Clinical and prognostic criteria of normal and impaired adaptation to birth stress in the mother and fetus – 2006

Can iridology signs reflect the degree of impairment of adaptation to birth stress?

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Clinical and prognostic criteria of normal and impaired adaptation to birth stress in the mother and fetus

Year:
2006
Author of the research:
Mamiev, Oleg B.
Academic degree of:
MD
Place of dissertation:
Kazan
Specialties WAC code:
14.00.01
Specialty:
Obstetrics and Gynecology
Number of Pages:
289
Contents thesis MD Mamiev, Oleg

List of Abbreviations. ‘

INTRODUCTION.

Chapter I. MODERN CONCEPTS OF PREDICTING birth outcomes (review) 1.1 System approach and the value of the functional state of the central nervous system in the evaluation of disadaptative pregnant.

1.2: Some premorbid conditions, triggers and markers disadaptative pregnant women, determining the pathogenesis of common obstetric and perinatal complications 28 1.3 Current methods for predicting complications of pregnancy and childbirth.

Chapter II MATERIALS AND METHODS

2.1: Brief description of the observations. 51.

2.2: Research Methods.

RESULTS own observation and discussion

Chapter III. CLINICAL HARKTERISTIKA examinee

PREGNANT. 79 ‘

Chapter IV. EVALUATION OF ADAPTATION AND DELIVERY IN FORECASTING

PREGNANT with complicated childbirth FOR MOTHER OR FOR FETAL 4.1: The functional state of the central nervous system and the autonomic nervous system in pregnant women according to psycho, higher nervous activity, cerebral blood flow, the vegetative status.

4.2: Evaluation of the organism back pregnant and fed-toplatsentarnoy system according to hormonal and immunological methods.

4.3: iridology and dermatoglyphic markers in women with complicated deliveries for the mother or for the fetus.

4.4: Diagnostic procedure types of adaptation to pregnancy and birth stress prediction in complicated deliveries only for their mother or for the fetus.

Chapter V. EVALUATION OF ADAPTATION AND DELIVERY IN FORECASTING

PREGNANT with complicated childbirth simultaneously for both mother and fetus 5.1: The functional state of the central nervous system and the autonomic nervous system in pregnant women according to psycho, higher nervous activity, cerebral blood flow, the vegetative status.

5.2: Evaluation of the organism back in pregnancy and placental system according to hormonal and immunological methods.

5.3: iridology and dermatoglyphic markers in women with complicated deliveries at the same time for both mother and fetus

5.4: Diagnostic procedure types of adaptation to pregnancy and birth stress forecasting labor with their complicated for both the mother and the fetus.

Chapter VI. EVALUATION compensatory and adaptive mechanisms AND PREDICTION OF LABOUR IN PREGNANT with complicated childbirth simultaneously for both mother and fetus IN BREAKDOWN ADAGGGTSII to birth stress 6.1: The functional state of the central nervous system and the autonomic nervous system in pregnant women according to psycho, higher nervous activity and cerebral blood flow , the vegetative status.

6.2: Evaluation of the organism back pregnant and fed-toplatsentarnoy system according to hormonal and immunological methods.

6.3: iridology and dermatoglyphic markers in women with complicated deliveries both to the mother and fetus in a failure to adapt. ‘.

6.4: Diagnostic procedure types of adaptation to pregnancy and birth stress forecasting labor disruption in adaptation mechanisms.
Introduction dissertation (part of the abstract) on “Clinical and prognostic criteria of normal and impaired adaptation to birth stress in the mother and the fetus”

Relevance.

One characteristic of the modern development of obstetrics and gynecology is a lot of development and introduction of new methods of investigation of the mother and the fetus, and to predict obstetric and perinatal complications. The most famous of these are magnetic resonance imaging, proton magnetic resonance spectroscopy, Magnetocardiography, noninvasive fetal electrocardiography using automatic methods for constructing models using neural networks, non-invasive fetal EEG, spectral analysis of heart rate based magnetocardiography using chaos theory and a number of others [312,316,385,424,436,443,448,463]. Many researchers have taken an active interest in the further development of methods of diagnosis of pathological conditions in the mother and fetus, with an emphasis on the identification of specific preclinical nosology, which is not always available when using routine methods. Undoubtedly, the development of scientific research in this area is making a major contribution to preventing and reducing the incidence of obstetric and perinatal complications. However, it seems to agree with the fact that the further development of the progress in this direction may depend not only on the development and implementation of Obstetrics and Perinatology of the latest scientific advances in the diagnosis of specific nosology at the preclinical stage of development, but, in addition, from some of the other principles approach to the problem. This situation is very important to be considered not only a clear pre-clinical diagnosis has not yet developed disease, but also for objective evaluation of the true natural resources adaptation of the mother and the fetus to birth stress, which are essential to the development and course of this disease. Daily practice of obstetrics shows that for all the achievements of modern diagnostic methods appropriate individual assessment of the potential of the child birth stress transfer, which is the most important in his life, and to a large extent determines its further development [120], to date, still need to be improved. Many professionals know that, often with seemingly identical initial conditions of the fetus, according to the estimates of its modern methods of investigation, they are various birth outcomes: the birth of healthy babies and children are able to express distress [117]. In addition also have to admit that is not always apparent in women with somatic diseases are complicated births, and in healthy pregnant women can not guarantee their normal outcome [121]. This is due to the fact that the planning obstetric tactics in pregnant women and mothers is not always possible to take into account the real potential backup and redundant mechanisms of adaptation and hidden defects in the functional mother-placenta-fetus (FSMPP).

The above suggests that for deep and informative features adaptive resources and homeostasis FSMPP need such research methods that would make it possible to install both the state as a major, distinct mechanisms of adaptation, and to receive its objective integrative assessment. Of these methods, used, in particular, in obstetrics, some authors prefer Cardiointervalographic (CIG) or (blue) cardiorhythmography [27,76,77,84,85,117,224,278,313]. This method allows to estimate the levels of activity and the potential of sympathetic-adrenal (ergotropic), parasympathetic (trophotropic), humoral, central (intracranial) and autonomous mechanisms (circuits) regulation, and their ratio. It is known that the structure of cardiac rhythm man laid voluminous information that is encoded in the sequence of cardio with different duration and reflects the nature of homeostasis and adaptation reserves of the body. This method is highly sensitive, thus reveals “predsimptomnye” violations of regulatory mechanisms and has promising prospects for the purpose of forecasting in obstetrics and perinatology.

CIG application in obstetrics has revealed a number of features that are of great interest and importance for obstetrics and perinatology. Research scientists, mostly domestic, it was found, that the variational parameters pulsogramm maternal and fetal changes in parallel, and the spectral analysis of the data, in particular, the limits on frequency domain components of CIG (slow, medium, and high) are the same [94,118,278]. These facts are worthy of attention, as evidence in favor of the identity of types of adaptation and sustainable type of reaction to stress in the mother and fetus in the study specifically FSMGSH. Probably why some researchers to obtain comprehensive information on the state of the compensatory-adaptive mechanisms FSMGSH allow the use of the analysis of CIG only in pregnant women [94].

The data presented are of great interest. A number of questions related to the presence in the general population of pregnant characteristic or similar types of adaptation FSMPP to the birth stress. It is acceptable to assume that if this assumption corresponds to the actually existing laws, the type of adaptation to pregnancy and child birth stress can have a significant impact on birth outcomes, the nature of obstetric and perinatal complications. Knowledge of an obstetrician, what type of adaptation belongs specific pregnant, will spend much more objectively forecast the upcoming birth outcome for mother and fetus and to make the most optimal design of individual obstetric tactical activities. However, it should be noted that the most rational approach to the identification and assessment of the type of adaptation in pregnancy should be considered multifactorial survey using them along with CIG and other methods.

In studying the literature, we found no specific information about the concept of “the type of adaptation to pregnancy birth stress”, as well as ongoing research in this direction.

All of the above defined the purpose and objectives of this study.

The purpose of the study.

Develop evidence-based algorithms for the evaluation of adaptation pregnant women for childbirth with the optimization of predicting their outcomes, to reduce the frequency of obstetric and perinatal complications.

Objectives of the study.

1. To assess the mental and emotional status of pregnant women, the state of higher nervous activity (GNI), cerebral blood flow and their effects on birth outcomes for mother and fetus.

2. To study the features of autonomic adaptation to birth stress in pregnant women according Cardiointervalographic structural analysis of heart rate and the functional state of the autonomic nervous system (ANS).

3. Determine the relationship between blood levels of cortisol in pregnant, natural inhibition factor globulin class “M” (EIF), trophoblastic {3]-glycoprotein (TBG), pregnancy-associated a2-glycoprotein (SBAG), a-fetoprotein, the coefficient of immunological adaptation (KIA) and the kinds of complications in childbirth.

4. Evaluate the possibilities and methods of dermatoglyphics iridodiagnostics to identify important marker of increased risk of complications in childbirth.

5. Based on multivariate analysis to determine the types of adaptation of the mother and the fetus to birth stress, to characterize each of them.

