The assessment version of the definition of perinatal risk was first proposed in 1973 by S. Hobel et al., who published an antenatal assessment system in which a number of perinatal factors are quantitatively distributed on a graduated scale. First of all, diseases of the cardiovascular system, kidneys, metabolic disorders, unfavorable obstetric history, anomalies of the reproductive tract, etc. were taken into account. Subsequently, C. Hobel developed two more assessment systems - intranatal and neonatal. Scoring risk factors makes it possible to assess not only the likelihood of an unfavorable birth outcome, but also the specific weight of each factor.
According to the authors, 10–20% of women belong to groups at increased risk of morbidity and mortality of children in the perinatal period, which explains the death of fetuses and newborns in more than 50% of cases. The number of identified risk factors ranged from 40 to 126.
We have developed our own system for calculating risk factors, which is less complex and easier to use. It was first used in the Canadian province of Manitoba, and was called the “Manitoba system” (Table 5).
Table 5 Manitoba Perinatal Risk Assessment System
Among children born to mothers classified by this system as a high-risk group, neonatal morbidity was 2–10 times higher. The disadvantage of the Manitoba system is that the assessment of some indicators is very subjective. Therefore, F. Arias supplemented the system with a scoring system for extragenital complications commonly encountered during pregnancy (Table 6).
Table 6 Indicative scoring of some extragenital complications of pregnancy, used when using the Manitoba system
* Toxoplasmosis, rubella, chlamydia, herpes.
According to this system, a screening examination was carried out at the first visit to the doctor of a pregnant woman and was repeated between the 30th and 36th weeks of pregnancy. As pregnancy progressed, perinatal risk was reassessed. If any new complications developed, the pregnant woman was transferred from the low-risk group to the high-risk group. If it was concluded that a pregnant woman belongs to a high-risk group, the doctor was recommended to select appropriate monitoring methods to ensure a favorable pregnancy outcome for both mother and child. In most cases, such women were recommended to be transferred under the supervision of a perinatologist.
In our country, the first perinatal risk scales were developed by L. S. Persianinov and O. G. Frolova (Table 7). Based on a study of literature data, our own clinical experience and a multifaceted study of birth histories when studying the causes of perinatal mortality by O. G. Frolova and E. I. Nikolaeva, individual risk factors were identified. These included only factors leading to a higher level of perinatal mortality in relation to this indicator present in the entire group of examined pregnant women. To quantify the significance of factors, a scoring system was used. The principle of risk scoring was as follows: each perinatal risk factor was assessed retrospectively based on newborn Apgar scores and perinatal mortality rates. The risk of perinatal pathology was considered high for children who received an Apgar score of 0–4 points at birth, average – 5–7 points, and low – 8–10 points. To determine the degree of influence of maternal risk factors on the course of pregnancy and childbirth for the fetus, it was recommended to make a total score of all available antenatal and intranatal risk factors. In principle, the scales of O. G. Frolova and L. S. Persianinov, with the exception of isolated differences, are identical: each contains 72 perinatal risk factors, divided into 2 large groups: prenatal (A) and intranatal (B). For convenience of working with the scale, prenatal factors are combined into 5 subgroups: 1) socio‑biological; 2) obstetric and gynecological history; 3) extragenital pathology; 4) complications of this pregnancy; 5) assessment of the condition of the fetus. The total number of prenatal factors was 52. Intranatal factors were also divided into 3 subgroups. Factors from: 1) mother; 2) placenta and umbilical cord; 3) fruit. This subgroup contains 20 factors. Thus, a total of 72 risk factors were identified.
Table 7 Perinatal risk scale by O. G. Frolova and E. I. Nikolaeva
An assessment of the degree of perinatal risk is carried out at the first visit to the antenatal clinic, at 28-32 weeks and before childbirth. After the assessment, a pregnancy management plan is drawn up; All pregnant women with high perinatal risk are examined by the head of the antenatal clinic and by the district obstetrician-gynecologist.
Anamnestic factors (1 screening - at the first appearance of a pregnant woman) Risk factors Score Socio-biological Mother's age Less than 18 years 2 40 years or more 4 Father's age 40 years or more 2 Occupational hazards: - mother 3 - father 3 Bad habits mother's: -smoking one pack of cigarettes a day 2 -alcohol abuse 4 Father's bad habits: -alcohol abuse 2 Marital status: single 1 Emotional stress 1 Mother's height and weight: -height 158 cm or less 2 -body weight 25 % above the norm 2 Sum of points A Enter the amount
Obstetric and gynecological history Parity -4 -7 births 1 -8 or more 2 Abortions before the first upcoming birth: -one 2 -two 3 -three or more 4 Abortions before repeated births or the last birth: -three or more 2 Intrauterine interventions 2 Premature births: -one 2 -two or more 3 Stillbirth, miscarriage, non-developing pregnancy: -one case 3 -two cases or more 7 Developmental anomalies in children born earlier 3 Neurological disorders in children born earlier 2
Weight of full-term children up to 2500 g, 4000 g and more 2 Infertility: -2 -4 years 2 -5 years and more 4 Scar on the uterus after surgery 4 Tumors of the uterus and/or ovaries 4 Isthmic-cervical insufficiency, benign diseases, deformation, previous destruction of the cervix 2 Malformations of the uterus 3 Chronic inflammatory processes and appendages, complications after abortion and childbirth, intrauterine contraception 3 Ectopic pregnancy 3 Assisted reproductive technologies - IVF 1 - intracytoplasmic sperm injection 2 Sum of points B Enter the amount
Extragenital diseases of the mother Cardiovascular - heart defects without circulatory disorders 3 - heart defects with circulatory disorders 10 - chronic arterial hypertension 1 -3 stages 2 -8 -12 -varicose veins 2 -Hypotensive syndrome 2 Kidney diseases 4 Coagulopathies 2 Myopia and other diseases eye 2 Chronic specific infections (tuberculosis, brucellosis, toxoplasmosis) 3
Endocrinopathies: - diseases of the adrenal glands, neurometabolic endocrine syndrome 5 -10 - diabetes 10 - diseases of the thyroid gland 7 - obesity 2 Anemia: - hemoglobin content 90 g/l 4 - hemoglobin content 100 g/l 2 - hemoglobin content 110 g/l 1 Positive reaction to lupus anticoagulant 4 Antibodies to phospholipids: -Ig G from 9 , 99 and above 2 -Ig. M from 9, 99 and above 3 Sum of points B Sum of points for anamnestic factors D
Factors of pregnancy. The second screening is at 2832 weeks, the third screening is at the end of pregnancy. Complications of pregnancy II III Severe early toxicosis 2 2 Recurrent threat of miscarriage 2 2 Edema of pregnant women 2 2 - mild 3 3 - moderate 5 5 - severe 10 10 Preeclampsia 11 11 Eclampsia 12 12 Preeclampsia:
Exacerbation of kidney disease during pregnancy 4 4 Acute infections during pregnancy, including acute respiratory viral infections 4 4 Negative Rh factor or ABO sensitization 5 or 10 5 or 10 Polyhydramnios 3 3 Oligohydramnios 4 4 Breech presentation of the fetus, large fetus, narrow pelvis 3 3 Multiple pregnancy 3 3 Postterm pregnancy 3 3 Incorrect position of the fetus (transverse, oblique) 3 3 Biological immaturity of the birth canal at 40 weeks pregnancy 4 4
HCG screening: - increased content 3 3 - decreased content 4 4 - increased content 6 6 - decreased content 8 8 - increased content 2 2 - decreased content 3 3 AFP: PAPP-A Total points D
Assessment of fetal condition Fetal hypotrophy -1 degree 10 10 -2 degrees 15 15 -3 degrees 20 20 Chronic placental insufficiency 4 4 -less than 7 4 4 -6 8 8 -5 12 12 -4 16 16 -less than 4 20 20 CTG assessment by Fisher Sum of points E Sum of points for pregnancy factors G Total score of prenatal factors (anamnestic factors and
Intrapartum risk factors (4 screening-in labor) Intrapartum complications Points Meconium staining of amniotic fluid 8 Prenatal rupture of water (in the absence of labor for 6 hours) 6 Pathological preliminary period 4 Anomalies of labor 10 Chorioamnionitis 4 Sum of points of intrapartum factors: AND Total amount perinatal risk points: K Intranatal gain (ratio of the sum of points of intranatal risk factors to the sum of points of prenatal risk factors in%): L
Determination of the degree of perinatal risk: Low risk - up to 15 points; Average risk level - 15 -24 points; High risk - 25 points or more;
Screening algorithm for perinatal risk factors: Screening stage Time and doctor's actions Stage I At the first appearance (anamnestic factors): D = A + B + C Stage II C 28 -32 weeks (pregnancy factors): F = D + E Stage III At the end of pregnancy (pregnancy factors): F=D+E Note During the III screening, the total score of prenatal factors is calculated. The value of this amount determines the degree of prenatal risk. During hospitalization, the level of care provided by the obstetric institution must correspond to the degree of prenatal risk of the pregnant woman: - low risk - level 1; -average degree of risk - level 2; -high degree of risk - level 3; IV During the first and second stages of labor (intranatal factors: I) Note During labor, if the clinical situation changes, the total amount of perinatal risk scores is recalculated and the intranatal gain is calculated.
