As for the topic...
She herself went through this 3 times, and if it was still required, she still went through it.
The first time, too, there were deviations on the triple test. After amniocentesis, it was necessary to do cordocentesis (the same puncture, only blood from the umbilical cord is taken for analysis). They found that the placenta is slightly mutated, hence the discrepancies in the analyzes. But after the analysis, there is complete confidence that everything is in order. "The child has a genetic passport that there are no gene deviations 99.9%" (c)
Third time in my second pregnancy. The analyzes are also slightly outside the norm. And I went through it again.
Regarding the procedure itself, it is almost painless, they ask me to lie down for 2 hours after that, they do a control ultrasound and, if everything is in order, they send me home. On this day, they give sick leave, and the next. day to work is possible. The first 2 times the procedure took 20 minutes (in 2002), the third time - 5 minutes (probably already filled with a hand).
IMHO I wouldn't be able to do otherwise. It is my choice.

Received today analysis. "high risk of down syndrome" ......... 1 to 197 ......... The doctor said: "redo the screening, suddenly the error of the laboratory" . I did the screening in Art-med, I have a doctor in another clinic, and I will redo it in it. I'll go on Monday. Keep your fists..........

Discussion

With my second son, I had almost the same screening result of 1:175. But I found out about it by the time the second screening came up. I didn’t do the second one, I went for an ultrasound to Malmberg (I think it’s spelled that way) - she is an excellent specialist in developmental anomalies - the ultrasound showed that everything is fine. I also went to a geneticist - he asked everything about hereditary diseases, bad habits and said that this was most likely a false positive. result. Also, in the initial stages, I took duphaston, the doctor said that he could have an effect. She explained that they take the mother's blood and try to determine what is happening with the child. This is a VERY unreliable analysis, which can be influenced by a bunch of factors. In short, I didn’t worry anymore, everything is fine with the child.

My risk was much higher. She refused amnio, but when the second screening was done, the result was even worse. Did for fidelity in two different places. I had a cordocentesis at 22 weeks. 3 minutes, not painful and not scary. They did it in RD 17, head of the department of genetics. I got there in the direction from the LCD. In the end, everything is fine. But my nerves to wait until the birth of a child would not be enough. And for sure, it would be worse for the child.

The relevance of this issue has become more and more obvious lately :) Girls, do not be lazy, connect! Pregnancy FAQ Managers, please include the collected statistics in the FAQ. So. Please look into your documents and see all 1st trimester screening figures. I explain: this is an ultrasound scan at 10-13 obstetric weeks (from menstruation) and blood for PAPP-A and free betta hCG. 1) Pregnancy period 2) TVP (collar space) by ultrasound 3) The result of PAPP-A in units (and norms in brackets) 4) ...

Discussion

Hello. Help dispel my worries about the results of 1 screening.
I am 37 years old, we are on the 5th, there was no birth. Previously, there were 2 deputy pregnancies, ectopic and after an accident (2009) long treatment and rehabilitation (this is all that is indicated in the anamnesis). According to genetics, a predisposition to Thrombophilia, but none of the relatives was noticed. I give Enoxaparin 4000 injections 1 injection per day. Dufaston 1 tab. 3 times a day.
The results of 1 screening came yesterday. Although the doctor warned on the ultrasound that the blood would definitely not be ice with age and taking Duphaston, but the main thing is that according to the ultrasound, everything is fine with us.
1) The term was set at 12 weeks 3 days (everything is the same day to day) both according to ultrasound and DPM.
2) TVP -2.1 mm, CTE -61 mm, BPR - 19 mm, OG - 73 mm, coolant -58 mm, Chorion - low on the back wall, Nasal bone - is determined, no fetal pathologies were detected by ultrasound, the length of the church canal was at 10-11 weeks 35-36mm, at the time of ultrasound 39mm.
3) PAPP-A 3.340 IU/l
4) PAPP-A 1.494 MoM
5) betta hCG 22.00 IU/l
6) betta hCG 0.584 MoM
Uterine arteries PI: 1.490 or 0.937 MoM
7) Trisomy 21 Baseline risk 1:145, Individual adjusted risk 1:2906
Trisomy 18 Baseline risk 1:350, Individual adjusted risk 1:7000
Trisomy 13 Baseline risk 1:1099, Individually adjusted risk Pre-eclampsia before 34 weeks 1:1288
Preeclampsia up to 37 weeks 1:244
Growth retardation up to 37 weeks. 1:720
Spontaneous delivery up to 34 weeks. 1:1461
8) At the time of the research on 08/08/18 (12 weeks and 3 days):
- Defects and anomalies of the fetus - NOT DETECTED
-Risk of fetal chromosomal abnormalities - INCREASED
- Risk of preeclapsia and fetal growth retardation -LOW

Pregnancy 2a, 29 years old, first with a healthy boy. Real 13 weeks 3 days, TVP 1.8. According to ultrasound, the nasal bone is 1.6. But the ultrasound was redone the next day and the nasal bone was 2.2 mm, KTP 64MM. And the blood data and risks were calculated for the 1st ultrasound: B-hCG 44.01 IU / l / 1.336 MoM (norms not indicated), PAPP-a PAPP-2.719 IU/l/0.597 MoM...equipment BRAHMS kryptor. Trisomy 21 baseline risk 1:724, individual 1:42, others do not exceed

Health experts have long been saying that women should take at least a two-year break between births, but a new study suggests that this is not enough. Several recent studies show that babies born three to five years after previous births are less likely to be born prematurely or underweight than those born after a shorter interval. The increase in the break between children is also beneficial for mothers ...

At present, the optimal mode of delivery for infected women has not been fully determined. To make a decision, the doctor needs to know the results of a comprehensive virological study. Natural childbirth includes a whole range of measures aimed at adequate analgesia, prevention of fetal hypoxia and early rupture of amniotic fluid, and reduction of trauma to the birth canal in the mother and skin of the baby. Only when all preventive measures are observed ...

Discussion

Absolutely agree. Unfortunately, at the moment there is no consensus on the safest management of childbirth with hepatitis C. According to statistics, the likelihood of a child being infected with hepatitis is slightly lower with a planned caesarean section than with natural childbirth. However, none of these methods can guarantee the safety of the child in terms of infection with hepatitis. Therefore, the choice of method of delivery is based more on the obstetric history than on knowledge of the presence of this infection.

Any person who is preparing to become a parent wants his child to be healthy, so that the pregnancy goes as smoothly and easily as possible. And possible threats come not only from external negative factors, but also from internal ones, and one of them is genetics. All biological characteristics that are inherited are contained in the 46 chromosomes that make up the genetic set of each person. These chromosomes contain encrypted information about many, many generations of the genus...

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

Recently, the number of women who decide to give birth to their first child after 35 and even after 40 years is growing. And if earlier women who gave birth after 28 years were already considered “old-timers”, today this does not surprise anyone. In the modern world, many women postpone the birth of children indefinitely because they first want to achieve career success, improve their financial situation, stabilize their personal lives, because now the age of marriage has also increased. Due to the fact that under...

Discussion

Hello Olga!
I really liked your article about late children. So detailed and very well built logically. And most importantly - so well conveying my own thoughts. I also gave birth to a child at almost 40 and do not regret it at all. I think if I had given birth earlier, there would have been more problems and much less satisfaction. I hope you raise this topic in your blog more than once, and we will read and comment :-) Therefore, I subscribe to your RSS feed. Thanks again!

Over the past decades, life has made significant changes in the relationship between the doctor and the patient. Currently phrases like; “The doctor forbade me to give birth!” - cause a smile and seem to be borrowed from a women's magazine of the middle of the last century. Now doctors do not “prohibit” anything, and even if they did, the patients, it seems, would not be in a hurry to follow such directives. A woman has the right to independently decide the issue of motherhood - this is evidenced by the current legislation and common sense. Meanwhile, it should be noted that over these decades, the health indicators of the female population of Russia have not improved significantly. In addition, the proportion of older women in childbirth is increasing year by year - a modern woman often seeks to first strengthen her position in society and only then have children. It is no secret that over the years we do not get younger, and accumulate a number of chronic diseases that can affect the course of pregnancy and childbirth.

Igor Bykov
Obstetrician-gynecologist

Modern science knows several thousand diseases. Here we will talk about the diseases that are most typical for women of childbearing age, and their impact on the course of pregnancy.

Hypertension 1 is one of the most common chronic diseases among young women. Manifested by vascular spasm and a persistent increase in blood pressure above 140/90 mm Hg. In the I trimester, under the influence of the natural factors of pregnancy, the pressure usually decreases somewhat, which creates the appearance of relative well-being. In the second half of pregnancy, the pressure increases significantly, pregnancy, as a rule, is complicated by preeclampsia (this complication is manifested by an increase in blood pressure, the appearance of edema, protein in the urine) and insufficient supply of oxygen and nutrients to the fetus. In pregnant women and women in labor with hypertension, complications such as premature detachment of a normally located placenta, postpartum hemorrhage, and cerebrovascular accident are not uncommon. That is why patients with severe hypertension (a significant increase in blood pressure) are sometimes recommended to terminate the pregnancy at any time.

If the risk is low, the district gynecologist observes the pregnancy together with the therapist. Treatment of hypertension during pregnancy is mandatory and differs little from the treatment of hypertension outside of pregnancy. Delivery, in the absence of other indications for surgery, is performed through the natural birth canal.

Arterial hypotension 2 quite common in young women and is manifested by a persistent decrease in blood pressure to 100/60 mm Hg. and below. It is easy to guess that problems with hypotension begin in the first trimester, when blood pressure already tends to decrease.

Complications of arterial hypotension are the same as in hypertension. In addition, during pregnancy there is often a tendency to overbearing, and childbirth is almost always complicated by the weakness of the birth forces.

Treatment of hypotension during pregnancy consists in normalizing the regime of work and rest, taking fortifying agents and vitamins. Hyperbaric oxygen therapy is also used (a method of saturating the body with oxygen under elevated barometric pressure). Delivery is carried out through the natural birth canal. Sometimes prenatal hospitalization is required before childbirth in order to prepare the cervix for childbirth and prevent overgestation.

