Causes and symptoms of preterm labor, differences from miscarriage, actions in the event of a threatened early delivery and prevention. Premature birth - treatment

02.08.2019

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.

What is preterm birth - they call births that occurred after 22 weeks and before 37 weeks of pregnancy. They are divided into two periods:

1. Childbirth at 22-28 weeks. The weight of a newborn is approximately 500-1000 grams. If a child born at this gestational age lives more than seven days, then the birth is considered early preterm. If the fetus died during childbirth or during the first week of life, then we are talking about spontaneous abortion (late miscarriage).

2. Childbirth in the period of 29-37 weeks. The fetus weighs about 1000-2500 g. Its body weight is sufficient for independent life, and the child's organs are considered viable (in the absence of developmental anomalies).

Premature birth is considered an unfavorable outcome of pregnancy, since a premature baby, due to the immaturity of organs and systems, to one degree or another, is not able to independently control most of the life processes. The immaturity of the central nervous and respiratory systems, endocrine organs, the absence of certain reflexes make such a child too vulnerable. The earlier the period at which the pregnancy was interrupted, the more often babies have vision problems, severe neurological disorders, etc.

Such children need special, constant and long-term care until the organs and systems mature completely, already outside the womb and begin to function independently. But even careful care and medical supervision do not guarantee that in the future, preterm birth will in no way affect the health of a premature baby.

There is a non-scientific myth that eight-month-old newborns are at greater risk of dying than seven-month-olds. In fact, the official position of medicine in case of a threat of preterm birth is as follows: it is necessary to extend the period of intrauterine development as much as possible, except in cases where the prolongation of pregnancy poses a threat to the life of the mother and child.

Classification

Premature births are those that occur between the 28th and 37th weeks of pregnancy. The mass of the fetus in this case is 1 - 2.5 kg. Depending on the gestational age, premature babies are classified into:

born extremely prematurely (before the 28th week),
born significantly premature (28-32 weeks),
born moderately or slightly premature (32 - 37th week).

Causes

What are the causes of premature birth? There are just a huge number of them. In the early stages, these are, as a rule, various inflammations and infectious diseases. Any inflammation in the uterine cavity affects the muscle tissue and prevents them from stretching. But as the baby grows and develops, the uterus must constantly stretch. If there are any obstacles to this, the uterus tries to throw off the fetus, and premature birth begins.

This is one of the reasons why doctors so strongly recommend getting tested for infectious diseases even before conception. Ideally, infections should be treated before pregnancy. However, if you have not done this in advance, then it's time to do it at the beginning of pregnancy.

In any case, throughout pregnancy, you need to be checked for infectious diseases. The sooner the disease is detected and treatment is started, the more likely it is to keep the pregnancy.

Premature birth at 26, 28, 30 weeks and later most often begins due to a pathology of the cervix, which is called isthmic-cervical insufficiency. With this pathology, the cervix is too weak to hold a gradually increasing fetus. As a result, under his pressure, she begins to open up, which provokes the onset of premature birth.

Very rarely, CI is congenital. Most often, this pathology becomes a direct consequence of abortions and miscarriages, after which you have to scrape out the uterine cavity, or other artificial interventions in this area, when you have to expand the cervix with the help of special tools.

It follows that in women after an abortion, especially if it was done in the first pregnancy, after miscarriages and complex gynecological diseases, the risk of preterm birth increases.

However, sometimes the cause of ICI lies in an excess of male sex hormones in a woman's body, which are produced in the mother's adrenal glands, and starting from a certain period in the child's body.

Infectious diseases and pathologies of the uterus are only the most common causes of premature birth. There are others. So, a multiple or polyhydramnios pregnancy, during which there is an excessive stretching of the uterus, can also end in premature birth.

We must not forget about the pathologies of the development of the uterus. Infantilism, a saddle or bicornuate uterus can also cause premature birth. Various endocrine diseases, including diabetes mellitus or disorders of the thyroid gland, often lead to premature birth.

In addition, it has been noted that the risk of preterm birth is higher in women from dysfunctional families, and has the influence of hard work, constant stress, smoking, alcohol, and drugs.

If a woman has already had a premature birth in the past, the likelihood of a recurrence of the situation increases in subsequent pregnancies.

As you can see, there are a lot of reasons. However, even if you have noticed one or more signs, this does not mean that you will certainly give birth prematurely. In most cases, as you already remember, women manage to carry the child to the end of pregnancy. Moreover, if you know about all your problems, it means that doctors will monitor your condition and will certainly be able to prevent an undesirable situation.

The main reasons contributing to the increased risk of preterm birth are:

unsettled family life
young age,
low socio-economic level,
abuse of drugs, alcohol, nicotine,
abortions and spontaneous miscarriages,
infections in the urinary system,
inflammatory processes in the genitals,
somatic diseases with complications,
violation of the structure and functioning of the genital organs,
complications during pregnancy.

The twentieth part (5%) of the total number of preterm births occurs in the period of 22 - 27 weeks. Their main reasons are:

isthmic-cervical insufficiency,
infection of the membranes as a result of their premature rupture.

Such features very adversely affect the outcome of childbirth, since the full maturity of the lungs of the fetus is not achieved. This does not allow the respiratory system of the newborn to fully function. In some cases, it is possible to accelerate the maturation of the lungs with medication.
There can be many more reasons for causing premature birth in the period of 28 - 33 weeks. However, although at this point the lungs of the fetus have also not reached full maturity, this process is effectively amenable to medical acceleration. With even longer terms of preterm birth, the prognosis for a favorable outcome improves.

signs

The most common symptom of preterm labor is abdominal tension. Depending on the gestational age, it can manifest itself in different ways. In the first months, these are pulling pains in the abdomen and lower back, in the last months, a feeling of petrification of the abdomen, accompanied by painful sensations in the lumbar region. To avoid overdiagnosis, it is necessary to differentiate pain from stretching of the abdominal muscles, pain in the intestines and manifestations of osteochondrosis or urolithiasis from signs of preterm labor.

The second most common but more dangerous symptom is watery vaginal discharge. They signal that there is a spontaneous rupture of the membranes and amniotic fluid is leaking, and the risk of infectious complications is growing every hour. Complicates 40% of preterm births and significantly increases the number of complications and infant deaths. Sometimes women confuse increased vaginal discharge and urinary incontinence with amniotic fluid leakage. Therefore, specific diagnostics are also needed not only for timely diagnosis, but also in order to avoid unnecessary medical interventions.

Bloody discharge from the vagina scares women the most, and it can be a sign of preterm labor, traumatic cervical erosion, or appear during the period of expected menstruation.

Signs indicating the onset of preterm labor are:

heaviness and pulling pain in the lower abdomen,
discharge from the vagina of a bloody or clear liquid,
prolonged (more than 30 seconds) cramping pains,
sensation of fetal movements.

If a pregnant woman has these signs, she should be immediately taken to the maternity hospital for qualified assistance.

Symptoms

Preterm birth is classified into:

threatening,
beginning,
begun.

With threatening premature birth, pain in the lower back and lower abdomen, increased excitability and tone of the uterus are noted. In a vaginal examination, changes in the cervix characteristic of labor are not found, the external uterine os is closed (in multiparous women, it misses the tip of a finger).

When preterm labor begins, cramping pains in the lower abdomen or regular contractions are usually noted. With the help of a vaginal examination, a shortened or smoothed cervix is \u200b\u200bdetermined.

For the onset of preterm labor, regular labor activity and the opening of the cervix by 2-3 cm are characteristic.

In almost 40% of cases, preterm labor begins with premature discharge of amniotic fluid. About 35% of preterm births occur quickly or rapidly.

Compared with timely births, premature births are characterized by an increase in the rate of opening of the cervix, a decrease in the duration of the active phase of labor (the period from the opening of the cervix by 3-4 cm to the end of labor) and the monotony of the rhythm of contractions. With a quick delivery, the duration of the intervals between contractions also decreases, the intensity, duration and pain of contractions increase.

