Fitness and healthy lifestyle 

What can cause premature birth. What to do if preterm labor begins? Risk of preterm birth


Description:

Termination of pregnancy between the 21st and 37th week is considered a preterm birth. In this case, a viable, but premature baby is born. Up to 25% of women do not carry a pregnancy, of these cases, 5-10% are premature births.

Premature births are dangerous for the mother and fetus, as they cause severe complications (perinatal morbidity and mortality, internal hemorrhages, etc.)


Symptoms:

A woman may notice the appearance of pulling pains in the lower abdomen and lower back. The pains are sometimes cramping in nature, i.e. we can talk about the beginning of the fights. In some cases, childbirth begins with the outflow of amniotic fluid or with the discharge of the mucous plug. In any of these cases, urgent hospitalization in the maternity hospital is necessary.


Causes of occurrence:

First of all, infection. Normally, the uterine cavity is sterile. Any inflammatory process makes the uterine wall inferior, so the pregnancy continues until the uterine wall 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). Particular attention should be paid to women with a history of chronic and acute inflammation of the uterine appendages and endometrium (the mucous membrane of the uterine body), intrauterine interventions (abortions, 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 to expel the infection from the body even before conception. If for some reason the necessary tests were not made before conception, then when diagnosing pregnancy, you should definitely undergo an appropriate medical examination, and you should not neglect regular examinations in the future. The sooner the presence in the body of a woman of microbes that can cause premature birth or potentially dangerous to the fetus is detected, the better. Modern medicine has a significant arsenal of tools to reduce the risk and infection of the fetus.
The second common cause of preterm birth is, ICI (isthmus - "isthmus", the place where the body of the uterus passes into the cervix, cervix - "womb"), that is, the inferiority of the muscle layer of the cervix, which during a normal pregnancy plays the role of a kind of sphincter (retaining ring ), which does not allow the embryo to "leave" the uterine cavity. ICI is congenital (very rare) and acquired. What can cause the development of ICI? The reasons are quite banal: trauma to the isthmus and cervix during abortions, especially when terminating the first pregnancy, 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 forced expansion of the cervical canal during diagnostic manipulations in the uterine cavity (hysteroscopy, i.e. examination of the uterine cavity with a special device - a hysteroscope; curettage of the endometrium), that is, any injury to the muscular layer of the cervix.

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

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

Also, premature birth can occur with overstretching of the uterus caused by multiple pregnancy, polyhydramnios, large fetus.

Heavy physical work, chronic stressful situation at work or at home, any acute infectious disease (flu, acute respiratory infections, tonsillitis, especially with fever, etc.) can also provoke an abortion.


Treatment:

For treatment appoint:


With the premature onset of contractions, first of all, tocolytic (that is, reducing the tone of the uterus) drugs are prescribed - partusisten, ginipral. First, these drugs are administered intravenously, and when contractions stop, a transition to tablet forms is possible. These medicines are usually taken until 37 weeks of pregnancy. Magnesium sulphate, 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, soothing) therapy - in order to break the vicious circle: in addition to the objective factors that increase the tone of the uterus, the fear of losing a child is added, which, in turn, further increases the tone uterus.

With the development of ICI for up to 28 weeks of pregnancy, “tightening” sutures are applied to the cervix, which prevent the ovum from “falling out” of the uterus. Sutures are placed under short-term intravenous anesthesia, while drugs are used that have a minimal effect on the child.

For a period of more than 28 weeks, with an inferior cervix, a special supporting Golgi ring is inserted into the vagina: it, without narrowing the cervix, holds the presenting part of the fetus, not allowing it to put pressure on the cervix. At the same time, if the contractions have stopped, further opening of the cervix does not occur.

The complex of treatment always includes the hormonal drug dexamethasone (microdoses of this hormone are prescribed, so that side effects are practically excluded). Its action is not aimed at preventing premature birth, but at stimulating the “maturation” of the lungs in a child (so that he is able to breathe on his own if he is still born prematurely).

A woman must necessarily observe bed rest, and in a hospital. In nutrition, it is better to avoid irritating, spicy, fatty, indigestible foods.

More difficult is the situation with premature rupture of amniotic fluid. At a gestational age of up to 34 weeks, if it was possible to suppress labor, the condition of the woman and the fetus is normal, there is no increase in body temperature, there are no inflammatory changes in the blood, it is possible to maintain and prolong pregnancy with the obligatory prescription of antibacterial drugs to prevent infectious complications. (The fact is that the discharge of water indicates a violation of the integrity of the fetal bladder. This means that the vagina is now communicating with the uterine cavity, that is, the path of infection is open, and taking antibacterial drugs is a vital measure.)

And carry out the necessary treatment.

Prevention comes down to monitoring a pregnant woman, timely identification of risk groups for preterm birth, diagnosis and treatment of emerging disorders (infections, isthmic-cervical insufficiency (ICN), concomitant extragenital pathology, prevention of placental insufficiency from early pregnancy).

Based on the letter of the Ministry of Health and Social Development of the Russian Federation of December 16, 2011 No. 15-4/10/2-12700 “On the direction of the methodological letter “Premature birth”” prevention of preterm birth is as follows:

Primary prevention

Effective:

  • limitation of repeated intrauterine manipulations (diagnostic curettage of the uterus during a medical abortion);
  • informing the public about the increased risk of premature birth of children conceived with the help of assisted reproductive technologies (IVF). Limiting the number of transferred embryos depending on the patient's age and prognosis.

Ineffective:

  • taking multivitamins before conception and during the first two months of pregnancy.

Secondary prevention

Effective:

  • introduction of anti-nicotine programs among pregnant women.

Ineffective:

  • the appointment of protein-energy nutritional supplements during pregnancy;
  • additional intake of calcium during pregnancy;
  • additional intake of antioxidants - vitamins C and E;
  • bed rest;
  • hydration (enhanced drinking regimen, infusion therapy), used to normalize fetoplacental blood flow to prevent premature birth.

To date controversial as a preventive measure:

  • use of a cervical pessary;
  • treatment of periodontal diseases during pregnancy.

Selected methods of prevention in the group of pregnant women at high risk of preterm birth

Stitches on the cervix. It is considered ineffective to suture a short cervix in all pregnant women, except for women at high risk of preterm birth. However, with a cervical length of 15 mm or less, with additional intravaginal administration of progesterone, the frequency of preterm birth decreases.

In twin pregnancy, suturing a shortened cervix, on the contrary, increases the risk of preterm birth.