Varicose disease 3(violation of the outflow of venous blood as a result of a deterioration in the functioning of the valvular apparatus of the veins, expansion of the veins) affects mainly the lower extremities and the vulva. Most often, varicose veins are first detected or first appear during pregnancy. The essence of the disease consists in changes in the wall and valvular apparatus of peripheral veins.

Uncomplicated varicose veins are manifested by dilatation of the veins (which is perceived by pregnant women as a cosmetic defect) and pain in the lower extremities. Complicated varicose disease suggests the presence of other diseases, the cause of which is a violation of the venous outflow from the lower extremities. These are thrombophlebitis, acute thrombosis, eczema, erysipelas (an infectious disease of the skin caused by pathogenic microbes - streptococci). Fortunately, complicated varicose veins are rare in young women.

Childbirth in patients with varicose veins is often complicated by premature detachment of the placenta, postpartum hemorrhage. Childbirth is carried out through the natural birth canal, if pronounced varicose veins of the external genital organs do not prevent this. During pregnancy and in the postpartum period, physiotherapy exercises and elastic compression of the lower extremities are necessary - the use of special tights, stockings or bandages that have a compressive (compressive) effect on the venous wall, which reduces the lumen of the veins, helps the venous valves work.

Heart defects are diverse, so the course of pregnancy and its prognosis in such cases are very individual. A number of severe defects, in which the heart cannot cope with its functions, is an absolute contraindication to carrying a pregnancy.

The gynecologist observes the rest of the pregnant women with heart defects in close contact with the therapist. Even if the pregnant woman feels good, she is sent for planned hospitalization at least three times during pregnancy: at terms of 8-12, 28-32 weeks and 2-3 weeks before delivery. In the absence of heart failure, delivery is through the natural birth canal. To exclude attempts, the imposition of obstetric forceps is sometimes used. Particular attention is paid to anesthesia in order to prevent an increase in the load on the heart under stress. A caesarean section is not advantageous in women with heart defects, since the operation itself is no less stressful on the cardiovascular system than natural childbirth.

Bronchial asthma- an allergic disease. Pregnancy sometimes alleviates the course of asthma, sometimes it aggravates it significantly.

Bronchial asthma during pregnancy requires the usual treatment for this disease with bronchodilator drugs, used mainly in the form of inhalations. Asthma attacks are not as dangerous for the fetus as it is commonly believed, since the fetus is much more resistant to hypoxia (oxygen starvation) than the mother's body. Conducting childbirth on the background of bronchial asthma does not require any significant adjustments.

Pyelonephritis 4 fairly common among women of childbearing age. This is an inflammatory disease of a microbial nature that affects the tissue of the kidney and the walls of the pelvicalyceal apparatus - the system through which urine flows from the kidneys. During pregnancy, pyelonephritis is often first detected, and long-term chronic pyelonephritis is often exacerbated due to the fact that pregnancy represents an increased functional load for the kidneys. In addition, the physiological bends of the ureters are aggravated, which creates favorable conditions for the habitation of pathogens in them. The right kidney is affected somewhat more often than the left or both.

A contraindication to pregnancy is a combination of pyelonephritis with hypertension, renal failure, and pyelonephritis of a single kidney.

Pyelonephritis is manifested by lower back pain, fever, detection of bacteria and leukocytes in the urine. The concept of "asymptomatic bacteruria" is distinguished - a condition in which there are no signs of an inflammatory process in the kidneys, but pathogenic bacteria are found in the urine, which suggests that they inhabit the renal pelvis and urinary tract in abundance. Like any inflammatory process, pyelonephritis is a risk factor for intrauterine infection of the fetus and other elements of the fetal egg (chorioamnionitis, placentitis - inflammation of the membranes, placenta). In addition, pregnancy in patients with pyelonephritis is much more often complicated by preeclampsia with all its attendant troubles.

Pyelonephritis and asymptomatic bacteruria are subject to mandatory treatment with antibiotics and agents that improve urine excretion. Childbirth in this case, as a rule, proceeds without features. Children born to mothers with pyelonephritis are more likely to be prone to purulent-septic diseases.

diabetes mellitus 5 during pregnancy poses a serious threat to the health of the mother and fetus. The obstetric classification of diabetes distinguishes between pregestational (existing before pregnancy) diabetes and gestational diabetes, or "diabetes in pregnancy" (impaired glucose tolerance, manifested in connection with pregnancy).

Diabetes mellitus has a number of categorical contraindications to pregnancy. This is diabetes complicated by retinopathy (damage to the vessels of the eyes) and diabetic nephropathy (damage to the vessels of the kidneys); diabetes resistant to insulin treatment; a combination of diabetes and Rhesus conflict; the birth of children with congenital defects in the past; as well as diabetes mellitus in both spouses (since in this case there is a high probability of having children with diabetes).

The first half of pregnancy in diabetic patients often proceeds without complications. In the second half, pregnancy is often complicated by polyhydramnios, preeclampsia, pyelonephritis.

1 You can read about folk remedies used for hypertension during pregnancy in the magazine "9 months" No. 7/2005.

2 You can read about folk remedies used for hypotension during pregnancy in the magazine "9 months" No. 6/2005.

3 Read more about varicose veins of the lower extremities in the magazine "9 months" No. 7/2005.

4 You can read more about pyelonephritis during pregnancy in the Pregnancy magazine No. 6/2005.

RUSSIAN ACADEMY OF MEDICAL SCIENCES

RESEARCH INSTITUTE OF OBSTETRICS AND GYNECOLOGY them. D. O. OTTA

V. V. Abramchekko, A. G. Kiselev, O. O. Orlova, D. N. Abdullaev

MANAGEMENT OF HIGH RISK PREGNANCY AND BIRTH

SAINT PETERSBURG

INTRODUCTION

Abramchenko V. V., Kiselev A. G., Orlova O. O., Abdullaev D. N. Management of high-risk pregnancy and childbirth.- St. Petersburg, 1995

Based on literature data and our own experience, the issues of identifying and managing high-risk pregnant women and women in childbirth are highlighted. Particular attention is paid to the treatment of women with complications of pregnancy and childbirth. In particular, the issues of managing pregnant women with breech presentation of the fetus, narrow pelvis, diabetes, and diabetes are highlighted. The second part of the monograph is devoted to a number of complications of pregnancy and childbirth: the regulation of labor activity, the prevention and treatment of mecoia aspiration syndrome, modern methods of treating fetal hypoxia

The book is intended for obstetrician-gynecologists, neonatologists and anesthesiologists working in obstetric institutions.

V. V. Abramchenko, A. G. Kiselev, O. O. Orlova, D. N. Abdullaev.

In Russia, the main goal in the field of maternal and child health" is to develop conditions for "preserving the health and working capacity of women, addressing issues of rational tactics - managing pregnancy 1 , childbirth, the postpartum and neonatal period, identifying ways to reduce maternal, perinatal and child morbidity and mortality . At the same time, the creation of optimal conditions for women's health and the development of pregnancy is the basis of "Prevention of perinatal pathology. O. G. Frolova et al. (1994) consider the reduction of reproductive losses to be one of the main directions in the protection of motherhood and childhood. The authors propose to consider reproductive losses as the end result of the influence of social, medical and biological factors "and the health of pregnant women and newborns. The authors refer to reproductive losses as the loss of embryos and fetuses throughout the entire gestation period. On average, 32.3% of all pregnancies in the Russian Federation end in childbirth.

According to statistics, high-risk pregnancies in the general population are approximately 10%, and in specialized hospitals or perinatal centers they can reach 90% (Yu. I. Barashnev, 1991 and others). Materials from WHO (1988) show that in Europe we are still far from defining what a rational birth technique should be.

In the work of the World Health Organization (WHO, Geneva, 1988, 1992), "family protection programs, in particular, maternal and child health, are also assigned a priority task. It is emphasized that deaths in the perinatal period are responsible for most of the stable and catastrophic high rates equal to infant mortality It has been shown that * perinatal mortality is closely associated with poor health and nutrition of the mother, complications of pregnancy and childbirth.

V. V. Chernaya, R. M. Muratova, V. N. Prilepskaya et al. (1991) recommend, depending on complaints, general somatic and reproductive history, objective examination data, 3 health groups should be distinguished among those examined:

- Healthy- in the anamnesis there are no violations in the formation and subsequent course of menstrual function, there are no pinecolic diseases, complaints; with an objective examination (laboratory and clinical), there are no changes in the structure and function of the organs of the reproductive system.

- Practically healthy- in the anamnesis there are indications of gynecological diseases, functional abnormalities

or abortions; there are no complaints at the time of the examination, or an objective examination may be anatomical changes that do not cause dysfunction of the reproductive system and do not reduce the working capacity of women.

__ sick- there may be (or be absent) indications of

gynecological diseases in history. Complaints at the time of the examination may or may not be present. An objective examination revealed the presence of a gynecological disease. On the. for the purpose of monitoring the state of health and the effectiveness of the medical and recreational activities carried out *, a “Control card of a dispensary patient (account file No. 30)” is entered for each patient.

Assessment of the health status of pregnant women should be carried out as follows:

The health of a pregnant woman can be considered as a state of optimal physiological, mental and social functioning, in which the race system! maternal organism ensure the usefulness of the health and development of the fetus.

The healthy group includes pregnant women who do not have somatic and gynecological diseases, who carry the pregnancy to the term of physiological childbirth. These pregnant women do not have risk factors for perinatal pathology.

To the group practically healthy pregnant women include women who do not have somatic and gynecological diseases, who carry their pregnancy to the term of normal delivery. The total assessment of the identified risk factors for perinatal pathology corresponds to a low degree of risk throughout pregnancy.

The rest of the pregnant women belong to the group sick, Assessment of the health status of the contingent of women who gave birth

should be carried out depending on the state of health at the time of pregnancy, childbirth and the postpartum period, with particular attention to the restoration of reproductive function.

