Maintaining premature births, the symptoms of their start, diagnosis of threat and prevention. Forecasts for a child. Contraindications for expectant tactics

09.05.2019

Premature childbirth scare many future mothers. Many authors have different opinions regarding the definition of this concept. If you take on average foreign and Russian experience, childbirth is considered premature, which came after 20 pregnancy weeks, but up to 37. It is known that some women have an increased risk of this situation. Let's consider in detail what factors can provoke it.

Risk of premature birth

The risk rises in women:

Causes from the fetus:

intrauterine death;
delay of intrauterine development;
congenital anomalies.

Symptoms and signs of premature birth

diarrhea, which has a permanent or periodic character (it may not be);
dull pain in the lower back - can be constant or intermittent;
or their expulsion;
the feeling of pressure in the pelvic area - the stomach dropped and the child presses the preserving place in the pelvis region;
catching pain at the bottom of the abdomen or all over its perimeter;
changes in vaginal discharge (on pink or brown);
fights every 10 minutes or less that may be accompanied by pain.

If your gynecologist believes that you have an increased risk of premature birth, you must prepare and know how to count the contractions. Fights do not always have a painful character. Sometimes they manifest as a belly for a while. You can touch the stomach and it will be sufficiently solid at that moment and be in a tone. If you learned your feelings and they appear every 10 minutes or even more often, you need to turn to a gynecologist as quickly as possible to get further instructions.

Premature childbirth - prevention and treatment

Although not all premature birth can be prevented, there are a number of actions that are able to reduce the risk of their offensive.

Drink a lot of water - from 8 to 10 glasses per day. Dehydration can cause cuts in the uterus, which can lead to the beginning of the generic activity.
Empty the bladder every 2-3 hours, no less often. Full urine can annoy the uterus and cause it to reduce it.
Avoid lifting weights and overvoltage. If you have older children, let you sit on your knees and express love by any other ways, besides wearing them in your hands.
During the day, do frequent breaks and rest, preferably on the left side. This posture contributes to a good blood flow to the child.
Avoid breast stimulation and sexual activity.

In the threat of premature births, a smear will necessarily take to determine a possible infection. In most cases, streptococci groups B (b) are determined. A pregnant woman who has no allergies to penicillin, penicillin G or ampicillin will be prescribed. If a woman has allergies to these drugs and

low risk anaphylaxis, the choice will fall at cefazoline;
high risk of anaphylaxis, then clindamycin or erythromycin, if bacteria show susceptibility to these drugs, and if it is impossible to check it at the moment, you choose vancomycin.

Women whose child's birthday risk ahead of time is very high, starting with 2 trimesters and to the kind of birth can be recommended to receive progestin.

Many bodies that begin ahead of time, the doctors turn out to be stopped. If the generic activity is just beginning, then there are medicines (tocologists), which are able to stop the cutting of the uterus, although their use is risky. Tocolics include magnesium sulfate, calcium channel blocker or, if the generation began before 32 weeks, prostaglandin inhibitors. The last is contraindicated later than 32 weeks of pregnancy, because they can cause short-term lowland, premature narrowing or closing of arterial duct.

Next, the woman will introduce intramuscularly corticosteroids (betamethasone or dexamethasone). They are needed to speed up the ripening of light fetus, reducing the risk of intracranial bleeding and mortality. This treatment is used up to 34 weeks of pregnancy.

The following scheme turns out: To begin with, experts delay the generic tocolices to affect the corticosteroids.

Forecasts for the child

If premature birth do not stop with medical intervention, the child will be born premature. The sooner it happens, the greater the risk to the health of the baby. Most premature children need special care in the department of intensive therapy of newborns.

In children born ahead of time, there are the following signs:

In the norm, docking labor should occur in the interval from 37 to 42 weeks of pregnancy. This is the best time when the baby is gaining sufficient weight, and its brain matures so much that it allows organs to fully function outside the mother's body.

But due to external factors or due to the state of health, a child may be born ahead of time and then the quality of his future life is under threat.

Premature birth is spontaneous expulsion of the fetus from the body of the uterus in a period of up to 37 weeks of pregnancy, as a result of which the risk of receiving child injury, pneumonia or the development of preeclampsia and eclampsia has the risk.

The more the term on which the baby appears, the more mature its body will be and the greater the chances that the child's health problems will not be found.

Fast page

Who is in the risk group of premature births?

Sometimes the baby appears ahead of time due to the influence of any external factors: an accident, weight lifting, a strong blow, airfare, etc. But much more often this is due to the problems in the mother's body about which some women may not even suspect.

When planning it is important to find out if you are not in the risk group of premature childbirth and non-pregnancy. This indicates the presence of the following factors:

Cropped cervix. Normally, it is at least 3.5 cm - it is enough to hold the load that the growing fruit gives. If the cervix is \u200b\u200bshorter, then it is likely that with a great pressure it will open.
Curry uterus. Most often, unbearable happens with a saddot counya uterus, while complete can give the opportunity to develop a full pregnancy.
Polymorphism of thrombophilia genes. Provocates blocking of umbilical cord vessels and placenta. As a result, the fruit is experiencing oxygen starvation, and if there is no special therapy for blood dilution during pregnancy, then the woman has a very risk of premature birth.
Abnormally small body sizes. A close space does not give the child to grow to the size of the docking, so the expulsion of the fetus occurs ahead of time.
Increased blood testosterone. Normally, testosterone in a pregnant woman should be higher than before conception. However, the critical level of this hormone in terms after 20 weeks can provoke generic activities.
Eastic-cervical insufficiency in history. The neck of the uterus before pregnancy can have normal sizes, but after conception at the end of 1 trimester to start shortening or disclosed. If the previous pregnancy had to face a similar problem, then most likely, it will also arise with the subsequent tooling the child.
Development of preeclampsia and eclampsia. The deterioration of the state of a woman can provoke generic activities, but if this does not occur, the doctors are forced to stimulate its beginning and make an emergency cesarean section.