The course of pregnancy can be complicated by the development of toxicosis in pregnant women, premature termination or post-term pregnancy, and premature abruption of the normally located placenta. Possible disruption of fetal development and death. A certain danger for the mother and fetus is posed by incorrect position of the fetus (oblique, transverse position), breech presentation fetus, abnormalities in the location of the placenta, polyhydramnios and oligohydramnios, multiple births. Severe complications (uterine bleeding, premature abortion, fetal death) can be a consequence of hydatidiform mole. At immunological incompatibility spontaneous miscarriage, toxicosis of pregnant women, hypoxia and fetal death are possible for mother and fetus; As a result of sensitization of a pregnant woman by erythrocyte antigens of the fetus, hemolytic disease of the fetus and newborn develops. The pathological course of pregnancy and fetal development disorders can be observed if the pregnant woman has certain extragenital and gynecological diseases.
To determine the degree of risk of perinatal pathology, an indicative scale for assessing prenatal risk factors, in points, is proposed; the scale is used taking into account individual characteristics anamnesis, course of pregnancy and childbirth (Table 3).
Assessment of prenatal risk factors (O.G. Frolova, E.I. Nikolaeva, 1980)
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With a score of 10 or more, the risk of perinatal pathology is high, with a score of 5-9 points - average, with a score of 4 points or less - low. Depending on the degree of risk, the obstetrician-gynecologist at the antenatal clinic draws up an individual follow-up plan, taking into account the specifics of the existing or possible pathology, including special research in order to determine the condition of the fetus: electrocardiography, ultrasound, amnioscopy, etc. If there is a high risk of perinatal pathology, it is necessary to decide on the advisability of continuing the pregnancy. Risk assessment is carried out at the beginning of pregnancy and at 35-36 weeks. to resolve the issue of length of hospitalization. Pregnant women with a high risk of perinatal pathology must be hospitalized for childbirth in a specialized hospital.
Owners of patent RU 2335236:
The invention relates to medicine, namely to obstetrics and gynecology. In a pregnant woman, socio-biological factors, obstetric and gynecological history, extragenital diseases, pregnancy complications and the condition of the fetus are determined in scores. The received points are summed up and, based on the resulting sum, the course and outcome of pregnancy are assessed as follows: favorable, further observation and delivery are carried out in obstetric facilities of the Central district or city hospital; doubtful, the tactics for further management of pregnancy and delivery are determined in the Interdistrict perinatal center or City maternity hospital; unfavorable, tactics for further management of pregnancy and delivery are determined in the Republican Perinatal Center or the Regional or Regional Maternity Hospital; extremely unfavorable with emergency hospitalization. The method allows you to assess the individual degree of risk of complications of the gestational period and the upcoming birth of a pregnant woman, give a forecast of the outcome of pregnancy with the definition of a standard risk group on a monitoring scale and, accordingly, apply a differentiated algorithm of actions in the process of pregnancy management, determine the optimal level of hospital for further observation and delivery, reduce the level maternal and perinatal losses. 1 salary f-ly, 1 ill., 5 tables.
The invention relates to medicine, namely to obstetrics and gynecology, it allows one to assess the individual risk level of possible complications of the gestational period and the upcoming birth of a pregnant woman, to predict the outcome of pregnancy with the determination of a standard risk group according to the monitoring scale and, accordingly, to apply a differentiated algorithm of actions in the process of pregnancy management , determine the optimal level of hospital for further observation and delivery, reduce the level of maternal and perinatal losses.
There is a known method for assessing perinatal risk factors, proposed by Frolova O.G., Nikolaeva E.I., 1980 (O.G. Frolova, E.I. Nikolaeva, 1980. Order of the USSR Ministry of Health No. 430 dated April 22, 1981 “On approval instructions and methodological guidelines for organizing the work of antenatal clinics"), but this method evaluates only 72 risk factors, which, based on work experience, is not enough to fully determine the individual risk group of pregnancy and upcoming birth.
The objective of the invention was to develop a monitoring scale for pregnant women at risk to assess the degree of individual risk of possible complications during the gestational period and delivery with the determination of tactics and the level of obstetric hospital for further management of pregnancy and childbirth.
The technical result when using the invention is an objective assessment of the degree of risk of possible complications, prognosis of pregnancy outcome and bringing risk groups of pregnant women to a unified standard, differentiation of tactics for managing pregnancy and childbirth.
We, using the heterogeneous sequential recognition procedure of A.A. Genkin and E.V. Gubler [Gubler E.V. Computational methods for analysis and recognition of pathological processes. - L.: “Medicine”, 1978. - 296 p.] informative features were selected and ranked using Kullback’s measure of informativeness. Diagnostic coefficients - points - were calculated for the selected characteristics.
When using the method, the points are summed until thresholds are reached: low (less than 30 points, achieving it means a favorable course and outcome of pregnancy), medium (31-49 points, reaching it means a questionable course and outcome), high (51-99 points, achievement it means an unfavorable course and outcome) and emergency hospitalization (101 or more points; achieving it means that it is necessary to decide on the advisability of prolonging pregnancy).
The diagnostic significance of the following factors was investigated:
I. Socio-biological: age of the pregnant woman, bad habits, harmful factors of work and life in the pregnant woman, marital status, somatic indicators, gestational age when taken under observation by the antenatal clinic, genetic factors;
II. Obstetric and gynecological history: menstrual function, diseases of the internal genital organs, infertility, parity of pregnancies, miscarriages, childbirth, condition of newborns.
III. Extragenital diseases: infectious diseases, neoplasms, diseases of the endocrine system, diseases of the blood and hematopoietic organs, mental disorders, diseases nervous system and sensory organs, diseases of the circulatory system, diseases of the respiratory system, diseases of the urinary organs.
IV. Complications of pregnancy: induced pregnancy, after in vitro fertilization, threatened miscarriage, toxicosis, bleeding, gestosis, Rh and ABO sensitization, fetoplacental insufficiency, amniotic fluid disturbances, fetal malposition, multiple pregnancy, large fetus, placenta previa, ultrasound findings.
V. Fetal condition: hypoxia, malnutrition, presence of congenital malformation, antenatal fetal death.
The development of complications such as decompensation of extragenital pathology, threat of miscarriage, bleeding, gestosis, fetoplacental insufficiency, intrauterine hypoxia, fetal hypotrophy, antenatal fetal death, and the presence of congenital malformations were taken into account.
Of these signs, 164 turned out to be the most informative (Table 1).
Table 2 shows a differentiated algorithm of actions in the process of pregnancy management, determining the optimal level of hospital for further observation and delivery.
The drawing shows an algorithm for implementing the method.
The method is carried out as follows.
During the gestational period, the risk group is assessed three times: 1 - when registering a pregnant woman with an antenatal clinic, 2 - at 20-24 weeks, 3 - at 30-34 weeks of pregnancy.