In the case of the onset of premature birth, the patient has:

untimely discharge of amniotic fluid,
violations of labor activity (weak, excessively strong, discoordination),
an increase or decrease in the time of delivery,
bleeding (in some cases, the cause is placental abruption, in others - retention of parts of the placenta),
inflammatory complications,
fetal hypoxia.

Timing

1. Pregnancy 22 - 27 weeks
The main cause is isthmic-cervical insufficiency, characterized by a weakened cervix. As a result, under the weight of a growing child, the uterus opens prematurely, water begins to leak and bleeding occurs. The weight of the child is 0.5 - 1 kg.
In most cases, preterm births during this period occur in women who give birth again, have had an abortion or rupture of the cervix. In this case, it is necessary to extend the gestation period as much as possible, and the child will have a chance to survive only if resuscitation equipment for premature babies is available in the maternity hospital.

2. Pregnancy 28 - 33 weeks
During this period, premature birth occurs in a third of women who become pregnant for the first time. The weight of the child is 1 - 1.8 kg. In 50% of cases, it is possible to prolong pregnancy with medication and prevent premature birth. Extending pregnancy by 2 to 3 days allows you to prepare the immature lungs of the child for functioning, so the likelihood of a successful outcome is high.

3. Pregnancy 34 - 37 weeks
At this time, premature birth is typical for women giving birth for the first time. Infections rarely cause them. The weight of the child is 1.9 - 2.5 kg, and his lungs are sufficiently developed for the full independent functioning of the respiratory system.

Prevention

Prevention of preterm birth - first of all, a woman needs to eat well, get plenty of rest, register on time for prenatal registration (before pregnancy 8 weeks) and regularly visit her gynecologist, limit (or completely exclude) sexual contacts, quit bad habits, and also learn manage your psycho-emotional state in order not to succumb to stressful situations or avoid them as much as possible.

If in a previous pregnancy a woman had a preterm rupture of the membranes or spontaneous preterm labor before 34 weeks of gestation, and the woman is currently carrying only one child, then she may be treated with a formulation containing 17-OH progesterone - 17 alpha-hydroxyprogesterone caproate (17GOPK).

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. But for a woman with a multiple pregnancy, such treatment will be ineffective, since twins are almost always born prematurely.

As your pregnancy progresses, you will need time to accept all the changes that are taking place in your body. Try to take a little time each day to focus on your baby, listen to his movements and take note of any unusual sensations, especially if they cause you pain or discomfort in the form of pressure on the pelvic bones.

Be aware of the signs of preterm labor, and if you notice any of them, tell your doctor immediately. The most important development in the management of preterm birth in the last 50 years has been the use of corticosteroids to accelerate the development of the baby's lungs before birth. The sooner you are diagnosed with preterm birth, the more likely it is that your baby will have minor problems from being born prematurely with this treatment.

Some doctors recommend bed rest for women, but be aware that in some cases it is highly discouraged! So, for example, if you have problems with increased thrombosis or varicose veins, then to prevent premature birth, it is better for you to limit your physical activity, and it is better to refuse bed rest - in such cases it can even be harmful.

How to avoid

The probability of a positive outcome of preterm birth is highly dependent on the start of preventive measures. That is why in the first place in importance is such a preventive measure as regular and full-fledged medical supervision.

The threat of preterm birth in some cases can be prevented. However, if preterm labor has already begun, then they can only be delayed for a few hours.
It is very important for a favorable outcome of subsequent pregnancies to comply with all preventive measures prescribed for a woman during premature birth. At the same time, pregnancy should be planned only after examination and preliminary preparation. In addition, during subsequent pregnancies, hospitalization in the maternity hospital is recommended during the following periods:

2 - 3 weeks (the fetal egg is fixed in the uterine mucosa),
4 - 12th week (placenta is formed),
18 - 22nd week (the uterus intensively increases in size),

as well as on the days corresponding to menstruation. This can significantly reduce the risk of preterm birth.

1. Contact a gynecologist at the antenatal clinic at the earliest stages of pregnancy, for registration and observation. Regular visits to the doctor create many more opportunities for the mother-to-be to get medical check-ups, dietary advice and be aware of the whole process that she has to go through.

2. Increase the period between pregnancies. There is an increased chance of preterm delivery during pregnancy immediately or shortly after delivery. In fact, the risk more than doubles for less than 6 months between pregnancies. First, it takes a long time for the uterus to return to its normal “pre-pregnancy” state, and there is also a risk of inflammation. Secondly, the short interval between pregnancies reduces the time to replenish the depleted mother's body with the vitamins, minerals and amino acids consumed during the previous pregnancy.

3. Strive for normal pre-pregnancy BMI (body mass index), normal pre-pregnancy BMI is 19-25 kg/m.

4. Eat food rich in vitamins and minerals or special vitamin complexes for pregnant women. Low concentrations of vitamins, minerals, proteins, and energy in the body carry the risk of decreased circulation and increased maternal infection, both of which can potentially increase the risk of preterm birth.

5. Avoid periodontal disease. Periodontal disease is a disease caused by a chronic bacterial infection that destroys the gums and periosteum that hold teeth in the mouth. Some studies have linked periodontal disease to preterm birth. Currently, this assumption is based on the idea that pathogenic oral microbes can be transmitted through the blood into the female genital tract, causing an inflammatory reaction that culminates in preterm birth.

6. Tell your doctor in detail about your obstetric, gynecological and medical history. Women with a history of preterm birth have an increased risk of recurrent preterm birth. Women should also inform their doctors of any suspicious signs or symptoms of STDs, such as vaginal discharge, so they can start treatment early. A fairly large number of women have cervical insufficiency (painless softening of the cervix leads to late miscarriage or premature birth).

In this case, the doctor will diagnose the condition of the cervix on an ultrasound and may need to place circular sutures around the cervix (known as a "cerclage") early in the pregnancy. In addition, women should also inform their doctor if they have any health problems (they may have conditions such as diabetes, asthma, hypertension, and seizures) to ensure proper follow-up to reduce the chance of problems such as premature childbirth.

7. Know the symptoms of preterm labor. These include: uterine contractions, cramping pains in the lower abdomen, back pain, and vaginal discharge.

8. Observe the regime of rest and drinking. An adequate rest regimen and sufficient fluids promote good circulation of blood, oxygen, vitamins and nutrients to the growing fetus.

9. Avoid mental and social stress. Depression, family troubles and stressful circumstances such as severe financial difficulties have also been associated with the onset of preterm labor.

10. Stay away from alcohol, tobacco and other similar substances. Smoking affects the peripheral circulation of the mother, has a powerful vasoconstrictive effect - it worsens the normal blood supply to the fetus, which leads to restriction of fetal growth and placental abruption, and, as a result, to premature birth. Alcohol, on the other hand, can cause fetal alcohol syndrome, which is characterized by physical handicaps, heart defects, and intrauterine growth retardation.

It is important to remember that preterm labor begins unexpectedly, most often there are no medical professionals nearby who can immediately provide the necessary assistance. Thus, the best way to protect yourself from premature birth is to follow the above recommendations.

Harbingers

What are the warning signs of preterm labor? In obstetrics, preterm births are defined as births between 28 and 37 weeks of gestation. If during this period you feel some unusual symptoms, this is an urgent reason to at least call the doctor, and even better to meet him. So, how does preterm labor begin:

Drawing pains in the lower abdomen, similar to menstruation.
Heaviness in the lower abdomen, it seems to you that something is pressing hard on the bladder and vagina.
Bloody discharge from the genital tract.
Cramping pains that last more than 30 seconds. Just do not confuse them with training fights (how to distinguish training fights from real ones - see the article "Childbirth begins").
Leakage of clear fluid from the vagina.
You no longer feel fetal movements.

