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The main dangers of early childbirth. Management of preterm labor, symptoms of their onset, threat diagnosis and prevention

In accordance with the definition, preterm delivery is considered to be delivery that occurred between 22 and 36 weeks of pregnancy when a fetus weighing 500 grams or more is born and has lived for more than 7 days.

The incidence of preterm birth is 6 to 15%. The highest incidence of preterm birth is observed in economically developed countries due to the widespread use of assisted reproductive technologies (in vitro fertilization - test-tube babies, artificial insemination - the introduction of partner's sperm into the uterus), older pregnant women, the presence of more stress in everyday life ...

Classification of preterm labor

Premature labor is divided into threatening, incipient and incipient.

- Threatening premature birth characterized by the absence of regular labor, periodic or constant increase in the tone of the uterus, the absence of structural changes in the cervix (smoothing, opening).
- Beginning premature labor characterized by weak regular labor (less than 4 contractions in 10 minutes), leading to structural changes in the cervix, as a result of which it is smoothed, and the opening is less than or equal to 3 cm.
- The onset of premature labor characterized by active labor (10 contractions in 10 minutes), opening of the cervix more than 3 cm.

Risk factors for premature birth

Causes of premature birth

At the current level of development of medical science, it is not possible to fully find out the causes of premature birth, however, it is believed that the development mechanism depends on the hormonal status and on the presence of infections in the mother's body. Unfortunately, in most cases, it is not possible to find out the mechanism of development of preterm labor, therefore it is generally accepted that in each individual case there is a combination of several factors.

Signs of premature labor

Clinically, the threat of premature birth is manifested by complaints of pain in the lower abdomen (sometimes patients describe them as menstrual pain) and pain in the lower back of an aching character, a feeling of tension in the uterus ("the stomach becomes like a stone"). Often there are complaints of frequent urination and increased fetal motor activity. With an external obstetric examination, the uterus is easily excitable, the presenting part is pressed against the entrance to the small pelvis. The discharge can be profuse mucous, transparent, sometimes brown (cervical mucus), which can also be the main complaint and, from the point of view of a pregnant woman, the only symptom. If you do not start treatment at this stage, then an increase in the tone of the uterus will lead to the development of weak labor (less than 4 contractions in 10 minutes), smoothing and opening of the cervix up to 3 cm inclusive, i.e. to incipient premature birth. Further, in the absence of treatment or if it is ineffective, active labor develops, the cervix opens by more than 3 cm, and they talk about already begun premature birth, the result of which is the birth of a premature fetus.

Diagnostics of the threat of premature birth

To make a diagnosis, it is necessary to conduct external and internal obstetric examinations. Of the additional research methods, ultrasound assessment of the length of the cervix, the width of the cervical canal and the shape of the internal os using a transvaginal (vaginal) sensor, as well as cardiotocography (one-step graphic recording of uterine contractions and fetal heartbeat) are very important.

Treatment aimed at maintaining pregnancy

Treatment, as a rule, is carried out in a hospital and it is aimed at prolonging (maintaining) pregnancy. Fetal malformations that are incompatible with life are a contraindication to prolongation of pregnancy. In other cases, they try to preserve the pregnancy.

The duration of hospitalization is individual in each individual case, and depends on: the activity of labor at the time of treatment, the degree of opening of the cervix, the integrity of the fetal bladder, the intrauterine state of the fetus, the presence of complications of pregnancy and, of course, the effectiveness of treatment. Typically at least 2 weeks.

In the case when the continuation of pregnancy is not advisable, i.e. it can lead to serious complications, both on the part of the mother and on the part of the fetus, the doctor, having previously informed the patient, decides on the method (through the vaginal birth canal or cesarean section) and the timing of delivery. The approach to the method of delivery, again, is individual in each case and depends on many reasons: the state of the birth canal, the condition of the fetus and its position in the uterus, the presence of intrauterine malformations, the duration of pregnancy, the presence or absence of amniotic fluid and the duration of anhydrous interval, the presence of diseases or abnormalities in the development of the uterus or other soft tissues of the birth canal, concomitant diseases of the mother.

Treatment for premature birth should include 4 components:

1. Tocolytic therapy, i.e. treatment aimed at reducing uterine contractile activity. There are several groups of tocolytic (removing the contractile activity of the uterus) drugs:
- β-adrenergic agonists: ginipral, partusisten, terbutaline, salbutamol. Currently, the most effective and safe drug of this series is ginipral. The drug exists in forms for intravenous administration and oral administration. In emergency cases, to relieve increased tone, the drug is used intravenously for 4-12 hours, after which they switch to a tablet form.
- calcium channel blockers: nifedipine. The drug exists in tablet form for oral administration. In emergency cases, appoint 10 mg (1 tablet) every 20 minutes 4 times, then switch to a maintenance dose of 10 mg (1 tablet) every 8 hours.
- magnesium sulfate 25% solution of magnesium sulfate, which is used only intravenously. Due to the presence of side effects to relieve the contractile activity of the uterus, it is used in extreme cases, when, for one reason or another, other drugs are contraindicated.
- inhibitors of prostaglandin synthetase: indomethacin. It is prescribed mainly rectally, the course dose is 1000 mg. Applied from 16 to 31 weeks of pregnancy due to the presence of certain side effects.

2. Prevention of Fetal Respiratory Distress Syndrome(RDS), which is the second most important (the first is intrauterine infection) cause of death of premature babies born before 34 weeks. Until this time, the fetal lungs are "immature" and unable to breathe independently. For this purpose, drugs from the group of corticosteroids (adrenal hormones) are used intravenously or intramuscularly, namely: betamethasone, dexamethasone, celestone, dexazone, etc. It takes at least 48 hours to achieve the desired effect.

3. Pain relief and sedation(sedative). With threatening and beginning premature birth, analgesics are prescribed (pain relievers, such as: analgin, ketorol), possibly in combination with antispasmodics (no-shpa, baralgin, papaverine). When preterm labor has begun, for the purpose of pain relief, the appointment of epidural anesthesia is indicated, which is the most effective method. For this purpose, local anesthetics are used, such as lidocaine, naropine, and marcaine. Unfortunately, epidural anesthesia is not always possible, which may be due to the presence of contraindications in the patient for this method of anesthesia, or to the absence of obstetric conditions (too large opening of the cervix). In such cases, antispasmodics and analgesics are used: analgin, no-shpa, baralgin, baralgetas, atropine, papaverine. From sedatives, it is possible to use valerian.

4. Antibiotics prescribed for prophylactic purposes, because The most common cause of premature birth is the presence of an infection in the mother's body. This precaution helps to avoid postpartum inflammatory disease in the mother and helps prevent infection of the fetus / initiate treatment if infection has already occurred.

Treatment at different stages and for different reasons is different; so, if there is threatening premature birth tocolytic drugs are prescribed by mouth or rectally, antispasmodics, sedatives (for example, valerian), treat existing / newly diagnosed infections. At this stage, both outpatient and inpatient treatment is possible, depending on the situation in each case.

With isthmicocervical insufficiency, it is possible to suture the cervix to avoid its premature opening.

Treatment incipient preterm labor carried out only in a hospital. It is necessary to use tocolytic drugs (which can be prescribed both in the form of an infusion (dropper), followed by a switch to tablets, and initially in the form of a tablet form with a special dosage regimen), preparation of the fetal lungs. It is possible to use antispasmodic drugs and analgesics (see above). They try to prolong pregnancy for at least 48 hours from the date of prophylaxis of fetal RDS.

Patients with incipient preterm labor hospitalized, prepare the lungs of the fetus and prepare for delivery. The use of tocolytic drugs at this stage in some cases is inappropriate and ineffective due to too late seeking medical help from the patient to the doctor.

The success of treatment directly depends on the obstetric situation, the duration of pregnancy, the presence of complications of pregnancy, the presence of amniotic fluid outflow, the presence of a living fetus and the timeliness of the patient's visit to the doctor. All other things being equal, the chances of giving birth to a practically healthy baby with adequate preparation for childbirth increase dramatically from 34 weeks of gestation.

The course of preterm labor and management tactics

The peculiarity of premature birth is that up to 36 weeks there is a "wrong" contractile activity of the uterus. Due to certain circumstances, abnormalities of labor are more common, such as uterine hypertonicity and discoordination (irregular contractions of different strength). With hypertonicity, contractions are frequent (more than 4 in 10 minutes), more intense, the interval between them is very short, as a result of which the uterus does not have time to completely relax. The consequence of this is a shorter duration of labor, which is also associated with the smaller size of the fetus. In the early postpartum period, uterine bleeding is common due to over-relaxation of the uterus.

Why premature birth is dangerous: due to the immaturity of organs and systems, the fetus often experiences hypoxia during childbirth, and fetal brain damage is one of the most common complications of premature birth.

In connection with the above, the tactics of managing preterm labor is individual in each case, but for the most part, preterm labor is carried out through the vaginal birth canal with anesthesia (the most effective method is epidural anesthesia, which, moreover, has a normalizing effect on contractions), using wait and see tactics. An episiotomy (perineal incision) is mandatory, which reduces the risk of birth trauma to the fetus.

Obstetrician-gynecologist D.V. Kondrashova

Preterm birth obstetricians call childbirth of a baby weighing 1-2.5 kg, which happened between 28 and 37 weeks of pregnancy. The birth of a child before this period is considered only if he has lived for more than seven days.

Premature birth always carries a certain danger, and the greater, the shorter the period in which they took place. So, premature birth at 28 weeks has a high risk of ending badly, because the immune, respiratory systems and internal organs of the baby are not yet ripe to perform their functions. The risks diminish closer to the expected date of birth, but even preterm birth at 36 weeks is best prevented if possible.

In the arsenal of doctors, there are many methods and schemes for prolonging pregnancy that have been worked out over the years, which turned out to be under. But it is possible to prolong the bearing of a baby, which is still too early to be born, only if labor has not yet begun. In this light, it is very important that a pregnant woman can independently recognize the signs of premature birth and immediately go to the hospital if this happens.

What does the expectant mother feel?

The risk of having a baby ahead of time can tell a woman the signs that she feels even before the onset of premature birth:

  • frequent painful contractions of the uterus;
  • pain in the abdomen as with menstruation or diarrhea (worse with movement);
  • upset stool, sometimes vomiting;
  • dull pain or change in pain in the back, sacrum, lower back, hips;
  • a feeling of pressure on the perineum and tailbone;
  • change in the nature of vaginal discharge (smearing bloody, transparent watery).

Already in the presence of any of these signs or several of them, it is necessary to consult a doctor for advice.

However, often everything starts suddenly and rapidly - and the birth process can no longer be stopped (the risk of events developing in this scenario increases if a woman's pregnancy is not the first in a row).

The following signs indicate the onset of labor:

  • increased frequency and intensification of contractions (more than 8 times per hour);
  • discharge of amniotic fluid;
  • discharge of the mucous plug.

When giving birth, childbirth must certainly take place, because the child is already in danger - he is deprived of a nutritious living environment.

In such a situation, it is extremely important to arrive at the hospital on time so that the doctors are able to take a premature birth and help the baby adapt to birth. Keep in mind that these babies need special care and specialized assistance, in the absence of which the outcome of preterm birth can be adverse.

What can doctors notice?

We want to urge you not to worry about this. Firstly, even in the case of the onset of childbirth ahead of schedule, doctors know very well what and how to do. Secondly, if you do not miss scheduled examinations and examinations, then there is no reason for concern, because doctors may suspect the risk of such a pregnancy outcome based on the results of the examination of the pregnant woman and laboratory tests. This can be indicated to them by the location and behavior of the fetus, shortening and softening of the cervix (which can be seen on ultrasound and on the gynecological chair).

But still, never stop listening to yourself and your own feelings. And if something worries you - do not be afraid to bother your doctor once again. Your own feelings remain the main guarantee, because even a pregnancy under strict medical supervision can end prematurely.