Appointment of progesterone. Effectively prescribing progesterone in a high-risk group (primarily among women with a history of preterm birth) reduces the risk of recurrent preterm birth by 35%. Studies have shown that weekly injections of this hormone, starting from the 16th to 20th week and continuing until the 36th week, significantly reduce the risk of recurrent preterm birth for women in this situation. It should be noted that progesterone and its derivatives are ineffective in multiple pregnancies.

When prescribing progesterone preparations, the informed consent of the woman is required, since the manufacturing companies, when registering these medicines in the Russian Federation, do not indicate threatening preterm labor and the possibility of using the drugs in the second and third trimesters of pregnancy in the indications for use.

Antibacterial prophylaxis. Identification and treatment of asymptomatic bacteriuria (the presence of bacteria in the urine of more than 10 cfu / ml). Treatment of bacterial vaginosis in pregnant women with a history of preterm delivery. Treatment of bacterial vaginosis and chlamydial infection given before 20 weeks' gestation may reduce the risk of preterm birth.

Premature birth is not good for the baby. If you experience pain in the lower abdomen, tension of the uterus, suspected outpouring of water, you should immediately consult a doctor. Recommendations for hospitalization should be strictly followed.

The earlier a pregnant woman went to the doctor, the earlier complex treatment was started, the more likely it is that it will be possible to prevent premature birth and give birth to a healthy baby.

If your baby is especially in a hurry and even before the end of the 37th week begins to make his way into this world, then he belongs to those 5% of children who are born prematurely every year.

The earlier a child is born, the more extensive medical care he will need for normal, healthy development.

Premature babies are usually very small and underweight. Their breathing is frequent and labored. The degree of maturity of various functions of the body depends on what week of pregnancy they were born.

The shorter the gestation period, the more important it is for preterm birth to take place in a perinatal center. Here, doctors have at their disposal all the methods and technical devices of intensive care necessary for the survival of your child. Of great importance is the introduction before preterm birth of glucocorticoids, which accelerate the maturation of the lungs of the child. At the same time, an intramuscular injection is given to the mother for two days in a row.

Once the baby is born, it will require a lot of attention and warmth, as well as close bodily contact with the mother or father. The kangaroo method is a good opportunity to develop the first important relationship with your child. Visit your baby as often as possible.

Children who are born before the end of the 37th week and weigh no more than 2.5 kg are considered premature, although in fact the number of months and weight are not decisive criteria for the viability of the child. The life of prematurely born children is in serious danger, premature babies die after premature birth 10 times more often than mature children. Along with the problem of poorly functioning organs, the child has to cope with such difficulties as the absence of a layer of subcutaneous adipose tissue, as a result of which the mechanisms of thermoregulation cannot work normally for him.

A typical sign of immaturity is too short fingernails. We can say that the child does not yet have claws: he can neither defend himself nor take ("claw") what he needs. The skin of a premature baby is almost transparent, red, like raw meat: he has no borders yet, and certainly no border fortifications; its protective shell has not yet formed. The ears do not yet have cartilaginous ridges, that is, the lobes simply do not exist. A premature baby is not ready to come into this world. The same goes for the eyes: the child is not interested in the outside world. Within the framework of the so-called Petrusse maturation scheme (Petrusse index), these data are brought together.

It is important that in such preterm birth it is possible to refuse the use of medications, which further reduce the child's chances of survival and, as proven, continue to be in the child's body for another day, whose liver and kidneys have not yet established the detoxification mechanisms.

Psychologically, premature birth may indicate a tendency to escape, excessive haste, and even certain intrigues on the part of the child, on the one hand, and an attempt by the mother to quickly get rid of him or let him go on an independent voyage, on the other. An attempt to expel a child ahead of time and expose it to the light may result in an unconscious attempt to get rid of it. Behind this is always an unconscious desire to end the pregnancy and get away from this situation as soon as possible.

Often the aspirations of the mother and child coincide, which, against the background of the extreme impatience of the characters of both, can lead to a rapid birth. In this situation, it is obvious that both are not able to wait for liberation from painful conditions and at the same time separation from each other. So the scene of preterm labor can be taxis, planes or even toilets. At the same time, one should not lose sight of the tendency to stage and attract the attention of others.

However, these tendencies are less threatening than reverse attempts to carry the pregnancy to maturity. If the child does not replay with an early arrival in life, in principle the situation is not dangerous. In any case, compared to other mammals, we humans are born prematurely. A child who has lost a secluded cave in the womb too quickly will need to create a “nest” comparable in terms of warmth and comfort for a long time to come. However, again, compared to other mammalian babies, “human babies” are in no hurry to leave it later, and some even “hang” there for a long time.

Premature babies can survive only in an incubator - an artificial uterus, which should replace the "nest" left too early in the mother's womb. This dramatic scenario can be caused by both the inhospitality of the mother and the excessive impatience of the child. Since the technical uterus - an incubator - functions much weaker than a natural one, premature birth turns into a false start, because a premature baby is forced to go through a number of stages of development again.

What a difficult test this is for both is also indicated by the problem associated with the subsequent getting used to each other. If the mother does not touch the baby for weeks, this means that a real bond will not form between her and the child subsequently, in order to avoid which competent professionals actively encourage mothers to spend as much time as possible near the incubator and touch the baby as often as possible. child, - after all, only in this way can this such an important connection arise.

In the life of the mother, a sharp reduction in the gestational age also brings only problems and no relief. The need to place the child in an incubator leads to a clear weaning from the table and bed, since the child can be left in the hospital for a long time, and the woman also becomes tied to the hospital walls. The resulting problems can be very significant for both parents, especially for the mother, not to mention the long-term consequences in terms of the well-being of the child. Missing opportunities for imprinting and the impossibility of breastfeeding play a very significant role, albeit a minor one, against the backdrop of an acute struggle for the life of the child.

A typical pregnancy lasts from 37 to 42 weeks, with an average of 40 weeks. Most babies are born at the expected time, a week or two before or after.

Prevention of preterm birth

your predisposition. Researchers have figured out what causes preterm labor. A woman is more likely to have a premature baby if:

  • last time she had a premature birth;
  • she is pregnant with two or more children;
  • she suffers from a chronic disease such as diabetes or hypertension;
  • she was obese or wasted before pregnancy;
  • she smokes;
  • during pregnancy she had infections such as bacterial vaginosis, infections of the urinary system;
  • she is under 17 or over 35;
  • she was subject to severe chronic stress or neurosis during pregnancy;
  • she became pregnant after cured infertility;
  • she has any abnormalities of the uterus and her cervix;
  • she was subjected to domestic violence during her pregnancy.

Prevention. If you're at risk for preterm labor because your last delivery was premature, your doctor may recommend weekly injections of progesterone, known as 17P. Weekly injections of progesterone, starting at 16-20 weeks, reduce the chance of recurrent preterm birth by 33%. This drug has contraindications, so consult your doctor in advance.