The group of observation for puerperas is established at her first visit to the antenatal clinic.

Group I - includes healthy individuals with a physiological course of pregnancy, childbirth and the postpartum period, with sufficient lactation.

Group II includes practically healthy individuals with a physiological or complicated course of pregnancy, childbirth and the postpartum period, who have risk factors for the occurrence or worsening of extra genital and gynecological diseases; complaints" at the time of the examination are absent, with an objective examination there may be anatomical changes

niya, ve causing violations of reproductive function and the general state of health.

Group III includes patients with a physiological or complicated course of pregnancy, childbirth and the postpartum period, whose objective examination revealed the presence of obstetric pathology, gynecological diseases, worsening of the course of extragenital diseases.

The allocation of these groups is determined by the different nature of medical events.

Dispensary observation of the contingent of women who gave birth is carried out within a year after childbirth. In the future, regardless of the health group, “observation is carried out three times by actively calling those who have given birth to the antenatal clinic (by the 3rd, 6th and 12th months after birth). Three months after childbirth, a bimanual examination and examination of the cervix with the help of mirrors with the use of the Schiller test screening test (if possible, colposco-p "ii), bacteriological and pytological studies are performed. At this stage, health measures and individual selection of contraceptive methods are necessary.

At the 6th month after delivery, in the absence of contraindications, intrauterine contraception should be recommended. An active call for women to a consultation is carried out in order to control lactation, menstrual function and prevent unwanted pregnancy, social legal assistance. The third visit is advisable for the formation of an epicrisis on the final rehabilitation of women by the year after childbirth, the issuance of recommendations on contraception, planning subsequent pregnancy and women's behavior in order to prevent existing complications.

At the same time, it is essential to emphasize that the analysis of domestic and foreign literature shows that the level of perinatal morbidity and mortality is especially high in a certain group of pregnant women, united in the so-called. chew high-risk group. The allocation of such a group of pregnant women and women in labor allows organizing a differentiated system for providing obstetric and pediatric care to this contingent of women and<их новорожденным детям. В этой связи особое значение приобретает совершенствование организации акушерско-гинекологической помощи в сельской местности.

So far, the urgency of the problem of maternal mortality has not decreased. The level of maternal mortality in the Russian Federation is high, exceeding the corresponding indicator of developed economic countries by 6-10 times, and does not tend to decrease (Sharapova E.I., 1992; Perfilieva G.N., 1994). The analysis shows that the high level of maternal mortality is mainly due to abortion and such

obstetric complications, such as bleeding, preeclampsia and purulent-septic complications.

Great importance is attached to the relationship and interaction of an obstetrician-gynecologist and a paramedical worker in the prevention of a number of complications of pregnancy, childbirth and perinatal morbidity and mortality.

From rare diseases not related to pregnancy in the Russian Federation, 95- 110 women, accounting for 14-16% of all maternal deaths 1 . A significant influence of extratenital pathology on the formation of the most dangerous obstetric complications was also established. Thus, in women who died from obstetric bleeding, extragenital pathology was determined in 58% of cases, from gestosis - in 62%, from sepsis - in 68%. While in the population of pregnant women, extrahegoital diseases occur in 25-30% (Serov V.N., 1990).

The proposed monograph will acquaint the reader with the modern tactics of managing pregnancy and childbirth in high-risk groups.

Chapter I. High risk pregnant women

"Researchers from many countries are engaged in determining the factors and high-risk groups of pregnant women. At the same time, most authors, based on clinical data, identified risk factors, and then developed a system for their assessment. In the Russian Federation, the most thorough studies on the identification of risk factors belong to L. S. Persianinov and et al. (1976) The authors, based on a study of literature data, as well as a multifaceted development of birth histories in the study of the causes of perinatal mortality, identified individual risk factors.They included only those factors whose presence led to a higher level of perinatal mortality compared to L. S. Persianinov et al (1976) divided all identified risk factors into prenatal (A)

and intranatal (B).

Prenatal factors were divided into 5 subgroups: 1) socio-biological factors; 2) obstetric and gynecological history data; 3) the presence of extragenital pathology; 4) complications of this pregnancy; 5) assessment of the condition of the fetus. The total number of prenatal factors was 52.

Intranatal factors were divided into 3 subgroups: 1) maternal risk factors, 2) placenta, and 3) fetus. This group contains 20 factors. Thus, a total of 72 risk factors were identified (see Table No. 1). A number of authors

lie from 40 to 126 factors. Further, the authors point out that the analysis of literature data, evaluation of the work of antenatal clinics and maternity hospitals convinced that for obstetrics and gynecology practice at present, the scoring system for assessing risk factors should be considered the most acceptable. It makes it possible to evaluate not only the probability of an unfavorable outcome of childbirth in the presence of each specific factor, but also to obtain a total expression for the probability of the influence of a particular factor. The assessment scale of risk factors (in points) was developed by the authors based on the analysis of 2511 births that ended in fetal death in the perineum.

Table 1RISK FACTORS DURING PREGNANCY AND DELIVERY

Continuation

8. Height-weight indicators of the mother:

height 150 cm or less 1

weight is 25% higher than normal 2 II. Obstetric-gynecological history

I. Parity:

2. Abortions before the first birth:

3 4 3. Abortions before repeated childbirth:

4. Premature birth:

5. Stillbirth:

6. Death in the neonatal period:

7. Developmental anomalies in children 3

8. Neurological disorders 2

9. Weight of children less than 3500 2 and more than 4000 g. 1

10. Complicated course

previous rads 1

I1. Infertility more than 2 - 5

12. Scar on the uterus after operations 4

13. Maggoi and ovarian tumors 1 - 4

14. Isshiko-vdrvikalnaya insufficiency 2

15. Maggie Malformations 3

3 4

8. Chronic specific infections (tuberculosis, brucellosis, syphilis, current soplasmosis, etc. ______ 2-6

9. Acute infections during pregnancy 2- 7

IV Complications of pregnancy

1. Severe early toxicosis 2

2. Bleeding in the first and second half of pregnancy 3-5

3. Late toxicosis.:

dropsy 2 nephropathy I-II-III

degree 3-5-1(

preeclampsia 11

eclampsia 12

4. Combined tokoikoya 9

5. Ph-negative blood 1

6. Ph and ABO-isooensibilia-

7. Miogovodve, 3

9. Breech presentation zЁSH

10. Multiple pregnancy m£Nz

11. Post-term pregnant! - SC

12. Repeated use of medications 1

V. Assessment of the state of the fetus

1. Fetal hypotrophy 10-20

2. Fetal hypoxia 3-8

less than 4.9 mg / day. at 30 over. 34

less than 12.0 mg / day. at 40 weeks fifteen

4. Presence of meconium in amniotic fluid 3

Continuation

B. INTRANATAL PERIOD

tal period, and 8538 deliveries with a favorable outcome. In addition, the results of a study of the fetal condition (ECG, F|KG, ultrasound examination) were used.

The total perinatal mortality for the totality of births in the group as a whole was conditionally taken as I point. Based on this provision, the assessment of points for each risk factor was made on the basis of the calculation of the level of perinatal mortality for the entire set of births and its indicators in women with the presence of one of these factors.

The risk assessment principle was as follows. The probability of the risk of an adverse outcome of pregnancy and childbirth for the fetus and newborn was divided into three degrees: high, medium and low. Each degree of risk was assessed on the basis of the Angar scale and the level of perinatal mortality. The degree of risk of perinatal pathology was considered high for children born with an Apgar score of 0-4 points, medium - 5-7 points and low -8-10 points.

To determine the degree of influence of maternal risk factors on the course of pregnancy and childbirth for the fetus L. S. Persianinov

et al. scoring of all antenatal and intranatal risk factors present in the mother of these children was performed. At the same time, women with a total assessment of prenatal factors of 10 points or more were assigned to the group of high-risk pregnant women, to the group of medium risk - 5 - 9 points, low - up to 4 points.

According to L. S. Persianinov et al. (1976) at the first examination of women (up to 12 weeks of pregnancy), the high-risk group is 18%, and by the end of pregnancy (32 - 38 weeks) increases to 26.4%. According to the literature, the high-risk group of pregnant women is 16.9 - 30% (Hicks, 1992,

Zacutti et al., 1992 and others).

During childbirth, women were distributed according to the degree of risk as follows: with low risk - 42.8%, medium - 30%, high - 27.2%. Perinatal mortality was 1, 4, 20, 0 and .65.2%, respectively. Thus, the proportion of the group of women with low risk during childbirth is decreasing, while the groups of medium and high risk are increasing, respectively. The data obtained by the authors show that risk factors in childbirth have a stronger effect on the level of perinatal mortality compared to those during pregnancy. The combination of high risk factors during pregnancy and childbirth is accompanied by a high rate of perinatal mortality (93.2%). Since the same level of perinatal mortality occurred in pregnant women and parturient women with risk factors estimated at 4 points, this group was classified as high risk factors. The presence of one of these factors in a pregnant woman or a woman in labor requires special attention from an obstetrician-gynecologist and other specialists who monitor her during pregnancy and childbirth. In conclusion, L. S. Persianinov et al. emphasize that the organization of specialized clinics, intense monitoring high-risk pregnant women can significantly reduce perinatal mortality. Thus, intensive dynamic monitoring of one of the high-risk groups made it possible to reduce the level of perinatal mortality by 30% compared with this indicator in a similar group of pregnant women who were under normal supervision.

O. G. Frolova, E. I. Nikolaeva (1976 - 1990) on the basis of a study of the literature, as well as the development of more than 8000 birth histories, individual risk factors were identified. Evaluation of the outcomes of childbirth based on the materials of 2 basic antenatal clinics showed that the group of low-risk pregnant women left 45%, medium risk - 28.6%, high risk - 26.4%. At the same time, perinatal mortality in the high-risk group of pregnant women was 20 times higher than in the low-risk group and 3.5 times higher than in the medium-risk group. During childbirth

the group of women with low risk was 42.8%, medium - 30%, high - 27.2%.