Often, women experience the so-called, which they take for premature birth. In this case, you should drink half a liter of water or juice, calm down and lie on your left side. If the alarm turned out to be false, the contractions will stop. In this case, the spasms, which intensify with movement in the event of the onset of labor, will stop when the position of the body changes in the event of false contractions, and the child will move at this time (which does not happen during childbirth).

Remember also that a lot depends on our thoughts and mood. Think only about the good, and most importantly, learn to calmly react to any situation, because in a state of panic, it is not always possible to think adequately.

Everything will be ok! Millions of women have gone through this - and now they are happy with their continuation in beautiful kids!

Specially for Elena Kichak

Premature birth is something that all expectant mothers are afraid of, even those for whom doctors do not find serious reasons for concern. This is the nature, pregnant women really get very suspicious. However, this suspiciousness is often beneficial, as it allows you to notice the pathology in time.

The causes of premature birth are very different, and this phenomenon, unfortunately, is not rare in medical practice. What leads to premature birth and how to prevent it?

Let's start with what is considered premature birth. This is the birth of a baby between 28 and 37 weeks of gestation, weighing 1-2.5 kg. Before 28 weeks of delivery, the process is called in the future only if the child has lived for more than 7 days, otherwise - a miscarriage for a long time.

Now about the reasons. Premature birth at 27 weeks and earlier usually occurs due to ICI (isthmic-cervical insufficiency) - a pathology of the cervix. Under fetal pressure, the cervix begins to open spontaneously at about the middle of pregnancy or a little later. That is why it is very important to register for pregnancy in a timely manner and go for an ultrasound scan, because it is on ultrasound that the length of the cervix is ​​most accurately determined, and, accordingly, is there a threat of premature birth (if the cervix is ​​very short). Women with diagnosed ICI should lead a sparing lifestyle, or even stay in bed. In addition, it is often necessary to have sutures on the cervix, which are removed before childbirth. It should be noted that women who have experienced abortions, diagnostic curettage of the uterine cavity and other medical interventions, during which there was a need for artificial expansion of the cervix, have an increased risk of ICI. Premature birth with ICI usually begins with the discharge of amniotic fluid. The tone of the uterus may not be there.

Premature labor at 29-30 weeks usually begins for other reasons. Risk factors include a young age of a pregnant woman (less than 18 years old), exacerbation of chronic diseases during pregnancy, infections, physical injuries. But even at these dates of born babies, unfortunately, the survival rate is not so great ... The problem is in the immaturity of the lungs.

Premature birth at 32 weeks is considered more successful. Of course, there is a great risk that a child born 2 months ahead of time will have serious pathologies and diseases, the survival rate of babies is quite high with proper medical care.

So, what are the signs of premature birth, because in many cases the tragedy can be prevented ...

1. A short, softened cervix.

Get your ultrasound done on time. This will help to notice the shortening of the cervix in time.

2. Painful, regular uterine cramps.

If you often have uterine tone, complain to the doctor and do not resist the prescription of medications or even hospital treatment.

3. Discharge of amniotic fluid.

If you notice unusual, profuse vaginal discharge (clear or greenish) - also see your doctor, as these can also be symptoms of premature birth - leakage of amniotic fluid.

Remember that you can only prevent premature labor if it hasn't started yet. If the cervix opens, the amniotic fluid leaves, doctors will no longer be able to prolong the pregnancy.

In modern obstetrics, pregnancy is considered full-term at terms from. Accordingly, childbirth before is considered premature 1, and the child born is called premature.

How does preterm labor start?

Yes, in fact, just as well as timely. A woman may notice the appearance of pulling pains in the lower abdomen and in the lower back. The pains are sometimes cramping in nature, i.e. we can talk about the beginning contractions... In some cases, childbirth begins with a rupture. amniotic fluid or from the departure mucous plug... In any of these cases, urgent hospitalization in a maternity hospital is required.

What could be the cause of premature birth?

First of all infection 2. Normally, the uterine cavity is sterile. Any inflammatory process makes the wall of the uterus defective, so pregnancy continues as long as the wall of the uterus can stretch, and then the body tries to get rid of the embryo.

That is why it is not necessary to spare money, time and effort for examination for the presence of infection. Every woman - ideally even before pregnancy - should be examined for infectious diseases, especially those that are often asymptomatic (carriage of chlamydial, ureaplasma, mycoplasma, toxoplasma infection, herpes simplex virus, cytomegalovirus). Special attention should be paid to women with a history of chronic and acute uterus and endometrium (the mucous membrane of the body of the uterus), intrauterine interventions (abortion, diagnostic curettage), as well as cases of spontaneous abortion. In the presence of an inflammatory process, it naturally needs to be cured. The drugs and procedures selected by the doctor will help expel the infection from the body even before conception. If, for some reason, the necessary tests were not done before conception, then when diagnosing pregnancy, you should definitely undergo an appropriate medical examination, and in the future you should not neglect regular examinations. The sooner the presence of microbes in a woman's body that can cause premature birth or potentially dangerous to the fetus is revealed, the better. Modern medicine has a significant arsenal of tools in order to reduce the risk of pregnancy and fetal infection.

The second common cause of premature birth is ischemic-cervical insufficiency, ICN (isthmus - "isthmus", the place of transition of the body of the uterus to the cervix, cervix - "uterus"), that is, the inferiority of the muscular layer of the cervix, which, during a normal pregnancy, plays the role of a kind of sphincter (holding ring) that does not allow the embryo " leave the "uterine cavity. ICI is congenital (very rare) and acquired. What can cause the development of ICI? The reasons are quite commonplace: injuries of the isthmus and cervix during abortion, especially when the first pregnancy is interrupted, deep ruptures of the cervix in previous births (this can happen, for example, during childbirth with a large fetus, the imposition of obstetric forceps), gross forcible expansion of the cervical canal during diagnostic manipulations in the uterine cavity (hysteroscopy, i.e. examination of the uterine cavity using a special device - a hysteroscope; endometrial scraping), that is, any injury to the muscular layer of the cervix.