6. Develop algorithms to recognize the type of adaptation to birth stress, predict the outcome of labor for subsequent planning of individual obstetric tactical actions in the light of the forecast, to validate this prediction system.

Scientific novelty of the research.

First created the concept of an objective assessment of the natural reserves and types of adaptation to pregnancy and child birth stress, with high accuracy to predict birth outcomes for mother and fetus and disorders of the reproductive potential of women in general.

First used a multifactorial assessment of basic resources, compensatory and adaptive mechanisms in pregnant women and fetuses, based on the study of mental and emotional status, higher nervous activity and cerebral hemodynamics, autonomic nervous system, the functional state of the fetoplacental complex, application and dermatoglyphics iridodiagnostics. The use of new methodologies for assessing adaptation to birth stress the first time that a general pregnant population is distributed into 4 types: Type 1 – satisfactory adaptation with normal birth outcomes for mother and fetus is 22%, type 2 (32%) – the state of stress adaptation mechanisms with signs of decompensation and complications in childbirth, only the fetus (18%) or only the mother (14%), type 3 (36%) – poor adaptation in the unstable voltage adaptation mechanisms with decompensation and complications in labor at the same time the mother and fetus, 4-ytip-failure of adaptation, according to 10% of cases.

For the first time revealed that each type of adaptation corresponds to the typical psycho-emotional personality structure and peculiarities of the basic nervous processes in the cortical neurons (excitation, unconditional and internal, conditioned inhibition) and some potential higher nervous activity.

It was found that for each type of adaptation to leave a place typical setup hemodynamic brain with certain parameters and their specific dynamics during the functional test. Thus central to the cerebral hemodynamic homeostasis are increasingly sophisticated mechanisms of interhemispheric lateralization pulsatile blood flow, not its absolute performance.

The first time the potential level, the relationship and interaction of the individual circuits and mechanisms of regulation of autonomic homeostasis in pregnant women with different types of adaptation to birth stress. In this case, found that as the level of adaptation to delivery is decentralized, the disintegration of a compensatory-adaptive mechanisms.

First results of hormonal and immunological studies showed that the highest potential of the functional activity of the fetoplacental system with a strong immunosuppressive function of the placenta in women with a normal birth outcomes for mother and fetus, and the lowest in pregnant women with the breakdown of adaptation (Type 4).

The first time that a state of heightened stress adaptation stressrealizuyuschey activation system and the dominance of the sympathetic influence pregnancy inhibits immunosuppressive mechanisms in the fetoplacental system.

Use iridodiagnostics and dermatoglyphics with information entropy analysis dermatoglyphic structures as a new approach to the study of dermatoglyphics, improves the accuracy of estimation of reserve capacity pregnant woman and fetus. Proved that the abnormal structure and dermatoglyphic iridology signs reflect the degree of impairment of adaptation to birth stress.

The practical significance.

The proposed methods of studying the state of the CNS, ANS, ¦ hormonal, immunological, and iridodiagnostics dermatoglyphic studies in pregnant women allowed to get objective information about the functioning of the most vital systems of pregnant women, which occurs at the level of implementation of adaptation processes.

Based on these studies the concept of the 4 types of adaptation of the pregnant woman and the fetus to birth stress, which allows long before birth predict risk of obstetric and perinatal complications. Developed diagnostic-prognostic tables and algorithms to high “degree of accuracy (94%) identify the type of adaptation to leave, to predict their outcomes and reduce the risk of obstetric and perinatal loss.

An original method of combined use of Luscher color test and color test relations, evaluation of higher nervous activity reoentsefalogramm graphical analysis with the calculation of cerebral reogemodinamicheskogo disadaptative, functional tests, graphing pulsogramm according to CIG, the calculation of the immunological adaptation study dermatoglyphic structures using information entropy analysis. Developed and proposed a formula coefficient of vertical hand-finger asymmetry entropies.

The methods of predicting fetal and newborn during labor and the early neonatal period, which can be used as a screening and baseline survey of pregnant women.

Testing work.

The results were presented at the final of the scientific sessions of the employees of the Astrakhan Medical Academy and regional scientific conferences obstetricians Astrakhan region (Astrakhan, 1991-2005), the II International Congress on immunorehabilitation and rehabilitation medicine (Antalya, 1996); at the international conference devoted to the 100th anniversary of the birth of Professor N.V.Popovoy-Latkin (Astrakhan, 1996), on an interregional scientific conference. “Scientific research scientists – the solution of socio-economic problems of the Astrakhan region” (Astrakhan, 2001) , All-Russian conference with international participation “The role of new technologies in reducing perinatal reproductive losses” (Ekaterinburg, 2001), on the 7th of the Volga Scientific-Practical Conference “Ways of reproductive health of women” (Volgograd, 2002), the IV-Russia Forum ” Mother and Child “(Moscow, 2002), on the Volga U1P scientific conference” Ways of reproductive health of women “(Astrakhan, 2003) on inter-chair of the conference staff Astrakhan State Medical Academy (Astrakhan, 2004), at the plenary session of the Scientific Council on Obstetrics and Gynecology, Medical Sciences and Ministry of Health of Russia (Volgograd, 2004).