Symptoms and signs of preterm labor

Preterm labor begins in the same way as normal term labor.

Possible symptoms:

  • periodic pulling pains in the lower abdomen and lower back with an increase in the tone of the uterus;
  • feeling of pressure in the vaginal area;
  • frequent urination;
  • possible leakage of amniotic fluid.

Preterm birth can be provoked by:

  • hormonal disorders;
  • birth canal infections;
  • problems in the hemostasis system and other disorders.

Usually the doctor pays special attention to expectant mothers:

  • having a low social status;
  • working with occupational hazards;
  • suffering from drug addiction or alcoholism;
  • having extragenital diseases (hypertension, heart disease, thyroid disease, anemia, diabetes mellitus);
  • who had a viral infection during pregnancy;
  • having a history (history) of premature birth;
  • having malformations of the uterus;
  • having multiple pregnancy or polyhydramnios, etc.

The danger of premature birth declares itself with regular, painful contractions. The first harbingers may be light bleeding or amniotic fluid. In this case, medical assistance must be provided very quickly. If you can't reach either the doctor or the midwife, your best bet is to go to the nearest hospital.

Based on the results of ultrasound and vaginal examinations, as well as on the basis of a record of labor activity made using CTG, the doctor will be able to determine whether you are at risk of preterm labor and, if necessary, begin appropriate treatment. A bacteriological smear from the vagina will allow you to find out if an infection is the cause of contractions.

Warning signs. In some cases, medical intervention can delay preterm labor and give the baby more time to develop before birth. Even if you only have one of the following symptoms, contact your doctor immediately. It's better to be overprotective than risk unsupervised preterm birth:

  • contractions every 10 minutes or more;
  • fluid or blood coming out of the vagina;
  • feeling of pressure in the pelvis, as if the child is pressing on it;
  • mild, dull back pain or menstrual-like pain;
  • changes in vaginal discharge from creamy white to watery and mucous.

When you call your doctor, you will be asked about your symptoms and the duration of your pregnancy. (Be sure to include what week you are in.) The woman may be asked to come to the clinic or hospital for a gynecological examination to see if her cervix is ​​dilated. If you are having contractions and your cervix is ​​dilated, then you are in preterm labor.

Too early birth

Too early a birth is indeed a real false start, since organs such as the lungs are not yet mature enough for the baby to breathe air adequately. The corresponding model shows that the children are not yet "hatched" and are too hasty to make acquaintance with the polar world. Not yet functioning detoxification mechanisms through the kidneys and liver do not allow the child to cope with the decay products of their own metabolism, to say nothing of external toxins. The world is too poisonous for him yet. The absent, as a rule, sucking reflex indicates that the child is not yet able and does not want to participate in the process of giving and taking. Immune weakness against the background of an immature immune system is a topical issue for the health of newborns in principle, but in relation to premature babies, it becomes especially relevant. That is why their entire state is a continuous cry for help and an appeal to the world around them.

With this model of behavior, premature babies enter into life, thereby finding themselves at the opposite pole from post-term babies. And if the latter always try to arrive later, the former seem to have been here all the time, which may turn out to be an unpleasant situation. Both of them have a problem with the exact time, which they work out from opposite sides, unless, in an effort to compensate, they again rush into their complete opposite. This alignment of events allows you to see once again how much the opposite poles have in common with each other.

An interesting and effective attempt to save the lives of premature babies is the Colombian "development" of the so-called kangaroo method, which shows very well what babies really need. Two gynecologists at the Juan de Dios Hospital in Bogota, citing a shortage of expensive incubators, urged mothers of premature babies to carry their babies and thus be a source of warmth for them. The results were amazing. The problem of maintaining temperature was solved, the continuous stimulation from the mother's breast helped most children learn to suck, so that along with mother's milk they received better immune protection. The negative effects of living in an incubator, such as creating a sense of isolation, also disappeared. Contrary to all predictions, 95% of "kangaroos" have reached the age of 10, while the efforts of high-tech medicine save the lives of approximately half of the children. Even of the four weakest babies, weighing less than a kilogram and having the worst chance of survival, three survived. The only way the doctors could explain these amazing results was the closeness to the mother and the psychological comfort that the children felt in loving motherly hands.

I wonder how quickly this method, which is not particularly favorable for the development of industry, will be applied in our country, who have enough money for incubators? It can lead to sensational breakthroughs in gynecology, though if we're being honest with ourselves, it's really "just" a step backwards, back to the customs and methods of old.

If the kangaroo method—despite the hygienic fears that would not be long in our minds—were applied to all other children, we could avoid many problems and expenses in the simplest way. Of course, these children would not have to suffer from the problems of maintaining cleanliness, as the children of archaic peoples, for whom this principle of "wearing" has been standard since time immemorial. This can be illustrated with an example of an anecdote. A missionary from Europe asks a black mother who is carrying a child, tying a handkerchief to her naked body: “How do you notice that the child has pooped?” - at which she looks at what, completely bewildered, and asks in response: “Yes, how do you notice this?”

Interestingly, an Austrian specialist in premature babies, Dr. Marina Markovich, has developed a very similar technique of gentle intensive care, which, first of all, involves reducing all intensive measures to the necessary minimum. At the first opportunity, Dr. Markovich was removed from his post. And although most representatives of modern neonatology copy its methods and even extrapolate the principles of gentle intensive care to the treatment of adults, there is no need to talk about the belated rehabilitation of her name in the circles of the Austrian medical establishment.

If we talk about the type of personality of women who are predisposed to miscarriage, first of all they are impatient creatures, lean, prone to a male vision of reality. But the fate of those who are full of fears and do not feel joy in connection with pregnancy, projecting hardships and problems onto it, is also predetermined. Among other things, long-term use of birth control pills can lead to underdevelopment of the reproductive organs, which increases the predisposition to preterm birth, since the woman's body and uterus, in particular, have not developed fully from the maternal principle. The game of new life clearly lacks the participation of the first principle of the moon. That is why this issue can also affect a temperamental woman with pronounced features of the first principle of Venus, who is not too ready to interact with the first principle of the Moon.

At the same time, it is also difficult for a woman who is overwhelmed with worries and suffering, inconsistency with the desired social circumstances (housing, finances), to build a suitable mental “nest” for her unborn child. The internal pressure resulting from all these circumstances often leads to one-sided attempts to unload by premature expulsion of the child.