Each sign is scored in accordance with Table 1, namely:
I. Socio-biological, such as: age up to 20 years and 30-34 years are assessed as “2” points, 35-39 years - “3” points, 40 years and older - “4” points; Availability bad habits- nicotine addiction is assessed as “1” point, alcoholism - “2” points, drug addiction, substance abuse - “3” points; harmful factors at work and in everyday life, such as: chemical, radioactive, unsatisfactory living conditions, taking medications in early dates pregnancy - “2” points; marital status (single, divorced, marriage registration during pregnancy) is assessed as “1” point; somatic indicators, such as height below 150 and above 165 cm, hirsutism - “1” point, male body type - “2” points; a body mass index of 26-30 is assessed as “1” point, 31-40 - “2”, 41 or more - “3” points; when pelviometry reveals a generally uniformly narrowed, transversely narrowed, simple flat, flat rachitic pelvis and a flat pelvis with a decrease in the direct size of the wide part of the cavity, it is scored as “2” points; I, II, III, IV degrees of pelvic narrowing - “2”, “10”, “20”, “50” points, respectively; registration at the antenatal clinic after 12 weeks of pregnancy is assessed as “1” point; the presence of genetic factors in a pregnant woman, such as hereditary diseases and congenital malformations, is assessed as “5” and “10” points, respectively.
II. Obstetric and gynecological history, namely menstrual dysfunction, such as an extended menstrual cycle, irregular menstruation is assessed as “1” point, menarche from 16 years of age and later, hypomenstrual syndrome – “2” points; the presence of inflammation of the uterine appendages in a woman who has given birth, operations on the appendages are assessed as “2” points, inflammation of the appendages in a nulliparous woman, isthmic-cervical insufficiency - “3” points, tumor formation of the uterine appendages, operations on the uterus for gynecological pathology - “4” points , uterine fibroids - “6” points, uterine hypoplasia - “8” points, uterine malformation - “10” points; the presence of infertility of hormonal origin is assessed as “4” points, tubal-peritoneal origin – “2” points, the duration of infertility for a period of 2-3 years or more than 3 years is assessed as “2” and “4” points, respectively; the presence of a spontaneous miscarriage in a nulliparous woman is assessed as “3” points, in a woman who has given birth - “2” points, recurrent miscarriage - “6” points; the presence of one induced abortion is assessed as “2” points, two, three or more abortions – as “3” and “4” points, respectively, the presence of complications of abortion such as bleeding, infection is assessed as “6” points, incomplete abortion – “4” points; the first pregnancy is assessed as “2” points, the second pregnancy – “1” point; the presence of moderate gestosis in the anamnesis is assessed as “4” points, severe and eclampsia as “8” and “10” points, respectively, a history of fetoplacental insufficiency is assessed as “6” points, exacerbation of extragenital pathology - “4” points,
the presence of a history of premature and delayed birth, rupture of the soft birth canal of II-III degree is assessed as “6” points, the presence of stillbirth, bleeding, purulent-septic infection - as “8” points, C-section assessed as “10” points; the presence of neonatal mortality is assessed as “8” points, congenital malformations - “6” points, neurological disorders of the newborn and a full-term weight of less than 2500 and more than 4000 grams. as "4" points.
III. Extragenital diseases, such as: influenza, ARVI during pregnancy are assessed as “2” points, tuberculosis, syphilis - as “4” points, viral hepatitis, HIV infection - as “8” points, rubella - “10” points; the presence of malignant neoplasms in the past and present is assessed as “10” points; diseases of the endocrine system, such as diabetes mellitus, thyroid diseases, diencephalic syndrome are assessed as “8”, “4”, “2” points, respectively; the presence of anemia is assessed as “5” points, coagulopathy, thrombocytopenia as “10” and “12” points, respectively; the presence of psychosis, schizophrenia, mental retardation is assessed as “6” points, personality disorders - as “8” points; myopia and other eye diseases are assessed as “4” points, inflammatory, hereditary and degenerative diseases of the central nervous system are assessed as “8” points, cerebrovascular accidents in the past and present – as “50” points; heart defects without circulatory failure in a woman are assessed as “2” points, heart defects with circulatory failure, heart rhythm disturbances, operated heart, hypertension are assessed as “8” points, myocardial, endocardial and pericardial diseases, vascular diseases – as “6” points; the presence of pneumonia is assessed as “4” points, bronchial asthma, bronchiectasis – as “6” points, lobectomy, pneumonectomy – “8” points; the presence of hydronephrosis is assessed as “4” points, pyelonephritis as “6” points, a single kidney – “50” points, glomerulonephritis, polycystic kidney disease is assessed as “100” points.
IV. Complications of pregnancy, namely the onset of pregnancy after ovulation induction are assessed as “10” points, after in vitro fertilization - as “20” points; severe toxicosis is assessed as “2” points, the presence of a threat of termination of pregnancy before 20 weeks is assessed as “6” points, after 20 weeks of pregnancy – as “8” points; the presence of bleeding is assessed as “100” points; the presence of dropsy is assessed as “2” points, mild gestosis is assessed as “10” points, moderate gestosis is assessed as “50” points, severe gestosis, preeclampsia, eclampsia is assessed as “100” points; the presence of a Rh antibody titer of 1:8 is assessed as “4” points, 1:16 - as “6” points, sensitization according to the ABO system - as “8” points; the presence of primary and secondary fetoplacental insufficiency is assessed as “8” and “6” points, respectively; the following disturbances of amniotic fluid, such as: polyhydramnios are assessed as “8” points, oligohydramnios - as “6” points, the presence of meconium fluid - as “10” points; incorrect fetal position (oblique, transverse, pelvic presentation) is assessed as “4”, “8”, “6” points, respectively; the presence of twins is assessed as “8” points, triplets or more – as “10” points, a large fetus – as “4” points; the presence of marginal placenta previa is assessed as “50” points, central - as “100” points; discrepancy with the gestational age of ultrasound data, such as fetometry, state of amniotic fluid, placentometry, is assessed as: “10” points; the presence of signs of congenital malformations is assessed as “20” points.
V. Conditions of the fetus, such as: hypoxia is assessed as “4” points, malnutrition – as “25” points, specified congenital malformation – as “50” points, antenatal fetal death is assessed as “100” points.
If there is no data for one of the parameters, its score is equal to “0”. The data obtained are summarized, and if the sum of points is less than “30”, then the prognosis for the course and outcome of pregnancy is favorable, in this case, further monitoring of the gestational period and delivery is carried out in the obstetric facilities of the Central District or City Hospital (CRH, Central City Hospital), information about the woman transferred to the attached Interdistrict Perinatal Center (MPC) or City Maternity Hospital (CHR). If the sum of points was from “31” to “49”, then the prognosis of the outcome is doubtful, in this case, information from the Central District Hospital, Central City Hospital or State Children's Hospital is transferred to the attached MPC or State Children's Department, a consultation is carried out at the Medical Center or State Children's Department, where the tactics for further management of pregnancy and delivery are determined , the Republican Perinatal Center (RPC) or the Regional, Regional Maternity Hospital (ORD, KRD) is notified. If the value of the sum of points is in the range from “51” to “99”, then the prognosis of the outcome is unfavorable, information from the Central District Hospital or Central City Hospital is transmitted directly to the Russian Orthodox Church or Ord, Regional Clinical Hospital, where the pregnant woman is consulted, the tactics and level of the hospital for further management are determined gestational period and delivery. If the total score is “101” points or higher, the prognosis is extremely unfavorable. Emergency hospitalization is carried out at the nearest obstetrics facility, and intensive therapy for the existing pathology is carried out. In addition, an emergency notification to the Obstetrics-Gynecology-Resuscitation Consultative Center (Air Ambulance), the issue of calling a specialized team and the possibility of prolonging pregnancy, the duration, method, hospital of delivery or interruption of the gestational period is being resolved.
The proposed method is illustrated by the following examples.
Example 1. Pregnant N., with the following factors:
I. Socio-biological: 24 years; without bad habits, work and everyday factors; Married; with a body mass index of 22; normal pelvic sizes; registered for pregnancy at the antenatal clinic at 10 weeks; without burdened genetic factors.
II. Obstetric and gynecological history: normal menstrual function; there are no diseases of the internal genital organs and infertility; there were no spontaneous or induced abortions; multipregnant, with an uncomplicated course of the previous gestational period, urgent spontaneous birth; newborn weighing 3157 g without harmful factors.
