The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2003.
To premature birth include such births that occurred for a period of 22 to 37 weeks of gestation (counting performed last month on the first day).
The incidence of preterm delivery in different countries is different, in Russia it ranges from 6 to 10%.
terms
Since 1993 the Russian Federation adopted a classification of preterm birth, which corresponds to WHO requirements, ie health care need (should be provided) all infants who were born at term 22 weeks or more, weight 500 or more gram. The timing of pregnancy are distinguished:
- superearly prematurity - 22-27 weeks (weight range of the child 500-999gr), the frequency of occurrence is 5-7%;
- early premature birth - 28-33 weeks (1000-2000gr weight of the child), the frequency of the number of premature births 33-42%;
- preterm birth 34-37 weeks (birth weight up to 2500g), are found in 50-60% of cases of premature birth.
Causes
There are many factors that can cause birth before the deadline.
Women's health
- various extragenital diseases (non-genital)
- hormonal disorders (diseases of the ovaries, adrenals, pituitary, thyroid),
- infectious processes, especially urogenital infections (cytomegalovirus, Chlamydia, herpetic and other infections)
- chronic infectious diseases (hepatitis, tonsillitis).
uterine factors
- anomalies of the uterus structure,
- growths in the uterus,
- intrauterine adhesions (synechiae)
- sexual infantilism.
A special place is occupied by cervical incompetence (CIN) - weakened cervical muscles. CIN may be a functional (sexual infantilism, or endocrine disorders) and organic (damage cervical muscles during locking abortions, Obstructed labor), genetic predisposition.
fruit factors
- Congenital malformations of the fetus, a genetic disorder.
Complications of pregnancy, which can be causes
- preeclampsia,
- Rhesus conflict between a woman's body and the baby during gestation,
- placenta previa, Placental abruption,
- prenatal outpouring of water,
- an excess of amniotic fluid,
- multiple pregnancy (uterine hyperextension)
- surgery on the abdomen during gestation bodies.
social factors
- poor nutrition,
- work related to the production of harmful,
- hard physical work, fatigue,
- smoking and alcohol consumption,
- age (younger than 18 and older than 30 years)
- disorder in their personal lives, and others.
The symptoms of preterm labor
Downstream prematurity divided into 3 stages of (threatening, starting, start):
The threat of premature birth
The threatening preterm labor suggest pulling or aching pain in the abdomen and in the lumbar region. The uterus periodically in a state of hypertonus and fetal movements become more frequent and become restless.
It is possible the appearance of secretions mixed with blood from the vagina.
During internal obstetric studies determined long cervix (3cm), cervical or closed channel passes a fingertip.
Starting prematurity
When starting preterm labor pain becomes more severe cramping and, moving away from the cervical canal mucus plug, appear allocation with blood.
Internal OB: shortens and softens the cervix (2.5 cm or less), the opening of the cervical canal at 2-3cm.
Went into premature labor
Generic activity becomes a regular, repeated contractions every 5-7 minutes, the cervix is smoothed, uterine mouth opening 3 cm and more. Possible rupture of the amniotic fluid.
Head or pelvic end pinned to the entrance to a small basin, enhanced allocation from the blood.
Diagnostics
Pain during childbirth to term should be differentiated from various diseases (pyelonephritis, And E. renal colic).
Diagnose the onset of preterm labor is quite simple. After collecting history, complaints of the outer and inner obstetric studies establish step premature birth, the estimated weight of the fetus and determine further tactics of women and outlook for fruit and pregnant.
Fetal ultrasonography performed for determining its weight and gestational age, control of cervical shortening (US dynamics) for outpouring or suspected discharge of water is determined by amniotic fluid index.
From laboratory analysis methods are used to smear the amniotic fluid holding amniotesta (suspected prenatal rupture).
preterm labor therapy
At the pre-hospital stage, the appearance of pain in the abdominal / lower back lower regions of the woman must be put to bed and to create psycho-emotional comfort.
It is desirable to provide a pregnant sedative (broth / tincture motherwort, valerian) antispasmodics (no-spa, papaverine in tablets or suppositories) to relax the uterus and immediately call an ambulance.
With the threat of premature birth or the beginning of a woman immediately admitted to the maternity ward. After clarification stage premature births account for the plan of conducting pregnant. When starting threatening or genera performed tocolysis (uterine relaxation and relief of its contractions) B2-agonists (partusisten, ginipral) and a solution of magnesium sulfate. Drugs are administered intravenously in the form of drip infusion.
Women produce physical and psycho-emotional rest (bed rest, sedatives) further administered intravenously spasmolytics (Nospanum, papaverine, Baralginum) prostaglandin inhibitors (indomethacin, diclofenac) to relieve uterine contraction, calcium channel blockers (Corinfar, verapamil), which enhance the effect of magnesia.
To normalize uteroplacental blood flow are assigned antiplatelet agents (Curantylum, Trental) aktovegin, vitamins E and C.
Prolongation of pregnancy spend as much time as you need it. The main goal of treatment - is prevention of respiratory distress syndrome (since the light from a premature baby is not mature enough, in the alveoli no surfanktanta, which does not allow them to be fallen down during inhalation). To stimulate the production of surfactant administered glucocorticoids (22 to 34 weeks). Used dexamethasone, prednisolone, betamethasone course of 2 days.
Keeping began preterm delivery
Premature birth are carefully controlled CTG and ultrasound. For labor analgesia using epidural anesthesia (EDA) - the preparations are administered in the intervertebral space; intravenous drugs are contraindicated, since an adverse effect on premature child).
In the second stage of labor is necessarily spent fetus protection. Required (in spite of the EDA) holding pudendal anesthesia (anesthesia of the perineum) and dissection of the perineum (to reduce the risk of injury to the fetus during exile).
Women in the second stage is on its side which is opposite the position of the fetus. Child after birth wrapped in warm diaper and placed under radiant heat lamp.
complications
Premature birth is almost always occur with complications:
- prenatal rupture of membranes;
- anomaly tribal forces (uterine inertia, rapid or fast delivery, discoordination tribal forces);
- Bleeding in the first, second, and in the postpartum period (placenta previa, placental abruption, impaired uterine function).
Prognosis depends on gestational age, presence of complications, and fetal weight previa, postpartum complications.
prevention
Prevention of premature birth should start at the planning stage of pregnancy.
It is necessary to treat chronic conditions and tested for urogenital infections, and maintain a healthy lifestyle, give up bad habits.
Important early statement on the account in the antenatal clinic and compliance with all the requirements and recommendations of the doctor.
It is necessary to give up strenuous exercise, minimize stress.
If a history of spontaneous and / or induced abortion, birth before term, and other risk factors during gestation shows the passage of prophylactic treatment in a threatening time (2-3 weeks, 4-12, and 18-24 weeks).
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