VA Sadauskas et al (1977) also emphasize the importance and expediency of identifying risk factors for the fetus during pregnancy and childbirth.

In each group, from 4 to 11 subgroups were identified, the severity of each factor was assessed according to a five-point system. The applied classification, according to the authors, quite accurately reflects the risk to the fetus in case of diffuse pathology in pregnant women and allows organizing timely and specialized intensive monitoring of the fetal condition. The expediency of identifying high-risk groups is also indicated by other domestic authors. So, A. S. Bergman et al. (1977) emphasize the role of functional and thyroid diagnostics in high-risk pregnant women; (1977). L. S. Persiaminov et al. (1977) point to the role and importance of the use of piperbaric oxygen in pregnant women with high risk factors for the fetus, as a way to reduce perinatal mortality. It is also reported about the role of some extragenital diseases as an increased risk factor (Butkyavichyus S. et al., 1977; Shui-kina E.P., 1976 and others).

Some researchers (Radonov D., 1983) proposes the organization of monitoring of high-risk pregnant women. Firstly, in order to improve the quality of monitoring pregnant women with an increased risk of perinatal pathology, the author developed a special classification based on the etiological principle, according to which 8 groups were distinguished:

Pregnant women with impaired uteroplacental circulation (late toxicosis, hypertension, xipo-nichesmiy nephritis, placenta previa, prostrate interruption);

Causes that adversely affect the fetus (ionization, isoimmunization, infections, chromosomal and gene abnormalities);

Adverse factors from the pelvis, uterus and appendages (narrow pelvis, uterine hypoplasia, tumors);

Incorrect position and presentation of the fetus, multiple pregnancy, multiple pregnancy, fetal growth retardation;

Adverse factors on the part of the mother before and during pregnancy (extragenital diseases, too young or old primiparas who have given birth to 3 or more children, smoking);

Aggravated obstetric history (infertility, death

birth, caesarean section, bleeding, late toxicosis);

Factors related to the social environment (difficult living conditions, insufficient training, etc.);

Psycho-emotional state (unwanted or out-of-wedlock pregnancy, bad psychoclimate iB family and at work). D. Radonov determines the degree of risk by a point system. All intermediate and high risk pregnant women are

hospital.

Secondly, after 20 weeks of pregnancy, all data are recorded on a special gravidogram, which can be used to diagnose early signs of a developing pathology (toxicosis, retarded fetal development, multiple pregnancy, etc.). Thirdly, due to the rapid development in the third trimester, especially in the last month of pregnancy, various complications of the usual weekly monitoring of high-risk pregnant women are not enough. Most of them must be hospitalized, which requires an increase in the number of beds in the "intensified observation unit" - from 1/4 to 1/3 of all beds in the maternity hospital. In this department, a thorough examination of the fetus is carried out (non-stress and oxytocin tests, daily counting of the most pregnant woman 3 times a day for 1 hour of fetal movements, ultrasound scanning, amnioscopy) with fixing the data obtained on a special graph. Thanks to "The implementation of these measures, it was possible to reduce perinatal mortality to 8.9%o in non-dispensary pregnant women - 13.76%o) ■

Domestic scientists have made a great contribution to the development of the problem of high-risk pregnant women. A number of scientists have established a number of risk factors that must be taken into account by a practical obstetrician-gynecologist during pregnancy, and this group of pregnant women often requires a comprehensive examination of the fetal condition using modern hardware and biochemical methods of observation. V. G. Kono-Nikhina (1978), when studying the risk of obstetric pathology in primiparas of various age groups, showed that the young (16-19 years) and older (30 years and older) age of primiparous women is a high risk factor for the development of obstetric pathology . In pregnant women of a young age, compared with the optimal (20-25 years), early and late toxicosis occurs more often (almost twice), especially severe forms of toxicosis, there is a threat of termination of pregnancy twice as often, overpregnancy occurs in 3.2 times more often. In older primiparas, compared with the optimal age, 3 times more often - early and late toxicosis are noted, also 2 times more often the threat of termination of pregnancy, and overpregnancy 6 times, premature and early rupture of amniotic fluid 1.5 times, weakness of birth forces 6.2 times, twice as often noted

There are births with a large fetus and in breech presentation, "pathological blood loss" increases by 2.3 times.

In older primiparas, compared to the optimal age, delivery operations are more often used: obstetric forceps - 3.1 times, vacuum - extraction of the fetus - 2.9 times, caesarean section almost 5 times High incidence of complications during pregnancy and childbirth, especially in primiparous older than 30 years, it is accompanied by a higher frequency of impaired functioning in the fetus and newborn: hypoxia is 6.5 times more common, and the incidence of newborns is 4.5 times higher.

The author believes that the use of the method of intensive monitoring of primiparas of young and older age contributes to a more favorable course of pregnancy and childbirth, and perinatal morbidity and mortality also decrease. According to T.V. Chervyakova et al. (1981) one of the most urgent problems of modern obstetrics is the determination of the tactics of pregnancy and childbirth in women at high risk of perinatal pathology. Addressing these issues will be one of the main ways to improve maternal, perinatal and child morbidity and mortality rates. According to the authors, as a result of the studies carried out, significant progress has been made in the development of criteria for identifying groups and the degree of risk. perinatal pathology.

All studies were carried out in the following 6 main areas: 1) clarification of risk groups for extragenital diseases of the mother; 2) with a complicated course of pregnancy; 3) with anomalies of tribal forces; 4) with the threat of intrauterine and postnatal infection; 5) with the threat of bleeding during childbirth and the early postpartum period. T. V. Cheriakova et al. indicate that as a result of these works, new interesting data have been obtained regarding the pathogenesis and clinic of complications of pregnancy and childbirth in women with various types of extragenital pathology, contraindications for maintaining pregnancy have been identified, indications and contraindications for the use of obstetric operations and anesthesia in childbirth have been clarified, issues have been resolved the use of various types of correlating therapy aimed at maintaining homeostasis in the body of the mother and fetus.

A number of authors offer a set of modern methods for diagnosing risk factors for the fetus during pregnancy. So, in (Study by G. M. Savelieva et al. (1981) in order to identify the degree of risk for the fetus in complicated pregnancy (nephropathy), overmaturity, miscarriage, Rh-sensitization), a complex of modern methods was used to judge feto-llacentral blood circulation

research and the condition of the fetus: cardiomonitoring, ultrasound scanning, the study of volumetric blood flow in the intervillous space of the placenta (OK), the concentration of placental lactogen and estriol in the blood and amniotic fluid: , activity of histidase and urokanyaase) amniotic fluid. The authors examined more than 300 pregnant women.

The conducted studies made it possible to identify a correlative relationship between OK and the appearance of changes in the pathological nature of the studied parameters; initial and pronounced signs of fetal hypoxia according to cardiomonitoring; the possibility of predicting the development of fetal hypoxia in childbirth according to some of the studied physiological and biochemical parameters. So, according to the value of OK, starting from 32 weeks, it is possible to predict the weight of newborns at the time of delivery. A decrease in OC by 30% or more indicates "intrauterine fetal hypoxia. An increase in OC with Rh sensitization above 200 ml / min per 100 g of placental tissue (normally about 100 ml / min, with a placental weight of 500 g) indicates the gigantic size of the placenta and the edematous form of hemolytic disease. . j

Analysis of the results of cardiomonitoring observation made it possible to determine the significance of basal changes, which were expressed as rhythm monotony, basal bradacardia, with iso- or arrhythmia. The authors give a number of the most informative indicators indicating the suffering of the fetus. Therefore, according to the authors, the use of these methods in practice in combination or in isolation makes it possible to more accurately identify the degree of risk to the fetus in a complicated pregnancy and determine the optimal medical tactics. Similar opinions are expressed by other authors. So, N. G. Kosheleva (1981) believes that pregnancy complications should be considered as a risk factor for perinatal pathology. The author points out that the acute forms of late toxicosis are especially unfavorable, while the loss of children in late toxicosis, which developed against the background of hypertension and kidney disease, is especially high.

Particular attention should be paid to the peculiarities of the course of pregnancy in diabetes mellitus. In the presence of a genital infection - endocerkitis, colpitis, or a combination of them, late toxicosis develops in every second or fourth pregnant woman, the threat of termination of pregnancy occurs in every sixth, with cervical colpitis four times more often with genital mikshlazma in the genital tract. Thus, in order to reduce perinatal mortality, it is important not only to diagnose a complicated course of pregnancy, but also to clarify the “background” in which these complications arose. Along

with this, it is necessary to constantly monitor the condition of the intrauterine fetus using modern methods of examination and treatment of the intrauterine fetus.

Of particular importance is the study of risk factors in order to reduce perinatal mortality in a antenatal clinic (Orlean M. Ya. et al., 1981). The authors have identified four risk groups in the conditions of the antenatal clinic: 1) socio-economic; 2) obstetric history; 3) obstetric pathology; 4) concomitant pathology. Rhck was determined by a scoring system from 5 to 45 points. 30 points in one group or 60 points in total is a high risk indicator. These activities made it possible to timely diagnose the early stages of toxicosis (shretoksikoz, vodka) of pregnant women, and their timely hospitalization in hospitals made it possible to reduce the frequency of I-II degree hephropathy. S. E. Rub "ivchik, N. I. Turovich (1981), using a scoring assessment of risk factors in obstetrics, developed by Prof. F. Lyzikov, revealed that the first risk group for the socio-alsh-biological factor was 4% , the second group of the claim - a burdened obstetric history - 17%, the third risk scold - pregnancy complications - 45%, the fourth risk rump - eustragevital pathology - 41% - At the same time, temporary ones with a combination of two or more factors amounted to 4% - In each risk group preventive measures are taken to prevent weakness of labor activity, miscarriage, treatment of subclinical forms of late toxicosis, treatment of Rh-conflict and pregnancy, and in the presence of znstratenital pathology, the presence of pregnant women in the dispensary with a therapist and an obstetrician-gynecologist.

Thus, the identification of pregnant women at risk of pregnancy pathology, timely preventive measures contribute to the reduction of complications in childbirth and perinatal mortality. Some authors (Mikhailenko E. T., Chernena M. Ya., 1982) developed an original method of prenatal preparation of pregnant high-risk groups w> the development of weakness of labor by increasing the endogenous synthesis of prostaglandins, which allowed the authors to reduce the incidence of weakness by 3.5 times labor activity and 2 times reduce the frequency of asphyxia in newborns. L. G. Si-chinav; and et al. (1981) propose to use ultrasound scanning data to determine the degree of risk to the fetus in Rhesus-conflict pregnancy.

At the same time, the optimal time for scanning in pregnant women with isoserological incompatibility of the blood of the mother and fetus should be considered 20–22 weeks, 30–32 weeks and immediately before delivery, which allows diagnosing the initial form of fetal hemolytic disease, determining

degree of risk For the last, which is important for the development of individual tactics for the management of pregnancy and childbirth. Other researchers also propose to use a prenatal diagnostic room more widely to assess the condition of the fetus (Shmorgun F. B., 1981; Zupping E. E. et al., 1981).

At the same time, it is recommended, in addition to cardiomonitoring, "to use biochemical methods - to determine the activity of thermojutabile alkaline phosphatase in the blood serum at the risk of pregnancy (Liivrand V. E. et al., 1981;), the coefficient of estrogen creaginine - as one of the indicators of the state of the intrauterine fetus ( Oinimäe X. V. et al., 1981), the content of steroid hormones and cortisone (Ttamer-mane L. P. et al., 1981); Daupaviete D. O. et al., 1981), to determine the dynamics of the content of placental lactogen in the blood plasma of pregnant pears at risk (Reisher N. A. et al., 1981), as well as the constituents of the symndao-adrenal system (Payu A. Yu. et al., 1981), sex determination is a risk factor based on analysis of X and Y-chromatin in the cells of the tissue of the membranes (Novikov Yu. I. et al., 1981).

N. V. Strizhova et al. (1981) to determine risk groups for late toxicosis of pregnant women, a complex immunodiffusion test is used using standard monospecific test systems for trophoblastic beta-globulin, placental lactogen, placental alpha in the amniotic fluid! - microglobulin, alphag - globulin of the "pregnancy zone", C-reactive protein, fibrinogen, alphag and beta-lipoproteins, as well as tissue antigens of the kidney. E. P. Zaitseva, G. A. Gvozdeva (1981), in order to timely diagnose the true severity of toxicosis, suggest using the immunological reaction to suppress leukocyte adhesion according to Holliday (Halliday., 1972). Postpartum complications are also being studied in women with an increased risk of developing infections (Zak IR, 1981).

There are isolated reports about the peculiarities of the mental development of children born from mothers of high-risk groups. So, M. G. Vyaskova et al. (1981), based on a deep and qualified examination of 40 children of sick mothers (with the involvement of a specialist in psychology and defectology), found that the children of sick mothers differ in the specifics of the development of mental activity, especially speech. The number of children with speech and intellectual pathology in the risk group turned out to be significant (28 out of 40), i.e. 70%. All children with speech and intellectual pathology need special assistance of a different nature - from counseling to education in special schools.

Single works are devoted to modern methods of diagnostics and especially treatment of pregnant women with a high risk of perinatal pathology. So, I. P. Ivanov, T. A. Aksenova

i (1981) note that with a complicated course of pregnancy (toxicoses, anemia, the threat of interruption), the presence of extragenital pathology, heart defects, vegetative-vascular dystonil, hypertension, diseases of the kidneys, endocrine system, etc. (often observed f its npl and central insufficiency, accompanied by hypoxia or fetal hypotrophy.

The degree of fetal suffering depends both on the severity and duration of the underlying disease, and on the severity of pathological changes in the placenta - a violation of its respiratory, transport, and hormonal functions. The success of antenatal disease prevention and treatment of intrauterine fetal suffering is largely determined by the informativeness of methods for diagnosing the condition of the fetus and the timeliness of targeted, highly effective therapy. I. P. Ivanov et al. in terms of dynamic monitoring of the state of the fetus, it is proposed to use phonoelectrocardiotraphy in combination with functional tests and ultrasound scanning, as well as indicators of estriol, placental lactogen, activity of a thermostable isoenzyme, alkaline phosphatase, which reflect the functional activity of the placenta and indirectly allow one to judge the state of the fetus, as well as determining the rate of uteroplacental blood flow by the radioisotope method, indicators of the acid-base state and activity of the dependent and innovatory processes.

The complex of data obtained allows timely and in due volume to carry out pathogenetically substantiated therapy of fetal hypoxia and prevention of fetal hypotrophy.

Of the modern methods of treating hypoxia, I. P. Ivanov et al. point to the widespread hyperbaric oxygenation in combination with medications (cocarbocoilase, ATP, sigetin, complamin, vitamins, etc.) against the background of the treatment of the underlying disease, taking into account the mother-fetal relationship. As a result of such therapy, disturbed indicators of the acid-base state and blood gases, hemodynamics, utero-mammary blood flow, indicators of placental function and fetal condition are normalized.

Foreign researchers also widely use monitoring methods for determining the condition of the fetus in high-risk pregnant groups (Bampson., 1980, Harris et al, 1981, etc.). Teramo (1984) studies show that 2/3 of women whose children die in the perinatal period or suffer from birth asphyxia or diseases in the neonatal period ™ can be detected in advance during pregnancy. Such high-risk women make up 1/3 of the total number of pregnant women. Careful monitoring of a pregnant woman in a antenatal clinic is essential to identify high-risk pregnant women.

The basis for identifying a high-risk pregnant woman is a detailed medical history, including social, medical and obstetrical data, as well as clinical signs and symptoms. The author emphasizes that, along with clinical methods, instrumental examination of the fetus in perinatal centers is necessary.

Tegato (1984) out of a total number of 1695 pregnant women, identified 1 high-risk pregnant woman in 480: history of cesarean section in 1 (60), premature birth (birth of a child weighing less than 2500 g) in history (46), childbirth with congenital | medical history (malformations - 20, neurological defects - 3, miscellaneous - 12) in anamnesis (35), stillbirth (17), chronic diseases (63), chronic urinary tract infections (34), diabetes mellitus ( 10), presence of diabetes mellitus in the family (185), pathological changes in glucose tolerance (21), hypertension (66), uterine bleeding in early pregnancy (IW), first birth over the age of 35 (9).

The author proposes to use cardiotocrgraphy with a decrease in motor activity. It has been shown that the number of movements less than 10 per 12 hours is associated with an increased frequency of fetal asphyxia (Pearson, Weaver, 1976). Next, it is necessary to monitor the growth of the fetus, determine estriol in blood plasma, urine, while it is important to consider what medications a woman takes during this period, since, for example, taking glucocorticoids reduces the production of estriol, it is advisable to analyze estriol every 2 to 3 days, and also determine placental lactsgene, functional tests (oxytocin test).

It is important to note that when using a stress-free test, the author recommends that cardiotocography (CTG) be performed every 1–3 days in preeclampeia, 1–3 times a week in chronic hypertension, every 1–3 days in intrauterine growth retardation, and prenatal effusion. amniotic fluid 1-2 times a day, three hepatosis of pregnant women - daily, with diabetes mellitus, class A according to White's classification weekly at a gestational age of 34-36 weeks, and at a gestational age of 37 weeks - 2-3 times a week, diabetes mellitus, classes A. B, C, D and gestational age 32 - 34 weeks. - every 2nd day., at 35 weeks. - daily, diabetes mellitus, classes F, R at a gestational age of 28 - 34 weeks. - every 2nd day, at 35 weeks. - daily. With changes in the curve of the fetal heart rate and the period of 26 weeks of pregnancy, 1 to 3 times a day.

In a comprehensive monograph by Babson et al. (1979) on the management of high-risk pregnant women and intensive care of the newborn, when determining the degree of risk in the perinatal period, the authors define that such a risk in the perinatal period is the danger of death or

the occurrence of disability during the period of growth and development of a person from the moment of the birth of life to 28 days after birth. At the same time, the authors distinguish between the risk associated with intrauterine development of the fetus and the risk associated with the development of the child after birth. This division allows a better understanding of the factors associated with risk in the perinatal period.

Risk factors related to fetal development

Women who are at high risk of fetal death or injury during pregnancy should be identified. Completely unexpected complications rarely occur in women who have undergone a comprehensive examination and long-term follow-up, during which significant deviations from the norm were detected in a timely manner, appropriate therapy was carried out during pregnancy, and the course of childbirth was predicted.

Here is a list of increased risk factors that contribute to perinatal mortality or morbidity in children. Approximately 10 - 20% of women belong to these groups, and in more than half of the cases, the death of fetuses and newborns is due to the influence of these factors.

1. A history of serious hereditary or family anomalies, such as defective osteogenesis, Down's disease.

2. The birth of the mother herself prematurely or very small for the gestational age at which the birth occurred or cases where the mother's previous birth ended in the birth of a child with the same deviations.

3. Serious congenital anomalies affecting the central nervous system, heart, skeletal system, lung anomalies, as well as general blood diseases, including anemia (hematocrit below 32%).

4. Serious social problems, such as teenage pregnancy, drug addiction, or absence of a father.

5. Absence or late start of medical supervision in the perinatal period.

6. Age under 18 or over 35 years old.

7. Height less than 152.4 cm and weight before pregnancy 20% below or above the weight considered standard for this height.

8. Fifth or subsequent pregnancy, especially if the pregnant woman is over 35 years old.

" 9. Another pregnancy that occurred within 3 months. after the previous I Chey.

| 10. History of long-term infertility or serious drug or hormonal treatment.