Research application of results in practice.

Results have been implemented in daily clinical practice of the city hospital, the Astrakhan regional perinatal center of Astrakhan region, the center of family planning and antenatal Astrakhan, and in antenatal clinics and maternity wards CRH cities and administrative centers of the Astrakhan region, there are two Russian patents on invention.

Publication.

Dissertation on the subject published 50 publications.

The main provisions to be defended.

1. All pregnant women in the population are divided into four types of adaptation to the birth stress, with type 1 (22%) – a satisfactory adaptation of normal birth outcomes for mother and fetus, type 2 (32%) – the state of stress adaptation mechanisms with symptoms decompensation and complications in childbirth only the mother or only fruit, type 3 (36%) – poor adaptation to the unstable voltage adaptive mechanisms, decompensated reaction to the stress of labor and delivery complications in both mother and fetus; Type 4 – failure of adaptation at birth is 10%.

2. The degree of impairment of adaptation to leave reflects the reproductive potential of women in general. Most unfavorable is Type 4, which have the highest risk of perinatal and maternal deaths.

3. Multicomponent screening pregnant using both psychodiagnostic, the study of higher nervous activity, cerebral blood flow, autonomic nervous system, the functional state of the fetoplacental complex, dermatoglyphics, iridodiagnostics and factor analysis and Bayesian forecasting models to determine the level of adaptation to the pregnant woman and fetus birth stress and predict outcomes childbirth.

4. The developed algorithm for accurate assessment of adaptation forecast birth outcomes for mother and fetus at 94%, helps to optimize obstetric tactics and reduce the frequency of obstetric and perinatal complications of pregnancy and childbirth.

The conclusion of the dissertation on “Obstetrics and Gynecology”, Mamiev, Oleg B.

CONCLUSIONS

1. Features of mental and emotional status of pregnant with complicated births are lack of multi-variant character accentuations with persistent dominance of only one of a number of possible responses to stress, a significant narrowing of the range of behavioral responses, instability control by intrapsychic coping mechanisms for anxiety. Higher nervous activity in these women is characterized by imbalance and a weakening of the excitation and the four species of the internal (conditional) inhibition with simultaneous inhibition of the external (absolute) inhibition.

2. Characteristic parameters of cerebral circulation in pregnant women with normal birth outcomes for both mother and fetus at rest is the predominance of right-hemisphere lateralization of cerebral blood flow with its reduction of the stress and stability with the left hemisphere hemodynamics correlated with the functional readiness of the mother-placenta-fetus for birth. In women with abnormal during labor, in contrast, dominated by blood flow in the left hemisphere, with its persistent decrease of the stress in both hemispheres, and while maintaining the left-hemispheric lateralization.

3. State of the autonomic nervous system in women with normal birth outcomes in contrast to women with their complicated course characterized by high functional capabilities with a clear dynamic balance between the sympathetic and parasympathetic nervous system. In this case, against the background of a functional test indicated a predominance of parasympathetic nervous system, the absence of signs of hyperactivity of the central (intracranial) and humoral components of adaptation. This state of vegetative homeostasis is a clear indication of functional readiness of the mother-placenta-fetus for birth.

4. Humoral factors of adaptation and proteins associated with pregnancy have different parameters specific to women with normal and abnormal reproductive outcomes. In the normal course of labor are high value trophoblastic | 31-glycoprotein and low pregnancy-associated a2-glycoprotein, a stable level of cortisol, a-fetoprotein, as well as low or no natural factor that inhibits the activity of the antibodies of class M. The pathological process of delivery is determined by the high cortisol levels while reducing trophoblastic p-glycoprotein and a-fetoprotein, and, to a lesser extent, a2-glycoprotein. The extent of these changes is directly related to the severity of the complications of childbirth process.

5. These dermatoglyphic and iridology studies provide an objective assessment of the level of adaptation woman and the fetus for birth. Number of pathological structures and dermatoglyphic iridoznakov progressively increases with decreasing adaptation pregnant woman and the fetus for birth.