The doctor will assess your condition, and possibly suggest hospitalization in the maternity hospital. But do not panic ahead of time - in many cases, labor activity can be slowed down with the help of special drugs, psychotherapy, an electric relaxer for the uterus, acupuncture, etc.

Consequences

For a pregnant woman who has experienced a premature birth, the consequences are most often fraught with psychological problems. After all, a young mother can blame herself for what happened. Because of this, many suffer from postpartum depression.

But careful care, attention and love for the baby will help overcome this condition. A weak baby now more than ever needs contact with his mother.

More severe consequences of premature birth for the child. It is often required to connect a premature baby to a camera that performs the functions of the respiratory system. After all, babies born before 35 weeks are deprived of the opportunity to breathe normally.

In such infants, the lungs are still poorly developed, they have few surfactants. Their deficiency is replenished by medication, which allows saving the majority of premature babies.

But still, in some cases, one cannot do without artificial ventilation of the lungs for a month. Sometimes these children develop chronic lung diseases due to the immaturity of the lung tissue. Therefore, the doctor prescribes drugs to stimulate the growth of this tissue.

The newborn is also connected to a vital organ control device to monitor breathing, heart rate, blood oxygen saturation, and blood pressure. This device prevents cardiac and respiratory arrhythmia and respiratory arrest.

When caring for a prematurely born child, a feeding device is also used. Initially, it can be administered intravenously. Thus, proteins, fats and carbohydrates, which are necessary for normal development, enter the baby's body.

For this purpose, a special technique is used using certain blood vessels and a pump for the sterile delivery of nutritional ingredients.

The incubator practically replaces the uterus of a premature baby. The right conditions for it are created there, the optimum temperature and humidity are maintained.

In the future, premature babies often become patients with special needs. Due to chronic lung disease, there may be an increased tendency to spastic bronchitis, an increased risk of developing asthma, and shortness of breath during an infection.

In addition, premature babies do not have very mature brains. There is too high sensitivity of the nervous tissue as a result of mechanical damage. The brain also lacks oxygen. All this subsequently negatively affects the work of the nervous system of the child.

Such children are often prone to neurosis, more emotional, active, whiny and need a special approach. They are not easy to deal with, they sleep little and eat poorly. As you get older, these side effects go away.

What can cause preterm labor

Of course, modern medicine can help a premature baby recover, but it is always better if he prepares for life in the womb exactly as much as nature intended.

Therefore, everyone who is preparing to become a mother, already in the early stages, needs to study in detail the information that can affect the duration of pregnancy, cause premature birth. Knowledge about what an obstetric pessary is, and what other ways to prevent preterm births exist will not interfere. In fact, there are a lot of these reasons, below are only their main groups.

Endocrine pathologies. Statistics say that if the mother has endocrine diseases and pathologies, the risk of preterm birth increases. They are also provoked by disorders in the field of sex hormones, and diabetes mellitus - all hormonal disorders.
Infections. Both sexual and somatic varieties are dangerous. Therefore, the former call for cure at the planning stage, and the latter to avoid during childbearing. By the way, even dental caries is a source of danger - after all, this is also a constant source of multiplying bacteria.
Anomalies, defects, changes in the uterus and cervix. There are many reasons for them. The main thing is that the gynecologist is aware of them - most often they provoke isthmic-cervical insufficiency, which can appear as early as 17 weeks. In this case, the pessary during pregnancy keeps the cervix from opening.
Genetics. It is amazing, but the fact is that most often preterm birth occurs in representatives of the Negroid race. This is due to the fact that their body produces imperfect collagen, a protein that makes the fetal membranes strong and allows them to stretch.
Features of pregnancy and fetus. A large fetus, multiple pregnancy - all this can cause a stretching of the cervix. Polyhydramnios, placental insufficiency and other pathologies associated with the placenta also work. Often, in multiple pregnancies, doctors decide to use a pessary to prevent preterm labor.

There are many other factors - adverse conditions of pregnancy, trauma, a certain age. You should not be afraid in advance - after all, calmness during pregnancy is vital. However, we must be prepared to prevent those situations that depend on us, and can cause premature birth.

Management of preterm birth

Therapy depends on the stage. So with threatening and beginning childbirth, treatment includes:

Strict bed rest;
Physical and sexual rest;
Psychotherapy and the use of sedatives (motherwort tincture, valerian extract);
Antispasmodic drugs that relax the muscles of the uterus (baralgin, no-shpa, papaverine);
Means that reduce the contractile activity of the uterus (magnesium sulfate solution, ginipral) - have the greatest effect in the treatment of preterm labor;
Physiotherapeutic effects (acupuncture, magnesium electrophoresis) - rarely used;
If necessary, antibiotic therapy;
A special group consists of drugs to accelerate the maturation of the lungs of the fetus in the period of 28-34 weeks (glucocorticosteroids, ambroxol preparations, surfactant - more often used after the birth of a child). This treatment is used to prevent neonatal respiratory distress syndrome (RDS), a disease associated with underdevelopment of lung tissue in a premature baby.

With the onset of premature birth, the main task of the doctor is the most careful delivery to reduce possible injuries. The longer the gestation period, the better the prognosis for the born premature baby. To date, there are methods for prolonging pregnancy with outflow of amniotic fluid in the absence of infection.

Scheme of management of the onset of preterm labor:

How to call

How to induce preterm labor? The artificial induction of premature labor is called labor induction. It should be carried out only in the absence of contraindications for natural childbirth. Childbirth is recommended for:

post-term pregnancy (diagnosis should be based not only on the term, but also on the condition of the fetus),
Rh-conflict (premature birth is necessary to prevent harm to the health of the child),
late gestosis (premature birth is necessary to prevent harm to the health of the mother).

A component of the most common drugs for labor induction are prostaglandids. Their effect lies in such a change in the structure of the cervical tissue, which ensures its maturation. In addition, a relaxing effect is achieved on the isthmus, cervix and lower segment of the uterus, and the release of endogenous oxytocin by the pituitary gland is stimulated, which enhances the contractile activity of the uterus.

The most commonly used form for prostaglandid preparations is a gel. It is inserted into the posterior fornix of the vagina and the cervical canal. In this case, it is necessary that the fetal bladder be intact (this condition prohibits the use of the gel in case of premature outflow of water). The onset of labor occurs after a few hours after the introduction of the gel, depending on the maturity of the uterus. In the absence of effect, two repeated injections of the gel are allowed.

What to do when threatened

With the threat of premature birth, prolongation of pregnancy is possible, but on condition that the cervix is closed and the amniotic fluid has not departed. Treatment takes place in a hospital, the duration of which can range from several days to months, and in some cases until the birth itself.

First of all, during contractions, a woman is prescribed drugs that help reduce the tone of the uterus. First, the drug is administered intravenously, and when the contractions stop, the woman will take it in the form of tablets up to the 37th week of pregnancy.

At the second stage of treatment, the doctor identifies and tries to eliminate the cause of premature birth. If an infection is detected, the pregnant woman is prescribed antibacterial drugs. With the development of isthmic-cervical insufficiency for up to 28 weeks, sutures are applied to the cervix, which will prevent the fetus from “falling out” of it ahead of time. The sutures will be applied under short-term intravenous anesthesia, which has minimal impact on the fetus. After 28 weeks, if the cervix is inferior, a special ring is inserted into the vagina if there is a threat of premature birth
Golgi, which will support the fetus for a certain time.

Always with the threat of premature birth, a pregnant woman is prescribed a special hormonal drug that accelerates the maturation of the lungs in the fetus. The drug is prescribed for reinsurance, if the baby is still born ahead of time, then thanks to the drug he will be able to breathe on his own.

In addition, the treatment includes bed rest, refusal to eat indigestible, spicy, fatty foods.