Very often, ICI is formed when there is an increased content of male sex hormones in the blood, which are produced in the adrenal glands of the mother, and later, of the fetus.

Infections and ischemic-cervical insufficiency are the main, but not the only factors that cause premature birth. Often lead to premature birth endocrinopathies- mild dysfunctions of the endocrine glands - the thyroid gland, adrenal glands, ovaries, pituitary gland (with gross violations, women, as a rule, cannot get pregnant on their own).

Also, premature birth can occur when overdistension of the uterus caused by multiple pregnancies, polyhydramnios, large fetuses.

Hard physical work, chronic stressful situation at work or at home, any acute infectious disease(flu, acute respiratory infections, tonsillitis, pyelonephritis, especially with an increase in body temperature, etc.) can also provoke abortion.

What to do when a premature birth starts?

If alarming symptoms appear: abdominal pain, urgent hospitalization is required. Only in the hospital can doctors choose the right tactics for each specific case.

Before the arrival of the ambulance team, you can drink 2 tablets of No-shpy or, if a woman is taking Ginipral, an additional tablet of this drug.

As a rule, in the hospital, they try to preserve the pregnancy, since every day spent in the womb increases the child's chances of survival.

What are doctors doing to stop preterm labor?

With a premature, onset of contractions, first of all, topolytic (that is, reducing) drugs are prescribed - partusisten, ginipral. First, these drugs are administered intravenously, and when the contractions stop, it is possible to switch to tablet forms. These medications are usually taken before. Magnesia sulfate, a 10% solution of ethyl alcohol and some other drugs are also used as agents that reduce the tone of the uterus.

At the second stage of treatment, they try to eliminate the very cause of premature birth. When an infection is detected, antibacterial drugs are prescribed (depending on the type of infection), sedative (that is, calming) therapy - in order to break the vicious circle: the fear of losing a child is added to the objective factors that increase the tone of the uterus, which, in turn, further increases the tone uterus.

With the development of ICI for a period of up to, "tightening" sutures are applied to the cervix, which do not allow the ovum to "fall out" from the uterus. Sutures are applied under short-term intravenous anesthesia, while drugs are used that have a minimal effect on the child.

Do doctors always try to stop preterm labor?

No not always.

There are situations requiring early delivery due to the threatening condition of the woman. In severe forms of late toxicosis (gestosis), chronic diseases of internal organs, doctors often cause premature birth to save the life of both the mother and the fetus.

What happens to a woman after a premature birth?

The course of the postpartum period 3 with preterm birth, as a rule, does not differ in any way from that after timely delivery. It happens that a woman is detained in a maternity hospital for longer than the prescribed period, but this is due in most cases to the condition of the child, and not of the woman herself.

It is advisable for all women after premature birth to undergo a comprehensive examination, including tests for the presence of infectious diseases and the carriage of infectious agents, and a study of the hormonal status. With ICI, it is necessary to perform (X-ray examination of the uterus and fallopian tubes after the introduction of a radiopaque substance into their cavities); in case of severe somatic diseases - to be examined by the appropriate specialists. Naturally, if violations are detected, you need to undergo a course of treatment.

During subsequent pregnancies, hospitalization in the maternity hospital in the so-called "critical time" is desirable. The greatest concern is the period of termination of the previous pregnancy. In addition, the following are considered critical periods: the first (fixation of the ovum in the uterine mucosa); (formation of the placenta); (intense increase in the volume of the uterus); days corresponding to menstruation.

What happens to a baby after a premature birth? 4

At present, it is possible to nurture children whose body weight at birth is more than 1 kilogram, but, unfortunately, such small babies survive only in 50% of cases. Sometimes children weighing from 500 to 1000 grams are nursed, but this happens extremely rarely, in addition, it is a very, very expensive process. It is easier for pediatricians to care for children born with a weight of more than 1500 grams, since all their organs are more "mature".

At the second stage of nursing premature babies, they are often sent to children's hospitals.

1 0 preterm birth is usually spoken after. Spontaneous termination of pregnancy in the period from conception to is called spontaneous abortion (miscarriage). For details on the threat of termination of pregnancy, see: A. Koroleva, "The threat of termination of pregnancy" / №1 -2001.
2 For more information about infectious diseases see: J. Mirzoyan "You need to know the enemy by sight. TORCH infections - what is it?" / №4-2001; S. Gonchar "Treatment - light, and non-treatment - darkness. Diseases threatening intrauterine infected fetus" / №5-2001.
3 During the postpartum period, see N. Brovkina's article "The Fourth Trimester" in this issue of the journal.
4 The subject of this article is preterm birth, therefore literally a few lines are devoted here to nursing premature babies. A detailed material on the methods of nursing premature and low birth weight babies will be published in one of the next issues of our magazine.

Elena Nesyayeva, obstetrician-gynecologist
Maternity hospital at City Clinical Hospital No. 20, Moscow

Discussion

[link-1]

Causes of premature birth [link-1] useful article for expectant mothers. Premature birth is dangerous for the life and health of the mother and the newborn, which can provoke premature birth: drug use, alcohol, malnutrition, chronic illness, stressful situations.

Well, yes ... the 20th hospital is, of course, an authority in nursing premature babies ... Why suddenly an article on premature birth should be ordered from a doctor from a hospital that specializes in renal pathologies, has old equipment and generally falls apart from dirt, poverty and old age? There is a wonderful maternity hospital in Moscow at the 8th City Clinical Hospital, which specializes in premature babies, so maybe it would be better to contact his doctors?

08/29/2001 13:04:42, V.

Well, you know ... without words: ((((((. Firstly, if there is a decent resuscitation in the maternity hospital), the mortality rate of babies weighing more than 1kg is still not 50%.

