Premature birth will be considered if they occur, starting from the 22nd week of pregnancy and inclusive up to 37 weeks, counting from the very first day of the last menstruation.
Spontaneous termination of a woman's pregnancy at week 22 and inclusive until 27 weeks falls into a separate category and does not apply to premature birth.
The classification of newborns depends on the body weight at birth.
A child born with a weight of up to 2500 grams will be considered a fetus with a reduced birth weight; with a weight of up to 1500 grams is a fruit, with a very low body weight; with a mass of up to 1000 grams is a fruit with an extremely low body weight. This division is associated with different predictions in groups of newborns.
In newborn babies, born with extremely low body weight, most often there are persistent violations of the central nervous system, various neurological disorders, as well as dysfunctional disorders of the respiratory, urogenital, digestive system; distinct visual and hearing impairments.
The frequency of premature birth from all births is up to 10% and varies in terms of gestation. и по 28 неделю беременности – это до 7% от всех случаев преждевременного появления на свет, а на сроке с 29 по 34 неделю беременности – это до 40 % от всех случаев преждевременного рождения, а во время 34 недели и по 37 неделю беременности – это до 53 % от всех случаев преждевременного появления на свет. During the 22nd week of pregnancy and on the 28th week of pregnancy it is up to 7% of all cases of premature birth, and at the period from 29 to 34 weeks of pregnancy it is up to 40% of all cases of premature birth, and during 34 weeks and after 37 weeks of pregnancy - this is up to 53% of all cases of premature birth.
Premature birth causes
The causes of premature births lie in the PRE-premature leakage of amniotic fluid. In percentage terms this is up to 38% of all premature deliveries. The next reason is the high incidence of perinatal morbidity - from 30% of all premature births, as well as intrauterine infection of the fetus. Infectious etiology and congenital heredity of fetal pathology also in a complex will lead to the termination of pregnancy. Exacerbates the situation and infection of the genital tract, hormonal disorders, violations of pregnant women in the system of hemostasis, as well as lipid metabolism in women with obesity. , артериа́льная гиперте́нзия (гипертония), анемия, заболевания сердца, болезнь Альцгеймера , перенесенная вирусная инфекция, истмико – цервикальная недостаточность, имеющиеся ранее у женщины в анамнезе преждевременные роды, различные пороки развития матки, миомы, многоплодная беременность, многоводие, макросомия при сахар Other causes of the threat of an unfavorable outcome of pregnancy can be such as socioeconomic, occupational hazards, drug addiction and smoking abuse, as well as diseases such as hyperthyroidism , hypertension (hypertension), anemia, heart disease, Alzheimer's disease , a viral infection, Istmiko - Cervical insufficiency, previously a woman's history of premature birth, various malformations of the uterus, fibroids, multiple pregnancies, polyhydramnios, macrosomia in the case of sugar om diabetes, surgery during pregnancy, the scar on the uterus and injuries, intra-abdominal bleeding, food poisoning, acute appendicitis.
Classification of preterm labor is not established, but the following intervals are distinguished:
This is a 22 - 27 week
28 - 33 week
34 -37 week of pregnancy
: The mechanism of preterm labor includes :
- social indications
- artificially induced causes
- medical indications
According to medical indications, the actual termination of pregnancy, regardless of the period, if pregnancy, as well as childbirth can harm a woman's health and pose a threat to her life, and if anomalies in fetal development are revealed. These indications are established personally by the attending physician obstetrician-gynecologist together with the doctors of the appropriate profile. For this, a woman writes a statement that the medical commission will consider.
Social testimony will affect the termination of pregnancy at 22 weeks, if there is a court ruling that the pregnant woman was deprived of parental rights, and there is a court decision to restrict the woman's parental rights if the woman is deprived of liberty and this pregnancy was the result of rape, if there is disability of the first and second groups of the husband, as well as his death occurred during pregnancy.
