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 with 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

Expressed early toxicosis pregnant=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
Change amniotic fluid with 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 makes individual plan dispensary observation, 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 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 high risk 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 the 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, and allows one to assess the individual degree of risk of developing possible complications gestational period and upcoming birth of a pregnant woman, predict 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 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 the antenatal clinic"), 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 of the 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, duration of infertility for a period of 2-3 years or more than 3 years is assessed as “2” and “4” points, respectively; Availability spontaneous miscarriage for a nulliparous woman it is assessed as “3” points, for 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, caesarean section is 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, cardiac arrhythmias, operated heart, hypertonic disease assessed as “8” points, diseases of the myocardium, endocardium and pericardium, 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, gestosis mild degree- as “10” points, moderate degree - “50” points, severe gestosis, preeclampsia, eclampsia are 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 position of the fetus (oblique, transverse, breech presentation) are 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 Ordnance, 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 hypoxia fetus 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 additional examination, consultations 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 for existing complications of the gestational period was started. 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 carried out through a small caesarean section, a living girl with signs of hypoxia and malnutrition of the 2nd degree was extracted. 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 health care facilities at the republican level for further treatment and rehabilitation.

Continuation of Table 1

Continuation of Table 1

Continuation of Table 1

Continuation of table 3

Continuation of table 4

Continuation of table 5

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: first pregnancy is assessed as 2 points, repeat pregnancy - 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

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

A high-risk pregnancy is one in which the risk of illness or death of the mother or newborn before or after birth is greater than usual.

To identify a high-risk pregnancy, a doctor examines a pregnant woman to determine if she has diseases or symptoms that make her or her fetus more likely to get sick or die during pregnancy (risk factors). Risk factors can be assigned scores corresponding to the degree of risk. Identifying a high-risk pregnancy is only necessary to ensure that a woman who needs intensive medical care receives it in a timely manner and in full.

A woman with a high-risk pregnancy may be referred to antenatal (perinatal) care (perinatal refers to events that occur before, during or after delivery). These units are usually associated with obstetric services and neonatal intensive care units to provide the highest level of care for the pregnant woman and baby. A doctor often refers a woman to a perinatal care center before giving birth, since early medical control very significantly reduces the likelihood of pathology or death of the child. A woman is also sent to such a center during childbirth if unexpected complications arise. Typically, the most common reason for referral is a high likelihood of preterm labor (before 37 weeks), which often occurs when the fluid-filled membranes containing the fetus rupture before it is ready for birth (a condition called preterm rupture of membranes ). Treatment at a perinatal care center reduces the likelihood of premature birth.

In Russia, maternal mortality occurs in 1 in 2000 births. Its main causes are several diseases and disorders associated with pregnancy and childbirth: blood clots entering the vessels of the lungs, complications of anesthesia, bleeding, infections and complications arising from increased blood pressure.

In Russia, the perinatal mortality rate is 17%. Slightly more than half of these cases are stillbirths; in other cases, babies die within the first 28 days after birth. The main causes of these deaths are congenital malformations and prematurity.

Some risk factors are present even before a woman becomes pregnant. Others occur during pregnancy.

Risk factors before pregnancy

Before a woman becomes pregnant, she may already have some diseases and disorders that increase her risk during pregnancy. In addition, a woman who had complications in a previous pregnancy has an increased likelihood of developing the same complications in subsequent pregnancies.

Maternal risk factors

The risk of pregnancy is affected by the woman's age. Girls aged 15 years and younger are more likely to develop preeclampsia(a condition during pregnancy in which blood pressure rises, protein appears in the urine and fluid accumulates in the tissues) and eclampsia (convulsions resulting from pre-eclampsia). They are also more likely birth of a low birth weight or premature baby. Women aged 35 years and older are more likely to increased blood pressure,diabetes,the presence of fibroids (benign neoplasms) in the uterus and the development of pathology during childbirth. The risk of having a baby with a chromosomal abnormality, such as Down syndrome, increases significantly after age 35. If an older pregnant woman is concerned about the possibility of abnormalities in the fetus, chorionic villus sampling or amniocentesis to determine the chromosome composition of the fetus.