The risk of premature births also increases with multiple pregnancy, at a very young age of a future mother, as well as as a result of stress.

One of the most cunning features of early childbirth is that they start suddenly. Only in rare cases the body begins to prepare for them in a few days. Mostly everything happens in a few hours and the first signs of premature genera are manifested:

Stretch pain. Moreover, the fights can be not very painful. Strong pain appears immediately before fasting.
The appearance of colostrum in combination with pulling pain.
The appearance of bloody secretions of red.
Powering of ammunition. It can occur portion, for several hours. There is also a variant that the entire volume of amniotic fluid will come immediately.
The sign of premature birth is the sudden ending of the abdomen. Normally, this is happening in women for 9 months of pregnancy. If the belly fell earlier, and even for a very short period of time, this is an alarm signal.
Folding the cervix more than 2 fingers. Determined by the gynecologist during the inspection on the gynecological chair.
Testing mucosa. It is only a relative symptom of premature births, since after the release of the cervical mucus, for example, in 30 weeks, some women move pregnancy to 36 - 37 weeks.

If any of the above symptoms occur, immediately consult a doctor. In most cases, timely medical intervention helps to avoid early childhood appearance.

Survival of children born to term

In Russia, a child born in 22 weeks of pregnancy is considered viable. From this period, children's resuscitative workers are obliged to make all available funds to save his life. In general, the painting of survival of premature children is as follows:

22 - 24 weeks - Theoretically lightweight child on this period is considered capable of perceiving artificial ventilation. However, the chances of the infant survival, if premature birth occurred at the 22nd week of pregnancy, extremely small.

And the point here is not only in the immaturity of the respiratory organs, the main problem is the immaturity of the central nervous system, which is extremely difficult to fully function outside the maternal womb.

25 - 26 weeks - If the baby appears in a technically well-equipped hospital, where there will be a powerful children's resuscitation, then it has chances to survive, but they are low - about 30%.

28 - 30 weeks - Although all the born are connected to the system of artificial ventilation of the lungs, many of them are already able to breathe independently on the third day. But if premature gods occurred at these times, then the kids still do not have a sucking reflex (due to brain immaturity), so their feeding is carried out through the probe.

31 - 33 weeks - under the condition of well-equipped children's resuscitation, the survival rate of children is about 85 - 90%. Their nervous system is more mature, so the sucking reflex in half of such babies is already present.

34 - 36 weeks - The child is quite mature, does not need a probe for feeding, or in artificial ventilation of the lungs. For a full existence outside the maternal womb, they only need to gain weight.

Of course, in each case, your nuances and premature complicated childbirth after 30 weeks can affect the state of the baby's nervous system much worse than the uncomplicated birth of 26 weeks.

Pregnancy and childbirth after premature birth

If the first gods occurred ahead of time, then the woman is not so easy to decide for another pregnancy. First of all, psychologically (especially if the child was born dead or did not survive after the resuscitation procedures conducted).

Before planning conception, it is necessary to establish the reason why the previous baby was born too early. Pregnancy after premature births requires a special approach and a thorough examination of the body of the future mother:

A visit to genetics and analysis on mutations of certain genes, which could occur in the fault of which later miscarriage.
The study of the hormonal background to identify hormones, the level of which could be too low or critically high to continue pregnancy.
Ultrasonic examination of uterus and appendages to identify the abnormalities of the structure of the reproductive system organs that could prevent the child to convey to the deadline.

Maintaining such pregnancy requires increased attention of the doctor, so the woman will have to visit the gynecologist more often than everyone else.

If the second child is not scheduled, then the reason for the unsuccessful first pregnancy has to find out already in the process of carrying the second, which significantly increases the risks of repetition of the previous scenario, as it is sometimes to wait for test results for several weeks.

Childbirth after premature births can occur in the deadlines, if the cause of the previous late miscarriage has been established and all measures have been taken to stabilize the state of pregnant.

In case a woman has a polymorphism of thrombophilia genes, it is most likely to have to be conveyed to 40 weeks. But with the help of the necessary drugs, there is a chance to extend the pregnancy up to 35 weeks, which is a good safe for the baby if it appears.

According to the definition of the World Health Organization, premature genera are those genera that occurred from up to 37 weeks of pregnancy or for 154-259 days of gestation, if the term is counted from the first day of the last menstruation. In the territory of Russia, those gods that occurred in the period from 28 to 37 weeks of pregnancy occurred from 28 to 37 months of gestation are considered premature. Births on a period of 22 to 27 weeks in Russia are allocated to a special category, which is considered to be late abortion, and not premature births. It is different deadlines in premature births and was due to the difference in statistical data between Russia and Europe. The birth of a kid on a period of from 37 weeks is no longer considered premature. In other words, if a woman has giving births on a period of 37 to 42 weeks, they are considered urgent, which began on time.

Causes of premature birth

So, what are the causes of premature births:

matter injury during past pregnancy - premature genera, large fruit (more than 4 kg), rapid and fast childbirth, the use of vacuum or obstetric tongs, gap during the birth of the cervix;
made earlier operations on the cervical uterus - amputation, conization;
intrauterine intervention - hysteroresecation, scraping, abortion;
gene defects that can cause the synthesis of the cervical tissue tissue;
randu-Osler, Marfana, Elessa-Danlo;
early deadlines for premature births may arise as a result of infectious diseases of female genital organs, provoked inferiority of the cervix - megaloviral infection, herpes, microplasmosis, chlamydia, ureaplasmosis, bacterial vaginosis and candidiasis;
endocrine disorders can cause changes in the structure of the cervix, its shortening or the expansion of the cervical canal;
increased load on the neck of the uterus, during pregnancy in multi-way, multipleness, large fruit;
common infectious diseases of the mother - chronic tonsillitis, rubella, viral hepatitis, flu;
common diseases at the stage of decompensation - hypertensive disease, heart patterns, diseases of the kidneys, liver, blood, diabetes;
rhow-conflict - arises when a woman has a negative rhesus factor, and the fetus is positive. The consequences of such a conflict can be tragic - there is a risk of developing a hemolytic disease in the baby, often a pregnancy ends with premature births, more often by cesarean cross section, in severe cases, the baby can die.

