born from women of different somatotypes).

The data of the woman being examined is substituted into the resulting formula, and the result obtained is used to judge the likelihood of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes.

Statistical processing of the results obtained from the proposed method was carried out using the application package STATGRAPHICSPlus 5.0 for Windows and SPSS 15.0 for Windows. Standard statistical methods were used [Gubler E.V. Computational methods for analysis and recognition of pathological processes. - L.: Medicine. - 1978. - 294 p.]. 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

A survey of 390 women was conducted. Of the women examined, 110 people were of the macrosomatic body type, 173 were of the mesosomatic type, and 107 were of the microsomatic type. Of these, 233 (59.7%) women were primiparous, and 157 (40.3%) were multiparous. The age of the women examined ranged from 18 to 38 years (average 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, pregnancy up to 10 weeks at the time of inclusion in the study, singleton pregnancy.

We found that hypoxic ischemic encephalopathy was significantly less common in newborns born to women with the mesosomatotype (Table 1) compared to macro- and microsomatotypes (p <0.05). It should be noted that the 3rd degree of severity of hypoxic ischemic encephalopathy was not found in the examined newborns, and the 2nd degree of severity was detected only in newborn children born to women with macrosomatotype and microsomatotype. The severity (stage) of hypoxic ischemic encephalopathy in newborns was determined according to the modified scale of Samat N., Sarnat M. (1976) as modified by Stoll B., Kliegman R. (2004) [Sarnat N.V., Sarnat M.S. Neonatalencephalopathyfollowingfetaldistressiaclinicalaiidelectroencephalographi cstudy // Arch. Neuro. - 1976. - Vol. 33. - P. 696-705.; Stoll V., Kliegman R. Nervous System Disorders // Nelson Textbook of Pediatrics. 17th ed. - Philadelphia: SAUNDERS, 2004. - P. 561-569.].

Cardiotocographic indicators of the fetus in the examined pregnant women after 32 weeks of gestation are presented in Table 2. The study was carried out on the UNIKOS fetal monitor with automatic calculation of fetal CTG. As can be seen from the data obtained, there were significant differences in all indicators in the study groups (p <0.05). Thus, the frequency of oscillations per minute and the amplitude of oscillations were significantly lower in the group of women whose newborn children had signs of hypoxic ischemic encephalopathy (p<0.05), and the lowest values were obtained in women with the microsomatotype (p<0.05) .

Table 3 presents indicators of the state of blood flow in the “mother-placenta-fetus” system in the third trimester of gestation in the examined pregnant women according to Dopplerography of utero-placental and fetal-placental blood flow. The study was conducted on a PhilipsEpiq 5 ultrasound scanner. It should be noted that disorders of the uteroplacental and fetal placental blood flow were least common in pregnant women with the mesosomatotype (p <0.05). In the study, grade III disturbances in uteroplacental and fetal placental blood flow were not encountered.

Tables 4 and 5 present anthropometric data and bioimpedance analysis indicators for the examined women. Coefficients C and D 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 [Patent No. 2764952 C1 Russian Federation. A method for predicting the risk of developing uterine hypotension in the early postpartum period in women of different somatotypes: No. 2021109375: application. 04/05/2021: publ. 01/24/2022 / K.G. Tomaeva, S.N. Gaidukov, E.N. Komissarova [and others]; applicant FSBEI HE SOGMA Ministry of Health of the Russian Federation].

Examples of specific implementation of the method:

Example 1. A 27-year-old woman, 6-7 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 49 kg, 2. body length - 159 cm. When conducting bioimpedance analysis, body fat mass was 20%, musculoskeletal body mass - 40.5%.

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 woman had a microsomatic type (0.38 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow did not reveal any blood flow disturbances. At 33 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 13 beats per minute, and the frequency of oscillations per minute was 9.

VRGIEN according to the resulting formula was 13.9%.

The patient was delivered vaginally at 39 weeks' gestation.

When monitoring the newborn, it was revealed that he did not have hypoxic ischemic encephalopathy, i.e. the actual data corresponded to the forecast for the proposed method.

Example 2. A 25-year-old woman, 6 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 44.5 kg, body length - 156 cm. When conducting bioimpedance analysis, body fat mass was 29%, musculoskeletal body mass - 34%.

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 woman had a microsomatic type (0.34 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow revealed a blood flow disorder of grade IA. At 33 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 7 beats per minute, and the frequency of oscillations per minute was 5.

VRGIEN according to the resulting formula was 55.4%.

The patient was delivered vaginally at 38-39 weeks of gestation.

When monitoring the newborn, signs of hypoxic ischemic encephalopathy of the 1st degree were revealed, i.e. the actual data corresponded to the forecast for the proposed method.

Example 3. A 25-year-old woman, 7 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 62 kg, body length - 169 cm. When conducting bioimpedance analysis, body fat mass was 18%, musculoskeletal body mass - 42.8%.

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 woman had a mesosomatic type (0.52 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow did not reveal any blood flow disturbances. At 34 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 17 beats per minute, and the frequency of oscillations per minute was 9.

VRGIEN according to the resulting formula was 4.3%.