A woman who weighed less than 40 kg before pregnancy is more likely to give birth to a baby who weighs less than expected for gestational age (small for gestational age). If a woman gains less than 6.5 kg in weight during pregnancy, then the risk of death of the newborn increases to almost 30%. Conversely, an obese woman is more likely to have a very large baby; Obesity also increases the risk of developing diabetes and high blood pressure during pregnancy.

A woman less than 152 cm tall often has a reduced pelvic size. She is also more likely to have a premature birth and have a low birth weight baby.

Complications during a previous pregnancy

If a woman has had three consecutive miscarriages (spontaneous abortions) in the first three months of previous pregnancies, then another miscarriage is possible with a 35% probability. Spontaneous abortion is also more likely in women who have previously given birth to stillbirths between the 4th and 8th months of pregnancy or who have had premature birth in previous pregnancies. Before attempting a new conception, a woman who has had a spontaneous abortion is recommended to undergo examination to identify possible chromosomal or hormonal diseases, structural defects of the uterus or cervix, diseases connective tissue, for example, systemic lupus erythematosus, or an immune reaction to the fetus - most often incompatibility with the Rh factor. If the cause of spontaneous abortion is established, it can be eliminated.

Stillbirth or death of a newborn may be a consequence of chromosomal abnormalities of the fetus, as well as the presence of diabetes mellitus, chronic disease kidney or blood vessel problems, high blood pressure, or a connective tissue disease such as systemic lupus erythematosus in the mother or her drug use.

The more premature the previous birth, the greater the risk of premature birth in subsequent pregnancies. If a woman gives birth to a child weighing less than 1.3 kg, then the probability of premature birth in the next pregnancy is 50%. If intrauterine growth retardation has occurred, this complication may recur in the next pregnancy. The woman is examined to identify problems that may cause fetal growth restriction (eg, high blood pressure, kidney disease, overweight, infections); Smoking and alcohol abuse can also lead to impaired fetal development.

If a woman has a baby that weighs more than 4.2 kg at birth, she may have diabetes. The risk of spontaneous abortion or death of the woman or baby is increased if the woman has this type of diabetes during pregnancy. Pregnant women are tested for its presence by measuring blood sugar (glucose) between the 20th and 28th weeks of pregnancy.

A woman who has had six or more pregnancies is more likely to have weak labor (contractions) during labor and bleeding after delivery due to weakened uterine muscles. Rapid labor is also possible, which increases the risk of heavy uterine bleeding. In addition, such a pregnant woman is more likely to have placenta previa (placenta located in the lower part of the uterus). This condition can cause bleeding and may be an indication for a cesarean section because the placenta often covers the cervix.

If a woman gives birth to a child with a hemolytic disease, then the next newborn has an increased likelihood of the same disease, and the severity of the disease in the previous child determines its severity in the subsequent one. This disease develops when a pregnant woman with Rh-negative blood develops a fetus whose blood is Rh-positive (that is, there is Rh incompatibility), and the mother develops antibodies against the fetal blood (sensitization to the Rh factor occurs); these antibodies destroy fetal red blood cells. In such cases, the blood of both parents is tested. If a father has two genes for Rh-positive blood, then all his children will have Rh-positive blood; if he has only one such gene, then the probability of Rh-positive blood in the child is approximately 50%. This information helps doctors provide appropriate care to mother and baby in subsequent pregnancies. Usually, during the first pregnancy with a fetus with Rh-positive blood, no complications develop, but contact between the blood of the mother and the child during childbirth causes the mother to develop antibodies against the Rh factor. The result is a danger to subsequent newborns. If, however, after the birth of a child with Rh-positive blood from a mother whose blood is Rh-negative, Rh0-(D)-immunoglobulin is administered, then the antibodies against the Rh factor will be destroyed. Due to this, hemolytic diseases of newborns rarely occur.

A woman who has had preeclampsia or eclampsia is more likely to have it again, especially if the woman has chronically high blood pressure.

If a woman has given birth to a child with a genetic disease or congenital defect, then before a new pregnancy, genetic testing is usually carried out on the child, and in the case of a stillbirth, on both parents. When a new pregnancy occurs, ultrasonography(ultrasound), chorionic villus sampling and amniocentesis to identify abnormalities that are likely to recur.

