The threat of premature birth at 26 weeks of gestation. group: factors determined by the socio-economic status of women. Video: how to understand that contractions have begun

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

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

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

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

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

Types of preterm birth

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

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

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

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

premature birth statistics

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

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

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

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

Causes of preterm birth

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

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

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

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

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

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

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

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

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

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

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

As you can see, there are a lot of reasons. However, even if you have noticed one or more signs, this does not mean that you will certainly give birth prematurely. In most cases, as you already remember, women manage to carry the child to the end of pregnancy.

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

Symptoms of preterm labor

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

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

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

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

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

Treatment for threatened preterm birth

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

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

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

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

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

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

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

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

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

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

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

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

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

Management of preterm birth

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

Effects of preterm birth on mother and baby

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

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

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

Besides, timing is considered critical.:

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

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

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

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

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

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

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

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

Prevention of preterm birth

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

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

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

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

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

Answers

The problem of preterm birth is widespread in obstetric practice. What can cause such an outcome of pregnancy, preventive measures and which births are considered premature, we will consider in this article.

What is called premature birth?

Under preterm birth, it is customary to understand the process of delivery that begins before 38 weeks - the period when the fetus is considered full-term and fully formed. The World Health Organization (WHO) has established the timing of preterm birth, namely from 28 to 38 weeks of pregnancy.

However, new technologies do not stand still and modern maternity hospitals are able to nurse babies born at 22 weeks weighing more than 550 g. less, the practice of nursing such crumbs is quite successful, and premature babies quite quickly catch up with their peers in development by the age of 2.5-3 years.

But, not every city maternity hospital is equipped with the necessary equipment to save the lives of such children, therefore, in Russia, preterm births are still understood as births from the full 28th week of the gestational period. However, regional perinatal centers are being actively built in the regions of Russia, which have all the necessary advanced equipment and qualified medical personnel, which make it possible for even babies weighing half a kilo to go out.

World practice calls preterm birth the process of labor activity, which began on the 22nd week of intrauterine development of the fetus.

How common are preterm births?

Unfortunately, since the birth premature baby not one future mother is insured. According to statistics, indicators in the USA are about 7% of the total number of deliveries per year, in France this figure is slightly less: about 5%.

Statistics show that rates of preterm birth are relatively low in Russia. According to the data given in the WHO report in 2016, the rate of preterm delivery in Russia is about 8%. Of this figure, more than half of the children are born at terms of 33-38 weeks. As a rule, all vital organ systems are already fully developed and such babies differ from those born on time only in their smaller size and the presence of a fluff on the skin (lanugo), which will subside on its own.

About 5% of children are born at 22-27 weeks, previously this process was called an abortion, but modern medicine, with the proper equipment, is able to get out even such heavy children. The rest falls on delivery at 30 weeks and 32 weeks of gestation, these newborns require special care, but their survival rate is much higher than that of low-weight 500-gram babies.

Who is at risk for premature delivery?

Factors that increase the risk of preterm birth include many external influences. It is impossible to reliably name the reason that caused labor activity before the right moment. Usually not one single factor, but a group of events entail such a sad outcome.

A pregnant woman is obliged to protect herself and the unborn baby from. Often some major shock at work, family tragedy, illness, or death loved one the expectant mother is knocked out of emotional balance, and her body reacts to this shock with premature labor.

The lifestyle of the mother most directly affects the positive outcome of pregnancy. Unfavorable social conditions, lack of food and sleep can increase the risk of complications or the threat of preterm birth. Those women who use tobacco, alcohol and drugs during pregnancy rarely carry their children to term.

The child of a smoking mother experiences severe hypoxia (lack of oxygen), is in constant intoxication from the decay products of ethyl alcohol and narcotic substances. The premature birth of such little man- this is the least of all the sad consequences of this lifestyle of his parent.

A history of chronic diseases (especially gynecological) in a woman can directly or indirectly affect the course of pregnancy and its outcome. Often the cause of the development of labor activity ahead of time are malformations of internal organs. For example, the underdevelopment of the uterus (baby uterus) or its irregular shape. A weak cervix (isthmic-cervical insufficiency) is not able to hold a constantly growing fetus and fluid in the cavity of this organ, and, often, this is the reason for the birth of children with extremely low weight in the early stages of gestation.

The onset of labor before the baby matures in the womb may depend on the age category of the woman. At risk are both too young parents under 18 years of age, and late-born women whose age has exceeded the mark of 45 years.

One of the birth factors premature baby there may be infectious and inflammatory processes and genital infections in the mother's body. Injuries to the abdomen during pregnancy at any time often end in spontaneous or induced labor before the due date.

Women with multiple pregnancies are more likely than others to give birth to premature babies due to overdistension of the uterus. However, the norms for the arrival of twins and triplets into this world are somewhat different. The birth of twins and triplets from the full 35th week is considered conditionally normal. prenatal development. Whereas early they can be called if they happened in the period from 22 to 35 weeks of pregnancy.