Smoking, alcohol and drug addiction can so narrow the size of the intrauterine “nest” of the child that he himself will seek to leave it as soon as possible, since the placenta is not sufficiently supplied with blood. If the mother's condition really leaves much to be desired, the child begins to have nightmares and develops a strong desire to leave the inhospitable place.

Often, preterm birth occurs in those mothers who, on the external level, did not make any “nest” for their child, which may indicate a lack of appropriate comfort on the internal level. They lack stamina or patience or enthusiasm, and as a result, they let everything take their course and do not care about the necessary achievement of biological maturity.

It can be said that the task of the mother is to let time flow and create space for herself and the child, exercise patience and accept everything that is measured by fate. It also helps to go on maternity leave, provided for by social norms: by accepting this opportunity with gratitude, the mother can finally immerse herself in the peace she needs now.

Theoretically, your child is viable, however, if he is born this month, then in life he will have a hard time overcoming his immaturity from birth. Be careful as the 7th month represents the most difficult part of your journey. Any harmless illness experienced by you in previous months can become critical during this period of pregnancy and cause premature birth. Be alert to any unusual sensations and report them to your doctor.

If you notice spotting

Seek immediate medical attention. Perhaps they are associated with the low location of the placenta, almost next to the internal cervical os. With this arrangement, the placenta is called presenting.
During this period of pregnancy, weak contractions of the uterus can lead to its partial detachment, which leads to blood discharge of varying degrees of intensity. Your doctor will prescribe bed rest for the rest of your pregnancy.

If you are expecting twins

You must be under special medical supervision, as twin pregnancies often end in premature birth. From 75% to 80% of primiparous and 45% of recurrent women are relieved from the burden ahead of time, because the uterus is more easily stretched than normal.

From this month:

  • you should take a urine test 2 times a month, the presence of protein is possible;
  • should visit a doctor 2 times a month;
  • rest as often as possible.

The main thing - do not overwork

Do not overload yourself, rest more. During this period, it is undesirable to travel, move or undertake activities that require great physical effort. Take care of yourself. Your child is still too small, he needs you.

Stop playing sports

Only physical exercises designed specifically for pregnant women are allowed. With good health, you can continue them until the very end of pregnancy.

Causes of preterm birth

  • Medical indications (approx. 54%).
  • Spontaneous preterm birth: Premature contractions (approx. 35%). Premature rupture of amniotic fluid (11%).

The most common causes:

  • Infections.
  • placental disorder.
  • Fetal pathology (malformations, chromosomal abnormalities, alloimmunopathies).
  • Pathology of the uterus.
  • Multiple pregnancy.

A premature baby is a baby born between the 35th and 37th weeks, counting from the 1st day of the last menstruation.

Among premature babies, 20-30% are twins.

A baby born before the 35th week is considered severely premature.

Reasons for premature birth:

  • improper location of the placenta, or placenta previa;
  • the cervix is ​​not tightly closed;
  • too stretched uterus during a twin pregnancy;
  • maternal diseases such as diabetes mellitus, herpes, AIDS, toxicosis, hypertension;
  • contagious infectious diseases of the mother during pregnancy, such as toxoplasmosis, listeriosis, viral hepatitis.

In fact, and this happens quite often, during the illness of the mother, the doctor decides to terminate the pregnancy due to the increased risk of abnormal development of the child:

  • traumatism. The most frequent cases are car accidents;
  • excessive fatigue associated with working conditions and transport.

Premature births are more common in women with low social status and difficult financial situation.

The appearance of painful contractions with increasing frequency signals the approach of preterm labor. Contractions may be accompanied by light pink or brownish discharge. In this case, it is better for you to go, without worrying and slowly, to the maternity hospital. There you will spend several days under the supervision of doctors, taking antispasmodics. Upon returning home, observe bed rest.

If you have had a slight leakage of amniotic fluid, not even accompanied by contractions, you should immediately go to the maternity hospital.

Risk to the child

Children develop strongly during the last trimester of pregnancy, and if they are born prematurely, they have to fight fiercely for life. Preterm birth is the most common cause of death among newborns. More than term babies, survivors are prone to chronic health problems such as developmental delay, hearing loss, blindness, chronic lung disease, and central paralysis. About 25% of babies born prematurely (before the 32nd week) suffer from a significant impairment in brain development.

Medicines used in preterm labor to slow down contractions

Drugs that reduce the force of uterine contractions are called tocolytics. Their use is tocolytic therapy.

The most popular tocolytics:

Magnesium sulfate

It is an IV muscle relaxant. Historically, it has been used to prevent seizures caused by preeclampsia (pregnancy hypertension). It is still the main preventative in such cases, but its ability to relax the muscles, including the uterine, has made it the number one remedy for stopping preterm labor. It's dangerous if it gets too high, because it can also relax your respiratory muscles, making you complain vehemently, if you're able to speak at all. Its incredible safety, however, lies in the ability to measure its amount in the bloodstream so that these levels don't happen. For this reason, the use of magnesium sulfate is very simple and, if done correctly, is very safe.

Treatment with magnesium sulfate is accompanied by hydration, as this drug must be administered with fluid intravenously. Since hydration itself can reduce contractions, magnesium sulfate has a hidden secondary effect of reducing uterine contractions.

Corinfar (procardia)

This drug lowers high blood pressure by relaxing the muscle layer surrounding the arteries. It blocks calcium in these muscles at the molecular level, causing relaxation. The uterus also rolls around, becoming cute and relaxed. The advantages of procardia are that it can be taken in ambulatory tablets and, in addition, in a convenient dose - once a day. Caution is needed when it is used together with magnesium sulfate, as it may enhance the hypotensive effect.

Terbutaline (bretin)

Terbutaline is an asthma medicine that relaxes the muscle tone of the bronchi during bronchospasm, often seen in asthma. It also relaxes the uterus, thus calming premature contractions. In addition, it makes the heart beat faster, and a fast pulse is a good indicator that you have received enough of this drug.

Even if you are taking terbutaline at doses that are considered frequent, if the contractions start before the next dose and the heart rate is less than 100 beats per minute, you can take the next dose sooner. Usually, adequate blood levels of terbutaline are associated with a heart rate of the order of at least 110. Yes, it can make you feel really crappy, like a pounding heart, but it's harmless and well worth it to stop your premature baby from being born.

The combination of terbutaline to stop contractions and steroids to help the baby's lungs mature can lead to an unhealthy combination of rapid heart rate and fluid retention. This combination can result in fluid in the lungs, called pulmonary edema, which is just as debilitating as pneumonia. Don't worry if you are given a combination of these medications; your doctor knows all about this known side effect. If it's been prescribed to you, take it. It's worth the risk. But if pulmonary edema began, all tricks away - from that moment on, terbutaline treatment would be discontinued.