11. Teratogenic viral disease in the first 3 months of pregnancy.

12. Stressful conditions, such as severe emotional stress, uncontrollable vomiting of pregnant women, anesthesia, shock, critical situations or a high dose of radiation.

13. Smoking abuse.

14. Complications of pregnancy or childbirth in the past or present, such as toxicosis of pregnancy, premature placental abruption, isoimmunization, polyhydramnios or discharge of amniotic fluid.

15. Multiple pregnancy.

16. Delay in the normal growth of the fetus or a fetus that differs sharply from normal in size.

17. No weight gain or minimal gain.

18. Incorrect position of the fetus, for example, breech presentation, transverse position, unidentified presentation of the fetus at the time of delivery.

19. The gestation period is more than 42 weeks.

Further, the author provides demographic studies on specific complications and the percentage of perinatal mortality for each of the complications, while in more than 60% of cases, fetal death and in 50% of cases, the death of a newborn are associated with complications such as breech presentation, premature detachment, placenta, pregnancy toxicosis , twins and urinary tract infection.

Factors causing an increased risk to the newborn

After delivery, additional environmental factors may increase or decrease the viability of the infant. Babson et al. (1979) point out that the following pre- or post-natal factors place the infant at increased risk and therefore require special treatment and supervision:

1. The presence in the anamnesis of the mother of the above risk factors during pregnancy, especially:

a) belated rupture of the fetal bladder;

b) incorrect presentation of the fetus and childbirth;

c) prolonged, difficult labor or very rapid labor;

d) prolapse of the umbilical cord;

2. Asphyxia of the newborn, assumed on the basis of:

a) fluctuations in the number of fetal heart beats;

b) staining of amniotic fluid with meconium, especially its discharge;

c) fetal acidosis (pH below 7.2);

d) an Apgar score of less than 7, especially if the score is given 5 minutes after birth.

3. Preterm delivery (up to 38 weeks).

4. Late delivery (after 42 weeks) with signs of fetal malnutrition.

5. Babies are too young for this stage of pregnancy (below 5% of the curve).

6. Babies too big for a given gestational age (below 95% of the curve) especially large babies born prematurely.

7. Any breathing disorders or stoppage.

8. Obvious birth defects.

9. Seizures, lameness, or difficulty sucking or swallowing.

10. Bloating and/or vomiting.

11. Anemia (hemoglobin content less than 45%) or hemorrhagic diathesis.

12. Jaundice in the first 24 hours after birth or bilirubin level above 15 mg/100 ml of blood.

1. Initial selection.

2. Selection during a visit to a pregnant antenatal clinic.

3. Selection during childbirth: upon admission to a maternity facility and upon admission to the maternity ward.

4. Evaluation at birth:

a) a newborn

b) mother.

5. Postpartum assessment:

a) a newborn

b) mother.

Pregnant women with identified risk factors are classified as follows: according to the criteria below at each stage:

I. Initial selection Biological and marital factors.

a) high risk:

1. Mother's age is 15 or younger.

2. Mother's age is 35 or older.

3. Excessive obesity.

b) Moderate risk:

1. The age of the mother is from 15 to 19 years.

2. The age of the mother is from 30 to 34 years.

3. Unmarried.

4. Obesity (weight 20% above the standard weight for a given height).

5. Exhaustion (weight less than 45.4 kg.).

6. Small stature (152.4 cm or less).

Obstetric history

A. High risk:

1. Previously diagnosed anomalies of the birth canal:

a) inferiority of the cervix; "

b) abnormal development of the cervix;

c) abnormal development of the uterus.

2. Two or more previous abortions.

3. Intrauterine fetal death or death of a newborn during a previous pregnancy.

4. Two previous premature births or the birth of babies at term, but with insufficient weight (less than 2500 g).

5. Two previous children are excessively large (weighing more than 4000 g).

6. Malignant tumor in the mother.

7. Uterine fibroids (5 cm or more or submucosal localization).

8. Cystic ovaries.

9. Eight or more children.

10. The presence of isoimmunization in a previous child.

11. History of enlampsia.

12. Previous child had:

a) known or suspected genetic or familial anomalies;

b) congenital malformations.

13. A history of complications that required special therapy in the neonatal period, or the birth of a child with a birth injury.

14. Medical indications for termination of a previous pregnancy. B. Moderate risk:

1. Previous preterm birth or the birth of a child at term, but with a small birth weight (less than 2500 g), or abortion.

2. One excessively large child (weight over 4000 g). t>"p^u

3. Previous childbirth ended with surgery: SC

a. caesarean section b. forceps, c. extraction for the pelvic end.

4. Previous prolonged labor or significantly obstructed labor.

5. Narrowed pelvis.

6. Serious emotional problems associated with a previous pregnancy or childbirth.

7. Previous operations on the uterus or cervix.

8. First pregnancy.

9. Number of children from 5 to 8.

10. Primary infertility. ,|

P. Incompatibility according to the ABO system in history.

12. Incorrect presentation of the fetus during previous births.

13. Presence of a history of endometriosis.

14. Pregnancy that occurred after 3 months. or earlier after the last birth.

Medical and surgical history

A. High risk:

1. The average degree of hypertension.

2. Moderate kidney disease.

3. Severe heart disease (II-IV degree of heart failure) or congestion caused by heart failure.

4. Diabetes.

5. Removal of endocrine glands in history.

6. Cytological changes in the cervix.

7. Cardiocellular anemia.

8. Drug addiction or alcoholism.

9. History of tuberculosis or PPD test (diameter greater than 1 cm)

10. Pulmonary disease. ;

11. Malignant tumor.

12. Gastrointestinal disease or liver disease.

13. Previous heart or vascular surgery.

B. Moderate risk.

1. The initial stage of hypertension.

2. Mild kidney disease.

3. Mild heart disease (I degree).

4. The presence of a history of hypertensive consisting of a mild degree at the time! ■ pregnancy.

5. Transferred pyelonephritis.

6. Diabetes (mild).

7. Familial diabetes.

8. Disease of the thyroid gland.

9. Positive results of a serological study.

10. Overuse of drugs.

11. Emotional problems.

12. The presence of sickle-shaped erythrocytes in the blood.

13. Epilepsy.

II. Selection during a visit to a pregnant antenatal clinic” in the prenatal period. ,

Early Pregnancy I

A. High risk: :";"■; : I

1. Absence of an increase in the uterus or its disproportionate increase. I

2, Effect of teratogenic factors:: I

a. radiation; !■:■, ■. ..... - ..... \|

b. infections;

in. chemical agents.

3. Pregnancy complicated by immunization.

4. The need for genetic diagnosis in the antenatal period. 5. Severe anemia (hemoglobin content of 9 g% or less).

B. Moderate risk:

1. Untreated urinary tract infection.

2. Suspicion of an ectopic pregnancy.

3. Suspicion of a failed abortion.

4. Severe indomitable vomiting of a pregnant woman.

5. Positive serological test for gonorrhea.

6. Anemia, not amenable to treatment with iron preparations.

7. Viral disease.

8. Vaginal bleeding.

9. Mild anemia (hemoglobin content from 9 to 10; 9 g%).

Late pregnancy

A. High risk:

1. Absence of an increase in the uterus or its disproportionate increase.

2. Severe anemia (hemoglobin content less than 9 g%).

3. The gestation period is more than 42 1/2 units.

4. Severe preeclampsia.

5. Eclampsia.

6. Breech presentation if normal delivery is planned.

7. Isoimmunization of moderate severity (necessary intrauterine transfusion of blood or complete exchange transfusion of blood to the fetus).

8. Placenta previa.

9. Polyhydramnios or multiple pregnancy.

10. Intrauterine fetal death.

11. Thromboembolic disease.

12. Premature birth (less than 37 weeks of pregnancy).

13. Premature rupture of the amniotic sac (less than 38 weeks of pregnancy).

14. Obstruction of the birth canal caused by a tumor or other causes.

15. Premature detachment of the placenta.

16. Chronic or acute pyelonephritis.

17. Multiple pregnancy.

18. Abnormal reaction to an oxytocin test.

19. Drop in the level of estriol in the urine of a pregnant woman. B. Moderate risk:

1. Hypertension during pregnancy (mild degree).

2. Breech presentation if a caesarean section is planned.

3. Unidentified presentation of the fetus.

4. The need to determine the degree of maturity of the fetus.

5. Post-term pregnancy (41-42.5 weeks).

6. Premature rupture of the membranes (delivery does not occur for more than 12 hours if the gestational age is more than 38 weeks).

7. Induction of labor.

8. Estimated disproportion between the size of the fetus and the pelvis by the time of delivery.

9. Unfixed presentation for 2 weeks. or less before the estimated due date.

A high-risk pregnancy is one in which the risk of illness or death of the mother or newborn before or after birth is greater than normal.

To identify a high-risk pregnancy, a doctor examines a pregnant woman to determine if she has diseases or symptoms that make her or her fetus more likely to get sick or die during pregnancy (risk factors). Risk factors can be assigned points corresponding to the degree of risk. Identification of a high-risk pregnancy is only necessary so that a woman who needs intensive medical care receives it in a timely and complete manner.

A woman with a high-risk pregnancy may be referred to antenatal (perinatal) care (the term "perinatal" refers to events that occur before, during, or after delivery). These departments are usually linked to obstetrics and neonatal intensive care units to provide the highest level of care for the pregnant woman and infant. A doctor often sends a woman to a perinatal care center before giving birth, since early medical supervision greatly reduces the likelihood of pathology or death of the child. A woman is also sent to such a center during childbirth if unexpected complications arise. Typically, the most common reason for referral is a high chance of preterm birth (before 37 weeks), which often occurs if the fluid-filled membranes containing the fetus rupture before it is ready to be born (that is, a condition called preterm rupture of membranes occurs). ). Treatment at a perinatal care center reduces the chance of preterm birth.

In Russia, maternal mortality occurs in 1 out of 2000 births. Its main causes are several diseases and disorders associated with pregnancy and childbirth: the ingress of blood clots into the vessels of the lungs, anesthesia complications, bleeding, infections and complications arising from high blood pressure.