The most difficult situation is the leakage of amniotic fluid. If it was possible to stop labor activity for up to 34 weeks, while the condition of the fetus and mother is normal, there is no increase in body temperature and inflammatory changes in the blood, then it is possible to prolong the pregnancy with the obligatory prescription of an antibacterial drug to prevent infection. The fact is that when amniotic fluid leaks, the integrity of the fetal bladder is violated, and now any infection can penetrate inside. That is why taking an antibacterial agent is a vital measure.

Diagnostics

There are two screening tests used to diagnose preterm labor in women who have signs of preterm labor or are at risk of developing them. These tests are called ultrasound cervical length measurement and fetal fibronectin analysis.

Measuring the length of the cervix with ultrasound
Your doctor can estimate the length of your cervix at your first prenatal visit. If he has any doubts, he will prescribe an ultrasound to more accurately measure the length of the cervix and look for signs of change. If the cervix begins to smooth out or expand (open), then there is a very high likelihood of a woman developing premature birth.

A gynecologist may also refer a woman for an ultrasound scan if the cervix is abnormally short on vaginal examination, if the woman is at high risk of cervical insufficiency or has symptoms that indicate cervical changes (eg, pelvic pressure, cramps, pain in back, increased cervical mucus, vaginal spotting or bleeding).

If the ultrasound shows that the cervix has begun to change, the woman should reduce physical activity as much as possible, refrain from sex and be sure to quit smoking if she has not done so before. Depending on the situation and the gestational age of the baby, the woman may have another ultrasound scan in the next few weeks to diagnose or refute preterm labor.

If the pregnancy is less than 24 weeks and the cervix has begun to change, but the woman has no other signs of preterm labor, then she will be advised to have a cerclage, a procedure in which a stitch is placed around the cervix that will keep it closed until the time of delivery. Most often, cerclage is done to women who have already had a history of late miscarriages (in the second trimester) or premature births, as well as if the expectant mother is diagnosed with isthmic-cervical insufficiency.

Screening for fetal fibronectin
This analysis is performed only for those women who have clearly expressed symptoms of preterm labor, especially if they have contractions. Fetal fibronectin (FFN) is a protein produced by the fetal membranes. If it (even in small amounts) is found in cervical mucus or in vaginal secretions between the 24th and 34th weeks of pregnancy, then the woman is considered "pregnant at increased risk of preterm birth."

But, despite the fact that this analysis is very accurate, it will not be able to accurately predict which day you will give birth. Therefore, a positive FFN result may be a signal for your doctor to prescribe drugs to delay labor and corticosteroids to help your baby's lungs mature faster.

If the FFN result is negative, it is very unlikely that you will give birth within the next two weeks. A negative result will not only bring peace to the woman, but also help her avoid hospitalization and unnecessary treatment.

Unfortunately, this method of diagnosing preterm labor is far from being found in every hospital; it is usually carried out only in large commercial (!!!) clinics. Accordingly, it is not free, and you may have to travel to another city to make it, so before making a decision, you need to weigh the pros and cons.

Pregnancy after preterm birth

Even if you do everything right during pregnancy (lead an absolutely healthy lifestyle, eat right, follow all the doctor's recommendations, take all the tests), you can still give birth to a child ahead of schedule. A baby born before the 37th week is considered premature, and the birth is considered premature.

Of course, if a woman has already had the bitter experience of preterm birth, she worries if she will be able to bear the next child for a full 9 months. So is it possible to fully endure pregnancy after premature birth ?! We hasten to reassure you: the fact that you had a premature baby does not mean that the next baby will be born prematurely!

In most cases, the reason why the birth began earlier than the expected date remains unclear. As a rule, childbirth always begins without warning, and it is often impossible to stop it. In addition, there are cases when doctors themselves recommend a woman to give birth early if her health (or the health of her child) is in danger.

Usually, preterm birth is recommended by doctors for:
severe bleeding that cannot be stopped;
severe preeclampsia and severe preeclampsia (eclampsia) in the mother;
aggravated diseases in the mother, especially such as: hypertension; pyelonephritis and other serious kidney diseases; severe anemia; chronic liver diseases; diabetes mellitus (especially if a woman had it before pregnancy); bronchial asthma; diseases of the adrenal glands;
intrauterine fetal death;
progressive deterioration of the fetus in the mother's womb;
incompatible with life malformations in the fetus.

If you have already had a preterm birth and decide to get pregnant again, you should consult with a perinatologist before conception, who specializes in pregnancies with various complications, including preterm birth.

Dangers for baby and mother

Premature birth can cause the following dangerous complications:

premature rupture of the fetal bladder and premature discharge of amniotic fluid,
oxygen starvation (hypoxia) of the child,
infection of the uterus or baby,
rapid delivery,
weak labor activity
ruptures or injuries to the child and mother,
bleeding in the mother.

The most common cause of the death of a child during premature birth is the degree of development of its organs (mainly the lungs) that is insufficient for a full-fledged life activity. To a large extent, the probability of death of a child depends on the term of premature birth.

- delivery at a gestational age of 28 to 37 weeks, accompanied by the birth of a premature and physically immature fetus weighing 1000-2500 g and 35-45 cm long. Premature birth can be threatening, incipient and incipient. Depending on this, the clinical manifestations and obstetric tactics in preterm labor will be different. With threatening and beginning childbirth, they tend to prolong the pregnancy. Preterm labor that has begun with the development of regular labor activity is carried out under the control of the state of the mother and fetus.

ICD-10

O60

General information

Premature birth ends in 5-12% of pregnancies. According to WHO definition, termination of pregnancy at terms of 22-28 weeks, which ended with the birth of a fetus weighing 500-1000 g and lived for at least 7 days, is considered as early preterm birth with an extremely low fetal weight. If a child born from premature birth dies before the 7-day period, such an outcome of pregnancy is regarded by obstetrics and gynecology as a late miscarriage.

Premature births are always associated with a high risk of complications for the newborn. Premature labor that develops at 22-27 weeks is prognostically less favorable in terms of fetal viability, since by this time the lungs of the newborn have not yet reached the required degree of maturity to ensure respiratory function. The outcome of preterm birth at 28-34 or more weeks of gestation is potentially more favorable for the newborn.

Causes

Causes related to the health of the pregnant woman, the condition of the fetus, the course of pregnancy, socio-biological conditions can lead to premature birth. Among the "maternal" factors, STDs (mycoplasmosis, chlamydia, ureaplasmosis, herpes, cytomegalovirus infection, etc.), acute viral lesions (rubella, influenza, viral hepatitis, etc.), chronic pathology of a pregnant woman (tonsillitis, pyelonephritis, etc.) can contribute to the development of preterm birth. heart defects, diabetes mellitus, hypertension), endocrinopathies (Addison's disease, Cushing's syndrome, hypothyroidism, obesity).

The term of pregnancy largely depends on the state of the reproductive organs. Premature birth is often found in women with diseases and abnormalities of the uterus - endometriosis, fibroma, uterine hypoplasia, bicornuate uterus, intrauterine septum, intrauterine synechia. The development of cervical insufficiency, leading to premature birth, is facilitated by damage to the uterus during diagnostic curettage, artificial abortions and childbirth, operations (conization, amputation of the cervix), etc.

The causes of preterm birth due to the condition of the fetus include, first of all, genetic disorders, severe congenital anomalies, malformations, intrauterine diseases (hemolytic disease) and fetal infections. In some cases, invasive prenatal diagnostics - cordocentesis, amniocentesis - can lead to premature birth.

The so-called combined factors of preterm birth associated with the course of pregnancy include immunological conflicts (Rhesus conflict), preeclampsia, placenta previa or its premature detachment, transverse position of the fetus, breech presentation, multiple pregnancy, multiple pregnancies and childbirth, etc.

The frequency of development of preterm birth directly depends on the socio-biological conditions in which the pregnancy proceeds. Premature birth can be provoked by heavy physical labor, excessive mental stress, stress, poor nutrition, and bad habits.

Symptoms of preterm labor

According to the clinical course, preterm labor can be threatening, beginning and beginning. When determining the stage of preterm labor, they are guided by an assessment of the contractile activity of the uterus, the state of the fetal bladder and the birth canal. In the case of the threatening nature of premature birth, the pregnant woman develops aching, pulling pains in the lower back and abdomen, tension of the uterus and its contractions, an increase in the motor activity of the fetus, and sometimes sanious discharge from the genital tract. Such symptoms require an urgent appeal to an obstetrician-gynecologist.

For beginning preterm labor, severe pain in the lower abdomen, regular contractions, a symptom of cervical plug discharge, the appearance of sanious discharge, and often leakage or outpouring of amniotic fluid are typical. With the onset of preterm labor, regular labor activity develops with an interval between contractions of less than 10 minutes, sanious discharge is noted, the presenting part of the fetus descends to the entrance to the pelvis and the rupture of the fetal bladder occurs.

In general, preterm labor is characterized by an untimely discharge of the waters; weak, sometimes strong or discoordinated labor activity; rapid or protracted course; placental abruption and bleeding; postpartum complications; fetal hypoxia.

Diagnostics

To establish the fact of preterm labor and their stage, an important criterion is the assessment of the condition of the cervix and fetal bladder. Vaginal examination and examination of the cervix in the mirrors are carried out to determine the degree of opening of the uterine os, the length and consistency of the cervix. With threatening childbirth, the examination reveals an unchanged neck, a closed external uterine os; at the beginning of childbirth, the cervix is shortened, the uterine os is ajar by 1-2 cm; at the beginning - smoothing of the cervix and opening of the uterine os by 2-4 cm is determined. The gynecological examination must be repeated in dynamics after 30-60 minutes.

To exclude urogenital infections and latent bacteriuria, cervical discharge is cultured for pathogens (staphylococcus, chlamydia, ureaplasma, gonococcus) and bacteriological examination of urine. With the help of ultrasound, the gestational age, the estimated weight of the fetus, its position and presentation, the integrity of the fetal bladder, the condition and localization of the placenta are specified, placenta previa is excluded. Auscultation and instrumental registration of the fetal heartbeat (fetal phonocardiography, cardiotocography) during preterm birth are necessary to detect signs of hypoxia.

Additionally, in order to determine the obstetric status, the Baumgarten tocolysis index is used, calculated by the sum of the points obtained by evaluating a number of objective parameters (presence of contractions, rupture of membranes, bleeding, opening of the cervix). At the same time, the lower the score, the more effective tocolytic therapy can be.

In some cases, with a slow opening of the cervix, premature birth must be differentiated from the pathology of the urinary tract and abdominal organs: pyelonephritis, cystitis, urolithiasis, gastroenteritis, spastic colitis, acute appendicitis.

Treatment for preterm birth

If preterm birth is suspected, immediate hospitalization of the pregnant woman in an obstetric hospital is necessary. If, with the threatening or incipient nature of preterm labor, the tactics of prolonging pregnancy is acceptable, then in the case of early labor, leakage of amniotic fluid, signs of infection or severe extragenital diseases, active labor management is resorted to.

Therapy for threatening and beginning preterm labor requires the appointment of bed rest, sedatives (motherwort, valerian, diazepam) and antispasmodics (drotaverine, metacin, papaverine); physiotherapeutic effects - electrorelaxation of the uterus (amplipulse therapy), electroanalgesia, acupuncture.

In order to accelerate the maturation of the lung tissue of the fetus and prevent respiratory failure of the newborn with the threat of premature birth for up to 34 weeks of pregnancy, glucocorticoid drugs (dexamethasone, prednisolone, betamethasone) are prescribed. Glucocorticoid therapy is contraindicated if a pregnant woman has gastric or duodenal ulcer, endocarditis, stage III circulatory failure, nephritis, active tuberculosis, osteoporosis, severe forms of diabetes mellitus, preeclampsia.

Carrying out tocolytic therapy allows to achieve the removal of contractile activity and tone of the uterus. In preterm birth, the introduction of magnesium sulfate, beta-mimetics (ipratropium bromide, terbutaline, fenoterol, etc.), prostaglandin inhibitors (naproxen, indomethacin) is indicated. Prevention of fetal hypoxia and placental insufficiency is carried out by the appointment of dipyridamole, pentoxifylline, vitamin E.

If streptococcal, gonococcal, chlamydial infections, bacterial vaginosis, trichomonas vulvovaginitis are detected, antimicrobial therapy is prescribed. In case of isthmic-cervical insufficiency, a special ring is applied to the cervix - the introduction of an obstetric pessary, according to indications (in case of insufficiency of the adrenal glands and thyroid gland) - hormonal correction.

Management of preterm birth

Taking into account the obstetric situation, the management of the onset of preterm labor can be expectant-conservative or active. In the first case, the progress of labor activity is monitored without the provision of special obstetric benefits. More often in preterm birth, there is a need for active intervention in the course of natural childbirth or a caesarean section.

The tactics of conducting preterm labor is influenced by the gestational age, the stage of labor, the condition of the fetal bladder, the degree of cervical dilatation, the presence of infection, the severity of labor, the presence and nature of bleeding. The management of preterm labor is accompanied by constant cardiomonitoring.

30% of preterm births are abnormal - with excessive, weak or discoordinated labor activity. Therefore, in the management of preterm labor, antispasmodic drugs and epidural anesthesia during childbirth are widely used. With excessive labor activity, drugs are administered that inhibit the contractile activity of the uterus; with the weakness of the patrimonial forces, rhodostimulation is performed. In order to protect the fetus during passage through the birth canal, they resort to dissection of the perineum - perineotomy.

Indications for caesarean section in preterm birth are severe pathology of the mother and fetus, breech presentation of the fetus. After the birth of a premature fetus, if necessary, they immediately begin to carry out the entire volume of resuscitation.

Complications

In children born from premature birth, due to the immaturity of all anatomical structures, the presence of birth injuries (intracranial hemorrhages, injuries of the cervical spine) is often noted; hypoxia; functional unavailability of the lungs. For a woman, premature birth can be complicated by ruptures and injuries of the cervix, postpartum hemorrhage, infections (suppuration of sutures, postpartum metroendometritis

ICD-10 code

Nowadays, preterm births have become quite common. Despite modern medical equipment that allows us to nurse premature babies even in very severe cases, we all understand that it is better if the growth and development of the child to the physiological norm occurs in the mother's womb, and not in an incubator, albeit an ultramodern one. That is why the threat of preterm birth is the number one fear among the "pregnant audience".

The problem of premature birth is quite serious, of course, that talking about this will not raise the mood of the expectant mother! But you should not worry and be afraid ahead of time either, because the probability of a successful delivery is much higher than the birth of a baby prematurely. In addition, if you know the signs of the onset of preterm labor and take the necessary measures in time, then the baby can be prevented from being born ahead of schedule. We'll talk about this a little lower.

What is preterm birth?
Premature birth is always associated with the struggle for survival, with a long, difficult and expensive treatment aimed at the recovery of the baby. I note that such cases do not always have a happy ending. The earlier the period at which the pregnancy was interrupted, the more often babies have vision problems, severe neurological disorders, etc. It is difficult to overestimate the risk of an early birth for a baby, because his body is simply not ready for independent functioning: the lungs, the gastrointestinal tract are not ready, his body cannot maintain body temperature, etc.

There are cases when induction of premature birth is simply necessary (for medical reasons or at the request of the pregnant woman). According to Russian legislation in our country, abortion can be carried out up to 22 weeks, this is no longer considered an abortion, but premature birth, despite the fact that they are classified as a late miscarriage. If a week after such an interruption of pregnancy, the child remains alive, then such births are classified as early premature, and the surviving fetus is considered a child.

The method of carrying out premature birth is determined by an obstetrician-gynecologist, taking into account the reasons that caused them. If the birth canal is not ready, and if the causes are late toxicosis, which is a threat to the life of the mother, eclampsia or convulsions, a caesarean section is performed, despite the almost complete absence of a chance that the child will survive.

If time does not play a role or abortion is carried out for social reasons, doctors perform the usual preparation of the birth canal using drugs that cause premature birth.

What kind of birth is considered premature?
Premature births are considered to occur before 37 weeks of gestation. In obstetric practice, there are intervals in which preterm birth can occur:

for a period of 22 weeks;
for a period of 22-27 weeks;
for a period of 28-33 weeks;
for a period of 34-37 weeks.

Since January 1, 1993, in our country, according to the adopted new live birth criteria recommended by the World Health Organization, intensive and resuscitation care is provided to newborns weighing 500 g or more, born from the 22nd week of pregnancy. Until 1993, preterm births were considered those that occurred after the 28th week of pregnancy, and resuscitation was only for newborns weighing 1000 g or more.

Babies born at 29, 30, 31 weeks of pregnancy almost always weigh more than a kilogram, their lungs are relatively well prepared for breathing, so they initially have a good chance of survival. But prematurity is not the only problem, it is often associated with hypoxia in labor and before childbirth, natal (birth) trauma (which often leads to the death of babies) and other diseases that caused premature birth.

Causes and symptoms of preterm labor.

Endocrine diseases in a pregnant woman increase the risk of preterm birth and problems during pregnancy. These include hormonal imbalance in the genital area, thyroid disease, diabetes mellitus.
Sexual infections (chlamydia, ureaplasmosis, etc.) that a woman has during the period of bearing a child double the risk of preterm birth. In addition, they can cause disease and malformations in a child. Cervical erosion, chronic salpingitis, endometritis, bacterial vaginosis also pose a threat.
Somatic infections (SARS, tonsillitis, viral hepatitis, untreated teeth) are a source of infection for the fetus and can provoke premature birth.
The presence of malformations, anomalies and tumors of the uterus, changes in the cervix and adhesions due to childbirth and abortion in most cases are the factor that provokes the onset of premature birth. Damage to the circular muscles of the isthmus of the uterus (usually during childbirth or during abortion), which prevent its disclosure during the bearing of the baby, leads to the occurrence of isthmic-cervical insufficiency (ICI). With this phenomenon, the cervix, under the weight and pressure of the fetus, begins to open slightly from 16-17 weeks of pregnancy, the fetal bladder “bulges” into it, which becomes infected, as a result, breaks, provoking premature birth.
Somatic diseases of a non-infectious nature in a pregnant woman (diseases of the kidneys, heart and liver, exhaustion, malnutrition) contribute to the weakening of the body and complicate the course of pregnancy. In this situation, preterm birth occurs very often.
Malformations of the fetus and the presence of genetic diseases provoke premature birth. Usually the threat occurs already at 32 weeks of gestation.
Various complications and features of pregnancy are also a risk factor. This includes the expectation of twins (premature births occur against the background of uterine hyperextension), polyhydramnios, complications in the form of preeclampsia in the later stages, feto-placental insufficiency, placenta previa and abruption. All this can also cause premature birth.
genetic features.
Abdominal injury.
The presence of bad habits in the mother.
Female age under 18 and age over 30 are risk factors.
Heavy physical labor, lack of sleep, chronic stress, mental strain.
Poor nutrition and living conditions.
Incomplete family, unwanted pregnancy.

Premature birth and gestational age.

Premature birth at 22-27 weeks.
Children born at this stage of pregnancy have the lowest survival rate, since their lungs are not yet mature, and their weight is in the range of 500-1000 g. The main factors that provoked premature birth at this stage of pregnancy are isthmic-cervical insufficiency, infection of the fetal bladder and his break. A child born at 22-23 weeks has practically no chance of survival, and those few who could survive (and there have been such cases in obstetric practice) become disabled in the future. Those born between 24 and 26 weeks are more likely to survive, and the prognosis for their health is much better. Premature births between 22 and 27 weeks of gestation occur in only five percent of cases.

Premature birth at 28-33 weeks.
Most children born at this term survive safely, which is largely due to the high level of development of neonatological care, however, it is worth noting that not all children have the fact of prematurity without consequences. Typically, children in this group weigh from 1000 to 1800 grams, their lungs are practically prepared for breathing. At this time, premature birth can occur for a variety of reasons, ranging from pregnancy complications to Rhesus conflict.

Premature birth at 34-36 weeks.
To be born at this stage of pregnancy for the child is not dangerous. A healthy, but premature baby born in a maternity hospital has every chance of quick adaptation and excellent health in the future. The weight of babies born at this time is usually more than two kilograms, the lungs are ready for independent work, a little support with medicines is required to accelerate their maturation. The main culprits of premature birth at this time are somatic diseases of the expectant mother, various complications of the course of pregnancy and intrauterine hypoxia against the background of feto-placental insufficiency.

Symptoms and signs of preterm labor.
Signs of preterm labor can be compared with the threat of termination of pregnancy in the early stages. Most often, their onset is indicated by the outflow of amniotic fluid, but a few days before this, a woman usually has symptoms-harbingers, to which she usually does not pay attention.

In obstetric practice, there are several stages of preterm birth:

Threatening premature birth. During this period, the symptoms of premature birth may not even be noticed. These include pulling pains in the lower back and lower abdomen of a weak nature, tension or contraction of the uterus, which can be seen by placing a hand on the stomach (usually it tenses), restless behavior of the baby (kicks more often), the appearance of mucous secretions from the genital tract, sometimes with an admixture of blood (on examination, the uterus is dense and closed). Contacting a doctor at this stage will help to avoid premature birth, usually minimal medication is prescribed and absolute rest is recommended for the pregnant woman.
Beginning premature birth. Symptoms are more pronounced, in particular, pain in the lower back and lower abdomen become more intense, cramp-like. At this time, the mucous plug often leaves, discharges from the genital tract of a bloody nature are observed, and water is often poured out. During the examination, the specialist reveals the shortening and softening of the cervix, its opening by 1-2 fingers.
Started premature birth. Usually, if the process of childbirth has begun, it can no longer be slowed down. Often, preterm births have a rapid course, for example, in primiparas they pass in 6 hours, with repeated births this time can be halved. The pains become very intense, acquiring a cramping character, and the contractions become regular (every ten minutes or less), the cervix quickly opens, the water leaves, the fetus is pushed to the entrance to the small pelvis.

So, if there are pains resembling pain during menstruation, a feeling of heaviness in the lower abdomen and pressure on the bottom, the activity of the fetus has increased significantly or vice versa weakened, unusual discharge from the genital tract has appeared, you should know that these are the first signs of premature birth. In this situation, in order to “calm down” your “hurry”, you need to seek medical help immediately. Any delay can cost you dearly. In any case, it is better to play it safe in advance than to regret your short-sightedness and carelessness later.

Treatment of threatened preterm birth.
Usually, if a pregnant woman sees a doctor at the stage of threatening preterm labor, she is recommended to be hospitalized in a maternity hospital, but this is not so necessary in all cases. Of course, first a gynecological examination is performed, tests are taken, the condition of the cervix, the child is assessed, the presence or absence of an infection in a woman is revealed.