III. Extragenital diseases: without infectious diseases; there were no malignant neoplasms in the past or present; no endocrine pathology; there is grade 1 anemia; no mental disorders; there are no diseases of the nervous system and sensory organs, circulatory system and respiratory organs; Among the diseases of the urinary organs there is chronic pyelonephritis.
IV. Complications of pregnancy: pregnancy occurred spontaneously; proceeds without signs of threat of interruption; without toxicosis, bleeding; no signs of gestosis; there is no Rh and ABO sensitization; no signs of fetoplacental insufficiency or disturbance of amniotic fluid were found; longitudinal position of the only large fruit without signs; data corresponding to the gestational age of fetometry, the state of amniotic fluid, placentometry, without signs of congenital malformations.
V. Fetal condition: normal fetal condition without signs of hypoxia, malnutrition, no antenatal death.
VI. The score for the risk factors of pregnancy and upcoming birth according to Table 1 was “12” points, which indicates a favorable outcome of the gestational period (Table 3). Since the woman belongs to a low-risk group, further observation in the conditions of the Central District Hospital or Central City Hospital, transfer of information about the pregnant woman to the MPC, GRD is indicated.
Diagnosis: Main: Pregnancy 10 weeks. Complication: Anemia. Associated: Chronic pyelonephritis.
Subsequently, the woman was observed in the antenatal clinic of the Central District Hospital; received antianemic therapy with monitoring of the level of hemoglobin, red blood cells, and blood coagulation system; prevention of activation of chronic pyelonephritis was carried out with phytouroseptics, positional gymnastics, urine tests and the functional state of the kidneys were monitored. The gestational period proceeded without complications, the pregnancy ended with urgent spontaneous birth of a healthy male newborn in the obstetric department of the Central District Hospital.
Example 2. Pregnant K., with the following factors:
I. Socio-biological: 29 years old; without bad habits, labor factors, unsatisfactory living conditions; divorced; with a body mass index of 24; normal pelvic sizes; registered for pregnancy at the antenatal clinic at 18 weeks; without burdened genetic factors.
II. Obstetric and gynecological history: normal menstrual function; chronic inflammatory disease of the uterine appendages, no infertility; there was a spontaneous miscarriage and 2 induced abortions; the previous gestational period is complicated by exacerbation of extragenital disease, premature spontaneous birth.
III. Extragenital diseases: without infectious diseases; there were no malignant neoplasms in the past or present; no endocrine pathology; no diseases of the blood or hematopoietic organs were detected; no mental disorders; there are no diseases of the nervous system and sensory organs, circulatory system and respiratory organs; Among the diseases of the urinary organs is kidney tuberculosis.
IV. Complications of pregnancy: pregnancy occurred spontaneously; proceeds without signs of threat of interruption; without toxicosis, bleeding; no signs of gestosis; there is no Rh and ABO sensitization; primary placental insufficiency was detected, there was no pathology of amniotic fluid; longitudinal position of the only large fruit without signs; An ultrasound examination revealed a discrepancy between the fetometric data and the gestational age, without signs of congenital malformations.
V. Fetal condition: the fetal condition is complicated by hypoxia.
The score for risk factors of pregnancy and upcoming birth according to Table 1 was “69” points, which indicates an unfavorable outcome of the gestational period (Table 4). The woman belongs to a high-risk group, it is necessary to transfer information from the Central District Hospital or Central City Hospital directly to the Russian Orthodox Church or Regional Clinical Hospital, Regional Clinical Hospital, where the pregnant woman is consulted, the tactics and level of the hospital for further management of the gestational period and delivery are determined.
Diagnosis: Main: Pregnancy 26 weeks. Complication: Primary fetoplacental insufficiency. Intrauterine fetal hypoxia. Concomitant: burdened gynecological history. Kidney tuberculosis.
Information about this pregnant woman was transferred to the Republican Perinatal Center, from where she was invited for a consultation. After an additional examination and consultation with a phthisiatrician, a meeting of the clinical expert commission was held - it was decided to prolong the pregnancy. She was hospitalized in the pregnancy pathology department of the Russian Orthodox Church, where therapy was carried out aimed at maintaining pregnancy, improving utero-fetal blood flow, including barotherapy. A repeated planned consultation at the Russian Orthodox Church was carried out at 32 weeks of pregnancy. Subsequently, the woman was observed in the antenatal clinic of the Central District Hospital, and the recommendations of the Russian Orthodox Church specialists were followed. At 36 weeks of pregnancy, the woman was hospitalized for preparation for planned delivery in the obstetric department of the Republican Clinical Hospital, where she was successfully delivered through the vaginal birth canal in a timely manner as a healthy newborn girl without signs of hypoxia and malnutrition.
Example 3. Pregnant R., with the following factors:
I. Socio-biological: 31 years old; without bad habits, work and everyday factors; Married; with a body mass index of 32 (obesity II-III degree); normal pelvic sizes; registered for pregnancy at the antenatal clinic at 16 weeks; without burdened genetic factors.
II. Obstetric and gynecological history: normal menstrual function; there are no diseases of the internal genital organs and infertility; 3 induced abortions, one of which was complicated by bleeding; there were no spontaneous miscarriages; multipregnant, no history of childbirth.
III. Extragenital diseases: without infectious diseases; there were no malignant neoplasms in the past or present; no endocrine pathology; there is grade 1 anemia; no mental disorders; there are no diseases of the nervous system and sensory organs, circulatory system and respiratory organs; without diseases of the urinary organs.
IV. Complications of pregnancy: pregnancy occurred spontaneously; proceeds without signs of threat of interruption; without toxicosis, bleeding; against the background of moderate gestosis; there is no Rh and ABO sensitization; Ultrasound examination revealed signs of placento- and fetometry that do not correspond to the gestational age; longitudinal position of the only fetus without signs of a large fetus, without signs of congenital malformations.
V. Fetal condition: fetal malnutrition was detected.
The score for risk factors of pregnancy and upcoming birth according to Table 1 was “124” points, which indicates an extremely unfavorable outcome of the gestational period (Table 5). Since the woman belongs to the emergency hospitalization group, emergency hospitalization is carried out at the nearest obstetrics facility, intensive therapy for gestosis, intrauterine fetal hypotrophy, and antianemic therapy is carried out. In addition, an emergency notification to the Obstetrics-Gynecology-Resuscitation Consultative Center (Air Ambulance), the issue of calling a specialized team and the possibility of prolonging pregnancy, the duration, method, hospital of delivery or interruption of the gestational period is being resolved.
Diagnosis: Main: Pregnancy 34 weeks. Head presentation. Complication: Preeclampsia of moderate severity. Primary fetoplacental insufficiency. Intrauterine hypoxia, fetal hypotrophy. Anemia 1st degree. Concomitant: burdened gynecological history. Repeatedly pregnant, 31 years old. Obesity II-III degree.
The woman was urgently hospitalized in the obstetric department of the Central Regional Hospital, and intensive therapy was started for existing complications of the gestational period. The Obstetrics, Gynecology and Resuscitation Consultative Center was urgently notified of the presence of such a pregnant woman, and it was decided to send a team of specialists from the AGRCC to the Central District Hospital. After the team arrived at the scene and assessed the situation according to absolute obstetric indications, early delivery was performed by a minor cesarean section, and a living girl with signs of hypoxia and malnutrition of the 2nd degree was removed. Intensive therapy of the mother and newborn continued in the central district hospital for 24 hours. Subsequently, the woman and the newborn were transported by air ambulance to a republican-level healthcare facility for further treatment and rehabilitation.