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Women who have experienced preterm labor or have had an abortion, especially during their first pregnancy, are also at risk. This is due to the body's reaction to a new pregnancy, if the latter ended ahead of schedule. An infrequent, but fairly common cause of premature expulsion of the fetus from the womb is Rh conflict. This happens when the mother's Rh factor is negative and the fetus's Rh factor is opposite. Is positive. In such a situation, the mother's body may take the child for a foreign object and will try with all her might to get rid of it.

If, nevertheless, you have any chronic diseases or other peculiarities, be sure to tell your doctor about them, such awareness can save your life and the life of your unborn child, because. doctors will be ready for force majeure. It is very important during the entire period of bearing a baby to adhere to healthy lifestyle life, say goodbye to harmful addictions, and before planning a child, it is advisable to come to grips with your health and treat all ailments.

Signs of preterm labor

Beginning premature birth or their threat is detected by a number of characteristic manifestations and changes in the woman's condition. It is important to recognize them in a timely manner and accept them. necessary measures for a relatively successful completion of labor activity.

Women who have given birth can identify signs of preterm labor by feeling similar to a normal term, or similar to the threat of termination of pregnancy in the first weeks.

But the process of early delivery is reversible if there is a threat in the form of the symptoms described below, or, the process of expelling the little man is just about to begin. But when the action has already begun, the cervix is ​​​​opened and there are periodic contractions, it remains only to accept the baby and try to save his life.

So, the obvious symptoms of the onset of labor before the due date are:

Bleeding from the genital tract;

Any plentiful vaginal discharge, which, most often, appear in case of leakage of amniotic fluid and rupture of the walls of the amniotic sac;

Tense stone stomach, cramping muscle contractions, accompanied by pain;

Drawing pains in the lumbar region and lower abdomen;

Feeling of strong pressure on the perineum;

Discharge of mucous dense clots of a transparent or yellowish color with possible blood streaks;

Unusual fetal activity in the form of kicking or, conversely, suspicious calmness.

It is important for any of the above symptoms to seek medical attention. As a rule, premature birth can be avoided with timely measures taken. Similar symptoms in the form of pulling pains in the lower back may be suspected of kidney disease, in particular, acute pyelonephritis or exacerbation of its acute form, and acute pain in the abdomen may be the result of malnutrition, appendicitis and other disorders.

The threat of the birth of a premature baby and its treatment

As mentioned earlier, the threat of premature birth can be prevented, and in the case of the beginning processes of childbirth, with the necessary medical assistance, they can be quickly stopped, allowing the woman to carry the baby and give birth on the due date.

Under the term "threat of preterm birth" obstetricians-gynecologists understand the processes in the body of a pregnant woman, activating the onset of labor in the wrong time. When this diagnosis is made, the expectant mother receives certain treatment in a hospital and is under medical supervision. Usually, the threat state is accompanied by pain in the pelvic area, vaginal discharge of varying intensity and color, and uterine hypertonicity.

The treatment is carried out permanently, the woman is given complete rest. First of all, drugs are introduced that reduce uterine tension and bring it to a normal state of rest. As an aid, sedative sedatives can be prescribed to normalize the woman's condition and exclude the possibility of new stressful shocks. In the event of a rupture of the amnion, a course of antibiotics is prescribed to protect the baby from infection and allow the fetus to be delivered to a safe period. Also, antibiotic therapy is prescribed when inflammatory processes are detected in the mother's body.

If the reason for the threat of early birth of the baby was isthmic-cervical insufficiency, then after eliminating the danger of intensifying labor under local anesthesia, a suture is applied to the cervix, which does not allow the cervix to open under the weight of the fetus and water. At 28 weeks and longer terms, a special constricting Golgi ring is installed on the cervix, which is removed after reaching the full 38 weeks of pregnancy.

As an effect on the fetus, a course of glucocorticoids is administered, which reduces the risk of developing respiratory distress syndrome(RDS) in a newborn, which can cause death. Such preparations prepare the lungs of the baby, and in the case of a premature birth, he can take his first breath without threatening his life.

When pregnancy is not preserved and early labor is stimulated?

There are situations when doctors do not strive by any means maintain pregnancy and prevent early delivery. This is done in cases where further gestation is impossible due to a threat to the life of the woman in labor. For example, when heavy bleeding, preeclampsia, exacerbation of chronic diseases, etc.

Moreover, preterm labor can be induced (caused artificial way) in cases where the child died in the womb and it is dangerous for the mother to leave him there, if the pregnant woman is convicted and is serving time in a correctional colony, if she is limited in parental rights or has agreed to late abortion, A Also in some other cases.

Management of preterm birth

Undoubtedly, the management of early delivery requires special skills from the doctor and should be accompanied by constant monitoring of state women and readiness for operational action.

Often, all processes of early expulsion of the fetus proceed Very fast and unpredictable. As a rule, at primiparous this process takes no more than 6 hours, while multiparous women give birth in 2-4 hours. Rapid labor is dangerous increased risk injuries of the newborn during rapid passage through the birth canal. The small size of the body and the softness of the child's bone tissue do not protect it from external wall pressure. uterus and vagina, which leads to fractures, hemorrhages and multiple hematomas. Rapid delivery is fraught with placental abruption and profuse bleeding, in which case real threat mother's life. The critical moment for the child is the period of exile itself.