The patient was delivered vaginally at 38 weeks' gestation.

When monitoring the newborn, it was revealed that he did not have hypoxic ischemic encephalopathy, i.e. the actual data corresponded to the forecast for the proposed method.

Example 4. A 24-year-old woman, 7 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 74 kg, body length - 178 cm. When conducting bioimpedance analysis, body fat mass was 26%, skeletal-muscular body mass - 35%.

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 woman examined was found to have a macrosomatic type (0.64 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow did not reveal any blood flow disturbances. At 33 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 10 beats per minute, and the frequency of oscillations per minute was 7.

VRGIEN according to the resulting formula was 38.6%.

The patient was delivered vaginally at 40 weeks' gestation.

When monitoring the newborn, it was revealed that he did not have hypoxic ischemic encephalopathy, i.e. the actual data corresponded to the forecast for the proposed method.

Example 5. A 26-year-old woman, 7 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 86 kg, body length - 177 cm. When conducting bioimpedance analysis, body fat mass was 33%, skeletal-muscular body mass - 25%.

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 woman examined was found to have a macrosomatic type (0.69 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow revealed a degree IB blood flow disorder. At 34 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 3 beats per minute, and the frequency of oscillations per minute was 3.

VRGIEN according to the resulting formula was 96.6%.

The patient was delivered vaginally at 39 weeks' gestation.

When monitoring the newborn, signs of hypoxic ischemic encephalopathy of the 1st degree were revealed, i.e. the actual data corresponded to the forecast for the proposed method.

Example 6. A 25-year-old woman, 6-7 weeks pregnant, underwent rapid diagnosis of human somatotype according to R.N. Dorokhov.

Anthropometric measurements according to generally accepted rules and methods gave the following results: body weight - 80 kg, body length - 175 cm. When conducting bioimpedance analysis, body fat mass was 30%, skeletal-muscular body mass - 33.5%.

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 woman examined was found to have a macrosomatic type (0.64 points). In the third trimester of pregnancy, Doppler ultrasound of the uteroplacental and fetal placental blood flow revealed a blood flow disorder of grade IA. At 33 weeks of gestation, when performing fetal cardiotocography, the amplitude of oscillations was 6 beats per minute, and the frequency of oscillations per minute was 5.

VRGIEN according to the resulting formula was 61.3%.

The patient was delivered vaginally at 38-39 weeks of gestation.

When monitoring the newborn, signs of hypoxic ischemic encephalopathy of the 1st degree were revealed, i.e. the actual data corresponded to the forecast for the proposed method.

Thus, carrying out calculations using the formula presented above, which can be done using a calculator or the Microsoft Excel program, allows us to predict with sufficiently high accuracy the prognosis of the occurrence of hypoxic ischemic encephalopathy in newborns long before the birth of their mothers, namely in the third trimester of pregnancy, which allows us to form among pregnant women in the third trimester of gestation are at high risk for the development of hypoxic ischemic encephalopathy in their newborns long before delivery, which will contribute to more effective implementation of treatment and preventive measures to prevent the development of hypoxic ischemic encephalopathy in newborns.

The advantages of the proposed method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes are that the method is simple to perform, easily reproducible, and widely available, since devices for bioimpedance analysis and fetal cardiotocography are widespread and safe for the body of a pregnant woman women due to the lack of radiation exposure, and also does not require large material costs, and allows you to calculate an individual prognosis for the development of the disease.

Claims (9)

A method for predicting the risk of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes, including clinical and ultrasound examinations of a pregnant woman, characterized in that the examined woman’s body weight and length are measured during pregnancy up to 10 weeks, and the somatotype is determined using the method of R.N. Dorokhov, a bioimpedance analysis is performed, which calculates the fat and skeletal muscle mass of the body of the woman being examined, and then after 32 weeks of pregnancy, cardiotocography of the fetus is performed, the frequency of oscillations per minute and the amplitude of oscillations are calculated, in the third trimester of gestation the severity of blood flow disturbances in the mother’s system is calculated -placenta-fetus according to Dopplerography data of utero-placental and fetal-placental blood flow and the obtained data are entered into the formula VRGIEN=85.21+(9.38×A)+(1.21×B)-(2.02×C)-(0.85×D)-(0.66×E)+(10.17 ×F), where VRGIEN is the probability of developing hypoxic ischemic encephalopathy in newborns born to women of different somatotypes, in%, A - maternal somatotyping scores, B - maternal body fat mass in%, C - skeletal muscle mass of the mother’s body in%, D - amplitude of oscillations in gestation after 32 weeks in beats per minute, E - frequency of oscillations per minute in gestation after 32 weeks, F - severity of Dopplerographic disturbance of uteroplacental and fetal-placental blood flow in the third trimester of gestation, where 0 - absence of blood flow disturbance, 1 - IA severity of blood flow disturbance, 2 - IB severity of blood flow disturbance, 3 - II severity of blood flow disturbance, 4 - III degree of severity of blood flow disturbance, and based on the results obtained, from 60 to 100% a high risk of developing hypoxic ischemic encephalopathy is predicted in newborns born to women of different somatotypes.