| METHOD FOR ASSESSING RISK FACTORS FOR PREGNANCY AND UPCOMING BIRTH USING A MONITORING SCALE FOR PREGNANT WOMEN IN RISK GROUPS | ||
| Table 1. | ||
| No. | Factors | Points |
| I. | Socio-biological | |
| I. 1. | Pregnant age: | |
| I. 2. | up to 20 years | 2 |
| I. 3. | 30-34 years | 2 |
| I. 4. | 35-39 years old | 3 |
| I. 5. | 40 years and older | 4 |
| I. 6. | Bad habits: | |
| I. 7. | No | 0 |
| I. 8. | smoking | 1 |
| I. 9. | alcoholism | 2 |
| I. 10. | addiction | 3 |
| I. 11. | substance abuse | 3 |
| I. 12. | ||
| I. 13. | No | 0 |
| I. 14. | chemical | 2 |
| I. 15. | radioactive | 2 |
| I. 16. | 2 | |
| I. 17. | taking medications in early pregnancy | 2 |
| I. 18. | Family status: | |
| I. 19. | lonely | 1 |
| I. 20. | divorced | 1 |
| I. 21. | marriage registration during pregnancy | 1 |
| I. 22. | Somatic indicators: | |
| I. 23. | height 150 cm and below | 1 |
| I. 24. | height 165 cm and above | 1 |
| I. 25. | male body type | 2 |
| I. 26. | hirsutism | 1 |
| I. 27. | ||
| I. 28. | 26-30 | 1 |
| I. 29. | 31-40 | 2 |
| I. 30. | 41 or more | 3 |
| I. 31. | Pelvic dimensions (pelviometry, cm): | |
| I. 32. | Distantia spinarum (D.s.) - less than 25 | 2 |
| I. 33. | Distantia cristarum (D.c.) - less than 28 | 2 |
| I. 34. | Distantia trochanterica (D.t.) - less than 30 | 2 |
| I. 35. | Conjugata externa (Ce.) - less than 20 | 2 |
| I. 36. | Conjugata diagonalis (C.d.) - less than 12.5 | 2 |
| I. 37. | Conjugata vera (C.v.) - less than 11 | 2 |
| I. 38. | Michaelis rhombus - angles do not correspond to 90°, long, diameter - less than 11 cm | 2 |
| I. 39. | Solovyov index - 14 cm or more | 2 |
| I. 40. | Narrow pelvis: |
Continuation of Table 1
| I. 41. | according to the shape of the narrowing | |
| I. 42. | generally uniformly narrowed (D.s.-24; D.c.-26; D.t.-28; C.e.-18; C.d.-11; C.v.-9) | 2 |
| I. 43. | transversely narrowed (D.s.-24; D.c.-25; D.t.-28; S.e.-20; S.d.-12.5; S.v.-11) | 2 |
| I. 44. | simple flat (D.s.-26; D.c.-29; D.t.-30; C.e.-18; C.d.-11; C.v.-9) | 2 |
| I. 45. | flat-rachitic (D.s.-26; D.s.-26; D.t.-31; C.e.-17; C.d.-10; C.v.-9) | 2 |
| I. 46. | flat pelvis with a decrease in the direct size of the wide part of the cavity (D.s.-26; D.c.-29; D.t.-30; C.e.-20; C.d.-12.5; C.v.-11) | 2 |
| I. 47. | by degree of narrowing: | |
| I. 48. | Conjugata vera: 11-9 | 2 |
| I. 49. | Conjugata vera: 9-7.5 | 10 |
| I. 50. | Conjugata vera: 7.5-6.5 | 20 |
| I. 51. | Conjugata vera: 6.5 or less | 50 |
| I. 52. | Placed under observation after 12 weeks of pregnancy | 1 |
| I. 53. | Genetic factors: | |
| I. 54. | hereditary diseases | 5 |
| I. 55. | congenital malformations | 10 |
| I. 56. | Sum of points for section I: | « » |
| II | ||
| II. 1. | Menstrual function: | |
| II. 2. | menarche 16 years and later | 2 |
| II. 3. | extended menstrual cycles(more than 30 days) | 1 |
| II. 4. | irregular menstruation | 1 |
| II. 5. | hypomenstrual syndrome | 2 |
| II. 6. | first day of last menstruation (day, month, year) | |
| II. 7. | Gestation period (weeks) by: first appearance in the housing complex | |
| II. 8. | ||
| II. 9. | inflammation of the appendages in a nulliparous woman | 3 |
| II. 10 | 2 | |
| II. eleven. | tumor formation of the appendages | 4 |
| II. 12. | uterine fibroids | 6 |
| II. 13. | uterine hypoplasia | 8 |
| II. 14. | uterine malformations | 10 |
| II. 15. | operations on the appendages | 2 |
| II. 16. | uterine surgery | 4 |
| II. 17. | isthmic-cervical insufficiency | 3 |
| II. 18. | Infertility: | |
| II. 19. | hormonal | 4 |
| II. 20. | tubo-peritoneal | 2 |
| II. 22. | 2-3 years | 2 |
| II. 23. | more than 3 years | 4 |
| II. 24. | Spontaneous miscarriage: | |
| II. 25. | in a nulliparous woman | 3 |
| II. 26. | the woman giving birth | 2 |
| II. 27. | recurrent miscarriage | 6 |
| II. 28. | Induced abortion: | |
| II. 29. | one | 2 |
| II. thirty. | two | 3 |
| II. 31. | three or more | 4 |
| II. 32. | complicated by bleeding | 6 |
Continuation of Table 1
| II. 33. | complicated by infection | 6 |
| II. 34. | incomplete | 4 |
| II. 35. | Pregnancy: | |
| II. 36. | first | 2 |
| II. 37. | repeated | 1 |
| II. 38. | complicated by moderate gestosis | 4 |
| II. 39. | complicated by severe gestosis | 8 |
| II. 40. | complicated by eclampsia | 10 |
| II.41. | complicated by placental insufficiency | 6 |
| II. 42. | 4 | |
| II. 43. | Childbirth: | |
| II. 44. | premature | 6 |
| II. 45. | belated | 6 |
| II. 46. | complicated by stillbirth | 8 |
| II. 47. | complicated by bleeding | 8 |
| II. 48. | complicated by purulent-septic infection | 8 |
| II. 49. | complicated by rupture of the soft birth canal of II-III degree | 6 |
| II. 50. | C-section | 10 |
| II. 51. | Newborn: | |
| II. 52. | death in the neonatal period | 8 |
| II. 53. | congenital malformations | 6 |
| II. 54. | neurological disorders | 4 |
| II 55. | weight of full-term children up to 2500 g and more than 4000 g | 4 |
| II 56. | Sum of points for section II: | « » |
| III | ||
| III. 1. | Infectious diseases: | |
| III. 2. | flu | 2 |
| III. 3. | ARVI | 2 |
| III. 4. | tuberculosis | 4 |
| III. 5. | viral hepatitis | 8 |
| III. 6. | syphilis | 4 |
| III. 7. | HIV infection | 8 |
| III. 8. | rubella | 10 |
| III. 9. | Neoplasms: | |
| III. 10. | The presence of malignant neoplasms in the past and present | 10 |
| III. eleven. | Endocrine system diseases: | |
| III. 12. | diabetes | 8 |
| III. 13. | thyroid diseases | 4 |
| III. 14. | diencephalic syndrome | 2 |
| III. 15. | ||
| III. 16. | anemia | 5 |
| III. 17. | coagulopathy | 10 |
| III. 18. | thrombocytopenia | 12 |
| III. 19. | Mental disorders: | |
| III. 20. | psychoses | 6 |
| III. 21. | schizophrenia | 6 |
| III. 22. | personality disorders | 8 |
| III. 23. | mental retardation | 6 |
| III. 24. | ||
| III. 25. | inflammatory diseases of the central nervous system | 8 |
Continuation of Table 1
| III. 26. | hereditary and degenerative diseases of the central nervous system | 8 |
| III. 27. | past and present cerebrovascular accidents | 50 |
| III. 28. | myopia and other eye diseases | 4 |
| III. 29. | ||
| III. thirty. | heart defects without circulatory failure | 2 |
| III. 31. | heart defects with circulatory failure | 8 |
| III. 32. | diseases of the myocardium, endocardium and pericardium | 6 |
| III. 33. | heart rhythm disturbances | 8 |
| III. 34. | operated heart | 8 |
| III. 35. | vascular diseases | 6 |
| III. 36. | hypertonic disease | 8 |
| III. 37. | Respiratory diseases: | |
| III. 38. | pneumonia | 4 |
| III. 39. | bronchiectasis | 6 |
| III. 40. | bronchial asthma | 6 |
| III. 41. | lobectomy, pneumonectomy | 8 |
| III. 42. | ||
| III. 43. | glomerulonephritis | 100 |
| III. 44. | pyelonephritis | 6 |
| III. 45. | hydronephrosis | 4 |
| III. 46. | kidney tuberculosis | 25 |
| III. 47. | polycystic kidney disease | 100 |
| III. 48. | single kidney | 50 |
| III. 49. | Sum of points for section III: | « » |
| IV. | Complications of pregnancy | |
| IV. 1. | Induced pregnancy (occurred after stimulation of ovulation: clomiphene, clostilbegit) | 10 |
| IV. 2. | Pregnancy after in vitro fertilization (IVF) | 20 |