Since the action of terbutaline causes an unexpected acceleration of heart contractions, attempts are being made to make its use more gentle, which, of course, makes the tocolytic control of preterm labor more gentle. For this purpose, a terbutaline pump (T-tompa) is now used, which delivers the drug through a small catheter needle into the leg, and which you can wear at home as a holster. There are companies that provide free support 24 hours a week for dosage control and cuts.

New Substances

There is no perfect cure for preterm birth. Undoubtedly, there will be many over the next 10 years, but now we are using magnesium sulfate, corinfar and terbutaline most often.

If there is a good reason for having a baby prematurely, tocolytic therapy will not work for you. Bleeding, infection, and other causes of preterm labor that remain untreated can pose a serious threat if tocolytic agents are used. Real success in containing preterm labor is achieved when your doctor manages to delay the birth by a week or two. If preterm labor is easily stopped and the pregnancy continues to the present date, then perhaps it was not preterm labor, but simply false contractions.

Just contractions do not mean premature birth. The contractions must be organized enough to direct the general vector of forces outward, causing thinning and stretching of the cervix (just like in real labor). Contractions may begin after the 12th week of a normal pregnancy. It's just that they are so weak that they are usually not even felt, much weaker than those that can cause harm.

When is the birth premature? Does the sex of the baby affect how he behaves during a premature birth?

Any birth before the 36-37th week (or due date) is considered preterm. Activity in attempts to stop preterm labor should be appropriate to the degree of lung maturity. Preterm labor at 35 weeks and 5 days is not as actively suppressed as labor at 28 weeks. Childbirth at 34-36 weeks deserves some intervention. Childbirth at 32-34 weeks deserves active intervention. In fact, any delivery before the 34th week requires the most significant intervention, including the use of steroids.

We don't know why, but girls are better at dealing with immature lungs than boys. And white girls do it better than African Americans. The order is that white girls do better than black boys, who do better than white boys, who in turn do better than black boys.

How to choose the right dentist

Dentist? Studies have been published in the press that say that if you have sore gums, then the risk of preterm birth increases fivefold. The first time I heard this, I was sure that it only applies to those who do not brush and floss at all or do it irregularly. Of course, such patients are likely to be malnourished and refuse to see doctors, thus exposing themselves to the risk of complications, including preterm birth. But new research is forcing any biases based on socioeconomic assumptions to be corrected.

This means that patients with dental problems put themselves at serious risk of preterm labor, so a visit to the dentist before conception can be just as important as checking everything else. Oh, and don't forget to floss.

Prevention of preterm birth

Be sure to attend all examinations prescribed by your doctor. The doctor will quickly figure out whether in your case you need to reckon with the risk of preterm birth. This is best judged by the results of an ultrasound examination, during which the length of the cervical canal is measured. If at the 28th week, with a closed uterine pharynx, the length of the cervix exceeds 30 mm, then with a high degree of probability it can be assumed that the contractions will not begin until the 38th week. By regularly monitoring the pH of the vagina, you are also taking effective measures to prevent preterm labor.

In addition, pay attention to healthy living conditions: once again we recall the complete absence of tobacco smoke in the environment around you, a balanced diet that includes the consumption of foods rich in vitamins and minerals. Be sure to move, but in moderation, and make it a habit to take short rest breaks throughout the day so that you can take your mind off all your business and worries. This is especially recommended for women expecting twins: with multiple pregnancy, there is initially a danger of its early termination.

Treatment of preterm birth

It is obvious that a woman who has started a premature birth should be immediately hospitalized in the maternity hospital in order to maintain the pregnancy for the longest possible period.

In the maternity hospital, doctors prescribe pregnant therapy, which is aimed at:

  • suppression of labor activity (uterine contractions);
  • support for the baby (if he is to be born prematurely, then his lungs should be as ready as possible for independent work, if possible at this stage of pregnancy);
  • relaxation and calming of the woman (contributes to the prolongation of pregnancy);
  • elimination of other negative symptoms, if any, and consultation with other specialists if necessary (if there is an extragenital pathology).

Premature birth is dangerous for the baby, so you must strictly follow the recommendations of doctors!

Provided that the child is still sufficiently supplied with the placenta, specialists will try to prolong the pregnancy. If labor begins before the 35th week, doctors will try to delay it by at least 48 hours. For this, tocolytic agents are used that relax the muscles of the uterus.

The organs of premature babies have not yet fully matured. First of all, doctors pay attention to the extent to which the lungs are able to perform their function. If they are still too immature, the baby will have to be provided with artificial oxygen after birth. Therefore, even before tocolytics, a woman is injected with glucocorticoids, which stimulate the early maturation of this organ. The fewer weeks the fetus is, the more important this treatment is. For babies born at 25 weeks gestation, each additional day in the mother's abdomen means a 5% increase in the chance of survival.

The use of drugs that promote the maturation of the lungs, significantly reduces the risk of cerebral bleeding. Thanks to effective interventions, retinal diseases have become much less common. But in some cases, they still cannot be avoided.

medical intervention. If you have symptoms of preterm labor, your doctor may want to do a fetal fibronectin test, which measures the level of a certain protein in your vaginal and uterine secretions. A negative analysis most often means that labor will not begin in the next two weeks. A positive test is not as reliable: you can give birth prematurely, or you can give birth at term. There is no test that accurately predicts which woman with preterm labor will go into preterm labor. In most cases, this is a nerve-wracking situation where you have to wait and see what happens. Some doctors recommend bed rest to prevent preterm labor, although it has not been scientifically proven that this actually helps to "postpone" labor. Be that as it may, despite the lack of evidence, many doctors are cautious and recommend bed rest for women with preterm labor.

Unfortunately, doctors cannot stop premature contractions, but they can prescribe an anti-labor drug that can stop contractions for two or three days. Although this does not seem like such a long time, it can be important: even a few extra days in the uterus can increase the chance of survival of a premature baby, especially in the very early stages (24-26 weeks). If your due date is 24-34 weeks, you will most likely be prescribed corticosteroid medications, which increase the amount of surfactant in the baby's lungs. This substance helps the baby breathe easier and spend less time on artificial respiration after a premature birth. The baby needs to stay in the uterus for at least 48 hours while you are on corticosteroids for the medication to get the most benefit. If your water has broken, you may be given antibiotics to prevent group B strep infection and prolong the time your baby is in the uterus.

Medical care after childbirth. After the birth of a premature baby, they are sent to the intensive care unit for infants, where there are medical equipment to help him breathe, maintain body temperature, eat and receive appropriate treatment. In this department, the baby is monitored by a neonatologist, a pediatrician who has received special training in order to work with premature babies. A premature baby can stay in the intensive care unit for up to several months, depending on how early he was born and what his health problems are.