In Russia, the perinatal mortality rate is 17%. Slightly more than half of these cases are stillbirths; in other cases, babies die in the first 28 days after birth. The main causes of these deaths are congenital malformations and prematurity.

Some risk factors are present even before a woman becomes pregnant. Others occur during pregnancy.

Risk factors before pregnancy

Before a woman becomes pregnant, she may already have certain diseases and disorders that increase her risk during pregnancy. In addition, a woman who had complications in a previous pregnancy is more likely to develop the same complications in subsequent pregnancies.

Maternal risk factors

The age of the woman affects the risk of pregnancy. Girls aged 15 years and younger are more likely to develop preeclampsia(a condition during pregnancy in which blood pressure rises, protein appears in the urine, and fluid accumulates in the tissues) and eclampsia (convulsions that are a consequence of preeclampsia). They are also more likely the birth of a child with low body weight or premature. Women aged 35 years and older are more likely to increased blood pressure,diabetes,the presence of fibroids (benign neoplasms) in the uterus and the development of pathology during childbirth. The risk of having a baby with a chromosomal abnormality, such as Down syndrome, increases significantly after the age of 35. If an older pregnant woman is concerned about the possibility of fetal abnormalities, a chorionic villus examination or amniocentesis to determine the chromosome composition of the fetus.

A woman who weighed less than 40 kg before pregnancy is more likely to give birth to an infant with a lower weight than expected according to the gestational age (low weight for gestational age). If a woman gains less than 6.5 kg during pregnancy, the risk of death of the newborn increases to almost 30%. Conversely, an obese woman is more likely to have a very large baby; obesity also increases the risk of developing diabetes and high blood pressure during pregnancy.

A woman less than 152 cm tall often has a reduced pelvis. She also has an increased chance of preterm labor and an underweight newborn.

Complications during a previous pregnancy

If a woman had three consecutive miscarriages (spontaneous abortions) in the first three months of previous pregnancies, then she has a 35% chance of having another miscarriage. Spontaneous abortion is also more likely in women who have previously had a stillbirth between the 4th and 8th months of pregnancy or have had preterm births in previous pregnancies. Before trying to conceive again, a woman who has had a spontaneous abortion is advised to be screened for possible chromosomal or hormonal disorders, structural defects in the uterus or cervix, connective tissue disorders such as systemic lupus erythematosus, or an immune response to the fetus—most often Rhesus incompatibility. -factor. If the cause of spontaneous abortion is established, it can be eliminated.

Stillbirth or neonatal death may be due to fetal chromosomal abnormalities, as well as diabetes mellitus, chronic kidney or blood vessel disease, high blood pressure, or a connective tissue disorder such as systemic lupus erythematosus in the mother or her drug use.

The more premature the previous birth, the greater the risk of preterm birth in subsequent pregnancies. If a woman has a baby weighing less than 1.3 kg, then the probability of premature birth in the next pregnancy is 50%. If intrauterine growth retardation was noted, this complication may recur in the next pregnancy. The woman is being evaluated for disorders that can lead to fetal growth retardation (eg, high blood pressure, kidney disease, overweight, infections); Smoking and alcohol abuse can also lead to impaired fetal development.

If a woman has a baby weighing more than 4.2 kg at birth, she may have diabetes. A woman or baby is more likely to have a spontaneous abortion or die if the woman has this type of diabetes during pregnancy. Pregnant women are tested for its presence by measuring blood sugar (glucose) between the 20th and 28th weeks of pregnancy.

A woman who has had six or more pregnancies is more likely to experience weak labor (labor) during labor and bleeding after delivery due to weakened uterine muscles. Rapid delivery is also possible, which increases the risk of severe uterine bleeding. In addition, such a pregnant woman is more likely to have placenta previa (the location of the placenta in the lower part of the uterus). This condition can cause bleeding and be an indication for a caesarean section because the placenta often overlaps the cervix.

If a woman has a child with a hemolytic disease, then the next newborn has an increased likelihood of the same disease, and the severity of the disease in the previous child determines its severity in the next. This disease develops when a pregnant woman with Rh-negative blood develops a fetus whose blood is Rh-positive (that is, there is incompatibility for the Rh factor), and the mother develops antibodies against the blood of the fetus (sensitization to the Rh factor occurs); these antibodies destroy the fetal red blood cells. In such cases, the blood of both parents is tested. If a father has two genes for Rh-positive blood, then all his children will have Rh-positive blood; if he has only one such gene, then the probability of Rh-positive blood in a child is approximately 50%. This information helps doctors provide proper care for mother and baby in future pregnancies. Usually, the first pregnancy with a fetus with Rh-positive blood does not develop any complications, but contact between the blood of the mother and the child during childbirth causes the mother to produce antibodies against the Rh factor. As a result, there is a danger to subsequent newborns. If, however, after the birth of a child with Rh-positive blood from a mother whose blood is Rh-negative, Rh0-(D)-immunoglobulin is administered, then antibodies against the Rh factor will be destroyed. Due to this, hemolytic diseases of newborns are rare.

A woman who has had preeclampsia or eclampsia is more likely to have it again, especially if the woman has chronically high blood pressure.

If a woman has a child with a genetic disease or a congenital defect, then before a new pregnancy, a genetic examination of the child is usually carried out, and in the case of a stillbirth, both parents. When a new pregnancy occurs, ultrasonography (ultrasound), chorionic villus testing, and amniocentesis are performed to detect abnormalities that are likely to occur again.

Developmental Defects

Defects in the development of a woman's genital organs (eg, doubling of the uterus, weakness or insufficiency of the cervix, which cannot hold a developing fetus) increase the risk of miscarriage. To detect these defects, diagnostic operations, ultrasound or X-ray examination are necessary; if a woman has had repeated spontaneous abortions, these studies are carried out even before the onset of a new pregnancy.

Fibromyomas (benign growths) of the uterus, which are more common in older adults, can increase the chance of preterm birth, complications during childbirth, abnormal presentation of the fetus or placenta, and recurrent miscarriages.

Diseases of a pregnant woman

Some diseases of a pregnant woman can be dangerous for both her and the fetus. The most important of these are chronic high blood pressure, kidney disease, diabetes mellitus, severe heart disease, sickle cell anemia, thyroid disease, systemic lupus erythematosus, and blood clotting disorders.

Diseases in family members

The presence of relatives with mental retardation or other hereditary diseases in the family of the mother or father increases the likelihood of such diseases in the newborn. The tendency to have twins is also common among members of the same family.

Risk factors during pregnancy

Even a healthy pregnant woman can be exposed to adverse factors that increase the likelihood of damage to the fetus or her own health. For example, she may be exposed to teratogenic agents (exposures that cause birth defects) such as radiation, certain chemicals, drugs, and infections, or she may develop a disease or pregnancy-related complication.

Drug exposure and infection

Substances that can cause congenital malformations of the fetus when taken by a woman during pregnancy include alcohol, phenytoin, drugs that counteract the effect of folic acid (lithium drugs, streptomycin, tetracycline, thalidomide). Infections that can lead to birth defects include herpes simplex, viral hepatitis, influenza, paratitis (mumps), rubella, chickenpox, syphilis, listeriosis, toxoplasmosis, Coxsackievirus and cytomegalovirus diseases. At the start of pregnancy, the woman is asked if she has taken any of these medications and has had any of these infections after conception. Of particular concern is smoking, alcohol and drug use during pregnancy.

Smoking- one of the most common bad habits among pregnant women in Russia. Despite awareness of the health risks of smoking, the number of adult women who smoke themselves or live with people who smoke has decreased slightly over the past 20 years, and the number of women who smoke heavily has increased. Smoking among adolescent girls has become significantly more common and exceeds that among adolescent boys.

Although smoking harms both mother and fetus, only about 20% of women who smoke stop smoking during pregnancy. The most common consequence of maternal smoking during pregnancy on the fetus is low birth weight: the more a woman smokes during pregnancy, the lower the baby's weight will be. This effect is more pronounced among older women who smoke, who are more likely to have children with a smaller weight and height. Women who smoke are also more likely to have placental complications, premature rupture of membranes, preterm labor, and postpartum infections. A pregnant woman who does not smoke should avoid exposure to tobacco smoke from other people smoking, as it can similarly harm the fetus.

Congenital malformations of the heart, brain, and face are more common in newborns born to pregnant smokers than to nonsmokers. Maternal smoking may increase the risk of sudden infant death syndrome. In addition, children of smoking mothers have a slight but noticeable lag in growth, intellectual development and behavioral formation. These effects, according to experts, are caused by exposure to carbon monoxide, which reduces the delivery of oxygen to body tissues, and nicotine, which stimulates the release of hormones that narrow the blood vessels of the placenta and uterus.

Alcohol consumption during pregnancy is the leading known cause of congenital malformations. Fetal alcohol syndrome, one of the main consequences of drinking alcohol during pregnancy, occurs in an average of 22 out of 1,000 live births. This condition includes growth retardation before or after birth, facial defects, a small head (microcephaly), likely due to underdevelopment of the brain, and impaired mental development. Mental retardation is a consequence of fetal alcohol syndrome more often than any other known cause. In addition, alcohol can cause other complications, from miscarriage to severe behavioral disorders in the newborn or developing child, such as antisocial behavior and inability to concentrate. These disorders can occur even when the newborn has no obvious physical congenital malformations.

The chance of a spontaneous abortion almost doubles when a woman drinks any form of alcohol during pregnancy, especially if she drinks heavily. Often, birth weight is below normal in those newborns who were born to women who drank alcohol during pregnancy. Newborns whose mothers drank alcohol have an average birth weight of about 1.7 kg, compared with 3 kg for other newborns.

drug use and dependence on them is observed in an increasing number of pregnant women. For example, in the United States, more than five million people, many of whom are women of childbearing age, regularly use marijuana or cocaine.