: Stages of premature birth :
- threat of premature birth
- beginning premature birth
premature onset of labor
Signs of premature birth
The symptoms differ little from ordinary births. The woman has a rapid desire to urinate, visually the low position of the presenting part of the fetus becomes visually noticeable and constant discharge from the genital tract. If the allocation is abundant, then in the pregnant woman the volume of the abdomen decreases and the VDM decreases (the height of the bottom of the uterus)
Premature birth symptoms
This is primarily an increase in the tone of the uterus and increasing aching pain in the lower abdomen, as well as the lower back. The woman has a feeling of bursting into the vagina, nausea. When there is a disease of chorioamnionitis, when the fetal membranes of the chorion and amnion inflame, the body reacts with chills and increased body temperature
Treatment includes immediate hospitalization in the department of pathology at the 22nd week of pregnancy, where ultrasound will be prescribed. The aim of which will be research, as well as an accurate definition of the gestational age and the mass of the fetus. This is necessary for the adoption of the correct development of obstetric activities. Ultrasound will make it possible to find out the dynamics of changes in the cervix itself, and this will reduce vaginal discharge and reduce the infectious risk for a woman. At the PPRS they make an ultrasound evaluation of the AH index (amniotic fluid) and decide on the advisability of prolonging pregnancy. At present, with PRPO, there are often favorable outcomes, the less time a woman has. Therefore, adhere to a waiting attitude. If it turns out that the uterus is in its tonus, then it is necessary to conduct an ultrasound to exclude detachment of the placenta. In case of a protracted threat it is necessary to conduct CTG (cardiotocography), which will allow to evaluate the condition of the fetus, as well as do dopplerometry - to investigate the blood flow in the placenta and fetus.
Drug treatment includes tocolytic therapy (for the suppression of contractions of the uterus is injected drug tocolysis), as well as symptomatic and sedative therapy.
After the signs of the threat of premature birth are cut, the woman remains in the department of pathology, where she undergoes further treatment. If there are signs of a chorionamionitis, a woman is hospitalized in the obstetric ward of the maternity hospital.
The patient is shown bed rest, emotional, sexual and physical rest. Physiotherapy methods include magnesium electrophoresis, acupuncture, electroanalgesia or electrosleep
Preventing premature birth
All women with a threat of 25 and inclusive for 34 weeks are being prevented by glucocorticoids, which will allow the maturation of the surfactant of the lung child. After 34 weeks, prevention of RDS (respiratory distress syndrome) is not carried out. How to avoid and how to prevent premature birth? Women are recommended emotional rest, bed rest, positive emotions, and in case of symptoms of a threat, immediately call an ambulance
Management of premature birth
The obstetrician - gynecologist advises the neonatologist ahead of time of the impending birth of the premature baby, and in the meantime they prepare the incubator, supply it with oxygen, warm the underwear, check the availability of medical equipment and medicines for resuscitation. The neonatologist must be present at the time of the birth of the child and must provide resuscitation assistance to the newborn.
In the normal course of labor, adequate analgesia is carried out-epidural analgesia. The main task of the first period of labor is the avoidance of rapid current, and thus the prevention of injuries of premature babies. In the case of rapid flow, an intravenous drip of tocolytics is made. Tokolysis lasts up to 3 hours and is canceled when the cervix is opened up to 9 cm. This is approximately 40 minutes before the birth.
If the labor activity is weak, then stimulate it. The most effective method combines the use of oxytocin with a solution of sodium chloride. With mild labor in the second period of labor continue to introduce oxytocin. The application of the Kristeller method - extrusion of the child with hands from the mother's womb is contraindicated, and the use of obstetric forceps is acceptable from 34 weeks. The delivery itself should be neat and careful.
Pudendal anesthesia, which provides blockade of the genital nerve, should be mandatory even in the presence of epidural analgesia. At the time of epidural analgesia, the anesthetic is injected into the dura mater of the spinal cord, and pudendal anesthesia is administered with a solution of novocaine or a solution of lidocaine. And the question of dissection of the perineum - perineotomy (straight incision to the rectum) or episiotomy (cut in the side of the rectum) is decided by the doctors depending on the week of pregnancy. With a shorter period, perineotomy is recommended.
If the pelvic pelvic presentation of the child, it is advisable to conduct a cesarean section, but if the woman refuses, it is permissible to perform births in a natural way with pudendal anesthesia and perineotomy. After birth, it is not recommended to lower the baby, and also to raise below the level of the uterus due to the occurrence of hyper hypovolemia. Prepare warm diapers for taking crumbs. After stopping the pulsation of the umbilical cord, they spend its separation, and before that they are engaged in release from the mucus of the airways. But I want to note that, nevertheless, the most sparing appearance of a child in the world is in the fetus itself.
More articles on this topic: