In maternity patients at high risk, it is necessary to perform a comprehensive assessment of the fetus with the help of cardiotocography, amnioscopy, determination of the nature of labor activity by methods of external and internal hysterography, determination of fetal and parenteral fetus, pH determination of amniotic fluid.
In this case, amnioscopy and registration of cardiac activity of the fetus is performed in order to establish a preliminary, and the determination of the pH of the blood from the present part of the fetus and the pH of the amniotic fluid is for an accurate differential diagnosis. Szanto, Baiflai, Kovacs (1993) believe that the determination of the pH of fetal and newborn blood opens up new opportunities in obstetric practice. During childbirth, monitoring the pH of fetal blood can prevent the development of complications. After giving birth, the determination of the pH of fetal blood allows early diagnosis of fetal acidosis and the timely initiation of intensive treatment.
All methods of assessing the fetus, with the exception of the pH of the amniotic fluid and cardiotocography, are reliable during a short period of time, for example, Zaling's sample does not exceed 30 minutes, that is, there is no possibility of a long-term prognosis.
Substantiation of the concept of complex (intensive) observation during the birth act. Childbirth is a great burden for both the mother and the fetus even with their physiological flow. When the birth occurs in women at high risk groups, in which the fetus is in a threatening state, intensive observation becomes even more important, since there can be a prognostically unfavorable effect of births on the fetus. Therefore, early diagnosis of threatening fetal conditions is necessary. Along with intensive monitoring of the fetus, it is necessary to decide the choice of the method of delivery with the aim of the most careful and rapid completion of labor.
At present, it seems obvious that classical methods of observation (auscultation of the fetus with an obstetric stethoscope, control of the appearance of a meconium admixture in the amniotic fluid, the definition of a generic tumor, etc.) are insufficient to accurately reflect the fetal condition during labor.
It should be noted that from the skin of the fetal head during labor, blood can be taken not only to determine the basic parameters of CBS, but also for analyzes performed with the help of other microstructural methods:
- when a fetal anemia is suspected, a study of hematocrit, hemoglobin, and erythrocyte count is performed;
- when the fetus is affected by Rh incompatibility, the blood group of the fetus is determined and a direct Coombs reaction is performed;
- in diabetes, the mother determines the sugar content in the blood of the fetus.
When determining the condition of the fetus during childbirth, the results of the analysis of blood taken from the skin of its head are crucial. Acidosis can be recognized in any stage of labor based on blood test data from the skin of the fetal head.
Comprehensive monitoring, which includes hardware methods, requires a certain technical equipment of the maternity unit and the appropriate training of doctors and midwives to decode the data of cardiocograms, take blood from the skin of the head (Zaling test), determine the pH of the amniotic fluid,
Intensive monitoring should mainly be performed in women at high risk of labor, ie, with complicated pregnancy, extragenital diseases, especially diabetes mellitus, presence of meconium admixture in the amniotic fluid, primiparous elderly, anomalies of labor, in the presence of pathological KIT curves. Particular attention should be paid to pregnant women and parturient women with early termination of pregnancy in the interests of the fetus, since already with the emerging threatening situation for the fetus, it is necessary to perform birth-giving, often with the opening of the fetal bladder, the administration of oxytetics, which in themselves can aggravate the fetal condition. Therefore, the correct determination of the degree of hypoxia of the fetus makes it possible to choose the most rational way of conducting labor.
The following complex approach to the evaluation of the fetal condition and the solution of the question of the most rational tactics of labor management is used:
- At the admission of a parturient woman belonging to a high-risk group, cardiotocography is performed to identify signs of impairment of the fetus.
- Produce an amniascopy or a visual assessment of the color of amniotic fluid. At the same time, we consider it important to produce after cardiotocography, since the introduction of mirrors or a tube can change the character of the fetal heart activity for some time. With meconium admixture in the amniotic fluid, a fetal bladder is opened to produce the next, third, stage of determining the fetal blood CBS. If the waters are light and the cardiotocograph data reflects minor disturbances in the fetal life, the fetal bladder is not opened.
- Further, the determination of the fetal blood COS is carried out - the Zaling assay, and at the rates that do not require urgent delivery, the fourth stage is carried out - determination of the pH of the amniotic fluid.
- For the head of the fetus, the sensor of the "Express" device is activated and, at favorable pH monitoring parameters of the water, conservative management of labor continues with the constant calculation of hourly intra-hour fluctuations in the pH of amniotic fluid. With the increase of acidosis according to pH-metry or deterioration of the parameters of intra-hour oscillations, the Zalinga sample is repeated.
The complex approach to the diagnosis of the intrauterine fetus can reliably diagnose early signs of hypoxia, monitor the fetus during delivery, promptly treat hypoxia and determine indications for operative delivery and promote the birth of a healthy child.
Fetal sex as a risk factor. A technique for determining the sex of the fetus in childbirth has been developed. The following circumstances served as the basis for the development of this method. Sex of the fetus as a genetic factor that affects perinatal mortality has not been systematically studied to date. Therefore, it is necessary to find out the following points:
- to assess the effect of the sex of the fetus on mortality in the perinatal period;
- to develop adequate cytogenetic methods for determining the sex of the fetus in childbirth;
- to determine the sex of the fetus in clinical conditions with various complications of pregnancy and childbirth and to find out its role in choosing the method of delivery.
A mathematical analysis of 11.5 thousand perinatal deaths of children showed that the antenatal fetal death does not depend on sex, but already intranatally and in the first 6 days of life a growing correlation between mortality and sex reaching 15% is traced. Correlation between mortality and sex is observed irrespective of the mass of perinatal deaths of children. The proportion of dead boys is significantly increased only in childbirth and in the postnatal period.
To determine the sex of the fetus, a method suitable for clinical conditions has been developed for the content of X and Y chromatin in the cells of the tissue of the amniotic membranes. The study of X- and Y-chromatin was carried out in the nuclei of cells of native amniotic fluid preparations. Based on the analysis of the content of X- and Y-chromatin in the cells of the amniotic membranes, the fetal gender was correctly established in 97.4% of cases, in the study of amniotic fluid - in 90%.
All cases of incorrect determination of the sex of the fetus concerned pregnancies with male fetuses and were characterized by the absence or underestimation of Y-chromatin with the female sex X-chromatin. Thus, the proposed method for the study of amniotic membranes allows the sex of the fetus in labor to be determined with a high degree of accuracy. Fruits of the male are less resistant to stress factors of childbirth.
Thus, the intranatal determination of the fetal sex by the method of microbiopsies of the tissue of the amniotic membranes and the subsequent microscopic examination of both X and Y chromatin allowed the gender to be correctly established in 97% of cases.