Symptoms and signs of early childbirth

As already mentioned earlier, the longer the baby will be in the womb of the mother, the more healthy and viable he will be born. From here it follows that it is necessary to know the symptoms of premature births in order to stop them if possible. You can stop the action process, but only when it comes to threatening and starting birth. In the event that the generic activity has already begun, and the neck of the uterus has already begun to open, then this process is no longer possible to stop. It remains only to take them carefully, trying to be all possible, save the child's life. It is extremely important to consult a doctor. So, what kind of symptoms of such an unpleasant phenomenon, like premature births.

Threatening premature birth make themselves to know the beginning of pain in the field of the lower back and the bottom of the abdomen. The uterus arrives in Tonus, as a result of which the stomach becomes hard, but the cervix does not open. The beginning of the premature birth of grapple-shaped cuts of the uterus is accompanied, in fact it is already full-fledged contractions. In this case, the cervical disclosure is shocked. Often, in this case, the separation of the oily water occurs.

In general, premature births in their symptoms are practically nothing different from ordinary, although it is often accompanied by different complications: excessive or weak generic activities, bleeding and detachment placenta. Often, premature birth in time is much smaller than the usual.

How and how can I cause premature birth?

If you are interested in how to cause premature childbirth, it should be done if necessary in the clinic and only if there are indications for this. Also increases the risk of premature genera. Drug use, alcohol, smoking, constant stress, as well as severe physical work. In the event that, in the past, a woman had a similar situation, it should be preventing premature birth. It consists in compliance with the special regime with the lack of physical stress, nervous stress, stress.

It is also extremely important to proper nutrition and adherence to a special diet. You will have to exclude harmful, sharp and fatty products that may contribute to the beginning of the birth ahead of time. As you can see, there are a lot of reasons. If you notice the first signs of the start of premature birth, then it is necessary to urgently consult a doctor, because in this case there is a high probability that they will be able to stop and preserve pregnancy.

What is the threat of early childbirth?

The threat of premature birth is primarily the death of the fetus, if he is born on an early term and will not be ready for life outside the womb. In the event that the generic activity begins in the period from 22 to 37 weeks, it is premature childbirth. If the childbirth occurred on the 22-28 week of pregnancy, then in this case the mass of the newborn will be from 500 to 1000 grams. In the event that such a child has lived for more than seven days after birth, then such labor is considered as very early premature. In the same case, if the baby died during childbirth or throughout the first week of his life, then in this case we are talking about spontaneous interruption of pregnancy (later miscarriage).

Births on the 29-27 week of pregnancy - at this stage, the weight of the baby is about 1000-2500 grams. The baby's mass of the baby at this stage is sufficient for its independent vital activity, while all its bodies are already considered viable (in the absence of anomalies of development). Also, at such a stage, appropriate treatment is made, because the immaturity of endocrine organs, the central nervous system, the lack of certain reflexes are capable of making it very vulnerable. Such children require special, active and long care. However, it is often even medical control and careful care is not able to guarantee that in the future such premature birth will not affect the health of a premature child.

So, the threat of premature births, first of all, increases the likelihood of the death of the baby in the early terms, as well as the development of deviations of nervous and endocrine systems at a later date of premature labor.

Premature childbirth at different timing

As a encouraging moment for those women who arrive in fear of the possibility of starting premature births, we want to give special statistics of such cases, as well as the common chances of a child for normal development. note that only 6-8% of all kinds are considered premature. You just think about the figures that only 8 women from 100 give birth earlier than the appointed time, the rest safely tear the baby.

Premature birth to 24, 25 weeks of pregnancy make up about 5-7%. Of course, such children are more difficult to go out, but still save quite many. Premature birth to 32, 33, 34 pregnancy weeks are the cause of more than 30% of premature children. It is already much easier to leave such babies, more than half of the kids survives.

Most of all premature births (approximately 50%) occurs on -37 week. From the intricate child, such a baby is only characterized by sizes. All organs and systems they have already developed to independently exist outside the womb. As you can see, many women have no reason to worry, most importantly consult a doctor in time.

Your actions

In the event that the term of your pregnancy is less than 37 weeks, and you have already moved the water and the contractions began, it is necessary to quickly call an ambulance or contact your attending physician. If the childbirth began, they can also end and stop. It happens at about half of the cases, with a different development of events in a woman begins real delivery, which is no longer possible to stop. In the event that the arrogant water has already been deployed, the doctor will hold amniothetts. It is needed to check - if it is water. In the event that an anhydrous interval of more than 12 hours, antibiotics harmless to the child are prescribed.

As you understand, if you notice the beginning of premature birth, then it is necessary, without thinking to go to the hospital, because in this case, even a few hours can become decisive. After all, the likelihood is that at the initial stage, doctors will be able to stop them, thereby save their life to prematurely and give it to him to develop normally in the womb, and be prepared for the emergence of the world. Therefore, you should not postpone.