Developmental defects

Defects in the development of a woman's reproductive organs (for example, a double uterus, a weak or insufficient cervix that cannot support the developing fetus) increase the risk of miscarriage. To detect these defects, diagnostic operations, ultrasound or x-ray examination are necessary; if a woman has had repeated spontaneous abortions, these studies are carried out before the onset of a new pregnancy.

Fibroids ( benign neoplasms) uteri, which are more common in older ages, may increase the likelihood of premature birth, complications during labor, abnormal presentation of the fetus or placenta, and recurrent miscarriages.

Diseases of a pregnant woman

Some diseases of a pregnant woman can pose a danger to both her and the fetus. The most important of these are chronic high blood pressure, kidney disease, diabetes mellitus, severe heart disease, sickle cell anemia, thyroid disease, systemic lupus erythematosus and blood clotting disorders.

Diseases in family members

The presence of relatives with mental retardation or other hereditary diseases in the family of the mother or father increases the likelihood of such diseases in the newborn. The tendency to have twins is also common among members of the same family.

Risk factors during pregnancy

Even a healthy pregnant woman can be exposed to adverse factors that increase the likelihood of problems with the fetus or her own health. For example, she may be exposed to teratogens (exposures that cause birth defects) such as radiation, certain chemicals, medications, and infections, or she may develop a pregnancy-related disease or complication.

Exposure to drugs and infection

Substances that can cause congenital malformations of the fetus when taken by a woman during pregnancy include alcohol, phenytoin, drugs that counteract the effect of folic acid (lithium preparations, streptomycin, tetracycline, thalidomide). Infections that can lead to birth defects include herpes simplex, viral hepatitis, influenza, paratitis (mumps), rubella, chickenpox, syphilis, listeriosis, toxoplasmosis, diseases caused by coxsackievirus and cytomegalovirus. At the beginning of pregnancy, the woman is asked if she has taken any of these medications and if she has had any of these infections since conception. Of particular concern is smoking, alcohol and drug use during pregnancy.

Smoking– one of the most common bad habits among pregnant women in Russia. Despite awareness of the health risks of smoking, the number of adult women who smoke or live with someone who smokes has decreased slightly over the past 20 years, while the number of women who smoke heavily has increased. Smoking among teenage girls has become significantly more common and is higher than among teenage boys.

Although smoking harms both mother and fetus, only about 20% of women who smoke stop smoking during pregnancy. The most common consequence of maternal smoking during pregnancy for the fetus is low birth weight: the more a woman smokes during pregnancy, the lower the baby's weight will be. This effect is stronger among older women who smoke, who are more likely to have babies who are smaller in weight and height. Women who smoke are also more likely to experience placental complications, premature rupture of membranes, preterm labor, and postpartum infections. A pregnant woman who does not smoke should avoid exposure to tobacco smoke from others who smoke, as it can similarly harm the fetus.

Congenital malformations of the heart, brain, and face are more common in infants born to pregnant women who smoke than to nonsmokers. Maternal smoking may increase the risk of sudden infant death syndrome. In addition, children of smoking mothers have a small but noticeable delay in growth, intellectual development and behavioral development. These effects, according to experts, are caused by exposure to carbon monoxide, which reduces the delivery of oxygen to the body's tissues, and nicotine, which stimulates the release of hormones that constrict the blood vessels of the placenta and uterus.

Alcohol consumption during pregnancy is the leading known cause of congenital malformations. Fetal alcohol syndrome, one of the main consequences of drinking alcohol during pregnancy, is detected in an average of 22 out of 1000 newborns born alive. This condition includes slow growth before or after birth, facial defects, small head size (microcephaly) probably associated with poor brain development, and mental development. Mental retardation is a consequence of fetal alcohol syndrome more often than any other known cause. In addition, alcohol can cause other complications, ranging from miscarriage to severe behavior problems in a newborn or developing child, such as antisocial behavior and inability to concentrate. These disorders can occur even when the newborn does not have any obvious physical birth defects.

The chance of spontaneous abortion almost doubles when a woman drinks alcohol in any form during pregnancy, especially if she drinks heavily. Often, birth weight is lower than normal in those newborns born to women who drank alcohol during pregnancy. Newborns whose mothers drank alcohol have an average birth weight of about 1.7 kg, compared with 3 kg for other newborns.