Considering all the nuances of such a process, the obstetrician-gynecologist must be experienced and competent enough to not only delicately carry out the whole process, but also to minimize the negative consequences for both the newborn and the woman in labor.

Prevention of preterm birth

To reduce the likelihood of developing early rapid delivery term, a pregnant woman must follow certain rules, because the successful course and completion of pregnancy depends on her attitude towards herself and her unborn child.

✔ Even at the stage of pregnancy planning, you should undergo a complete medical examination, which will identify violations in the work internal organs and give you time to prepare your organism to such an important and responsible mission as bearing and giving birth to a new life.

✔ Upon confirmation uterine pregnancy stands as early as possible in the territorial antenatal clinic, where qualified specialists will observe the intrauterine development of the baby. This will allow, in case of developmental anomalies and other pathologies, to identify them as early as possible for prompt action.

✔ During pregnancy itself, you should protect yourself from hard physical labor, conflict and stressful situations, avoid exposure to toxic substances and move carefully, especially on slippery surfaces.

✔ You should not, without special need, appear in crowded places, especially during epidemics of viral diseases, avoid contact with contagious sick people and animals.

✔ If possible, do not postpone pregnancy and childbirth at work for no apparent reason, because. fatigue, both physical and mental , in the most negative way can affect your health.

✔ Carefully monitor the state of your health and pay attention to all the signals of your body, because a timely visit to the doctor with suspicious symptoms will help to avoid the development negative consequences, including negate the risk of preterm birth.

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

How does preterm labor begin?

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

What can cause premature birth?

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

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

The second most common cause of preterm labor is isthmic-cervical insufficiency, ICI (isthmus - "isthmus", the place of transition of the uterine body to the cervix, cervix - "womb"), that is, the inferiority of the muscular layer of the cervix, which during a normal pregnancy plays the role of a kind of sphincter (retaining ring) that does not allow the embryo " leave the uterine cavity. ICI is congenital (very rare) and acquired. What can cause the development of ICI? The reasons are rather banal: trauma to the isthmus and cervix during abortions, especially when the first pregnancy is terminated, deep ruptures of the cervix in previous births (this can happen, for example, during childbirth large fruit, the imposition of obstetric forceps), a gross forced expansion of the cervical canal during diagnostic manipulations in the uterine cavity (hysteroscopy, i.e. examination of the uterine cavity with a special device - a hysteroscope; curettage of the endometrium), that is, any injury to the muscular layer of the cervix.

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

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

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

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

What to do at the onset of preterm labor?

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

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

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

What do doctors do to stop preterm labor?

With a premature, onset of contractions, in the first place, topolitic (that is, reducing) drugs are prescribed - partusisten, ginipral. First, these drugs are administered intravenously, and when contractions stop, a transition to tablet forms is possible. These medicines are usually taken before. Magnesium sulphate, a 10% solution of ethyl alcohol and some other drugs are also used as agents that reduce the tone of the uterus.

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

With the development of ICI for a period up to the cervix, "stretching" sutures are applied, which prevent the fetal egg from "falling out" of the uterus. Sutures are placed under short-term intravenous anesthesia, while drugs are used that have a minimal effect on the child.

Do doctors always try to stop preterm labor?

No not always.

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

What happens to a woman after a premature birth?

Flow postpartum period 3 in preterm delivery, as a rule, is no different from that after timely delivery. It happens that a woman is detained in a maternity hospital longer than the prescribed period, but in most cases this is due to the condition of the child, and not the woman herself.

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

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

What happens to the baby after a premature birth? 4

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

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

1 0 premature birth, as a rule, they say after. Spontaneous interruption pregnancy in terms from conception to is called spontaneous abortion (miscarriage). For details on the threat of abortion, see: A. Koroleva, "The threat of abortion" / No. 1 -2001.
2 For more information about infectious diseases, see: Zh. Mirzoyan "You need to know the enemy by sight. TORCH infections - what is it?" / No. 4-2001; S. Gonchar "Treatment is light, and non-treatment is darkness. Diseases that threaten intrauterine infected fetus" / No. 5-2001.
3 0 during the postpartum period, see the article by N. Brovkina "The Fourth Trimester" in this issue of the journal.
4 The subject of this article is preterm birth, so nursing premature babies devoted here just a few lines. Detailed material about methods of nursing premature and underweight babies will be published in one of the next issues of our journal.

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

Discussion

[link-1]

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

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

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

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

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

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

08/28/2001 11:56:48 AM, Dodo

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

Comment on the article "Premature birth"

Preterm birth and depression. Girls, surely someone has similar stories. Please help me how to deal with...

Discussion

If you want to keep the GV, then decant and decant. Hands, breast pump - what can you do. There is Cons on GW, ingenious! And also mom hurried. It will help to establish guards, calm ..
And if you feel that you can’t cope on your own, a psychologist. There is also contact. GW friendly.
And ask God for help...