| IV. 3. | Bloody discharge on days corresponding to expected menstruation | 4 |
| IV. 4. | Threat of miscarriage before 20 weeks | 6 |
| IV. 5. | Threat of interruption after 20 weeks | 8 |
| IV. 6. | Severe toxicosis | 2 |
| IV. 7. | Bleeding | 100 |
| IV. 8. | Preeclampsia: | |
| IV. 9. | dropsy | 2 |
| IV.10. | mild degree | 10 |
| IV. eleven. | medium degree | 50 |
| IV. 12. | severe | 100 |
| IV. 13. | preeclampsia | 100 |
| IV. 14. | eclampsia | 100 |
| IV. 15. | Rh sensitization: | |
| IV. 16. | antibody titer 1:8 | 4 |
| IV. 17. | antibody titer 1:16 | 6 |
| IV. 18. | ABO sensitization | 8 |
| IV. 19. | ||
| IV. 20. | primary | 8 |
| IV. 21. | secondary | 6 |
| IV. 22. | Amniotic fluid disorders: | |
| IV. 23. | polyhydramnios | 8 |
| IV. 24. | oligohydramnios | 6 |
| IV. 25. | meconium | 10 |
| IV. 26. | ||
| IV. 27. | oblique | 4 |
| IV. 28. | transverse | 8 |
| IV. 29. | breech presentation | 6 |
| IV. thirty. | Multiple pregnancy: | |
| IV. 31. | twins | 8 |
| IV. 32. | triplets or more | 10 |
| IV. 33. | Large fruit | 4 |
| IV. 34. | Placenta previa: | |
| IV. 35. | regional | 50 |
| IV. 36. | central | 100 |
| IV. 37. | ||
| IV. 38. | 10 | |
| IV. 39. | state of amniotic fluid (quantity - IAF, transparency, presence of suspension, impurities): inconsistency with gestational age | 10 |
| IV. 40. | 10 | |
| IV. 41. | presence of signs of congenital malformations | 20 |
| IV. 42. | Sum of points for section IV: | « » |
| V. | Fetal condition | |
| V.1. | fetal hypoxia | 4 |
| V.2. | fetal malnutrition | 25 |
| V.3. | specified congenital malformation | 50 |
| V.4. | antenatal fetal death | 100,1 |
| V.5. | Sum of points for Section V: | « » |
| V.6. | « » |
| Table 2. | ||
| Risk group | Sum of points | Actions |
| Low risk | Less than 30 | 2. Transfer of information to the MPC, GRD. |
| Medium risk | 31-49 | 1. Transfer of information to the MPC or GRD. 2. Consultation, observation in the conditions of the MPC or GRD. 3. Transfer of information to the ROC or ORD, KRD. |
| High risk | 51-99 | 1. Transfer of information to the ROC, or ORD, KRD. |
| Emergency hospitalization | 101 or more | 2. Emergency notification to the Obstetrics, Gynecology and Resuscitation Consultative Center (Aviation). |
| Table 3. | ||
| Monitoring scale for pregnant women at risk | ||
| Assessment of pregnant N. | ||
| No. | Factors | Points |
| I. | Socio-biological | |
| I. 1. | Pregnant age: 24 years | «0» |
| I. 6. | Bad habits: | |
| I. 7. | No | «0» |
| I. 12. | Harmful factors of work and life in a pregnant woman: | |
| I. 13. | No | «0» |
| I. 18. | Marital status: Married | «0» |
| I. 22. | Somatic indicators: height 162 cm | «0» |
| I. 27. | Body mass index: body weight, kg/(body length, m) 2 =22 | «0» |
| I. 31. | «0» | |
| I. 41. | according to the shape of the narrowing: | «0» |
| I. 47. | by degree of narrowing: | «0» |
| I. 52. | Placed under observation until 12 weeks of pregnancy | «0» |
| I. 53. | Genetic factors: | «0» |
| I. 56. | Sum of points for section I: | «0» |
| II | Obstetric and gynecological history | |
| II. 1. | Menstrual function: normal | «0» |
| II. 7. | Gestation period (weeks) by: first appearance in the housing complex - 10 | «0» |
| II. 8. | Diseases of the internal genital organs: | «0» |
| II. 18. | Infertility: | «0» |
| II. 24. | Spontaneous miscarriage: | «0» |
| II. 38. | Induced abortion: | «0» |
| II. 35. | Pregnancy: | |
| II. 37. | repeated | "1" |
| II. 43. | Childbirth: | «0» |
| II. 51. | Newborn: | «0» |
| II 56. | Sum of points for section II: | "1" |
| III | Extragenital diseases | |
| III. 1. | Infectious diseases: | «0» |
| III. 9. | Neoplasms: | «0» |
| III. 10. | There are no malignant neoplasms in the past or present | «0» |
| III. eleven. | Endocrine system diseases: | «0» |
| III. 15. | Diseases of the blood and hematopoietic organs: | |
| III. 16. | anemia | "5" |
| III. 19. | Mental disorders: | «0» |
| III. 24. | Diseases of the nervous system and sensory organs: | «0» |
| III. 29. | Diseases of the circulatory system: | «0» |
| III. 37. | Respiratory diseases: | «0» |
| III. 42. | Diseases of the urinary organs: | |
| III. 44. | pyelonephritis | "6" |
| III. 49. | Sum of points for section III: | "eleven" |
| IV. | Complications of pregnancy | |
| IV. 1. | «0» | |
| IV. 3. | «0» | |
| IV. 4. | «0» |
Continuation of table 3
| IV. 5. | «0» | ||
| IV. 6. | Severe toxicosis - no | «0» | |
| IV. 7. | Bleeding - no | «0» | |
| IV. 8. | Preeclampsia: | «0» | |
| IV. 15. | Rh sensitization: | «0» | |
| IV. 18. | ABO sensitization | «0» | |
| IV. 19. | Fetoplacental insufficiency: | «0» | |
| IV. 22. | Amniotic fluid disorders: | «0» | |
| IV. 26. | Malposition: | «0» | |
| IV. thirty. | Multiple pregnancy: | «0» | |
| IV. 33. | Large fruit | «0» | |
| IV. 34. | Placenta previa: | «0» | |
| IV. 37. | Ultrasound data: | «0» | |
| IV. 42. | Sum of points for section IV: | «0» | |
| V. | Fetal condition | «0» | |
| V.5. | Sum of points for Section V: | «0» | |
| V.6. | Total points for all sections: | "12" | |
| Risk group | Sum of points | Actions | |
| Low risk | Less than 30 | 1. Observation in the conditions of the Central City Hospital, Central District Hospital. 2. Transfer of information to the MPC or State Dispatch Office. |
| Table 4. | ||
| Monitoring scale for pregnant women at risk | ||
| Assessment of pregnant K. | ||
| No. | Factors | Points |
| I. | Socio-biological | |
| I. 1. | Pregnant age: 29 years | «0» |
| I. 6. | Bad habits: | |
| I. 7. | No | 0 |
| I. 12. | Harmful factors of work and life in a pregnant woman: | |
| I. 16. | unsatisfactory living conditions | "2" |
| I. 18. | Family status: | |
| I. 20. | divorced | "1" |
| I. 22. | Somatic indicators: height 158 cm. | «0» |
| I. 27. | Body mass index: body weight, kg/(body length, m) - 24 | «0» |
| I. 31. | Pelvic dimensions (pelviometry, cm): normal | «0» |
| I. 41. | according to the shape of the narrowing: | «0» |
| I. 47. | by degree of narrowing: | «0» |
| I. 52. | Placed under GI observation at 12 weeks of pregnancy | "1" |
| I. 53. | Genetic factors: | «0» |
| I. 56. | Sum of points for section I: | "4" |
| II | Obstetric and gynecological history | |
| II. 1. | Menstrual function: | «0» |
| II. 7. | Gestation period (weeks) at: first appearance in the housing complex - 18 | "2" |
| II. 8. | Diseases of the internal genital organs: | |
| II. 10. | inflammation of the appendages in a woman giving birth | "2" |
| II. 24. | Spontaneous miscarriage: | |
| II. 26. | the woman giving birth | "2" |
| II. 28. | Induced abortion: | |
| II. thirty. | two | "3" |
| II. 35. | Pregnancy: | |
| II. 37. | repeated | "1" |
| II. 42. | complicated by exacerbation of extragenital pathology | "4" |
| II. 43. | Childbirth: | |
| II. 44. | premature | "6" |
| II. 51. | Newborn: | «0» |
| II 56. | Sum of points for section II: | "18" |
| III | Extragenital diseases | |
| III. 1. | Infectious diseases: | «0» |
| III. 9. | Neoplasms: | «0» |
| III. eleven. | Endocrine system diseases: | «0» |
| III. 15. | Diseases of the blood and hematopoietic organs: | «0» |