Roddom

In the hospital, when conducting premature birth, the doctor must monitor the heartbeat of the baby. If there is no need for anesthesia, it is recommended not to use Promedol and other narcotic analgesics, as they can negatively affect the kid's respiratory system. In most cases, the doctor prescribes epidural anesthesia. In the event that the period of pregnancy is less than 34 weeks, then the feminine can prescribe hormones that contribute to the acceleration of the development of the lungs in the kid (prevention of respiratory distress syndrome). In addition, preparations will also be assigned to suspend generic activities for a while. When pregnancy - more than 34 weeks, a woman in most cases give birth naturally. In some cases, during premature births make a cesarean section. Such a need happens in the event of complications - such as severe bleeding or a state that threatens the life of the baby.

Pregnancy after premature birth

A new pregnancy after premature births is better to schedule in advance, passing before such a responsible moment of surveys not only by the genital organs, but also internal. It is also necessary in obligatory pass the blood to identify the concentration of thyroid hormones, whose lack, can cause repeated premature births. It is also necessary to do an ultrasound of a large pelvis organs, examine the heart, pass the blood to determine the number of hormones and immunity indicators.

Timely, or urgent (on time) childbirth are a physiological completed process of pregnancy. Complications of premature births are directly related to the last period and largely determine the necessary measures for this comprehensive medical and social problem.

It lies in the impression of premature newborns, measures to improve their future life, as well as in additional socio-economic expenses. Therefore, the most difficult and most important is the question of how to prevent premature childbirth.

Definition and features of the flow

The dates of childbirth adopted abroad and in Russia, which are considered premature, differ than the difference in statistics is due. On the recommendation of the World Health Organization are considered premature births that occur in terms of 22 to 37 weeks of pregnancy, or at 154-259th day, with a mass of the fetus from 500 to 2,500 g and the length of the body is at least 25 cm.

In the Russian Federation in 1992, a timeline was taken - 28-37 weeks, or on the 196-259th day, and spontaneous interruption of 22-27 weeks is a separate category that is not classified as childbirth.

Such a difference is due to the fact that to enjoy newborns from 22 weeks with a body weight from 500 to 1,000, highly qualified and experienced neoatologists are needed, as well as special highly sensitive devices for artificial ventilation of lungs and other perfect equipment. All this is available in specialized profile neonatal centers of Russia, but is absent in ordinary hospitals.

For multipleness, premature is considered to be childbirth from 22 to 35 weeks of pregnancy. Since the body's mass of each of them is lower than with one-bed pregnancy, early birth is more dangerous for them. However, the majority of children born at the 28th week of pregnancy and later succumb to successful surcharge.

Among the birth to the share of premature ranges from 6 to 10%, of which from 5 to 7% - on July 22-28, from 33 to 42% - on July 29-34 and 50-60% - at 34-37 weeks . The frequency of morbidity and mortality of premature children in the perinatal period is 30-70%.

What are the features and how are premature childbirth?

They are characterized by:

the beginning (significant numbers of them - about 40%) of premature waters;
development of abnormal generic activities;
an increase in duration or, on the contrary, rapid or rapidly;
the emergence of asphyxia of the fetus or hypoxia of varying degrees;
bleeding in the last and early postpartum periods;
frequent infectious complications.

Classification and consequences

There is no generally accepted single classification. Letter of the Ministry of Health of the Russian Federation premature childbirth, in accordance with the periods of gestation, is recommended to divide on:

Very early

Frequency 5%, occur after 27 weeks + 6 days. The newborn at the same time is characterized by a deep prematurity, body weight below 1,000 g. And pronounced lung immaturity, although in some cases the prevention of respiratory distress syndrome is effective.

The forecast of survival for such children is extremely unfavorable, and mortality rates and morbidity are as high as possible. The surviving premature children born at the 24th week of pregnancy and even later, very often later remain disabled, due to persistent physical and mental disabilities.

Early

Frequency (15%) - 28-30 weeks + 6 days. The presence of such children is regarded as "heavy." Characteristic of them are the mass of the body less than 1,500 gr. And the immature pulmonary fabric, the accelerated development of which it is possible to achieve with the use of glucocorticosteroid preparations (dexamethasone) and means that stimulate the formation of a surfactant - a biologically active substance that covers the epithelium of the alveoli mucosa and does not allow their walls to fall.

The severity of the state of children born in 30 weeks of pregnancy is expressed significantly less compared to previously born, and is approaching the average degree.

Premature

Frequency (20%) - 31-33 weeks + 6days. The survival rate of children born on the 32nd week of pregnancy is very high and averages 95%. The degree of their prematurity is regarded as the average. However, they are very prone to infectious diseases, since the bookmark and the formation of the enzyme system of the fetus in these timing is still beginning.

Late premature

Frequency (70%) - 34-36 weeks +6 days. By this time, the pulmonary fabric fabric is practically formed and there is no need to stimulate its maturation. In addition, these children have significantly lower susceptibility to infectious pathogens, compared with the newborn of the previous group, and drug prolongation of pregnancy does not significantly influence the causes of mortality.

The totality of the signs and nature of the occurrence differ:

Spontaneous premature genera (70-80%), among which from 40 to 50% proceed with regular generic activities with a preserved fruit bubble and 25-40% - with an infringement of spindle water in the absence of regular generic activity.
Induced, or artificial premature genera (20-30%), implemented according to certain medical reasons.

Indications for artificial premature childbirth and their stimulation

Indication indications may be associated with pathology in the human body or / and fetus. In the first case it is:

severe decompensated endogenous (organs or systems) diseases that threaten the life of a woman;
severe in the form of severe preeclampsia and / or eclampsia;
the pathology of the hepatic function, accompanied by a violation of the jelly current (intrahepatic cholestasis of pregnant women);
complication of pregnancy in the form of Hellp-syndrome (erythrocyte hemolysis in combination with a reduced blood platelet content and increased activity of hepatic enzymes) and some others.