Calm down, the family needs you in your mind, without hysteria ..
When the baby is discharged, nest, the kangaroo method (undress to a diaper and you have a naked body and endless hugs))). Yes, at this moment the whole family should stand shoulder to shoulder and take care of themselves .. and even you - a thermos with tea, broth, hot food ...

Everything will be fine! Pray you and many others will pray for Pavlusha!

exhale, you are not the first and, unfortunately, not the last.
Ask for help, allow yourself to be weak, try to sleep more, rest and do not reproach yourself for anything.
My twins were born at 36 weeks by emergency c-section. Sevushka - the eldest of the twins got my edema + Rh conflict. On the very first day of mechanical ventilation, urgent hospitalization in Filatovka. Then jaundice was added to the ventilator, bilirubin went off scale, they were preparing for a complete blood transfusion ... With all this, they did not let me out of the RD, because. I lost almost a liter of blood during ECS ​​and my kidneys worked very badly.
We sewed in several ways at once: 1 - doctors from Filatovka asked to bring the second twin, motivating them by the fact that more healthy baby will draw out the weaker one. Doctors in the Republic of Dagestan agreed to help, wrote Senechka some kind of diagnosis and transferred to Filatovka.
2) on the same day, the babies were christened in intensive care.
I don't know what exactly helped: our prayers, baptism, twin brother nearby, BUT the next morning bilirubin began to fall and the question of a blood transfusion was dropped. Gradually, my children began to improve. Seva spent 12 days on a ventilator and was fed through a tube for a couple more days.
My Senechka was born very small, 46 cm tall and 2500 weight, Sevushka was larger, but not much.
My boyfriends quickly caught up with their peers, by six months they no longer differed from single-borns at term in anything, which wildly pleased and surprised both the pediatrician and the neurologist.

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

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

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

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

Vertical delivery, Natural birth, Natural birth after caesarean, Cesarean section, Premature birth, Childbirth in water, Childbirth at home, Birth of twins, Family birth, Induction of labor, labor induction, Rapid labor, etc. on [link-1]

April, May, June passed in the struggle with protein and for hemoglobin. In June, we all won. The girl was lying very low, 10 centimeters below the norm, so the doctor advised her to wear a bandage without removing it. However, I had my own idea. About 8 months ago, I had a certain feeling that we were not reaching the PDR. That is, after 28 weeks, I stopped worrying that a miscarriage, or premature birth, all anxiety was gone. But it was thrill that we will have a girl before. Main...

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

The most common complications associated with twin/twin/triple pregnancy are: Premature birth. Low weight at birth. 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. Duration multiple pregnancy decreases with each extra child. On average, a pregnancy with one baby lasts 39 weeks ...

All 9 months, a baby is growing under your heart, which is surrounded not only by your love and affection, but also by reliable protection from amniotic membranes and amniotic fluid. The fetal bladder forms a sealed reservoir with a sterile environment, thanks to which the child is protected from infection. Normally, the rupture of the membranes and the outflow of amniotic fluid occurs before childbirth (when the cervix is ​​​​fully open) or directly during childbirth. If the integrity of the bladder has been compromised before, it's...

Discussion

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

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

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

14. In many women's consultations take a smear on the water, how accurate is this method of diagnosing premature outflow of water?
Vaginal discharge containing fetal water, when applied to a glass slide and dried, forms a pattern resembling fern leaves (fern phenomenon). Unfortunately, the test also gives a lot of inaccurate results. In addition, in many medical institutions, laboratories work only during the day and on weekdays.
15. What are the modern methods for diagnosing premature rupture of membranes?
Modern methods diagnosis of premature rupture of the membranes is based on the determination of specific proteins, which are abundant in the amniotic fluid and are not normally found in the vaginal discharge and other body fluids. To detect these substances, an antibody system is developed, which is applied to the test strip. The principle of operation of such tests is similar to a pregnancy test. Most exact test is a test based on the detection of a protein called placental alpha microglobulin. The commercial name is Amnishur (AmniSure®).

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

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

18. What if the test result is positive?
If the test is positive, call ambulance or contact the maternity hospital if the pregnancy is more than 28 weeks and the gynecological department of the hospital if the pregnancy is less than 28 weeks. The sooner treatment is started, the greater the chance of avoiding complications.

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

20. If more than 12 hours have passed since the alleged rupture of the membranes, is it possible to test?
No, if more than 12 hours have passed since the alleged rupture and the signs of outflow of water have stopped, then the test may show an incorrect result.

Questions and answers about premature amniotic fluid leakage

1. How common is premature rupture of membranes?
True premature rupture of membranes occurs in about one in ten pregnant women. However, almost every fourth woman experiences some kind of symptoms that can be confused with premature rupture of the membranes. This is a physiological increase in vaginal secretion, and slight urinary incontinence in later pregnancy and copious discharge with genital tract infections.