And, in addition, the very statement of the question "sometimes nurses children weighing from 500 to 1000 grams, but this happens extremely rarely, in addition, it is a very, very expensive process." What does that mean: don't even try ?! Let them die like that ?! (quite in the spirit of our medicine). Lord, doctors in children's hospitals lay down with bones, nursing such children (our roommate was raised from 670, 26 weeks), and the obstetrician-gynecologist speaks in this tone ...

No, it's all true - it is difficult to leave such a baby, and the obstetrician-gynecologist thinks first of all about the woman, and the article is primarily about the problems of women in labor, not children, but nevertheless, this approach only causes bitterness and bewilderment ...

28.08.2001 11:56:48, Dodo

Yes, the article is informative. We were born at exactly 36 weeks. And the reason for this was precisely the dissolution of the shell, only they could not say for sure what it provoked: the day before I raised a 3-liter jar with compote, the tone was increased in the middle of pregnancy or an infection. In general, the correct recommendations are given there.
About premature babies. With us, a girl who gave birth to a boy at 29 weeks, was cesarean and he was being taken out!

Comment on the article "Premature birth"

Premature birth and depression. Girls, surely someone has similar stories. Help, how to deal with yourself ...

Discussion

If you want to keep the HW, then pump and pump. Hands, breast pump - what you can do. There is a Cons for GW, brilliant! Moreover, my mother is in a hurry too. It will help to establish the guards, calm down ..
And if you feel that you yourself cannot cope, a psychologist. There is also a contact. GW friendly.
And ask God for help ...

Calm down, the family needs you in their mind, no hysteria ..
When the baby is discharged, nest, the kangaroo method (undress to a diaper and you have a naked body and endless hugs))). Yes, at this moment the whole family should stand shoulder to shoulder and take care of themselves ... and even for you - a thermos with tea, broth, hot food ...

Everything will be fine! You and many others will pray for Pavlusha!

exhale, you are not the first and, unfortunately, not the last.
Ask for help, allow yourself to be weak, try to sleep more, rest and don't beat yourself up for anything.
My twins were born at 36 weeks with an emergency COP. Sevushka, the eldest of the twins, got my swelling + Rh-conflict. On the first day of mechanical ventilation, urgent hospitalization in Filatovka. Then jaundice was added to the mechanical ventilation, bilirubin went off scale, they were preparing for a full blood transfusion ... during the pacemaker I lost almost a liter of blood and my kidneys worked very badly.
We sewed in several ways at once: 1 - doctors from Filatovka asked to bring a second twin, arguing that a healthier baby would pull out a weaker one. The doctors in the Republic of Dagestan met halfway, wrote some diagnosis to Senechka and transferred him to Filatovka.
2) on the same day, the babies were christened in intensive care.
I don't know what exactly helped: our prayers, baptism, a twin brother is nearby, BUT the next morning bilirubin began to fall and the question of blood transfusion disappeared. Gradually, my children began to improve. Seva spent 12 days under mechanical ventilation, fed through a tube for a couple of days.
My Senechka was born very small 46 cm tall and 2500 weight, Sevushka was larger, but not much.
My guys quickly caught up with their peers, by six months they no longer differed from single-borns on time in anything, which wildly delighted and surprised both the pediatrician and the neurologist.

Calm down, you will need strength, and your son will definitely recover, he will grow up beautiful, healthy and smart to the delight of dad and mom.

I was given a premature birth, from 27 to 38 weeks, gave birth on time !! It all depends on what reasons they put it ?!

Staphylococcus aureus, fungi of the genus Candida, all these are conditionally pathogenic microorganisms that swarm around us, but only occasionally cause disease. For a number of reasons, newborns are especially sensitive and skin diseases such as thrush and staphylococcal infections are familiar to many mothers firsthand. Ugly specific rashes will not leave specialists in doubt that a newborn has staphylococcus aureus. But the diagnosis must certainly be confirmed by laboratory. This disease ...

Pregnancy at 37-40 weeks is full-term and labor can begin at any time. And there are three main signs that indicate their imminent approach. Discharge of the mucous plug. It can occur 2 weeks before delivery, but most often within a day. The cork looks like a small lump of pinkish, brown or yellowish mucus. Often, the cork does not come off entirely, but in parts. During pregnancy, she closes the entrance to the cervical canal, protecting the fetal bladder from ...

Vertical childbirth, Natural childbirth, Natural childbirth after cesarean, Caesarean section, Premature birth, Water birth, Birth at home, Birth of twins, Family birth, Stimulation of labor, labor arousal, Rapid labor, etc. on [link-1]

April, May, June were in the fight against protein and for hemoglobin. In June, we all defeated this. The girl was lying very low, 10 centimeters below normal, so the doctor advised to wear the bandage without removing it. However, I had my own calculation. At about 8 months, I had a certain feeling that we were not getting to the PDR. That is, after 28 weeks I stopped worrying that a miscarriage, or premature birth, all anxiety was gone. But there was an acute feeling that we would have a girl earlier. The main thing...

In domestic medicine, the situation is such that more attention is paid to the so-called tone of the uterus. In the presence of pulling pains in the lower abdomen and back or discomfort, in many cases, a diagnosis of the threat of premature birth is made and the woman is intensively treated, preserving the pregnancy. Although more than half of pregnant women (62%) with similar symptoms do not need prolongation. This group of women suffers from pulling pains and other symptoms due to concomitant pathologies. AND...

The most common complications associated with twin / triple pregnancy are: Premature birth. Low birth weight. Delayed intrauterine development of the fetus. Preeclampsia. Gestational diabetes. Placental abruption. Cesarean section. Premature birth. Childbirth before the 37th week of pregnancy is considered premature. The duration of multiple pregnancies decreases with each additional child. On average, pregnancy with one baby lasts 39 weeks ...

All 9 months, a baby is growing under your heart, which is surrounded not only by your love and affection, but also by reliable protection from the amniotic membranes and amniotic fluid. The fetal bladder forms an airtight reservoir with a sterile environment that protects the baby from infection. Normally, rupture of membranes and rupture of amniotic fluid occurs before childbirth (when the cervix is ​​fully open) or directly during childbirth. If the integrity of the bubble has been broken before, this is ...