Drug use and dependence on them is observed in an increasing number of pregnant women. For example, in the United States, more than five million people, many of them women of childbearing age, regularly use marijuana or cocaine.

An inexpensive laboratory test called chromatography may be used to test a woman's urine for heroin, morphine, amphetamines, barbiturates, codeine, cocaine, marijuana, methadone, and phenothiazine. Injecting drug users, that is, drug addicts who use syringes to use drugs, have a higher risk of developing anemia, infection of the blood (bacteremia) and heart valves (endocarditis), skin abscess, hepatitis, phlebitis, pneumonia, tetanus and sexually transmitted diseases (including including AIDS). Approximately 75% of newborns with AIDS had mothers who were injection drug users or prostitutes. Such newborns are more likely to have other sexually transmitted diseases, hepatitis and other infections. They are also more likely to be born premature or have intrauterine growth restriction.

Main component marijuana, tetrahydrocannabinol, can pass through the placenta and affect the fetus. Although there is no definitive evidence that marijuana causes birth defects or slows the growth of the fetus in the womb, some studies suggest that marijuana use may cause behavioral abnormalities in the baby.

Use cocaine during pregnancy causes dangerous complications in both mother and fetus; many women who use cocaine also use other drugs, which compounds the problem. Cocaine stimulates the central nervous system, acts as a local anesthetic (pain reliever), and constricts blood vessels. The narrowing of the blood vessels leads to decreased blood flow and the fetus does not receive enough oxygen. Reduced delivery of blood and oxygen to the fetus can affect the development of various organs and usually leads to skeletal deformities and narrowing of some parts of the intestine. Nervous system diseases and behavioral problems in children of women who use cocaine include hyperactivity, uncontrollable tremors, and significant learning problems; these disorders may continue for 5 years or more.

If a pregnant woman suddenly has high blood pressure, has bleeding due to placental abruption, or has a stillborn baby for no apparent reason, her urine is usually tested for cocaine. Approximately 31% of women who use cocaine throughout pregnancy experience preterm labor, 19% experience intrauterine growth retardation, and 15% experience placental abruption prematurely. If a woman stops taking cocaine after the first 3 months of pregnancy, the risk of premature birth and placental abruption remains high, but fetal development is usually not affected.

Diseases

If high blood pressure is first diagnosed while a woman is already pregnant, it is often difficult for a doctor to determine whether the condition is caused by pregnancy or has another cause. Treatment of such a disorder during pregnancy is difficult, since the therapy, while beneficial for the mother, carries a potential danger to the fetus. At the end of pregnancy, an increase in blood pressure may indicate a serious threat to the mother and fetus and should be quickly corrected.

If a pregnant woman has had a bladder infection in the past, a urine test is done at the beginning of pregnancy. If bacteria are detected, the doctor will prescribe antibiotics to prevent infection from entering the kidneys, which can cause premature labor and premature rupture of membranes. Bacterial infections of the vagina during pregnancy can lead to the same consequences. Suppressing the infection with antibiotics reduces the likelihood of these complications.

A disease accompanied by an increase in body temperature above 39.4°C in the first 3 months of pregnancy increases the likelihood of spontaneous abortion and the occurrence of defects in the nervous system in the child. A rise in temperature at the end of pregnancy increases the likelihood of premature birth.

Emergency surgery during pregnancy increases the risk of premature birth. Many diseases, such as acute appendicitis, acute liver disease (biliary colic) and intestinal obstruction, are more difficult to diagnose during pregnancy due to the natural changes that occur during this time. By the time such a disease is diagnosed, it can already be accompanied by the development of severe complications, sometimes leading to the death of the woman.

Complications of pregnancy

Rh factor incompatibility. The mother and fetus may have incompatible blood types. The most common is Rh factor incompatibility, which can lead to hemolytic disease in the newborn. This disease often develops when the mother's blood is Rh negative and the baby's blood is Rh positive due to the father's Rh positive blood; in this case, the mother develops antibodies against the blood of the fetus. If a pregnant woman's blood is Rh negative, the presence of antibodies to the fetal blood is checked every 2 months. The likelihood of developing these antibodies increases after any bleeding in which maternal and fetal blood may be mixed, particularly after amniocentesis or chorionic villus sampling, as well as during the first 72 hours after birth. In these cases, and at the 28th week of pregnancy, the woman is injected with Rh0-(D)-immunoglobulin, which combines with the antibodies that have appeared and destroys them.