Indications from the fetus are:

progression of deterioration of the state, despite the measures taken;
malformations that are incompatible with life;
intrauterine death.

To this end, drugs that stimulate the "maturation" of the cervix, which increase the tone and the contractile activity of the uterus are used. These drugs include mifepristone in combination with mizoprostol, oxytocin, dinoprostonton and dinoprost. They are injected into the vagina, in the cervix, intraamniotically, intravenously in large doses and on the designed schemes.

An attempt to self-induction at home is able to lead to extremely severe complications, often ending with death even when providing emergency medical care.

Possible complications

The prematurity of childbirth is often the cause of certain complications that develop them significantly more often, compared to urgent. These complications include:

massive bleeding due to its prelation or dense increment;
rales of the cervix and crotch tissues due to their unpreparedness to the passage of the fetus in rapid childbirth;
infection of generic pathways with the development of septic states; Development of coagulopathic conditions during protracted births, etc.

Hygogalactium is associated with unpreparedness on this term of the body of a woman, complications during pregnancy and childbirth, a weak sucking reflex in an immature newborn and forced late applying it to the breast of the parent.

But the greatest threat of premature birth is for the health and life of the child. The survival rate in perinatal centers among children born to 23 weeks of pregnancy is only 20%, at the 26th week - already 60% and in 27-28 weeks - up to 80%.

According to the sign of survival and, depending on the mass of the body, children are divided into categories:

I - body weight Low (1 500-2 5000). Children of this category often survive, about 3 years, they reach the level of development of peers and further continue to develop in accordance with the accepted age indicators.
II - body weight is very low (1 000-1 500 g). Approximately 50% of such children are not amenable to charging, and the rest of the remaining organic or systemic disorders are often developing.
III - body weight is extremely low (500-1,000 g). Specialized neonatal centers are able to leave some of these children, but almost always they have resistant disorders of the function of the central nervous system, respiratory organs, digestion, urogenital system.

However, such criteria as a term of pregnancy, mass and growth, do not always correspond to the maturity of the fetus. For example, among children with a mass of 2,500 gr. From 18 to 30% are domestic, and with a mass of 3,000 gr. - From 4 to 8% premature.

Therefore, in determining maturity, the proportionality of the physique is also taken into account, the condition of the bones of the skull, the nature of the distribution and the density of the growth of flush hair, the color and thickness of the skin, the severity of the subcutaneous fat layer, the location of the umbilical ring, the degree of development of the external genital organs of the child, etc.

Causes of premature birth and risk factors

Among specialists there is no single and clear idea of \u200b\u200bthe mechanisms for the development of this violation. Most of them are the main causes of hormonal disorders, chronic infectious processes and neoplasms of internal genital organs, as well as violations in the rolling system of blood.

The main mechanisms of pathology are associated with:

Increased emissions into the blood of specific information protein molecules in infectious processes in the body of a woman.
The development of coagulopathic processes (violation of blood coagulation), which cause microtrombosis in the placenta with its subsequent premature detachment.
An increase in the content and activation of the oxytocin receptor system in the muscle layer of the uterus. This contributes to the increase and contractual activity due to the opening of the calcium cells of muscle cells and the flow of calcium ions in them.
Premature breaking of the fetal shells due to the infection of the lower sections of the fruit bubble, which is usually occurring in exhaustic-cervical insufficiency.

Risk factors

Multiple contributory factors are usually considered as causes of pregnancy. What can premature childbirth provoke? All risk factors can be conventionally combined into 4 groups.

Complications arising in the process of this pregnancy:

infection of the vagina and cervix;
bleeding from the uterus;
severe gestosis flowing with edema, increased arterial pressure and proteinuria (protein in the urine);
sensitization on the Rh Factor;
antiphospholipid syndrome;
multi-way and multiplot;
pelvic prevention of the fetus;
prelation of placenta or premature detachable;
pathology, including asymptomatic, urinary tract;
prematurely "ripened" to childbirth cervix;
premature disruption of the integrity of the fetal shells and the expulsion of water;
anomalies for the development of the fetus.

Related common diseases:

acute infectious diseases during pregnancy, including intestinal, especially leaking with high temperatures;
the presence in the body of chronic foci of infection (chronic tonsillitis, rhinosinusitis, periodontitis, etc.);
severe physical exertion, injuries and surgical interventions during pregnancy;
arterial hypertension and cardiovascular failure;
severe forms of diabetes;
renal pathology.

Humidated obstetric and gynecological history:

disorders of the menstrual cycle;
anomalies for the development of internal genital organs and the presence of benign tumors of the uterus;
coyncing or amputation of the cervix, Eastic Cervical Insufficiency;
pregnancy after premature births;
four or more childbirth;
two or more medical or one and later spontaneous abortions;
pregnancy as a result of using auxiliary reproductive technologies.

Socio-biological:

age - less than 18 years (due to the insufficient maturity of the reproductive system) and more than 34 years (due to the acquired chronic diseases);
unfavorable socio-economic life conditions;
frequent stressful states and negative emotional and mental loads;
nicotinic, alcoholic, narcotic intoxication.

Can sex provod preterm labor?

In the last periods of pregnancy, excessively active sexual relationships can provoke a reduction in smooth muscle fibers of the cervical cervix and its expansion, lead to an increase in the uterine tone. This is capable of causeing damage and premature breaking of the fetal shells in the field of the lower pole of the fruit bubble, infection, the leakage or the destruction of the oily water and stimulation of the generic activity.

Do candles cause premature bodies?

The building is an antispasmodic drug, that is, it removes the spasm of smooth muscles. When pregnant, it, like other spasmolytics, is sometimes prescribed to reduce the tone of myometrium in the threat of miscarriage and in some other cases. With the normal course of pregnancy, theoretically, it can contribute to the disclosure of the cervix and provoke the beginning of the birth, especially in the presence of exhausco cervical insufficiency. However, reliable descriptions of such an effect of the drug do not exist.