| III. 19. | Mental disorders: | «0» |
| III. 24. | Diseases of the nervous system and sensory organs: | «0» |
| III. 29. | Diseases of the circulatory system: | «0» |
| III. 37. | Respiratory diseases: | «0» |
| III. 42. | Diseases of the urinary organs: | |
| III. 46. | kidney tuberculosis | "25" |
| III. 49. | Sum of points for section III: | "25" |
| IV. | Complications of pregnancy | |
| IV. 1. | Induced pregnancy (occurred after stimulation of ovulation: clomiphene, clostilbegit) - occurred spontaneously | «0» |
Continuation of table 4
| IV. 3. | Bloody discharge on days corresponding to expected menstruation - no | «0» |
| IV. 4. | Threat of abortion before 20 weeks - no | «0» |
| IV. 5. | Threat of interruption after 20 weeks - no | «0» |
| IV. 6. | Severe toxicosis - no | «0» |
| IV. 7. | Bleeding - no | «0» |
| IV. 8. | Preeclampsia: | «0» |
| IV. 15. | Rh sensitization: | «0» |
| IV. 18. | ABO sensitization | «0» |
| IV. 19. | Fetoplacental insufficiency: | |
| IV. 20. | primary | "8" |
| IV. 22. | Amniotic fluid disorders: | «0» |
| IV. 26. | Malposition: | «0» |
| IV. thirty. | Multiple pregnancy: | «0» |
| IV. 33. | Large fruit | «0» |
| IV. 34. | Placenta previa: | «0» |
| IV. 37. | Ultrasound data: | |
| IV. 38. | fetometry (size of fertilized egg, embryo, fetus): gestational age discrepancy | "10" |
| IV. 42. | Sum of points for section IV: | "18" |
| V. | Fetal condition | |
| V.1. | fetal hypoxia | "4" |
| V.5. | Sum of points for Section V: | "4" |
| V.6. | Total points for all sections: | "69" |
| High risk | 51-99 | 1. Transfer of information to the ROC or ORD, KRD. 2. Consultation, observation in the conditions of the ROC or ORD, KRD. |
| Table 5. | ||
| Monitoring scale for pregnant women at risk | ||
| Assessment of pregnant woman R. | ||
| No. | Factors | Points |
| I. | Socio-biological | |
| I. 1. | Pregnant age: | |
| I. 3. | 30-34 years | "2" |
| I. 6. | Bad habits: | |
| I. 7. | No | «0» |
| I. 12. | Harmful factors of work and life in a pregnant woman: | |
| I. 13. | No | «0» |
| I. 18. | Marital status: Married | «0» |
| I. 22. | Somatic indicators: 164 cm. | «0» |
| I. 27. | Body mass index: body weight, kg/(body length, m) 2 | |
| I. 29. | 31-40 | "2" |
| I. 31. | Pelvic dimensions (pelviometry, cm): normal | «0» |
| I. 40. | Narrow pelvis: | |
| I. 41. | according to the shape of the narrowing: | «0» |
| I. 47. | by degree of narrowing: | «0» |
| I. 52. | Placed under observation at 16 weeks of pregnancy | "1" |
| I. 53. | Genetic factors: | «0» |
| I. 56. | Sum of points for section I: | "5" |
| II | Obstetric and gynecological history | |
| II. 1. | Menstrual function: normal | «0» |
| II. 7. | Gestation period (weeks) according to: first appearance in the housing complex - 31 | "2" |
| II. 8. | Diseases of the internal genital organs: | «0» |
| II. 18. | Infertility: no | «0» |
| II. 24. | Spontaneous miscarriage: no | «0» |
| II. 28. | Induced abortion: | |
| II. 31. | three or more | "4" |
| II. 32. | complicated by bleeding | "6" |
| II. 35. | Pregnancy: | |
| II. 37. | repeated | "1" |
| II. 43. | Childbirth: no | «0» |
| II 56. | Sum of points for section II: | "eleven" |
| III | Extragenital diseases | |
| III. 1. | Infectious diseases: no | «0» |
| III. 9. | Neoplasms: no | «0» |
| III. eleven. | Endocrine system diseases: no | «0» |
| III. 15. | Diseases of the blood and hematopoietic organs: no | «0» |
| III. 16. | anemia | "5" |
| III. 19. | Mental disorders: no | «0» |
| III. 24. | Diseases of the nervous system and sensory organs: no | «0» |
| III. 29. | Diseases of the circulatory system: no | «0» |
| III. 37. | Respiratory diseases: no | «0» |
| III. 42. | Diseases of the urinary organs: no | «0» |
| III. 49. | Sum of points for section III: | "5" |
| IV. | Complications of pregnancy | |
| IV. 1. | Induced pregnancy (occurred after stimulation of ovulation: clomiphene, clostilbegit) - occurred spontaneously | «0» |
Continuation of table 5
| IV. 3. | Bloody discharge on days corresponding to expected menstruation - no | «0» |
| IV. 4. | Threat of abortion before 20 weeks - no | «0» |
| IV. 5. | Threat of interruption after 20 weeks - no | «0» |
| IV. 6. | Severe toxicosis - no | «0» |
| IV. 7. | Bleeding - no | «0» |
| IV. 8. | Preeclampsia: | |
| IV. eleven. | medium degree | "50" |
| IV. 15. | Rh sensitization: no | «0» |
| IV. 18. | ABO sensitization: no | «0» |
| IV. 19. | Fetoplacental insufficiency: | |
| IV. 20. | primary | "8" |
| IV. 22. | Amniotic fluid disturbances: no | «0» |
| IV. 26. | Abnormal fetal position: no | «0» |
| IV. thirty. | Multiple pregnancy: no | «0» |
| IV. 33. | Large fruit: no | «0» |
| IV. 34. | Placenta previa: no | «0» |
| IV. 37. | Ultrasound data: | |
| IV. 38. | fetometry (size of fertilized egg, embryo, fetus): gestational age discrepancy | "10" |
| IV. 40. | placentometry (thickness, structure, degree of maturity): discrepancy with gestational age | "10" |
| IV. 42. | Sum of points for section IV: | "78" |
| V. | Fetal condition | |
| V.2. | fetal malnutrition | "25" |
| V.5. | Sum of points for Section V: | "25" |
| V.6. | Total points for all sections: | "124" |
| Emergency hospitalization | 101 or more | 1. Emergency hospitalization to the nearest obstetrics facility. 2. Emergency notification to the Obstetrics, Gynecology and Resuscitation Consultative Center (Aviation). |
1. A method for assessing the degree of risk of complications of the gestational period and upcoming birth, characterized by the fact that socio-biological factors are determined in a pregnant woman and assessed in points, namely: age up to 20 years or 30-34 years is assessed as 2 points, 35- 39 years old - 3, 40 years old and older - 4; the presence of bad habits: nicotine addiction - assessed as 1 point, alcoholism - 2, drug addiction or substance abuse - 3; harmful factors of work and life in a pregnant woman: chemical factors of work, or radioactive factors of work, or unsatisfactory living conditions, or taking medications in the early stages of pregnancy are assessed as 2 points; marital status: single, or divorced, or marriage registration during pregnancy is scored as 1 point; somatic indicators: height 150 cm and below, or 165 cm and above, or hirsutism - 1, male body type - 2; a body mass index of 26-30 is assessed as 1 point, 31-40 - 2, 41 or more - 3; pelvic dimensions: Distantia spinarum less than 25 cm, or Distantia cristaram less than 28 cm, or Distantia trochanterica less than 30 cm, or Conjugata externa less than 20 cm, or Conjugata diagonalis less than 12.5 cm, or Conjugata vera less than 11 cm, or Michaelis' rhombus - angles do not correspond to 90°, length, diameter - less than 11 cm or Solovyov index - 14 cm or more are assessed as 2 points; narrow pelvis: generally uniformly narrowed, or transversely narrowed, or simple flat, or planar-rachitic, or flat pelvis with a decrease in the direct size of the wide part of the cavity is assessed as 2 points; degree of narrowing: I degree of pelvic narrowing is assessed as 2 points, II degree - 10, III