How to choose a good hospital. If you are at risk for preterm birth, find out which hospitals have an intensive care unit for babies. Hospitals are assigned a certain level, which indicates how well they care for newborns. A level 1 hospital does not have an infant intensive care unit; at a level 3 hospital, care is provided at the highest level, with excellent equipment and the most experienced staff. Also, remember that half of preterm births occur in women who were not at risk.

Diagnostics

  • Anamnesis
  • Vaginal examinations: Assessment of the state of the uterine os. Smear (bacteriology, pH).
  • Ultrasound: Vaginal: measurement of the length of the cervical canal (4.5 + 1 cm). Abdominal: fetometry, assessment of the state of the placenta and amniotic fluid, if necessary, Doppler. Laboratory: diagnosis of infections (leukocytes, CRP).

Measures for the threat of premature birth

General:

  • Physical rest, bed rest.
  • Suggest a consultation with a pediatrician.
  • Check indications for transfer to the perinatal center.
  • Treatment of causes/symptoms, if necessary, immediate delivery.
  • Before reaching the full 24+0 weeks of gestation, induction of maturation of the lungs is prescribed only in exceptional cases and after consultation with a pediatrician.
  • After a full 35+0 weeks of gestation, measures to extend the pregnancy are not taken.

Premature discharge of amniotic fluid:

  • Bed rest.
  • Tocolytics are discontinued 48 hours after induction of lung maturation.
  • Prophylactic administration of antibiotics.
  • Several times a day, control of CTG, laboratory parameters, measurement of temperature and vital parameters.
  • In rare cases, intrauterine NaCl installation to fill the amniotic sac.
  • Delivery, if more than one sign. Leukocytosis > 15,000/L and/or CRV > 20 mg/L. Rectal temperature > 38°C. Contractions, despite the use of tocolytics, high uterine tone.
  • Emergency delivery: Fetid amniotic fluid. Fetal tachycardia.

Premature contractions:

  • Bed rest.
  • Induction of maturation of the lungs with betamethasone (2 x 12 mg IM with an interval of 24 hours).
  • Tocolytics until the end of the maturation of the lungs, subject to the opening of the neck.
  • CTG several times a day.
  • Regular monitoring of laboratory data.
  • Delivery with incessant contractions.

Nervous insufficiency:

  • Bed rest.
  • Induction of maturation of the lungs with betamethasone (2 x 12 mg IM with an interval of 24 hours).
  • Tocolytics before the end of the maturation of the lungs.
  • It is possible to impose a cerclage on the cervical canal / total closure of the uterine os.
  • CTG several times a day.
  • Regular laboratory control.

Possible alternatives:

  • Fenoterol: intravenously through a perfusor/infusion pump. Start with 2 mcg/min. Increase by 0.8 mcg every 20 min. (maximum 4 mcg/min) via perfusor, boluses: start with 3-5 mcg every 3 min.
  • Traktocil IV via perfusor/infusomat: 6.75 mg in 1 minute (bolus). 18 mg/hour for 3 hours = 300 mcg/min. 6 mg/hour for 15-45 hours = 100 mcg/min.
  • Nifedipine: by mouth. 10 mg every 20 minutes for up to 4 doses (saturation), then up to 20 mg every 4-8 hours (not officially approved).
  • Other tocolytics: Magnesia (no evidence of effectiveness). Indomethacin (not more than 48 hours and< 32 недель гестации). NO-донаторы (нет достаточных данных).

Contraindications:

  • Emergency conditions of mother and child.
  • Amnion infection syndrome.
  • Eclampsia.
  • Intrauterine fetal death.
  • Specific medical contraindications.

Methods of delivery

C-section:

  • Planned premature birth according to indications from the mother and fetus with an immature cervix.
  • If, if infection is suspected, rapid independent childbirth is not expected.
  • With the gluteal and transverse position of the fetus.
  • With signs of hypoxemia.

Spontaneous childbirth:

  • With ongoing labor activity, rapid opening of the cervix and the beginning of the exile phase, cephalic presentation.
  • Ready for a caesarean section.

If the pregnancy for a woman ends earlier than the period set 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 much 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 premature delivery and its dangerous consequences for the child's health in the future.

What is preterm birth

Labor activity, completed by delivery earlier than 38 obstetric weeks, characterizes pathological childbirth. For the health of the crumbs, this is a pathological process, however, thanks to modern technologies, doctors have learned to nurse children born from the 28th obstetric week onwards. 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, a pregnant woman is urgently placed for preservation.

signs

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

Since the crumbs in the second half of pregnancy are characterized by increased physical activity, diagnosis can be difficult. However, a vigilant expectant mother should pay attention to the following alarming symptoms:

  • increased tone of the uterus on palpation;
  • pulling or cramping pains in the lower abdomen;
  • constant activity of the fetus;
  • frequent urge to go to 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 the woman detects leakage of amniotic fluid, you must immediately call an ambulance or immediately file a complaint with the local gynecologist. Early labor activity can provoke a miscarriage, which should not be allowed under any circumstances. Early childbirth begins with a sharp pain in the abdomen, which only intensifies in different positions of the body. Pregnancy is at risk, and it is better for a woman to consent to hospitalization in the hospital.

Causes

Most expectant mothers ask 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 the 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;
  • pelvic presentation of the fetus;
  • intrauterine infections;
  • fetal gene mutations;
  • antiphospholipid syndrome;
  • severe forms of gestosis;
  • rupture of membranes;
  • isthmic-cervical insufficiency;
  • excessive sexual activity;
  • the presence of hidden urinary tract infections;
  • diabetes mellitus during pregnancy;
  • pathology of the thyroid gland in the expectant mother;
  • preeclampsia;
  • multiple pregnancy (twins);
  • female inflammation during pregnancy;
  • uterine bleeding.

Classification

Premature birth is not considered a disease, but 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 remote idea of ​​the degree of the pathological process and potential diseases in a person who was born:

  1. Very early birth. The premature appearance of the crumbs falls on the period of 22-27 weeks. The weight of the fetus varies between 500 - 1,000 g, the doctor diagnoses the underdevelopment of internal organs and systems, problems with opening the lungs.
  2. early childbirth. Premature birth occurs between 28 and 33 weeks. The child weighs up to 2 kg, while the natural ventilation of the lungs is disturbed, the circulatory system is imperfect.
  3. Premature births at 34-37 obstetric weeks, although they are considered pathological, are encouraging parents, since all internal organs and systems have already been formed. A newborn weighs about 2,500 g.