Discussion

11. When examining, is the doctor always able to confidently diagnose premature effusion of water?
With a massive rupture, it is not difficult to diagnose. But, unfortunately, in almost half of the cases, doctors of even leading clinics doubt the diagnosis if they rely only on examination data and old research methods.

12. Is it possible to diagnose premature effusion of water using ultrasound?
Ultrasound examination makes it possible to tell whether a woman has oligohydramnios or not. But the cause of low water can be not only rupture of the membranes, but also impaired renal function of the fetus and other conditions. On the other hand, there are cases when a small rupture of the membranes occurs against the background of polyhydramnios, for example, with kidney pathology of a pregnant woman. Ultrasound is an important method of monitoring the condition of a woman who has a premature rupture of the membranes, but does not answer the question of whether the membranes are intact.

13. Is it possible to determine the leakage of water using a litmus test?
Indeed, there is such a method for determining amniotic fluid, based on determining the acidity of the vaginal environment. This is called the nitrazine test or amniotest. Normally, the vaginal environment is acidic, and the amniotic fluid is neutral. Therefore, the ingress of amniotic fluid into the vagina leads to the fact that the acidity of the vaginal environment decreases. But, unfortunately, the acidity of the vaginal environment also decreases in other conditions, for example, with infection, urine, semen. Therefore, unfortunately, a test based on determining the acidity of the vagina gives a lot of both false positive and false negative results.

14. In many antenatal clinics they take a swab on water, how accurate is this method for diagnosing premature outpouring of water?
Vaginal discharge containing fetal water, when applied to a glass slide and dried, forms a pattern resembling fern leaves (fern phenomenon). Unfortunately, the test also gives a lot of inaccurate results. In addition, in many hospitals, laboratories are open only during the day and on weekdays.
15. What are the modern methods for diagnosing premature rupture of the membranes?
Modern methods for diagnosing premature rupture of the membranes are based on the determination of specific proteins, which are abundant in the amniotic fluid and are not normally contained in the vaginal discharge and other body fluids. To detect these substances, an antibody system is developed that is applied to the test strip. The way these tests work is similar to a pregnancy test. The most accurate test is a protein-detecting test called placental alpha microglobulin. The trade name is AmniSure®.

16. What is the accuracy of the Amnishur test?
The accuracy of the Amnishur test is 98.7%.

17. Can a woman put the Amnishur test on her own?
Yes, unlike all other research methods, the Amnishur test does not require examination in mirrors and a woman can put it at home. Everything you need for the test is included in the kit. This is a tampon, which is inserted into the vagina to a depth of 5-7 cm and held there for 1 minute, a tube with a solvent, in which the tampon is washed for 1 minute and then discarded, and a test strip, which is inserted into the test tube. The result is read after 10 minutes. In case of a positive result, as with a pregnancy test, 2 strips appear. If the result is negative - one strip.

18. What if the test result is positive?
If the test is positive, you need to call an ambulance or go to the hospital if the pregnancy is more than 28 weeks and to the gynecological department of the hospital if the pregnancy is less than 28 weeks. The sooner treatment is started, the greater the chances of avoiding complications.

19. What if the test is negative?
If the test is negative, you can stay at home, but at the next visit to the doctor, you need to talk about the troubling symptoms.

20. If more than 12 hours have passed from the moment of the alleged rupture of the membranes, can a test be performed?
No, if more than 12 hours have passed since the alleged rupture and the signs of water leakage have stopped, then the test may show an incorrect result.

Questions and answers about premature amniotic fluid leakage

1. How common is premature rupture of membranes?
True premature rupture of the membranes occurs in about every tenth pregnant woman. However, almost every fourth woman experiences certain symptoms that can be confused with premature rupture of the membranes. This is a physiological increase in vaginal secretion, and a slight urinary incontinence in the later stages of pregnancy and profuse discharge during infection of the genital tract.

2. How is the premature rupture of the membranes manifested?
If a massive rupture of the membranes has occurred, then it cannot be confused with anything: a large amount of clear liquid, odorless and colorless, is immediately released. However, if the gap is small, doctors also call it subclinical or high lateral tear, then it can be very difficult to make a diagnosis.

3. What is the danger of premature rupture of the membranes?
There are 3 types of complications that can lead to premature rupture of the membranes. The most frequent and severe complication is the development of an ascending infection, up to the sepsis of the newborn. In a premature pregnancy, premature rupture of the membranes can lead to premature birth with all the consequences of the birth of a premature baby. With massive outpouring of water, mechanical injury to the fetus, prolapse of the umbilical cord, placental abruption is possible.

4. Who is more likely to have ruptured membranes?
Risk factors for premature rupture of the membranes are infection of the genital organs, overstretching of the membranes as a result of polyhydramnios or with multiple pregnancies, abdominal trauma, incomplete closure of the uterine pharynx. Premature rupture of membranes during a previous pregnancy is an important risk factor. However, in almost every third woman, rupture of the membranes occurs in the absence of any significant risk factors.

5. How quickly does labor occur with a premature rupture of the membranes?
This is largely determined by the gestational age. In full-term pregnancies, half of women experience spontaneous labor within 12 hours and more than 90% within 48 hours. With premature pregnancy, it is possible to maintain the pregnancy for a week or longer if the infection does not join.

6. Can a small amount of amniotic fluid be released normally?
Normally, the membranes are hermetically sealed and no, even the smallest, penetration of amniotic fluid into the vagina occurs. For leakage of amniotic fluid, women often mistake increased vaginal secretion or mild urinary incontinence.

7. Is it true that in case of premature outpouring of water, pregnancy is terminated regardless of the term?
Premature rupture of the membranes is indeed a very dangerous complication of pregnancy, but with timely diagnosis, hospitalization and early treatment, premature pregnancy can often be prolonged if no infection occurs. With a full-term pregnancy and close to full-term, as a rule, the onset of labor is stimulated. Modern methods of diagnosis and treatment, in this case, allow you to smoothly prepare a woman for childbirth.
8. If there is a premature rupture of the membranes, but the mucous plug has not come off, does it protect against infection?
The mucous plug really protects against infection, but when the membranes are ruptured, one protection by the mucous plug is not enough. If treatment is not started within 24 hours of the rupture, serious infectious complications can occur.