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

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

4. Who is more likely to rupture the membranes?
Risk factors for premature rupture of the membranes are infection of the genital organs, overstretching of the membranes due to polyhydramnios or multiple pregnancies, abdominal trauma, incomplete closure of the uterine os. An important risk factor is premature rupture of the membranes during a previous pregnancy. However, in almost every 3rd woman, rupture of the membranes occurs in the absence of any significant risk factors.

5. How quickly does labor occur in case of premature rupture of the membranes?
This is largely determined by the duration of pregnancy. At full-term pregnancy, half of the women spontaneous labor occurs within 12 hours and more than 90% within 48 hours. With a premature pregnancy, it is possible to keep the pregnancy for a week or longer if the infection does not join.

6. Can a small amount of amniotic fluid be released normally?
Normally, the fetal membranes are airtight and no, even the smallest penetration of amniotic fluid into the vagina occurs. Women often mistake increased vaginal secretion or slight urinary incontinence for leakage of amniotic fluid.

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

9. Is it true that the waters are divided into anterior and posterior, and the outpouring of the anterior waters is not dangerous, is it often normal?
The fetal waters are indeed divided into anterior and posterior, but no matter where the rupture occurs, it is a gateway for infection.

10. What precedes a breakup?
By itself, the rupture of the membranes occurs painlessly and without any precursors.

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

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

And being now at the 35th week of pregnancy, I became interested - is there a tendency to premature birth? well, there is a feature of the body, etc. ...

Premature births are those that occur between 28 and 37 weeks of gestation.

Discussion

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

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

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

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

I also want to thank all the doctors working in the intensive care units and pathology of newborns. In my case, these are doctors, nurses and staff of the maternity hospital at the 2nd CIB, as well as the 3rd Children's Clinical Hospital in Moscow.

Svetlana Cheremisina

Pregnancy is a wonderful period that ends with childbirth. But in some cases, for various reasons, labor activity may occur earlier, for example, at 30 weeks. Expectant mothers are very afraid of such a phenomenon and are trying in every possible way to protect themselves from factors that could provoke the untimely birth of a baby, but there are those who do not know about them. Why is premature birth so dangerous, and what causes it?

Causes

At 35-37 weeks of pregnancy, the body of a woman and a child are already ready for childbirth. If the birth of the baby comes before the set time, the birth is called premature.

The reasons for this phenomenon can be different, the most common include:

1. infectious diseases and different kinds inflammation. Each inflammatory process that is localized in the uterine cavity leads to damage to the muscle tissue and prevents it from stretching. This is unacceptable, as the baby is growing and he needs enough space. If the uterus cannot stretch, it tries to get rid of the fetus, which leads to premature birth.
2. Pathology of the cervix. The threat of premature birth for the above reason most often occurs at 27-29 weeks and subsequent. Pathology is represented by isthmic-cervical insufficiency, which is expressed in the weakness of the uterus and its inability to hold the fetus. As a result of pressure, the uterus opens, which leads to untimely delivery. Most often, the cause of such a pathology is the presence of abortions or miscarriages in a woman, in which the scraping method was used.
3. Multiple pregnancy. When carrying more than one baby, the uterus is strenuously stretched, which leads to the premature birth of children.
4. Various types of disorders and diseases. The cause of untimely birth can also be illnesses in the expectant mother, for example, diabetes, problems with the thyroid gland and the endocrine system.
5. External factors. The threat of premature birth may be in women who are subject to hard physical labor, stress, and take drugs, alcohol and smoke.

The presented factors are far from the only ones that can provoke premature birth child. There are many more reasons and very often, they depend on individual features women and her lifestyle.

It is very important to visit a specialist regularly so that the pregnancy passes without any failures and threats. It is recommended to take tests that will help identify the presence of infections before pregnancy.

Symptoms

If you give birth at 22-28 weeks of pregnancy, the weight of the baby will be from 500 to 1000 grams. If the child survives within a week, his birth is called premature birth, if not, late miscarriage. Babies who are born at 29-37 weeks most often weigh from 1000 to 2500 grams, this body weight is considered sufficient for normal life.

The body of a premature baby cannot independently control all important processes. He is too vulnerable, as there is an immaturity of the nervous and endocrine system, and some reflexes are also missing. A child born prematurely requires special care and control by doctors.

Childbirth at 30 weeks of gestation can occur with the following symptoms:

• Minor pains and contractions appear in the lumbar region and lower abdomen.
• There is a tension of the uterus, the stomach becomes hard.
• The woman begins to feel the frequent and restless stirring of the baby.
• Abundant discharge with an admixture of blood or bloody mucus appears.
• Minor and short contractions begin.
• The mucous plug comes off or water leaks.
• On examination, the uterus is soft and slightly open.

At similar symptoms you should immediately visit a gynecologist. If appropriate treatment is provided in time, childbirth will not begin at 30. If you ignore the changes, the process of premature labor can no longer be stopped.

Consequences of premature birth

For those who gave birth prematurely, the consequences were fraught, especially on the part of the psyche. Expectant mothers are very worried about the threat of miscarriage, so premature birth is a big psychological trauma for them. Often, such women suffer from postpartum depression.