Prematurity of childbirth is considered a multifactative disorder. The more combinations of causal factors are detected by a woman, the probability of pregnancy is higher, and such a patient should be included in the risk group.

Clinical signs

Due to the unpreparedness (immaturity) of the cervix, there is a risk of anomalous development of labor, as a result of which the whole process acquires a protracted character. In addition, 40% of such genera are flowing without any precursors and begin with antenatal influence of spindle water. However, in most cases, the symptoms of premature births are practically no different from those on time.

Depending on the clinical course, such labor is divided into:

Threatening.
Starting (for the term up to 34 weeks).
Started.

Due to the lack of specific symptoms, the threat of premature births often represents certain difficulties in terms of diagnosis. It is mainly manifested:

an increase in the tone and excitability of the uterus during her palpation;
complaints of pregnant on the strengthening of discomfort or the appearance of moderate pain at thenime of the belly of a pulling or grapple-shaped character, on the "menstrual-like pain in the lumbar region; In some cases, complaints may be absent;
subjective and objective increase in the activity of the fetal mechanical or, on the contrary, the cessation of its activity;
a feeling of cutting or pressure into the vagina, frequent urges on the urination, and sometimes - for defecation, which is associated with a low location and pressure on the internal fabrics of the preteal of the fetus.

In addition, in the case of a premature break of the fruit shells, the feminine complains of the selection from the vagina of a liquid nature. The consequence of the abundant pouring of the octoped waters is to reduce the volume of the abdomen and reduce intrauterine pressure. At the same time, the body temperature is often rising, which is accompanied by chills, sometimes pronounced. This indicates the rapid development of the inflammation of the fetal shells (chorionenionitis).

Diagnostics of the threat is carried out on the basis of the above signs and is specified by vaginal inspection, tonsometry, outer multichannel hysterography and ultrasound research in dynamics.

With a vaginal inspection of changes in the cervix, it is formed, it has a length of about 1.5-2 cm, its outer zev is closed or, if the childbirth is repeated, passes the fingertip (up to 1 cm). You can also determine the predatory part of the fetus, pressed to the entrance to a small pelvis. These instrumental studies indicate an increase in the tone of myometrium.

How to understand that premature childbirth began?

Their beginning is characterized by pronounced gravity pains in the lower parts of the abdomen or regular battles confirmed by hysterography. With a vaginal examination, a shortened and softened or (often) smoothed neck of the uterus and the disclosure of its outer sewing in the dynamics of up to 3 cm is determined. Palparato and ultrasound is observed by the deployment of the lower uterine segment.

Signs of the beginning of childbirth:

Regular generic activity (regular contractions) with an interval between them about 10-15 minutes.
Departure of the accumulation waters.
Minor, separating isolation of a bloody character.
With vaginal examination at the entrance to a small pelvis, a fruit preserving is determined.
The dynamic disclosure of the outer food zea is more than 3-4 cm.

Maintaining premature births

The reference tactics can be conservative and expectant or active. Its choice is due to the following main factors:

The state of a woman.
Pregnancy timing.
The presence and severity of bleeding.
The clinical flow of childbirth (threatening, beginning or started) and their severity.
The state of the fetus.
Degree of cervical disclosure.
The state of the fruit bubble.
The presence of symptoms of infection.

Expectant tactic

In the occurrence of pain at the bottom of the abdomen and the lumbar region, it is necessary to call "ambulance" in order to hospitalize a pregnant woman. Proponial assistance is to ensure physical and psycho-emotional rest - bedding, psychologically soothing effect, receiving the infusion or tincture of the mother-in-law and hawthorn, bravery or the extract of Valerian root, antispasmodic preparations (but-shpa, drootserin, papaverine) in tablets, intramuscularly or in the form Candles.

Conservative treatment of threats of premature genera in hospital

The purpose of the therapeutic impact is pregnancy prolongation. The maintenance consists in:

treating threat;
prevention of fetal asphyxia;
prevention of infectious complications based on measuring body temperature, blood tests and stroke tests and cervical channel microflora.

In the threat of a woman, bedding is prescribed, conditions are created for physical and emotional peace, light sedative and antispasmodic preparations inside, intramuscularly, in the form of rectal candles, magnesial ionophoresis, igloreflexotherapy, electrocolateral therapy.

Application of tocolices

If necessary, the tocolic agents are applied. Extra cocolics with a different mechanism for the suppression of contractile activity of the uterus. These include:

beta adrenomimetic drugs that contribute to a decrease in the content of calcium ions (ritodrine, terbutalin, hynipral); They are used inside or intravenously;
magnesium sulfate (intravenously drip), reducing the reduction of the reduction and excitability of myometrium, too, by reducing the concentration of calcium ions in the cell cytoplasm;
nonteroidal anti-inflammatory drugs (rectally indomethacin), which are inhibitors of forebanding synthesis; The application is recommended after the 32nd week of pregnancy (in order to avoid complications).

Nifedipine belongs to the tocoleic drugs that block the entry of calcium into the cell. During the studies of the effect of nifedipine, in the threat of premature genera, good results were obtained in terms of suppressing the contraction of the uterus, which it compares or even exceeds beta adrethrenimetics (riteodrine, etc.), and the lack of an adverse effect on the fetus. The drug makes it possible to increase the term of pregnancy up to 1 week. However, when applied, care must be taken, since the drug is capable of leading to hypotension, especially orthostatic.