9. Is it true that the waters are divided into front and back waters and the outpouring of the front waters is not dangerous, often occurs in the norm?
Fruit waters are indeed divided into anterior and posterior, but no matter where the rupture occurs, it is the gateway for infection.

10. What precedes the breakup?
By itself, the rupture of the membranes is painless and without any precursors.

51. In the case of childbirth that occurs in the period from 28 to 30 weeks of pregnancy, a certificate of incapacity for work for pregnancy and childbirth is issued by the medical organization where the birth took place for a period of 156 calendar days.

52. In case of termination of pregnancy at a period of up to 27 full weeks of pregnancy, the birth of a still fetus or a live fetus that has not survived the first 6 full days (168 hours), a certificate of incapacity for work is issued in accordance with Chapter II of this Procedure for the entire period of incapacity for work, but for a period not less than three days. If the newborn has survived the first 6 full days (168 hours), a certificate of incapacity for work for pregnancy and childbirth is issued for a period of 156 calendar days.

And being now in the 35th week of pregnancy, I wondered - is there a tendency to premature birth? well, there is a feature of the organism, etc ...

Premature delivery is considered to be between 28 and 37 weeks of gestation.

Discussion

I rated the usefulness of this article as "very useful" because this problem is very close to me. My four-year-old eldest daughter Sasha was born at the 26th week of pregnancy, and, of course, we had much more worries, and most importantly, worries about the health and well-being of the child than the parents of babies born on time.

And when, after a year and a half, we were expecting a baby again, the fear that everything could happen again accompanied us throughout the pregnancy, because the first birth was premature, and after them very little time passed, besides, we lost our son, Sashulka's twin brother, at the age of four months, so it was not easy psychologically either, but we decided to keep the pregnancy.

On the other hand, the experience, in many ways bitter, helped to more seriously and thoroughly survive the second pregnancy, which fortunately was resolved on time, albeit through a (planned) Caesarean section.

I want to draw attention to this article of all expectant mothers, tk. the problem of premature birth is becoming more and more urgent from year to year, and here the advice given in this article can really be very, very useful, I think, due to the above reasons, I can be an expert in some way here.

I would also like to thank all the doctors working in the intensive care and pathology departments of newborns. In my case, these are doctors, nurses and staff of the maternity hospital at the 2nd CIB, as well as the 3rd CCH in Moscow.

Svetlana Cheremisina

If the pregnancy for a woman ends earlier than the period established by the doctor, and the child is born, premature birth takes place. The degree of threat to the health of a new person depends entirely on the number of obstetric weeks, how long the mother carried the baby under her heart. It is important to be aware of the potential causes of preterm birth in order to avoid such a sudden delivery and its dangerous consequences for child health in the future.

What is premature birth

Labor, completed by delivery earlier than 38 obstetric weeks, characterizes abnormal labor. For the health of the crumbs, this is a pathological process, however, thanks to modern technologies, doctors have learned to care for children born from the 28th obstetric week and beyond. However, health problems still cannot be avoided, since the fetus has not yet fully completed its intrauterine development. Therefore, if there is a threat of premature birth, the pregnant woman is urgently put on storage.

Signs

The longer the child stays in the mother's womb, the more likely it is to be born strong and healthy. However, situations are different, and one should not exclude cases when a woman does not take care of her pregnancy for the period set by a gynecologist. The characteristic signs of premature birth are not much different from natural labor, and the first harbinger is the leakage of amniotic fluid.

Since the baby in the second half of pregnancy is characterized by increased physical activity, diagnosis can be difficult. However, an alert mom-to-be should pay attention to the following alarming symptoms:

  • increased tone of the uterus on palpation;
  • pulling or cramping pains in the lower abdomen;
  • constant fetal activity;
  • frequent urge to use the toilet;
  • pulling sensation in the lumbar region;
  • bursting feeling of the vaginal area.

How do they start

If there is a pulling pain in the lower abdomen, while a woman detects a leakage of amniotic fluid, you must immediately call an ambulance or immediately contact your local gynecologist with a complaint. Early labor can provoke a miscarriage, which should not be allowed under any circumstances. Early labor begins with sharp abdominal pain, which only intensifies in different positions of the body. Pregnancy is at risk, and the woman is better off agreeing to be admitted to the hospital.

Causes

Most expectant mothers ask themselves the main question, how to avoid premature birth. In fact, the first step is to find out in detail why this pathological process is progressing, and how to reduce the risk of untimely birth of the baby. The specialist reports this even when planning a pregnancy in order to save a woman from subsequent problems for 40 obstetric weeks. In modern obstetric practice, the following causes of premature birth are distinguished:

  • previous abortions, instrumental cleaning of the uterine cavity;
  • abuse of bad habits;
  • infection of the cervix and vagina;
  • rhesus conflict;
  • polyhydramnios and multiple pregnancy;
  • premature aging or placental abruption;
  • breech presentation of the fetus;
  • intrauterine infections;
  • fetal gene mutations;
  • antiphospholipid syndrome;
  • severe forms of gestosis;
  • rupture of the membranes;
  • isthmic-cervical insufficiency;
  • excessive sexual activity;
  • the presence of latent urinary tract infections;
  • diabetes mellitus during pregnancy;
  • pathology of the thyroid gland in the expectant mother;
  • preeclampsia;
  • multiple pregnancy (twins);
  • inflammation like a woman during pregnancy;
  • uterine bleeding.