An inexpensive laboratory test called chromatography can be used to test a woman's urine for heroin, morphine, amphetamines, barbiturates, codeine, cocaine, marijuana, methadone, and phenothiazine. Injecting drug users, that is, drug users who use syringes to use drugs, are at higher risk of developing anemia, infection of the blood (bacteremia) and heart valves (endocarditis), skin abscess, hepatitis, phlebitis, pneumonia, tetanus, and sexually transmitted diseases (in including AIDS). Approximately 75% of newborns with AIDS had mothers who were injection drug addicts or engaged in prostitution. These newborns are also more likely to have other sexually transmitted diseases, hepatitis, and other infections. They are also more likely to be born prematurely or have intrauterine growth retardation.

Main component marijuana, tetrahydrocannabinol, can cross the placenta and affect the fetus. Although there is no definite evidence that marijuana causes birth defects or slows the growth of the fetus in the uterus, some studies show that marijuana use leads to abnormal behavior in the child.

Use cocaine during pregnancy causes dangerous complications for both the mother and the fetus; many women who use cocaine also use other drugs, exacerbating the problem. Cocaine stimulates the central nervous system, acts as a local anesthetic (pain reliever) and constricts blood vessels. Narrowing of the blood vessels leads to a decrease in blood flow, and the fetus does not receive enough oxygen. Reduced delivery of blood and oxygen to the fetus can affect the development of various organs and usually leads to skeletal deformities and narrowing of some parts of the intestine. Neurological and behavioral disorders in children of women who use cocaine include hyperactivity, uncontrollable tremors, and significant learning problems; these disturbances may continue for 5 years or even more.

If a pregnant woman suddenly has high blood pressure, bleeds as a result of placental abruption, or has a stillborn baby for no apparent reason, her urine is usually tested for cocaine. Approximately 31% of women who use cocaine throughout their pregnancy experience preterm labor, 19% of fetal growth retardation, and 15% of premature placental exfoliation. If a woman stops taking cocaine after the first 3 months of pregnancy, the risk of preterm birth and premature placental abruption remains high, but fetal development is usually not impaired.

Diseases

If high blood pressure is first diagnosed when a woman is already pregnant, it is often difficult for a doctor to determine whether the condition is due to pregnancy or has another cause. Treatment of such a disorder during pregnancy is difficult, since therapy, while beneficial to the mother, carries a potential danger to the fetus. At the end of pregnancy, an increase in blood pressure may indicate a serious threat to the mother and fetus and should be quickly eliminated.

If a pregnant woman has had an infectious lesion of the bladder in the past, then a urine test is done at the beginning of pregnancy. If bacteria are found, the doctor prescribes antibiotics to prevent infection from entering the kidneys, which can cause preterm labor and premature rupture of the membranes. Bacterial infections of the vagina during pregnancy can lead to the same consequences. Suppressing the infection with antibiotics reduces the chance of these complications.

The disease, accompanied by an increase in body temperature above 39.4 ° C in the first 3 months of pregnancy, increases the likelihood of spontaneous abortion and the occurrence of defects in the nervous system in a child. An increase in temperature at the end of pregnancy increases the likelihood of preterm birth.

Emergency surgery during pregnancy increases the risk of preterm birth. Many diseases, such as acute appendicitis, acute liver disease (biliary colic), and intestinal obstruction, are more difficult to diagnose during pregnancy because of the natural changes that occur during this time. By the time such a disease is nevertheless diagnosed, it may already be accompanied by the development of severe complications, sometimes leading to the death of a woman.

Complications of pregnancy

Rh factor incompatibility. Mother and fetus may have incompatible blood types. The most common is Rh incompatibility, which can lead to hemolytic disease in the newborn. This disease often develops when the mother's blood is Rh-negative and the baby's blood is Rh-positive due to the father's Rh-positive blood; in this case, the mother develops antibodies against the blood of the fetus. If the pregnant woman's blood is Rh-negative, the presence of antibodies to the fetal blood is checked every 2 months. These antibodies are more likely to form after any bleeding in which maternal and fetal blood may mix, such as after amniocentesis or chorionic villus testing, and during the first 72 hours after delivery. In these cases, and at the 28th week of pregnancy, the woman is injected with Rh0-(D)-immunoglobulin, which combines with the antibodies that have appeared and destroys them.

Bleeding. The most common causes of bleeding in the last 3 months of pregnancy are abnormal placenta previa, premature placental abruption, diseases of the vagina or cervix, such as infection. All women who bleed during this period have an increased risk of miscarriage, severe bleeding, or death during childbirth. An ultrasound (ultrasound), examination of the cervix, and a Pap test can help determine the cause of the bleeding.

Conditions associated with amniotic fluid. Excess amniotic fluid (polyhydramnios) in the membranes surrounding the fetus stretches the uterus and puts pressure on the woman's diaphragm. This complication sometimes leads to respiratory failure in women and premature birth. Excess fluid may occur if a woman has uncontrolled diabetes mellitus, if multiple fetuses develop (multiple pregnancy), if the mother and fetus have incompatible blood types, or if the fetus has congenital malformations, especially esophageal atresia or defects in the nervous system. In about half of the cases, the cause of this complication remains unknown. Lack of amniotic fluid (oligohydramnios) can occur if the fetus has congenital malformations of the urinary tract, intrauterine growth retardation, or intrauterine death of the fetus.

preterm birth. Preterm birth is more likely if the pregnant woman has defects in the structure of the uterus or cervix, bleeding, mental or physical stress, or multiple pregnancies, and if she has previously had uterine surgery. Preterm labor often occurs when the fetus is in an abnormal position (eg, breech presentation), when the placenta separates prematurely from the uterus, when the mother has high blood pressure, or when too much amniotic fluid surrounds the fetus. Pneumonia, kidney infections, and acute appendicitis can also cause preterm labor.

Approximately 30% of women who have preterm labor have a uterine infection even if the membranes do not rupture. Currently, there is no reliable data on the effectiveness of antibiotics in this situation.

Multiple pregnancy. The presence of multiple fetuses in the uterus also increases the chances of fetal birth defects and birth complications.

delayed pregnancy. In a pregnancy that lasts more than 42 weeks, fetal death is 3 times more likely than in a normal pregnancy. To monitor the condition of the fetus, electronic monitoring of cardiac activity and ultrasound (ultrasound) are used.

Underweight newborns

• A premature baby is a newborn born before 37 weeks of gestation.
• An underweight infant is a newborn weighing less than 2.3 kg at birth.
• A small infant for its gestational age is a child with a body weight insufficient for the gestational age. This definition refers to body weight, not height.
• An infant with developmental delay is a newborn whose development in the uterus was insufficient. This concept applies to both body weight and height. The newborn may be developmentally delayed, small for gestational age, or both.

When it is necessary?

Day hospital- this is a short-term stay department, where a pregnant woman spends several hours a day while performing the necessary procedures (for example, droppers), and after they are completed, she goes home
.

In many conditions, already from the beginning of pregnancy, the doctor can warn that at certain times it will be necessary to go to the hospital. it planned hospitalization. First of all, this applies to women who have various diseases of internal organs, such as arterial hypertension (high blood pressure), diabetes mellitus, heart and kidney diseases. Also, hospitalization is planned for women with miscarriage (previously had 2 or more miscarriages) and other adverse outcomes of previous pregnancies, or if the current pregnancy did not occur naturally, but with the help of hormonal therapy or IVF (in vitro fertilization). Such hospitalization will be for critical periods (dangerous in terms of miscarriage and premature birth) and for the period in which the previous pregnancy was lost.
In the case of planned hospitalization in the hospital, first of all, an additional examination is carried out, which is not possible on an outpatient basis, and prevention of possible complications of pregnancy. The timing of such hospitalizations can be discussed with the doctor in advance, they can be shifted by 2-3 weeks if necessary.

emergency hospitalization recommended for conditions that threaten the health of the expectant mother, the health of the baby and abortion. In this case, refusing hospitalization, a woman may lose her only chance for a successful pregnancy.
The need for hospitalization may arise at any stage of pregnancy, starting from the first days and ending with those cases when childbirth does not occur at the expected time (pregnancy prolongation). Women up to 12 weeks of pregnancy are hospitalized in the gynecology department of the hospital, and after 12 weeks in the department of pathology of pregnant women of the maternity hospital.

High risk pregnant women

1. Severe toxicosis of the 11th half of pregnancy.

2. Pregnancy in women with Rh and ABO - incompatibility.

3. Polyhydramnios.

4. The alleged discrepancy between the size of the fetal head and the mother's pelvis (anatomical narrow pelvis, large fetus, hydrocephalus).

5. Incorrect positions of the fetus (transverse, oblique).

6. Post-term pregnancy.

7. Antenatal fetal death.

8. Threatening premature birth.

11 . Pregnancy and extragenital pathology.

(gestational age 22 weeks or more).

1. Cardiovascular diseases (heart defects, arterial hypertension).

2. Anemia.

3. Diabetes.

4. Pyelonephritis.

5. Thyrotoxicosis.

6. High myopia.

7. Chronic lung diseases (chronic bronchitis, bronchial asthma, history of lung operations).

8. Pregnant women with a gestational age of up to 35 weeks and extragenital pathology are hospitalized in somatic departments of the appropriate profile.

111. Pregnancy and selected risk factors.

1. Pregnancy in a nulliparous 30 years and older.

2. Pregnancy and uterine fibroids.

3. Breech presentation.

4. A scar on the uterus from a previous operation.

5. Multiple pregnancy.

6. Pregnancy in women who gave birth to children with malformations.

7. Pregnant women with intrauterine growth retardation.

8. Threat of abortion.

9. Recurrent miscarriage at critical stages of pregnancy from 22 weeks

10. Anomalies in the development of the fetus.

11. Chronic placental insufficiency.

12. Delayed intrauterine development of the fetus.

13. Pregnancy and uterine fibroids.

14. Termination of pregnancy for medical reasons.

15. Placenta previa.

16. Hepatosis of pregnant women.