Bleeding. The most common causes of bleeding in the last 3 months of pregnancy are pathological placenta previa, premature placental abruption, diseases of the vagina or cervix, such as infection. All women who experience bleeding during this period have an increased risk of miscarriage, severe bleeding, or death during childbirth. Ultrasound (ultrasound), examination of the cervix, and Pap test can help determine the cause of bleeding.

Conditions related to amniotic fluid. Excess amniotic fluid (polyhydramnios) in the membranes surrounding the fetus stretches the uterus and puts pressure on the woman's diaphragm. This complication sometimes leads to breathing problems in the woman and premature birth. Excess fluid may occur if a woman has uncontrolled diabetes, if multiple fetuses develop (multiple pregnancy), if the mother and fetus have incompatible blood types, and if the fetus has congenital malformations, especially esophageal atresia or defects of the nervous system. In approximately half of cases, the cause of this complication remains unknown. A lack of amniotic fluid (oligohydramnios) can occur if the fetus has congenital urinary tract defects, intrauterine growth retardation, or intrauterine fetal death.

Premature birth. Premature birth is more likely if the pregnant woman has defects in the structure of the uterus or cervix, bleeding, mental or physical stress or multiple pregnancies, or if she has previously had uterine surgery. Premature labor often occurs when the fetus is in an abnormal position (such as a breech position), when the placenta separates from the uterus prematurely, when the mother has high blood pressure, or when there is too much amniotic fluid surrounding the fetus. Pneumonia, kidney infections and acute appendicitis can also cause premature birth.

Approximately 30% of women who go into preterm labor have a uterine infection, even if the uterine lining does not rupture. There is currently no reliable data on the effectiveness of antibiotics in this situation.

Multiple pregnancy. Having multiple fetuses in the uterus also increases the likelihood of fetal birth defects and birth complications.

Delayed pregnancy. In a pregnancy that continues beyond 42 weeks, fetal death is 3 times more likely than in a normal pregnancy. To monitor the condition of the fetus, electronic cardiac monitoring and ultrasound examination (ultrasound) are used.

Low weight newborns

• A premature infant is a newborn born at less than 37 weeks of gestation.
• A low birth weight infant is a newborn weighing less than 2.3 kg at birth.
• A small for gestational age infant is a child whose body weight is insufficient for the gestational age. This definition refers to body weight, but not height.
• A developmentally delayed infant is a newborn whose development in the uterus was insufficient. This concept applies to both body weight and height. The newborn may be developmentally delayed, small for gestational age, or both.

CTG (cardiotocography) is a method for studying the fetal heartbeat and uterine contractions in pregnant women, in which all recording data is recorded on a special tape. A child's heart rate will depend on several factors, such as the time of day, and the presence of risk factors.

• In what cases is CTG prescribed?

  How are the final CTG indicators deciphered?

  Decoding of the final ones is carried out by a specialist taking into account such data as: fetal heart rate variability, basal rhythm, acceleration, deceleration and physical activity fetus Such indicators, at the end of the survey, are displayed on the tape and look like graphs of different shapes. So, let's take a closer look at the above indicators:

  1. 1. Variability (or amplitude) refers to disturbances in the frequency and regularity of contractile movements of the rhythm and amplitude of the heart, which are based on the results of the basal rhythm. If no pathology of fetal development is observed, heart rate indicators should not be uniform, this is clearly visible through visualization by the constant change of numerical indicators on the monitor during a CTG examination. Changes within normal limits can range from 5-30 beats per minute.
     2. The basal rhythm refers to the average heart rate of the baby. Normal indicators are a heartbeat from 110 to 160 beats per minute when the fetus and woman are calm. If the child is actively moving, the heart rate will remain from 130 to 180 beats for one minute. Indicators of the basal rhythm within normal limits mean the absence of a hypoxic state of the fetus. In cases where the indicators are lower than normal or higher, it is believed that there is a hypoxic condition, which negatively affects the baby’s nervous system, which is in an underdeveloped state.
     3. Acceleration means an increased rate of heartbeat, compared to the level of basal rhythm indicators. Acceleration indicators are reproduced on the cardiotocogram in the form of teeth; the norm is two to three times in 10-20 minutes. Perhaps a slight increase in frequency up to four times in 30-40 minutes. It is considered a pathology if acceleration is completely absent over a period of 30-40 minutes.
     4. Deceleration is a decrease in heart rate compared to the degree of basal heart rate. Deceleration indicators take the form of dips or otherwise negative teeth. Within the normal functioning of the fetus, these indicators should be completely absent or very insignificant in depth and duration, and very rarely occur. After 20-30 minutes of CTG examination, when deceleration occurs, suspicions arise that the condition of the unborn baby is worsening. Of great concern in fetal development are the repeated and varied manifestations of deceleration throughout the examination. This may be a signal of the presence of decompensated stress in the fetus.

  Importance of Fetal Health Indicators (FSI)

  After the graphical results of the CTG study are ready, the specialist determines the value of the fetal condition indicators. For normal child development, these values ​​will be less than 1. When the PSP indicators are from one to two, this indicates that the condition of the fetus begins to deteriorate and some unfavorable changes appear.

  

  When PSP indicators are above three, this means that the fetus is in critical condition. But if only such data is available, the specialist cannot make any decisions; first, the full history of the pregnancy will be considered.

  You need to understand that not only pathological processes in the development of the baby can cause deviations from the norm; these can also be some conditions of the pregnant woman and the baby that do not depend on the disorders (for example, elevated temperature readings in a pregnant woman or, if the baby is in a state of sleep).

  What CTG scores are considered normal when performing CTG, and is it considered a pathology?

  The results of cardiotocography are assessed using a special Fisher point scale - assigning 0-2 points to each of the above indicators. Then the scores are summed up and a general conclusion is made about the presence or absence of pathological changes. A CTG result from 1 to 5 points indicates an unfavorable prognosis - the development of hypoxia in the fetus, a 6 point value may indicate incipient oxygen deficiency.

  What does a CTG score of 7 points mean in the conclusion?

  CTG 7 points - this score is considered an indicator of the onset of fetal oxygen deficiency. In this condition, the specialist prescribes appropriate treatment to avoid the occurrence of hypoxia, as well as to improve the baby’s condition if it is present. With a score of 7 points at week 32, treatment measures begin without delay. The doctor who monitors the course of pregnancy can urgently send the woman to hospital treatment or limit herself to IV drips at the day hospital.

  During the lighter stage of oxygen starvation, one gets by with more frequent and longer stays in the fresh air, weather permitting. Or taking medications to prevent this condition.

  Even if, after deciphering the CTG examination, the specialist determines a result of 7 points, which is an alarming sign, you should not panic, because modern medicine can help the future baby get rid of this condition.

  If pathological processes are identified in the baby, which are a reaction to uterine contractions, it is necessary to urgently consult a gynecologist with the results of the study. After assessing the results, the specialist will be able to prescribe competent treatment, as well as send you for a second CTG examination.

  CTG assessment value 8 points

  Many expectant mothers are interested in the question of the 8-point CTG value, are these indicators a cause for concern? CTG 8 points shows the lower limit of normal, and this condition of the fetus usually does not require either treatment or hospitalization.

  What is the significance of grades of 9 and 10?

  Normal values ​​are considered to be 9 and 10 points. These indicators can mean one thing: the development of the fetus is going well, without the development of pathologies. A score of 10 points indicates that the condition of the unborn baby is within normal limits.

  What pathological processes can be detected by CTG examination?

  How to perceive the results of CTG? Relying only on the obtained CTG data, it is impossible to finally determine the diagnosis, since pathological deviations from the 10-point norm can be a temporary condition in response to some external stimulus. This technique is easy to implement and will help without special costs identify deviations from the norm in fetal development.

  The CTG method will help identify the following pathologies:

  
  

  When deviations from the norm were detected during decoding of CTG, the doctor prescribes an ultrasound, as well as. If necessary, the pregnant woman is prescribed treatment and repeat CTG.