Classification

Premature delivery is not considered a disease, however, the general condition of the newborn depends entirely on the time of early delivery. If it was not possible to bring the child to the 40th obstetric week, a conditional classification is presented below, which gives at least a distant idea of ​​the degree of the pathological process and potential diseases in a person who was born:

  1. Very early labor. The premature appearance of the crumbs falls on a period of 22-27 weeks. The weight of the fetus varies between 500 and 1000 g, the doctor diagnoses underdevelopment of internal organs and systems, problems with the opening of the lungs.
  2. Early childbirth. Premature birth of a child occurs between 28-33 weeks. The child weighs up to 2 kg, while the natural ventilation of the lungs is impaired, the circulatory system is imperfect.
  3. Premature birth at 34-37 obstetric weeks, although considered pathological, encourages parents, since all internal organs and systems have already been formed. The newborn weighs about 2,500 g.

Indications for artificial premature birth

In practice, there are cases when doctors deliberately insist on premature, rapid stimulation of labor. The need for this arises when diagnosing extensive pathologies in the body of a mother or child. In addition, the lives of both can be at risk. Such critical moments are the detection of the following pathologies:

  • decompensated endogenous diseases of a complicated form, fraught with death for the patient;
  • preeclampsia and eclampsia, as a manifestation of severe gestosis, fraught with the inevitable death of the infant;
  • extensive liver pathologies in pregnant women, when the natural outflow of bile is pathologically disturbed;
  • diagnostics of HELLP-syndrome in the body of a pregnant woman with increased activity of liver enzymes;
  • intrauterine malformations incompatible with the further viability of the fetus;
  • intrauterine fetal death, fraught with infection and blood poisoning of a pregnant woman.

How to call

If you suspect a pathology or the presence of one of the above pathological factors, a pregnant woman is taken to the hospital. When determining the diagnosis and the need to stimulate labor prematurely, doctors use certain drugs, which are usually injected into the vagina intra-amniotically. In this case, we are talking about the following medicines: the synthetic hormone Mifepristone in combination with Misoprostol, Oxytocin, Dinoprostone and Dinoprost. Superficial self-medication is contraindicated, since there is a high probability of death of the mother and child.

Diagnostics

With an internal deviation of the intrauterine development of the fetus, labor may begin earlier than the period specified by the doctor. Such thoughts are prompted by hypertonicity of the uterus, discharge of amniotic fluid, dilatation of the neck of the genital organ and acute pain syndrome, attacking the consciousness of a woman in labor with cyclical attacks. An additional examination method is ultrasound, which determines the condition and position of the fetus in the womb. Before stopping acute pain syndrome, the doctor may prescribe a special test to confirm the fact of the onset of labor.

Test

A special test system called Actim Partus reliably determines the binding insulin-like growth factor-1 (SIPFR) in the mucus of the cervical canal. The enzyme in a capacious concentration is produced by the fetal membranes of the embryo a few days before the onset of labor. It is possible to carry out such a laboratory study only in a hospital environment, since it is not possible to organize the collection of material at home without special equipment and tools.

How to prevent

Since the baby will be born prematurely at an early stage, with low body weight and extensive lesions of internal organs, the doctor's task is to stop premature labor with the help of medications, alternative methods can also be used. Since labor can begin at any time, a woman first of all needs to be hospitalized, then examined, and then prescribe effective treatment, and leave under strict medical supervision. If you act correctly, the baby can be born on time, without pathologies.

Dexamethasone for the threat of premature birth

To prevent the development of respiratory distress syndrome, doctors use synthetic glucocorticosteroids. With the threat of early birth, the drug Dexamethasone for intramuscular administration has proven itself well. It is allowed to use it strictly for medical reasons for an obstetric period of 24 - 34 weeks. There are two schemes for the use of this medication:

  • 12 mg twice over 24 hours;
  • 6 mg for 4 visits throughout the day.

Conservative treatment in a hospital setting

The determination of the complex treatment scheme is carried out individually - according to medical indications after the identification of the main cause (pathogenic factor) of the progressive pathology. In order to ensure positive dynamics and prolongation of pregnancy, doctors in the conditions of compulsory hospitalization unite representatives of different pharmacological groups:

  • antispasmodic drugs intramuscularly or rectally: No-shpa, Drotaverin, Papaverine;
  • adrenergic agonists for intravenous administration: Ritodrin, Terbutalin, Ginipral;
  • NSAIDs rectally: Indomethacin from 32 weeks of gestation;
  • glucocorticosteroids, oral or intramuscular progestogens: Progesterone, Utrozhestan, Dexamethasone.

Management of preterm labor

In order to avoid potential complications with children's health, intensive care should be carried out in a hospital setting. A positive result will definitely be if you strictly follow all medical prescriptions. There are several methods of dealing with such a global violation, it all depends on the general condition of the patient, the fetus. Below are several effective tactics that are chosen by the doctor, based on the complexity of the specific clinical picture:

  1. Wait-and-see tactics. A woman is provided with peace - physical and emotional, they are given soothing decoctions, mild sedatives and antispasmodics are used.
  2. Active tactics. If the cervix opens by 3 cm or more, doctors use epidural analgesia or inject Partusisten intravenously.

Consequences for mother and child

For a woman, the consequences of premature childbirth are not so significant, more associated with the physiological characteristics of the female body. For example, the perineum may tear, or the doctor performs a caesarean section with further stitches. But for a baby, the consequences of premature birth can seem fatal. It all depends on the due date. As an option:

  • severe birth trauma;
  • congenital diseases;
  • early mortality.

Pregnancy after childbirth premature

After pathological childbirth, the woman's body must recover properly, so it is certainly not recommended to rush to re-conception. Doctors advise to see a gynecologist throughout the year, undergo a full medical examination, timely treat latent diseases (if any), and only then think about the next replenishment of the family.

Prophylaxis

To avoid difficult decisions and dangerous consequences for the baby's health, it is required to take a responsible attitude to the pregnancy planning period, to undergo a complete medical examination in a timely manner. If a successful conception has already occurred, it is important:

  • register on time for pregnancy;
  • eliminate bad habits;
  • take vitamins;
  • beware of taking certain medications;
  • eat properly and fully;
  • regularly go for an ultrasound scan;
  • protect yourself from infectious and viral diseases.

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