It is worthwhile to dwell on the leakage of amniotic fluid in more detail. Very often, because of fear, women do not go to the doctor if the water has broken, and the contractions have not yet begun, but in vain. In this case, no one will immediately terminate the pregnancy (there is nothing to be afraid of), especially if its terms have not reached 34 weeks. If there are no signs of infection, the pregnant woman is simply placed in the maternity hospital, where for several days (five to seven or more) specialists will prepare the lungs of the fetus for independent work (glucocorticoids are usually prescribed), while the pregnant woman herself will be protected from infection by antibiotic therapy and the creation of sterile conditions . Delivery will occur only after the lungs of the fetus are ready so that the baby can breathe on its own. Prolongation of pregnancy in case of premature rupture of the membranes is carried out based on the timeliness of treatment and the condition of the pregnant woman at the time of treatment.

With the threat of premature birth for a period of 35 weeks or more with the outflow of amniotic fluid, the pregnant woman is delivered, because the adaptation of such children to extrauterine life is, as a rule, successful. If the amniotic sac is preserved, the treatment is aimed at stopping the onset of labor and eliminating the cause that caused it. If there is only a threat of preterm birth, outpatient treatment is sometimes possible, but in most cases hospitalization is recommended. Often, creating a calm environment for a pregnant woman is enough to stop labor activity and continue the pregnancy.

Once the birth process has begun, it cannot be stopped. If the fetal bladder is intact, then drugs are used as therapy, the action of which is aimed at relaxing the uterus, as well as sedative therapy, physiotherapy and bed rest.

If the treatment was unsuccessful, the contractions did not stop, but increase each time, the question of delivery arises.

Danger of rapid premature birth.
As a rule, premature labor, which is of a rapid nature, is always associated with hypoxia, which is due to frequent uterine contractions and too rapid progress of the fetus through the birth canal. Soft bones and small sizes of the fetal head, as well as weak vessels in combination with the above, can provoke severe birth injuries of the fetus, intracranial hemorrhages and trauma to the cervical spine. By the way, it is precisely because of the way the birth process proceeded, in the case of premature birth, that a premature baby may suffer, and not because of the fact of prematurity.

If the specialists could not stop the premature birth, then they do everything to ensure that the birth takes place as carefully as possible. No methods are used to protect the perineum from ruptures, as this can cause injury to the fetus. Even in the case of breech presentation of the fetus, childbirth is carried out naturally (in the absence of contraindications), and in hospitals all conditions have been created for nursing newborns. In the case of deep prematurity, a caesarean section is performed.

In the case of discoordinated labor activity or its weakness, gentle labor is carried out with thorough anesthesia, careful stimulation, while monitoring the condition of the fetus.

If the pregnancy was prolonged after the outflow of amniotic fluid, there is a high probability of developing endometritis and postpartum hemorrhage. Preterm birth at 35 weeks has virtually no complications.

Caesarean section for preterm birth is not used if the fetus is not fully full-term, and there are clear signs of chorioamnionitis and intrauterine infection, as well as in the case of intrauterine death of the fetus.

In these situations, natural childbirth is necessary, a caesarean section poses a threat to the life and health of a woman.

Prevention of preterm birth is to eliminate the factors that cause them even at the stage of pregnancy planning. Therefore, it is very important to be healthy at the time of pregnancy, or if it happened by chance, it is necessary to register and undergo an examination as soon as possible.

One of the most common and serious fears among pregnant women is premature birth. Even if the pregnancy proceeds calmly, the woman is healthy and does not belong to any risk group, the fear of facing such a dangerous situation remains very strong.

That is why it makes sense to familiarize yourself with the disturbing topic in advance, and not to think about it anymore. Unless, of course, God forbid, you do not happen to face her personally.

Premature birth is called before the 38th week of pregnancy. For a long time, they talked about premature birth, only starting from the 28th week, before this period, the onset of labor was called a miscarriage. However, modern medical technologies allow nursing children born after 22 weeks and weighing more than 500 g. Therefore, already at this time, birth is called premature if the child was born alive and lived for at least 7 days.

Due to the fact that children born before 28 weeks are too difficult to leave, many doctors still say that preterm birth is delivery after 28 weeks, and before that it can only be a miscarriage. After all, not every hospital has expensive life-saving equipment for children weighing less than 1 kg.

However, no matter how you call the situation, but to keep the pregnancy or save the life of the baby, if the pregnancy could not be saved, the doctors will be in any case. Another thing is that without the appropriate equipment and drugs, as well as without the fervent desire of the mother, it is very difficult to do this. That is why it is very important to get to a specialized hospital, to a specialized maternity hospital.

Types of preterm birth

According to the gestational age, preterm births are divided into 3 types:

Very early - premature birth at 22-27 weeks - the weight of the fetus during this period is usually from 500 to 1000 g;
Early premature birth at 28-33 weeks - the weight of the newborn is from 1000 to 2000;
Premature birth at 34-37 weeks - the weight of the child is about 2500 g.

Shared also threat premature birth, beginning And started premature birth. The types of treatment will depend on the type of premature birth, timing, as well as the general condition of the mother and child.

In addition, the chance of a child's survival also largely depends on the period at which preterm birth occurs. However, in any case, the longer the baby is in the womb, the better for him. And every day for which the birth can be delayed will make him healthier and stronger.

premature birth statistics

As an encouraging moment for women who are overcome by the fear of preterm birth, we can cite general statistics on preterm birth. Note that only 6-8% of all births are preterm. Think about it, only 8 women out of 100 give birth prematurely, the rest carry their children safely.

And of this number, only 5-7% falls on the terms from 22 to 27 weeks. Of course, these children are the most difficult to get out, but quite a few manage to save a life. A little more than 30% of premature babies are born between 27 and 33 weeks. It is already much easier to get out of such children, much more than half of them survive.

More than 50% of all preterm births occur at 34-37 weeks. Babies that appeared during this period differ from full-term ones only in size. All systems in their body are already sufficiently developed to exist independently in the outside world.

As you can see, the vast majority of women have absolutely nothing to worry about. For the rest, the main thing is to see a doctor in time. The sooner treatment is started, the greater the chance of a successful outcome.

Causes of preterm birth

What are the causes of premature birth? There are just a huge number of them. In the early stages, these are usually various inflammation and infectious diseases. Any inflammation in the uterine cavity affects the muscle tissue and prevents them from stretching. But as the baby grows and develops, the uterus must constantly stretch. If there are any obstacles to this, the uterus tries to throw off the fetus, and premature birth begins.

In any case, throughout pregnancy, you need to be checked for infectious diseases. The sooner the disease is detected and treatment is started, the more likely it is to keep the pregnancy.

Preterm birth at 27-29 weeks and later most often begins due to pathology of the cervix, which is called isthmic-church insufficiency. With this pathology, the cervix is too weak to hold a gradually increasing fetus. As a result, under his pressure, she begins to open up, which provokes the onset of premature birth.

It follows from this that women after an abortion especially if it was done in the first pregnancy, after miscarriages and complex gynecological diseases the risk of preterm birth increases.

Infectious diseases and pathologies of the uterus are only the most common causes of premature birth. There are others. So, multiple pregnancy or pregnancy, during which there is an excessive stretching of the uterus, can also end in premature birth.

We must not forget about the pathologies of the development of the uterus. Infantilism, saddle or bicornuate uterus can also cause premature birth. Various endocrine diseases often lead to preterm birth, including diabetes or disorders in the thyroid gland.

In addition, it has been observed that the risk of preterm birth is higher in women from dysfunctional families, and hard work, permanent stress, smoking, alcohol, drugs.

If a woman has already had a premature birth in the past, the likelihood of a recurrence of the situation increases in subsequent pregnancies.

Moreover, if you know about all your problems, it means that doctors will monitor your condition and will certainly be able to prevent an undesirable situation.

Symptoms of preterm labor

As mentioned above, the longer the child is in the womb, the more viable and healthy he will be born. It follows from this that it is very important to provide timely assistance to a woman who has begun childbirth, and, if possible, stop them. So, it is very important to consult a doctor in time. And for this you need to know the symptoms of premature birth.