Indications for artificial preterm birth

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

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

How to call

If a pathology or the presence of one of the above pathological factors is suspected, a pregnant woman is taken to the maternity hospital. When determining the diagnosis and the need to stimulate labor prematurely, doctors use certain medications that are usually injected into the vagina intraamniotically. In this case, we are talking about the following medicines: the synthetic hormone Mifepristone in combination with Misoprostol, Oxytocin, Dinoprostone and Dinoprost. Superficial self-treatment 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, childbirth may begin earlier than the period specified by the doctor. Such thoughts are prompted by the hypertonicity of the uterus, the discharge of amniotic fluid, the expansion of the neck of the reproductive organ and the acute pain syndrome that attacks the consciousness of the woman in labor with cyclic 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 onset of labor.

Test

A special test system called Actim Partus reliably detects binding insulin-like growth factor-1 (IGFFR) in cervical mucus. 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 conduct such a laboratory study only in a hospital, since it is not possible to organize material sampling at home without special equipment and tools.

How to prevent

Since at an early stage the child will be born prematurely, with low body weight and extensive lesions of internal organs, the task of the doctor is to stop preterm labor with the help of medications, and alternative methods can be used. Since labor activity can begin at any moment, the first thing a woman needs to be hospitalized, then examined, and then prescribed an effective treatment, left under strict medical supervision. If you act correctly, the baby can be born right on time, without pathologies.

Dexamethasone for threatened preterm birth

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

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

Conservative treatment in a hospital setting

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

  • antispasmodic drugs intramuscularly or rectally: No-shpa, Drotaverine, Papaverine;
  • adrenomimetics for intravenous administration: Ritodrin, Terbutaline, Ginipral;
  • NSAIDs rectally: Indomethacin from 32 weeks of pregnancy;
  • glucocorticosteroids, gestagens orally or intramuscularly: Progesterone, Utrozhestan, Dexamethasone.

Management of preterm birth

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 a few effective tactics that are chosen by the doctor, based on the complexity of a particular clinical picture:

  1. Expectant tactics. A woman is provided with peace - physical and emotional, they give soothing decoctions, use mild sedatives and antispasmodics.
  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 birth are not so significant, they are more related to the physiological characteristics of the female body. For example, the perineum may be torn, or the doctor performs a caesarean section with further suturing. But for a baby, the consequences of premature birth can seem fatal. It all depends on the timing of the birth. As an option:

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

Pregnancy after premature birth

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

Prevention

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

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

Video

In our country, threatening preterm birth is an indication for hospitalization.

If it is possible to prolong pregnancy, treatment should be aimed, on the one hand, at suppressing the contractile activity of the uterus, and on the other hand, at inducing the maturation of the fetal lung tissue (at 28-34 weeks of gestation). In addition, it is necessary to correct the pathological process that caused premature birth.

To stop tonic and regular contractions of the uterus, complex treatment and individual selection of therapy, taking into account the obstetric situation, are used.

Non-drug treatment

Preferential position on the left side, which helps to restore blood flow, reduce contractile activity of the uterus and normalize uterine tone in 50% of pregnant women with threatening preterm birth. According to other studies, prolonged bed rest, used as the only method of treatment, does not give positive results.

There are no convincing data on the benefits of hydration (enhanced drinking regimen, infusion therapy) used to normalize fetoplacental blood flow to prevent preterm birth.

Medical treatment

If there are conditions for conducting tocolytic therapy, it is preferred. The drugs of choice are currently P-adrenergic agonists, the drug of the second stage is magnesium sulfate, which can quickly and effectively reduce the contractile activity of the myometrium.

p-Adrenergic agonists can be used to delay delivery during the prevention of respiratory distress syndrome with glucocorticoids or, if it is necessary to transfer a woman in labor to a perinatal center, where it is possible to provide highly qualified care to premature newborns.

From p-adrenomimetics, hexoprenaline, salbutamol, fenoterol, terbutaline are used.

Mechanism of action: stimulation of p2 receptors of smooth muscle fibers of the uterus, which causes an increase in the content of cyclic adenosine monophosphate and, as a result, a decrease in the concentration of calcium ions in the cytoplasm of myometrial cells. The contractility of the gadamuscular muscles of the uterus is reduced.

Indications and prerequisites for the appointment of p-mimetics:

  • therapy of threatening and beginning premature birth;
  • a whole fetal bladder (the exception is the situation with leakage of amniotic fluid in the absence of chorioamnionitis, when it is necessary to delay childbirth for 48 hours to prevent fetal respiratory distress syndrome with glucocorticoids);
  • opening of the uterine os by no more than 4 cm (otherwise the therapy is ineffective);
  • live fetus without developmental anomalies;
  • no contraindications for the use of β-agonists.

Contraindications:

Extragenital pathology of the mother:

  • cardiovascular diseases (aortic stenosis, myocarditis, tachyarrhythmias, congenital and acquired heart defects, cardiac arrhythmias);
  • hyperthyroidism;
  • angle-closure glaucoma;
  • insulin dependent diabetes mellitus.

Obstetric contraindications:

  • chorioamnionitis (risk of generalization of infection);
  • detachment of a normally or low-lying placenta (risk of developing Kuveler's uterus);
  • suspicion of insolvency of the scar on the uterus (risk of painless uterine rupture along the scar);
  • conditions when prolongation of pregnancy is impractical (eclampsia, preeclampsia).

Fetal contraindications:

  • fetal malformations incompatible with life;
  • antenatal fetal death;
  • fetal distress not associated with uterine hypertonicity;
  • severe fetal tachycardia associated with the characteristics of the conduction system of the heart.

Side effects.

On the part of the mother's body: hypotension, palpitations, sweating, tremor, anxiety, dizziness, headache, nausea, vomiting, hyperglycemia, arrhythmia, myocardial ischemia, pulmonary edema.

On the part of the fetus / newborn: hyperglycemia, hyperinsulinemia after birth as a result of ineffective tocolysis and, as a result, hypoglycemia; hypokalemia, hypocalcemia, intestinal atony, acidosis. When using tablet preparations in medium doses, side effects are not pronounced.

Hexoprenaline. With threatening and beginning preterm labor, it is advisable to start with intravenous drip of the drug at a rate of 0.3 μg per minute, i.e. 1 ampoule (5 ml) - 25 μg of hexoprenaline is dissolved in 400 ml of isotonic sodium chloride solution and injected intravenously, starting with 8 drops per minute, gradually increasing the dose until the contractile activity of the uterus decreases. The average rate of administration is 15-20 drops per minute, the duration of administration is 6-12 hours. 15-20 minutes before the end of intravenous administration, oral administration of the drug is started at a dose of 0.5 mg (1 tablet) 4-6 r / day for 14 days .