As a rule, treatment begins with the appointment of beta adrethrenimetics or Magnesia sulk acid. In case of ineffectiveness, non-steroidal anti-inflammatory drugs and calcium anthonists are prescribed. The combination of tocolithic tools among themselves is applied only in terms of up to 28 weeks and with the disclosure of the external zea cervix more than 2 cm. It is possible to further use tocologists according to a specific scheme as supportive therapy.

The use of gestagenov, glucocorticosteroids

High degree of efficiency of application for stopping or preventing premature births are the Gestagens (progesterone), to which the ureasuala refers. Its combination with beta adrenomimetics allows to reduce the dosage of the latter. Urozhenan is recommended to be used carefully due to its property to increase the sensitivity of the uterus of a pregnant woman to bacterial flora.

In addition, antibacterial therapy and therapeutic stamps of the cervix are often shown. To prevent the development of RDS (respiratory distress syndrome), the fetus uses glucocorticosteroids. The conventional conference held in August 2,000 was recognized as the most efficient and recommended for use intramuscular administration of dexamethasone in terms of 24 to 34 weeks twice (12 mg twice for 1 day) or fourfold (6 mg four times as well as 1 day).

In exceptional cases, after careful observation, treatment is carried out in an outpatient basis (at home).

Contraindications for expectant tactics

Absolute contraindications to conservative tactics of the threat of premature births are:

Pregnancy from 36 weeks and more.
Oblique, transverse location of the fetus.
Foot premium in combination with the central rupture of the fruit bubble and an open cervical canal.
Signs of intrauterine infection.

Relative contraindications:

pregnancy 34-35 weeks;
foot prevention of the fetus in combination with a high gap of the fruit bubble and a closed cervical canal;
criminal (outside the medical institution) intervention in the uterus cavity in order to interrupt pregnancy, but in the absence of explicit infection;
multipleness, nephropathy, heavy extragenital (accompanying) pathology in a woman;
the presence of pathogenic microorganisms in the vagina or the third degree of purity;
the presence of leukocytosis in the blood with a shift to the left under the condition of normal body temperature.

With relative contraindications, in the threat of premature genera, preventive measures of fetal hypoxia are carried out, antibacterial therapy (according to indications), therapy of the main pathology and preparation for childbirth. In the absence of their start, over 5 days their stimulation is carried out by administering prostaglandins intravenously or drip administration of oxytocin under control of cardiotockography. Active maintenance is necessary in cases:

Suspicions for the presence of fruit development anomalies.
Complications of pregnancy in the form of severe gestosis, not amenable to correction.
Severe somatic pathology in the guinea.
Pullen water and lack of a fruit bubble.
The presence of regular bouts.
Threats of intrauterine asphyxia of the fetus.
The presence of infection symptoms.

Active tactics of premature birth

The first period of birth is characterized by a high degree of mobilization of adaptive mechanisms of the body of a pregnant and placental-fruit system. The gradual exhaustion is sometimes leading to a rapid change in the obstetric situation, violation of the livelihood systems of the fetus and to the development of its hypoxia. In this regard, it is necessary to conduct permanent cardiomonitorial control and implement an individual solution to the issues of the relevant preventive (every 2 hours) and therapeutic measures.

After opening the neck up to 3 cm, the use of epidural analgesia is recommended. It helps to reduce or eliminate pain syndrome, expansion of the cervical canal, relaxing the muscles of the pelvic bottom in the second period (period of expulsion), improving blood microcirculation in the tissues of the manufacture and fetus, and also reduces the likelihood of the development of discoordination uterine reductions and increase blood pressure. In addition, epidural analgesia, in contrast to the anesthesia by Promedol, does not cause oppression of the breath of the newborn.

In the event of a threat of fast or rapid generations, the correction of the contractile function of the uterus is carried out by drip administration of intravenously of the PARTSISEN. It is introduced at a certain speed for 10 minutes with a gradual decline in the dose to establish the required frequency and regularity of the kits, the opening of the outer mouth to 8 cm and advance the fetus head into the narrow cavity department of the small pelvis.

The second period is characterized by a high degree of danger of injuries (mainly cranopy-brain) fetus. Therefore, during the period of expulsion, the protection of the crotch of women in labor to prevent breaks is not carried out. In order to stretch the soft tissues of the pelvic bottom and facilitate the passage of the fetus, the obstetrician gynecologist stretches its fingers and muscles from the vagina in the direction of sedlication bumps. If necessary, the crotch is carried out.

With premature childbirth testimony to resolve through cesarean section are:

Heavy form of gestosis (preeclampsia and eclampsia).
Placental preview.
Premature detachment at a normal placenta location.
Cross-positioned fruit or complications arising in the case of its pelvic preview.
A burdened obstetric history of a woman in connection with, without pregnancy, the birth of a dead fetus.

Prevention of premature birth

Removable diagnostic preventive methods that allow in a long term (over 3 weeks) in a long term (over 3 weeks), there is no prematurity of childbirth.

Tests

To date, the generally accepted and most informative is the test for premature birth, based on the definition of cervical mucus in terms after 20 and weeks of glycoprotein Fibronctin. The latter largely contains in the cells of the enveloms of the fetus and groundwater waters.

The identification of fibronectin in the cervous mucus indicates the appearance of air-coopedy water and is considered as a precursor. The highest (up to 71%) test sensitivity two weeks to premature births. Three weeks before them, the informativeness of the test is about 59%, and at the time of pregnancy up to 37 weeks - no more than 52%. This test is possible only in a medical institution.

There is also a rather informative test for the definition in the conditions of women's consultation of a premature disorder of the fetal shells. To independently define in the vaginal discharge of the octoper waters, a test gasket is proposed - "Frautest AMNIO". However, diagnosis with this test is unreliable.

Transvaginal ultrasound

Another relatively informative study is an echographic dynamic determination of the neck of the neck by means of a transvaginal sensor of the device. If the neck length exceeds 3 cm, then the probability of childbirth over the next week does not exceed 1%.

