Clinical and psychological ground of principles of prognostication of premature delivery risk

Abstract

The objective: to assess the diagnostic significance of anamnestic and clinical-psychological factors and develop the prediction criteria for the threat of premature birth (PB). Materials and methods. An analysis of the data of pregnant women who were tested in the II and early III trimesters (screening is the I stage of the study) was carried out. The pregnant women were conditionally divided into two groups. The main group included 30 women whose further course of pregnancy was complicated by the threat of PB. The comparison group included 222 women without clinical manifestations of threat of PB during the current pregnancy. During the II stage of the study, the systematization of existing anamnestic and clinical-psychological factors among the examined women was performed. At the III stage, a comparative analysis of the frequency of the symptoms identified at the I stage was carried out in pregnant women in groups with the calculation of diagnostic coefficients (DC) of measures of informativeness (MI) according to formulas. Diagnostic (prognostic) tables were created for each factor, DC and MI were calculated based on the ratio of frequencies. According to the methodology for calculating the accuracy of the diagnostic decision to achieve a probability level of 95 % (p=0.05), the limit ∑DC is a constant = ±13, to achieve a probability of 99 % = ±20, to achieve a probability of 99.9% = ±30. If there is a factor in the column of the scale that is not included in the spectrum of exclusions, put a check mark in the “yes” column of the corresponding row. In the absence of such a check mark is placed in the “no” column of the corresponding row. Regarding the filling of each row, the sum of DC is calculated by adding up the indicated DCs, in the case of reaching the value of ∑DC, a preliminary diagnostic conclusion is made about the probability for threat of PB (at ∑DC = -13), which has a confidence level of 95 % (p=0.05). If the value of ∑DK = -20 is reached, a final diagnostic conclusion is made about the probability of 99 % for threat of PB (p=0.01). If the limit of the range is -13 < ∑DC < +13, the conclusion is significant because in such case its “p” is > 0.05.Results. Based on the values ​​of DC and MI of Kullbak (valid signs), a clinical scale to predict threat of PB with a confidence level of 95 % (p=0.05) or 99 % (p=0.01) was developed. Among the informative signs (factors) for predicting of threat of PB the following factors were established: spontaneous miscarriage in the anamnesis, high personal and situational anxiety (45 points and above), IV and more pregnancies and artificial abortion in the anamnesis, as well as the level of neuroticism (16 points and above). Conclusions. It has been established that anamnestic and clinical-psychological factors, namely, miscarriage in the anamnesis, artificial abortion in the anamnesis, IV and more pregnancies, high levels of personal and situational anxiety and neuroticism, are important and effective criteria for predicting the threat of premature birth.