degree - 20, IV degree - 50; registration at the antenatal clinic after 12 weeks of pregnancy is assessed - 1 point; genetic factors: hereditary diseases are assessed as 5 points, congenital malformations - 10; obstetric and gynecological history, namely menstrual function: extended menstrual cycles more than 30 days or irregular menstruation is assessed as 1 point, menarche from 16 years of age and later - 2, hypomenstrual syndrome - 2; disease of the internal genital organs: inflammation of the uterine appendages in a woman who has given birth is assessed as 2 points, operations on the appendages - as 2, inflammation of the appendages in a nulliparous woman - as 3, isthmic-cervical insufficiency - as 3, tumor formation of the uterine appendages or operations on the uterus for gynecological pathologies - 4, uterine fibroids - 6, uterine hypoplasia - 8, uterine malformation - 10; infertility: infertility of hormonal origin is assessed as 4 points, tubal-peritoneal origin or duration of infertility for a period of 2-3 years - 2, more than 3 years - 4 points; the presence of spontaneous miscarriage in a nulliparous woman is assessed as 3 points, in a woman who has given birth - 2, recurrent miscarriage - 6; induced abortion: one induced abortion is assessed as 2 points, two induced abortions - 3, three or more abortions or incomplete abortion - 4, abortion complicated by bleeding or complicated by infection - 6; pregnancy: the first pregnancy is assessed as 2 points, the second one - 1, moderate gestosis or exacerbation of extragenital pathology is assessed - 4, severe - 8, eclampsia - 10, history of fetoplacental insufficiency - 6; childbirth: premature or late birth or rupture of the soft birth canal of II-III degree is assessed as 6 points, childbirth complicated by stillbirth or complicated by bleeding or complicated by purulent-septic infection - 8, cesarean section - 10; newborn: death of a newborn in the neonatal period is assessed as - 8, congenital malformations in a newborn - 6, neurological disorders or full-term weight less than 2500 g or more than 4000 g - 4; extragenital diseases, namely: infectious diseases: influenza during pregnancy or ARVI is assessed as 2 points, tuberculosis or syphilis - 4, viral hepatitis or HIV infection - 8, rubella - 10; neoplasms: malignant neoplasms in the past and present are assessed as 10 points; diseases of the endocrine system: diencephalic syndrome is assessed as 2 points, thyroid diseases - 4, diabetes mellitus - 8; diseases of the blood and hematopoietic organs: anemia is assessed as 5 points, coagulopathy - 10, thrombocytopenia - 12; mental disorders: psychosis, or schizophrenia, or mental retardation is assessed as 6 points, personality disorders - 8; diseases of the nervous system and sensory organs: myopia and other eye diseases are assessed as 4 points, inflammatory diseases of the central nervous system or hereditary and degenerative diseases of the central nervous system - 8, cerebrovascular accidents in the past and present - 50; diseases of the circulatory system: heart defects without circulatory failure are assessed as 2 points, diseases of the myocardium, endocardium and pericardium or vascular disease - 6, heart defects with circulatory failure, or cardiac arrhythmias, or operated heart, or hypertension - 8; respiratory diseases: pneumonia
The invention relates to medicine, namely to obstetrics and gynecology
To determine the degree of risk of perinatal pathology, an indicative scale for assessing prenatal risk factors, in points, is proposed; The scale is used taking into account the individual characteristics of the medical history, the course of pregnancy and childbirth.
Assessment of prenatal risk factors (O.G. Frolova, E.I. Nikolaeva, 1980)
Risk factors=Score
Socio-biological factors
Mother's age:
under 20 years old=2
30-34 years old=2
35-39 years old=3
40 years and older=4
Father's age:
40 years or more=2
Occupational hazards:
mother's = 3
father's=3
Bad habits
from the mother:
Smoking (one pack of cigarettes per day)=1
Alcohol abuse=2
from father:
Alcohol abuse=2
Emotional stress on mother = 2
Mother's height and weight:
Height 150 cm or less=2
Body weight is 25% higher than normal = 2
Obstetric and gynecological history
Parity (number of previous births):
4-7=1
8 or more=2
Abortion before childbirth in first-time mothers:
1=2
2=3
3 or more=4
Abortion between births:
3 or more=2
Premature birth:
1=2
2 or more=3
Stillbirth:
1=3
2 or more=8
Death of children in the neonatal period:
one child=2
two or more children=7
Developmental anomalies in children = 3
Neurological disorders in children=2
Body weight of full-term children is less than 2500 g or 4000 g or more = 2
Infertility:
2-4 years=2
5 years or more=4
Scar on the uterus after surgery = 3
Tumors of the uterus and ovaries=3
Isthmic-cervical insufficiency=2
Uterine malformations=3
Extragenital diseases of a pregnant woman
Cardiovascular:
Heart defects without circulatory disorders = 3
Heart defects with circulatory disorders=10
Hypertension stages I-II-III=2-8-12
Vegetovascular dystonia=2
Kidney diseases:
Before pregnancy= 3
exacerbation of the disease during pregnancy = 4
Adrenal diseases=7
Diabetes mellitus=10
diabetes mellitus in relatives=1
Thyroid diseases=7
Anemia (hemoglobin content 90-100-110 g/l) = 4-2-1
Bleeding disorder=2
Myopia and other eye diseases=2
Chronic infections (tuberculosis, brucellosis, syphilis, toxoplasmosis, etc.)=3
Acute infections=2
Complications of pregnancy
Severe early toxicosis of pregnant women=2
Late toxicosis of pregnant women:
dropsy=2
Nephropathy of pregnant women I-II-III degree = 3-5-10
preeclampsia=11
eclampsia=12
Bleeding in the first and second half of pregnancy = 3-5
Rh and AB0 isosensitization = 5-10
Polyhydramnios=4
Oligohydramnios=3
Breech presentation of the fetus = 3
Multiple pregnancy=3
Post-term pregnancy=3
Incorrect position of the fetus (transverse, oblique) = 3
Pathological conditions of the fetus and some indicators of disruption of its vital functions
Fetal hypotrophy=10
Fetal hypoxia=4
Estriol content in daily urine
less than 4.9 mg at 30 weeks. pregnancy=34
less than 12 mg at 40 weeks. pregnancy=15
Changes in amniotic fluid during amnioscopy = 8
With a score of 10 or more, the risk of perinatal pathology is high, with a score of 5-9 points - average, with a score of 4 points or less - low. Depending on the degree of risk, the obstetrician-gynecologist at the antenatal clinic draws up an individual follow-up plan, taking into account the specifics of the existing or possible pathology, including special studies to determine the condition of the fetus: electrocardiography, ultrasound, amnioscopy, etc. If there is a high risk of perinatal pathology, it is necessary to resolve the issue about the advisability of continuing pregnancy. Risk assessment is carried out at the beginning of pregnancy and at 35-36 weeks. to resolve the issue of length of hospitalization. Pregnant women with a high risk of perinatal pathology must be hospitalized for childbirth in a specialized hospital.