Other preventive measures

Preventive measures before pregnancy include informing women on risk factors, minimizing any manipulations on the internal genital organs, refusal to smoking and unmotivated receptions of pharmaceutical vitamin preparations before and within 2 months after conception. Reception during pregnancy women from the risk of progesterone derivatives, antibiotics and other antibacterial drugs for the purpose of the gynecologist, conducting antibacterial therapy and so on.

The method of overlaying seams during a shortened neck has an ambiguous prophylactic effect. In some cases, an obstetric pessary is used separately or in addition to the seams on the cervix. It is installed in the vagina and is a ring. This ring, in the threat of premature births, should provide an additional support, due to which the pressure on the lower uterine segment is reduced and an obstacle is created to disclose the outer sewing and breaking the fetal shells. However, most experts respond to skeptical about the effectiveness of this medical product.

The main role in addressing the prevention of pathology and its complications belongs to the female consultation. Its personnel are engaged in identifying women with risk factors, carries out dynamic observation of them, develops an individual plan of preventive measures, makes hospitalications to the department of pregnant women to conduct a survey and individual adequate treatment.

The awareness of women on pathology allows them even at the stage of preparation for conception to take advantage of a specialist, and in pregnancy - to seek medical attention in time. Deep knowledge of doctors and the ability to correctly analyze possible causes and risks make it possible to avoid the unfounded appointment of drugs, often leading to side effects and complications, as well as reduce the frequency and severe consequences of this pathology.

Since the beginning of the development of pregnancy, many women listen carefully to their body, fearing the miscarriage or premature birth. Of course, such anxiety should not be redundant, because it can hardly sweat the nerves of the future mother. But the normal attentive attitude towards its body and to the growing baby is really necessary. After all, the risk of premature births are present at many pregnant women, so we clarify the signs of premature births at the age of 28.

Risk of childbirth

Doctors argue that premature labor can happen from any pregnant woman if a number of factors contribute to this. However, some future mothers probability of such an outcome of pregnancy are much higher than that of the rest.

As practice shows, an infectious damage is becoming the most common cause of premature labor. After all, the uterine cavity is normally sterile, and inflammatory processes disturb the normal structure of its walls in general, and the muscular layer in particular. For this reason, the future mothers are urgently not recommended to refuse surveys for various infections. And ideally, it is worth passing them at the stage of conception planning.

At the same time, it is worthwhile to show special care, which have already encountered chronic and acute inflammatory lesions of appendages, uterus or endometrials, with intrauterine interventions (abortions or diagnostic scraps). Also in the risk group, girls enter the history there are cases of spontaneous interruption of pregnancy.

The second most common cause of early childbirth is considered to be edema-cervical insufficiency - the presence of inferiority of the muscular layer of the uterine neck, which, with a healthy pregnancy, performs the function of a peculiar retaining ring, warning the exile of the embryo. Such pathology may be congenital (which is extremely rare) or acquired. The probability of the occurrence of exemption-cervical insufficiency increases during the injuries of the coastal and the uterine neck during abortion and previous birth (for example, at the birth of a large child, the impression of obstetric forceps, etc.). Also, the danger represents the conducted diagnostic manipulations, under which the violent and rather rude expansion of the sector of the cervical canal was carried out. Extremely cervical insufficiency may arise due to hormonal problems, for example, with an excessive amount of androgens in the female organism, etc.

Among the possible factors increasing the risk of premature births, it is worth identifying various pathologies in the activities of the endocrine glands represented by the thyroid gland, adrenal glands, ovaries, pituitary gland. Typically, such violations are not obvious, and do not particularly affect the patient's well-being.

Sometimes the role of a provocating factor with premature birth plays the separation of the uterus, for example, with multiple pregnancies, multi-way and large sizes of the fetus.

The pathologists of the uterus development (congenital) can also play their role, among which infantilism, as well as a saddot or counya uterus.

Another reason for the early appearance of crumbs into the world may have a number of other reasons presented by severe physical work, any acute infectious diseases (especially, with increasing body temperature indicators), strong and chronic stress, both at home and at work. As a provoking factor, there may be a healthy lifestyle: overwork, bad habits, etc.

Also, these statistics show that if a woman has a history of premature birth, the chance increases with the fact that with a new pregnancy, the situation will repeat. Therefore, in this case, the doctors may insist on hospitalization to the date "X" to prevent the possible start of generic activity.

If you fall into a risk group for the probability of developing premature births, do not panic. Just inform about your fears at the attending physician and fully adhere to his recommendations. In addition, try to exclude the influence of all negative factors that depend on you.

How to recognize the approach of premature births at the 28th week of pregnancy?

In fact, premature childbirth can be completely stopped if they get into the hands of specialists before they reach the stage of active generic activity.

Signs of childbirth

So, if a pregnant woman concerns drawing sensations in the lower abdomen and in the lower back or even a minor pain, it is worth listening to her body carefully and consult with the doctor. A parallel increase in the uterus tone also says about the possibility of premature genera, as a result of which the belly is noticeably hard. At the same time, the kid in the abdomen can show unprecedented activity or the opposite will die for a long time. Also, the appearance of mucous discharge can also be observed, sometimes with blood admissions. This is a serious reason for the immediate emergency call.

If drawing sensations are enhanced and acquired a grapple-shaped character, it is better not to slow at all, and immediately call doctors. At this stage of early childbirth, it is sometimes possible to avoid. In time, noticed signs on the 28th week and timely appeal to women's consultation will help maintain the right course of pregnancy. There are some doubts - go to the doctor right away!

It is worth noting that the modern development of medicine allows you to leave the kids born on a period of 28 weeks of pregnancy. And in the absence of serious pathologies, they can completely catch up with their peers in development.