It is really possible to stop the process, but only if we are talking about threatening and beginning childbirth. In the event that labor has already begun, and the cervix has begun to open, then it is impossible to stop childbirth. It remains only to carefully hold them and try to save the baby.

Signs of preterm labor are very important to know. Threatened preterm birth make themselves felt by pain in the lower abdomen and lower back. The uterus is in good shape, which makes the stomach hard. However, the cervix does not open.

Incipient preterm labor accompanied by cramping contractions of the uterus, a rhythmic increase in the tone of the uterus. In fact, these are already full-fledged fights. In this case, the cervix begins to shorten and open. Quite often in this case there is an outpouring of amniotic fluid.

How does preterm labor begin? In terms of symptoms, they practically do not differ from the usual ones, although they are often accompanied by various complications: weak or, on the contrary, excessive labor activity, placental abruption and bleeding. Preterm births often take much less time than regular births.

Treatment for threatened preterm birth

Finding the symptoms of premature birth, the first step is to call an ambulance. Many women have a desire to get to the hospital on their own, but it is better to refrain from this. Extra movements and loads can speed up the process of childbirth, and in a car or taxi there simply will not be the necessary drugs and equipment.

In addition, if preterm labor begins early, it is very important to get into a maternity hospital that specializes specifically in such complications. In this case, the hospital will have not only equipment and drugs that help maintain pregnancy, but also everything that is necessary for nursing premature babies.

After calling the ambulance, it is best to take a sedative, such as valerian or motherwort. An antispasmodic will not hurt either, as a rule, in any house there is a nosh-pa. You need to take 2 tablets at once. After that, you need to lie down and wait for the arrival of the doctor. Talk to your baby, promise that everything will be fine. Such communication usually calms the woman.

After arriving at the hospital, the pregnant woman will first be examined, including on the gynecological chair, to clarify the situation. Is it really a preterm birth? What is the condition of the cervix and so on.

Treatment of the threat of preterm labor and incipient preterm labor, or rather their stop, begins with the appointment drugs that reduce the tone of the uterus, for example, patrusiten or genipral. While the situation remains unstable, drugs are administered intravenously. After the condition of the pregnant woman has stabilized, the injections are replaced with tablets, and they are kept up to 37 weeks, that is, until the period allows the birth to be considered full-term.

Can't do without sedatives. It is very important to normalize the psychological state of a woman. A stressful situation contributes to the development of premature birth, and fear for the health of the baby is a very strong stress. A sedative will help break this vicious cycle.

The next stage of treatment depends on what caused the situation. That is, if a woman has an infection, then she will be prescribed a course of antibiotics. By the way, they will also be prescribed if, for up to 33 weeks, the amniotic fluid leaves or begins to leak, and the child remains defenseless against all infections that the mother comes into contact with, a course of antibiotics is simply necessary. If the amniotic fluid leaves at 34 weeks, premature birth will no longer be stopped.

If we are talking about ICI, then the treatment will also depend on the term. Up to 28 weeks impose suture on the cervix to prevent it from dilating and keep the pregnancy going. The operation is performed under local, very short-term anesthesia.

At a later date, put on the cervix golgi ring, which tightens the neck, and performs the same function as the seams.

Another drug that is sure to be prescribed to a pregnant woman in case of premature birth is dexamethasone. This drug does not contribute to the preservation of pregnancy, its task is to make the child more viable. The fact is that the biggest problem that makes it difficult to save the life of premature babies is that their lungs are underdeveloped.

In the lungs of children up to 37 weeks, there is too little of a special substance - surfactant. It should cover the entire inner surface of the alveoli and prevent them from collapsing during breathing. The hormone contained in dexamethasone promotes the accumulation of surfactant. If necessary, the same drug is administered to newly born children.

However, not in all cases, doctors will by all means try to keep the pregnancy. In some cases, when the situation threatens the life of the mother or child, obstetricians will not only stop the course of childbirth, but, on the contrary, will stimulate them.

This is done in severe forms of preeclampsia, exacerbation of chronic diseases of the internal organs of a woman. With the outpouring of amniotic fluid after 34 weeks, there is also no need to maintain pregnancy.

Management of preterm birth

The management of preterm labor requires a special approach: more careful and attentive. Particular attention is paid to anesthesia. It is equally important to constantly monitor the condition of the mother and fetus, as the situation predisposes to various complications.

Effects of preterm birth on mother and baby

What are the consequences of preterm birth? For mother the consequences will be minimal. By and large, there are not many differences from ordinary births. Moreover, due to the small size of the child, perineal tears are less likely to occur. In some cases, a woman is still detained in the hospital, but, as a rule, this is due to the condition of the baby.

However, she will still need to undergo an examination to more accurately establish the causes of the incident, as well as prescribe treatment to prevent a recurrence of the situation.

The next pregnancy after premature birth, the woman will be under constant medical supervision. Especially at critical times. Naturally, the period at which premature birth began last time will be equated to the critical one.

Besides, timing is considered critical.:

2-3 weeks, when the attachment of the fetal egg occurs;
4-12 weeks, at this time the placenta is formed;
18-22 weeks, at this time the most intensive growth of the uterus occurs.

You also need to be more careful on days when menstruation was supposed to be on the calendar.

For a child the consequences of premature birth will be more difficult, although much depends on how long the baby was born.

If a baby is born before 28 weeks of gestation, he will most likely be transferred immediately to a specialized hospital, where there will be all the necessary facilities to take good care of him.

This does not mean that a mother cannot see her child. Most likely, she will be allowed to see him, and if the baby’s condition allows, they will be allowed to feed and change diapers. In any case, the child really needs maternal love and care.

Babies born between 28 and 34 weeks of gestation are more viable and can get by with an intensive care unit in a conventional maternity hospital.

After 34 weeks, the baby's organs are already developed enough to exist in the outside world. He can already breathe, eat, digest food and remove waste products. The only problem of premature babies at this time is insufficient weight. In this case, the child can stay with the mother in a regular ward.

In all three cases, the mother and relatives will have to spend a lot of time and effort caring for a premature baby. However, the body of young children is very flexible, and most importantly, it is still developing, which means that over time the child will fully recover, and will not be any different from other children.

Prevention of preterm birth

How to avoid preterm birth? Prevention, as you know, is always better than cure. In order to minimize the risk of preterm birth, it is necessary to take care of some very important points even before the start of pregnancy:

Undergo a full medical examination, during which all chronic diseases, individual characteristics of the body and uterus, as well as the presence of infections will be identified. As a result, all infections and inflammations will be treated in advance, and all chronic diseases and body characteristics will be known to doctors even before conception, which means they will be taken into account when;
Timely register with the antenatal clinic, as well as tell the doctor in detail about all your diseases and characteristics, show medical documents - in general, inform the doctor as fully as possible about your state of health;
Avoid contact with contagious patients, in order to avoid infection already during pregnancy;
Avoid exorbitant physical exertion, and also try to reduce the number of stressful situations as much as possible. If a woman has a difficult and nervous profession, or the situation at home is stressful, it makes sense to take sedatives throughout pregnancy. Naturally, after consulting with your doctor;
Regularly undergo all necessary studies, including tests for viruses and infections, ultrasound, KGT, and so on;
Carefully monitor your condition before and during pregnancy.

All these measures will minimize the risk of preterm birth. However, the main thing is to remember that no matter what week the premature birth begins, at 25, 30, 35 ... doctors will do everything possible to save the life and health of the child and mother.

Some women try to delay the moment of hospitalization as much as possible. They can be understood: who wants to hang around in the hospital when you can spend a little more at home? However, it is better to go to the hospital in a timely manner and start treatment.

Remember that you are risking not only your condition, but also the life of your child. If the situation stabilizes, the doctors themselves will let you go home, because they also understand that it will be easier and calmer for you at home.

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