The worst consequences early birth carries the baby. Since his body is not fully formed and not all systems function correctly, it requires connection to a special chamber that ensures proper breathing.

Babies born before 35–37 weeks cannot breathe normally. They have poorly developed lungs and practically no surfactants. To fix problems, specialists use a special drug therapy. It is very important that the child stays in the chamber until the functioning of the respiratory organs is fully normalized.

Some babies have immaturity of the lung tissue, which in the future leads to the development of diseases of the respiratory system. To avoid this, drugs are prescribed, the action of which is aimed at tissue growth. The child is constantly under the control of devices that reflect the functioning of his organs, in particular, the heart. As part of the therapy, an artificial nutrition apparatus is used so that the baby receives all the necessary fats, proteins, carbohydrates, as well as other useful substances.

With proper rehabilitation, premature babies will grow up healthy and active.

How to avoid preterm birth?

If there is reason that labor will begin at the 30th week of pregnancy, a number of measures must be taken to prevent this process. First you need to immediately visit a specialist and get advice.

1. Pay special attention to the appearance pain, which resemble menstrual, unusual discharge, increased mobility of the child.
2. Pass the necessary tests, undergo an ultrasound procedure, hCG, and also follow all the additional recommendations and appointments of a gynecologist.
3. If the examination showed the presence of anemia, thrush or other disease, undergo appropriate treatment, but only under the supervision of a doctor.
4. If necessary and the conclusions of a specialist, stay in the inpatient department.

Treatment of preterm birth at thirty weeks is aimed at stopping them and threading the gestational age to the standard.

Methods of treatment

During the period of therapy, medications and non-drug methods of treatment can be used. The latter include:

• Ensuring sexual, emotional and physical peace.
• Bed rest with legs elevated.
• Physiotherapy procedures.

Of the medicines, drugs are prescribed that provide a stop in labor and relaxation of the uterus. Sedatives are also used and those that are aimed at eliminating the symptoms of premature birth.

Andrenomimetics are often used in combination with calcium channel blockers. It can be Ginipral, Nifedipine, Verapamil and other drugs. Initially, such funds are administered intravenously, then tablet forms can be used.

In order for the treatment to be effective, it must be carried out in a hospital, under the supervision of doctors.

To avoid the phenomenon of the early appearance of the baby at any week of pregnancy, it is necessary to carry out appropriate prevention. It includes the surrender of all necessary analyzes for infectious diseases and control of chronic pathologies.

What is preterm birth

Unfortunately, premature births are not uncommon, but today the capabilities of the pediatric neonatological service make it possible to nurse babies even in the most difficult cases. However, the threat itself, as before, frightens any woman, since it is obvious that it is much better for a child to grow and develop in the mother's womb than even in the most adapted incubator.

Stories non-traditional childbirth- these are always stories about the struggle for survival, about many months of difficult, expensive path to the health of a newborn, but the stories do not always end happily. Vision problems, severe neurological disorders are more common the more early term the pregnancy was terminated.

The risk for the child cannot be overestimated, as he is simply not ready. His lungs are not ready, and he needs to breathe on his own, not ready gastrointestinal tract, but it is necessary to independently digest food, the child is not even able to maintain body temperature.

In some obstetric situations, it is necessary to induce preterm labor. These are the cases where it is necessary medical indications, or the position is interrupted at the request of the woman.

In our country, according to the new abortion law, abortion is possible up to 22 weeks. This is not an abortion, but an early birth. Although they are classified as late miscarriage if the baby survives after them for 7 days, they are classified as very early births.

If the birth canal is not ready, and the cause was a life-threatening woman late toxicosis, eclampsia and convulsions, despite the almost complete lack of chances for the survival of the child, a caesarean section is performed.

The fear of having a premature baby for a woman is completely natural. But you shouldn't tell yourself, I'm afraid of premature birth, you just need to know what their causes are, how they begin, and take timely measures to prevent this from happening.

Knowing what can trigger childbirth can help you avoid similar situations and prevent your haste from being born too early.

Preterm birth, statistics

The statistics are not really encouraging. From 5 to 12% of children are born prematurely every year.

The World Health Organization classifies these cases differently than in Russia.

In Russia, births are considered premature at a period of 28 to 37 weeks, with a fetal weight of more than 1 kg, while WHO expands the boundaries from 22 weeks to 37.

Please note that in Russia, up to 22 weeks, you can terminate a pregnancy, in the USA, say, at 22 weeks, this is a newborn subject to resuscitation and nursing. If in Russia a child is born between 22 weeks and 28 weeks, and has a body weight of 500 grams to 1 kg, he will be called a child only after he can stay alive for 7 days. There is not even a law that would oblige children to be nursed at these gestation periods. Until the newborn lives its first 7 days of life, it is called simply, late miscarriage ...

If childbirth has begun, at a period that determines the possibility of survival for the child, in Russia they still start from 27-28 weeks, at an earlier date, at 22 weeks - 26 weeks, cases of nursing children are described mainly abroad, but still these are children with many health problems.