6. Complex multifactorial study of pregnant using both psychodiagnostic, clinical and physiological, immunological, hormonal, dermatoglyphic and iridology techniques allowed to establish four types of adaptation of pregnant women and fetuses to birth stress:

Type 1 – satisfactory adaptation of an uncomplicated birth outcomes for both mother and fetus;

Type 2 – the state of stress adaptation mechanisms with signs of decompensation and complications in childbirth only in the fetus or the mother only;

Type 3 – poor adaptation in the unstable voltage adaptation mechanisms with decompensation of the generic stress both the mother and fetus;

Type 4 – failure to adapt to adverse birth outcomes for both mother and fetus.

7. On the basis of simultaneous multi-component surveys of pregnant using probabilistic and statistical methods of factor analysis and recognition algorithms are designed to adapt to the generic type of stress in the pregnant woman and the fetus, allowing accurately predict birth outcomes for mothers and children in 94% of cases.

8. The developed algorithms to recognize the type of adaptation make it possible to optimize the monitoring of pregnant determine whether conservative or operative delivery, and thereby reduce the risk of obstetric complications and perinatal losses.

PRACTICE GUIDELINES

1. To identify the type and level of adaptation to the 1st stage of the prediction in early pregnancy should be used psychodiagnostic, dermatoglyphics and iridodiagnosis. For each specific indicator with forecast tables (Astrakhan, 2006) should determine the appropriate prognostic factor (PC). In this case, if the total PC on one of the types of adaptation reaches 13 points, and all other is lower, including and negative PCs, with 95% of surveyed refers to this type of adaptation. PC if the total for each of the pathological types adjustment range from -9 to -13 points or less, the pregnant woman with a probability of 80% to 95% can be attributed to one-third type of adaptation with normal birth outcomes and to monitor her prenatal conditions according to the order number 50.

2. In establishing the forecast uncertainty between the 2nd and 3rd types of adaptation pregnant should be referred to the 3rd type, and between the 3rd and 4th types, respectively, to the 4th type of adaptation.

3. After 32 weeks of gestation in all pregnant women should be implemented n-th stage of forecasting to avoid uncertain or incorrect prediction. This should apply rheoencephalography, cardiointervalography, determination of blood cortisol levels in pregnant women, the EIF, pregnancy-associated glycoprotein-ar, Trojan foblasticheskogo (3]-glycoprotein, a-fetoprotein, immunological factor adjustment and then use predictive tables and final adjustment type adaptation and forecasting the outcome of labor.

4. At the nth stage in forecasting to better ensure the accuracy of the forecast should be used prediction algorithm of the fetus and the newborn at birth and early neonatal period, which is based on a factor analysis (Astrakhan, 1998, 2004). I

5. Monitoring pregnancy type 2 adaptation to adverse birth outcomes for the fetus early in pregnancy should be focused on a more thorough assessment of embryo-fetal chorion, placenta, using modern methods of prenatal diagnosis and treatment. Given that these women have obstetric complications during labor are not available, the exponent of intrapartum fetal threat according to the algorithm (step 4) 66% to 86% are allowed vaginal delivery. At 87% -93% delivery should be managed conservatively with close monitoring of fetal (CTG), prevention of hypoxia. With average 94% -97% delivery can start acting conservatively readily if needed to move quickly to abdominal delivery. With average 98% -100% in the interest of the fetus should be considered as the preferred delivery by cesarean section.

6. When monitoring of pregnant women with adverse birth outcomes for the mother should be focused on early detection of pathology of the reproductive system (inflammatory disease, uterine fibroids, the development of macro defects, etc.), as well as extragenital diseases and rational adjustment for gestational age. After the n-th stage to predict additional prophylaxis birth trauma in the mother of uterine abnormalities, bleeding during delivery and the postpartum period. Obstetric tactics basically these women should focus on conservative management of labor, as the risk of complications during delivery to the fetus is missing.

7. Due to the low reproductive potential of women in general, with the 3rd and especially with the 4th types of adaptation should first be carefully planned to avoid pregnancy and abortion. Watching these women with early pregnancy should be based on the most in-depth assessment at the same time as the state of the fetoplacental system and physical health of pregnant women. Need to use advanced, feasible methods of diagnosis, counseling these women doctors of other specialties with an early correction of pathology. During pregnancy and especially during the 4th type of adaptation needed prevention and treatment of complications of pregnancy: the threat of termination, hypothyroidism placenta, preeclampsia, hemostatic disorders, etc., optimally, in obstetric hospital. Births at the 3rd type of adaptation is permissible start behaving conservatively under the strict control of the state of the mother and fetus when ready, if necessary, to move quickly to abdominal delivery. For pregnant women with Type 4 adaptation of the most gentle and efficient way rodorazreshe-tion should be considered elective caesarean sections.

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