СОВРЕМЕННЫЙ ПОДХОД К ОЦЕНКЕ ПЕРИНАТАЛЬНОГО РИСКА, ОСНОВАННЫЙ НА ИСПОЛЬЗОВАНИИ ПРОГНОСТИЧЕСКИХ КРИТЕРИЕВ АНТЕНАТАЛЬНЫХ, ИНТРАНАТАЛЬНЫХ И РАННИХ НЕОНАТАЛЬНЫХ ПОТЕРЬ

Abstract

The problem of perinatal losses is still actual in obstetrics today. At the same time there are cases of non-estimation or extra-estimation of perinatal risk in obstetrical practice. The usage of famous prognostic systems gives the opportunity to select pregnant women into groups of high risk and provide the necessary organizational and tactic measures. But to define the character of possible complications, to establish the degree of their severity and time of appearance is really impossible. Objective of the study: to develop a new approach to estimation of perinatal risk based on the determination of prognostic criteria for antepartum and intrapartum fetal death, early neonatal death of a newborn in order to increase the efficacy of predicting of unfavourable perinatal outcomes. Materials and research methods. The retrospective case-control study in patients with antepartum (n=134) and intrapartum (n=41) fetal death, early neonatal death of the newborn (n=61) and favourable perinatal outcome (n=50) was conducted. There was used the Bayes algorhythm with Wald's consecutive analysis in the modification of Genkin-Gubler to determine prognostic criteria. The comparative estimation of the efficacy of the proposed prognostic method and traditional method of determining perinatal risk was performed retrospectively in patients with perinatal losses (n=102) and favourable perinatal outcome (n=100). ROC analysis was performed. Results. There were identified 42 risk factors divided into three groups: universal for all types of perinatal losses, common for two of them and specific for each of them (antepartum and intrapartum fetal death, early neonatal death of a newborn). There was determined the prognostic influence of factors in their presence and absence. It was found that universal and common risk factors had different prognostic influence for each type of perinatal losses. There was presented the method for differential predicting of perinatal losses. The sensitivity of the new and traditional prognostic methods was 95.1% and 69.6%, specificity was 80% and 53%, and the accuracy of predicting of unfavourable outcome was 87.6% and 61.4% respectively. Conclusion. The investigation permitted to propose the new approach to estimation of perinatal risk, based on differential predicting of perinatal losses being is more effective than traditional method in predicting adverse perinatal outcomes.