22 weeks - 24 weeks is the birth of a child weighing from 500 to 700 grams. Cases of nursing of children at such a period are rare, described in medical journals and often widely covered in the media, if this happens.

25 weeks - 27 weeks is a routine neonatal service, unfortunately, these cases do not always end well. Despite the fact that, by law, doctors are required to fight for the life of a child if he has a body weight of more than a kilogram, and was born at 28 weeks and later, everything possible is done for those babies who have not gained this weight.

29, 30, 31 weeks - this is almost always a child's weight of more than a kilogram, lungs relatively well prepared for breathing, and high chances of survival.

However, a premature baby is not the only problem; often the cause of death of children is hypoxia in childbirth and before childbirth, natal trauma and other diseases.

Causes of preterm birth

Why do preterm births happen? The answer to this question also hides the answer to the question of how to prevent premature birth. Let's try to understand all the variety of possible reasons.

1. Endocrine pathology and pregnancy. The probability is higher in those women who suffer from endocrine diseases. And it does not have to be such endocrine diseases as hormonal disorders in the genital area, thyroid disease, diabetes mellitus also increase the risk of problems.

2. Sexual infections. Chlamydia during pregnancy, ureaplasmosis, and other infections can not only provoke the onset of labor, but also cause disease, malformations in the child. The danger is also cervical erosion, chronic salpingitis, endometritis, bacterial vaginosis.

3. Somatic infections. Tonsillitis, viral hepatitis, and even SARS and untreated teeth serve as a source of infection for the fetus and create a risk.

4. Malformations and anomalies of the uterus and its tumors, changes in the cervix after abortion and childbirth, adhesions in the uterine cavity after childbirth and abortion. Damage to the closing apparatus of the uterus, the circular muscles of its isthmus, a kind of lock that does not allow the neck to open, during childbirth and abortion, leads to isthmic-cervical insufficiency, ICI. With her, the cervix is ​​​​not able to withstand the mass of the growing fetus and begins to gradually open already from a period of 16-17 weeks. In addition to cervical injuries, uterine anomalies and hormonal factors lead to CI. Under the weight of the child, the cervix gradually opens, the fetal bladder swells into it, becomes infected, and sooner or later it ruptures and the onset of preterm birth.

5. Somatic non-communicable diseases of the mother. Diseases of the kidneys, liver and heart, general emaciation, weight loss and malnutrition weaken the body and make your situation difficult.

6. Malformations in the child himself and his genetic diseases. Usually in such cases there is a threat at 32 weeks and earlier, this is a mechanism that nature has provided, natural selection is underway and a strong and full-fledged child survives.

7. Features and complications of pregnancy. If a woman has twins, preterm births often occur, the reason is overstretching of the uterine wall, the same happens with polyhydramnios. Complications such as late preeclampsia, feto-placental insufficiency, placenta previa and abruption are common causes the need to cause the appearance of a mar/lysha into the world.

8. Abdominal injury.

9. A woman's age under 18 (biological immaturity) and age over 30 are also risk factors.

10. Bad habits including drug addiction, smoking and alcoholism.

11. Poor nutrition and living conditions.

12. Heavy physical labor, lack of sleep, stress, mental overload.

13. Unwanted child, incomplete families.

Preterm birth and gestational age

What causes preterm birth at different stages of pregnancy? It turns out that each stage of pregnancy has its own main reasons.

Premature birth at 22-27 weeks.

This group of premature babies has the saddest survival statistics, because the lungs at this time are not at all mature, and the weight of the fetus is extremely low, only 500-1000 grams.

The main cause of childbirth at this time is isthmic-cervical insufficiency, infection of the fetal bladder and its rupture.

If a child was born at 22-23 weeks, he has almost no chance, even those who survive, mostly these are cases of nursing in European countries and in the USA, in the future they are children with disabilities.

Babies born between 24 and 26 weeks survive more often and have a better prognosis for their health. Fortunately, childbirth at this time is only 5% of all cases.

Preterm birth at 28-33 weeks

The level of development of neonatological care allows to ensure the survival of the majority of children in this group, although not all prematurity goes without consequences.

The weight of newborns is on average from 1000 to 1800 grams.

The reasons for this period are varied and numerous: various complications, Rhesus conflict and much more. These children have lungs almost ready for breathing, and the use of medications, oxygen support, incubators help to exit most of them.

Preterm birth at 34-36 weeks

Childbirth at this time is almost not dangerous for the child, of course, it will be bad if he is born outside the hospital, but a healthy premature baby born in the maternity hospital has every chance of successful adaptation and health in the future.

Children usually weigh more than 2 kilograms, their lungs are almost ready for spontaneous breathing in most cases, and only a little medical support is required in order to accelerate their maturation.

The main causes are somatic diseases of the mother, complications of pregnancy and intrauterine hypoxia due to feto-placental insufficiency.

Symptoms and signs of preterm labor

Signs resemble the threat of termination of pregnancy at an earlier date.