Salbutamol. Intravenous tocolysis: the rate of intravenous administration of the drug is 10 μg / min, then gradually, under the control of tolerability, it is increased with a 10-minute interval. The maximum allowable rate is 45 µg/min. Orally, the drug is taken at 2-4 mg 4-6 r / day for 14 days.

Fenoterol. For intravenous tocolysis, dilute 2 ampoules of 0.5 mg of fenoterol in 400 ml of 0.9% sodium chloride solution (1 ml -2.5 μg of fenoterol), which is administered intravenously at a rate of 0.5 μg / min. Every 10-15 minutes the administered dose is increased until the effect is achieved. The average rate of administration is 16-20 drops per minute, the duration of administration is 6-8 hours. 20-30 minutes before the end of intravenous administration, oral administration of the drug is started at a dose of 5 mg (1 tablet) 4-6 r / day for 14 days.

Terbutaline is diluted in 0.9% sodium chloride solution. Dose for 1 intravenous infusion 5 mg. The minimum rate of administration is 5 micrograms per minute, after 20 minutes it is increased by 2.5 micrograms until the contractions stop, not exceeding the dose of 20 micrograms per minute. Then the dose is reduced to the minimum that maintains the effect achieved. The duration of the infusion is 8 hours. Orally, the drug is taken at 2.5-5 mg 4-6 r / day for 14 days.

There is evidence of the inappropriateness of long-term oral use of β-agonists due to receptor desensitization. Some foreign authors recommend using tocolytics for 2-3 days, i.e. during the period when the prevention of fetal distress syndrome is carried out.

Intravenous tocolysis is carried out in the position of a woman on the left side under cardiac monitoring.

During the infusion of any β-agonists, it is necessary to control:

  • mother's heart rate every 15 minutes;
  • maternal blood pressure every 15 minutes;
  • blood glucose level every 4 hours;
  • volume of injected fluid and diuresis;
  • the amount of blood electrolytes 1 time per day; i auscultation of lungs every 4 h;

The frequency of side effects as a manifestation of the selectivity of action on receptors depends on the dose of β-agonists. With the appearance of tachycardia, hypotension, the rate of administration of the drug should be reduced, with the appearance of retrosternal pain, the administration of the drug should be stopped.

The use of calcium antagonists (verapamil) to prevent side effects of b-adrenomimetics in a daily dose of 160-240 mg in 4-6 doses 20-30 minutes before taking the tablet preparation of b-adrenomimetics is justified.

Tocolytic therapy with magnesium sulfate is used if there are contraindications to the use of b-agonists or if they are intolerant. Magnesium sulfate is an antagonist of calcium ions involved in the contraction of the smooth muscle fibers of the uterus.

Contraindications:

  • violations of intracardiac conduction;
  • myasthenia gravis;
  • severe heart failure;
  • chronic renal failure.

Intravenous tocolysis with magnesium preparations: at the beginning of preterm labor, intravenous tocolysis of magnesium sulfate is carried out according to the scheme: 4-6 g of magnesium sulfate are dissolved in 100 ml of 5% glucose solution and injected intravenously over 20-30 minutes. Then they switch to a maintenance dose of 2 g / h, if necessary, increasing it every hour by 1 g to a maximum dose of 4-5 g / h. The efficiency of tocolysis is 70-90%.

In case of threatened premature birth, a solution of magnesium sulfate is injected intravenously at the rate of 20 ml of a 25% solution per 200 ml of 0.9% sodium chloride solution or 5% glucose solution at a rate of 20 drops per minute or intramuscularly of a 25% solution 2 r / day, 10 ml .

The tocolytic concentration of the drug in serum is 5.5-7.5 mg% (4-8 meq / l). In most cases, this is achieved at an infusion rate of 3-4 g/h.

When carrying out tocolysis of magnesium sulfate, it is necessary to control:

  • arterial pressure;
  • the amount of urine (at least 30 ml / h);
  • knee jerk;
  • respiratory rate (at least 12-14 per minute);
  • fetal condition and contractile activity of the uterus.

If there are signs of an overdose (inhibition of reflexes, a decrease in the frequency of respiratory movements), it is necessary:

  • stop intravenous administration of magnesium sulfate;
  • within 5 minutes, intravenously inject 10 ml of a 10% solution of calcium gluconate.

Non-steroidal anti-inflammatory drugs have anti-prostaglandin properties. Preferred in cases where it is necessary to provide a quick effect for transporting the patient to the perinatal center.

Indomethacin is used in the form of rectal suppositories of 100 mg, and then 50 mg every 8 hours for 48 hours. Orally, the drug is used (25 mg every 4-6 hours) with caution due to the ulcerogenic effect on the mucous membrane of the gastrointestinal tract. The drug gives a cumulative effect. If necessary, you can resume taking the drug after a 5-day break. There is a risk of narrowing of the arterial duct in the fetus and oligohydramnios. It is necessary to determine the volume of amniotic fluid before starting treatment, and then after 48-72 hours. If oligohydramnios is detected, the use of indomethacin should be discontinued. The use is limited to a gestational age of less than 32 weeks in pregnant women with threatened or incipient preterm labor, with a normal volume of amniotic fluid, lasting 2-3 days.

Fetal contraindications are fetal growth retardation, kidney anomalies, oligohydramnios, heart defects with involvement of the pulmonary trunk, transfusion syndrome in twins.

In our country, a scheme for the use of indomethacin orally or rectally has been developed and is being applied, while the course dose should not exceed 1000 mg. To relieve tonic contractions of the uterus, indomethacin is used according to the scheme: 1st day 200 mg (50 mg 4 times in tablets or 1 suppository 2 r / day), 2nd and 3rd days 50 mg 3 r / day, Days 4-6, 50 mg 2 r / day, 7th and 8th days, 50 mg at night. The total course dose should not exceed 1000 mg. If it is necessary to reuse the interval between the administration of the drug should be at least 14 days. Calcium channel blockers - nifedipine.

Used to stop labor activity. Side effects are comparable to magnesium sulfate and are less pronounced than those of p-adrenergic agonists.

Dosing regimen:

Maintenance dose of 10 mg every 8 hours (can be used for a long time up to 35 weeks of gestation).

Possible complications: hypotension (nausea, headache, sweating, feeling hot), decreased uteroplacental and fetal blood flow. The appointment is contraindicated together with magnesium preparations due to the synergistic effect on the inhibition of muscle contractions, in particular on the respiratory muscles (respiratory paralysis is possible).

Ed. IN AND. Kulakova

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