In most cases, childbirth begins with the outflow of amniotic fluid, but a few days before that, a woman may feel the harbingers of premature birth, but most often no one pays attention to them.

Obstetricians distinguish:

1. Threatened preterm birth.

This is a period of harbingers that you may not notice. Weak pulling pains in the lower back and lower abdomen, the appearance of contractions, tension of the uterus, which can be noted simply by placing a hand on the stomach (the stomach stiffens, tenses).

The baby can behave restlessly, often kicking, and mucous secretions often increase from the genital tract, which can even have an admixture of blood with streaks.

On examination, the doctor does not detect changes in the cervix, it is dense and closed. If you consult a doctor during this period, minimal medication and peace of mind for the woman may be enough to prevent.

2. How does preterm labor start?

Pain in the lower back and lower abdomen become pronounced, cramping in nature. Mucus plug comes off, may be bloody issues from the genital tract, water is often poured out.

On examination, the doctor finds a shortening and softening of the cervix, it is ajar and freely passes 1-2 fingers.

3. Started preterm birth.

If childbirth has begun, they are unlikely to be stopped.

In 30% of cases, delivery proceeds rapidly, in primigravidas in 6 hours, with repeated births, the terms can be even less.

The pains become intense, acquire the character of contractions that follow regularly, at intervals of less than 10 minutes, the cervix smooths out and opens quickly, the water leaves, the fetus descends to the entrance to the small pelvis.

How to avoid preterm birth?

What you should pay attention to in your position:
the appearance of menstrual-like pain, a feeling of heaviness in the lower abdomen, a change in the activity of the fetus, either too violent or, on the contrary, its weak activity, a feeling of pressure on the bottom, on the bladder and vagina, the appearance of any unusual discharge from the genital tract.

These are the first signs and a reason to immediately consult a doctor.

By knowing how to recognize preterm labor, you won't make the mistake of staying home when you can still stop it and prevent your baby from being born prematurely.

Treatment of threatened preterm birth

The threat of premature birth, the symptoms of which are described above, is a reason to immediately consult a doctor. In any case, even if it seemed and nothing really happens, it is better to be safe than to miss dangerous symptoms.

If you apply at the threat stage, you may be offered hospitalization in a maternity hospital, but this is not always necessary. In any case, with such complaints, you will find a detailed gynecological examination and tests, it is very important to assess the condition of the cervix, the condition of the child, to identify infections, if any, in a woman.

The leakage of amniotic fluid deserves special attention. This feeling of constant dampness, aggravated by movement. Many women are afraid to seek an appointment if the water has broken and there are no contractions. This is fundamentally not true. No one will immediately terminate the pregnancy if it has not reached at least 34-35 weeks, if there are no signs of infection, you will simply be admitted to the hospital, the lungs of the fetus will be prepared for several days, you will be protected from infection by antibiotic therapy and sterile conditions, and childbirth will occur when the baby is ready to breathe on its own.

The timing of prolongation of pregnancy in case of rupture of the fetal bladder is determined by the timeliness of treatment and the state at the time of treatment.

If there are no infectious complications, the pregnancy may well be extended by 5-7 days or even more, which allows doctors to do everything possible to ensure that everything goes as smoothly as possible, and the child is ready to be born.

The threat of premature birth at 35 weeks or more with the outflow of amniotic fluid is not a reason to try to prolong the pregnancy, the woman is given birth, because almost always the children at these terms are quite mature and easily adapt to extrauterine life.

If amniotic sac intact, the treatment is reduced to the termination of the onset of labor and the implementation of therapeutic measures in relation to the causes of complications.

If a woman has only a threat, outpatient treatment is possible in some cases, but still obstetricians prefer hospitalization, often a simple removal of a woman from a stressful environment at home and at work, hospitalization stops labor activity, and the pregnancy continues.

On the whole amniotic sac tocolytic (relaxing the uterus) and sedative (calming) therapy are prescribed, physiotherapy is carried out, bed rest and complete peace.

In order to prepare the lungs of the fetus for breathing, glucocorticoids or dexamethasone are prescribed to all women during hospitalization in the maternity hospital.

If such treatment has not been successful, the contractions continue and grow in strength, the question arises of the inevitability of the appearance of haste into the world.

If you have a birth at 32 weeks, as well as at an earlier date, measures are required to prepare the lungs of the fetus.

It is optimal if they give dexamethasone, and childbirth is delayed for at least a few days, but even for 3-6 hours, the medicine received by the mother helps the maturation of the surfactant, the substance that helps lungs of a newborn open up for the first breath.

Management of preterm labor

The conduct of the procedure largely depends on how the birth proceeds.

In any case, these births cannot be called physiological, but they can proceed with normal contractile activity of the uterus with the birth canal ready, or with discoordination of labor, with poorly prepared birth canals.

In 30% of cases, childbirth has the character of rapid. In primiparous, they take no more than 6 hours, in multiparous 4 hours.

Why is premature birth dangerous if it proceeds rapidly?

During such childbirth, the fetus suffers from hypoxia, since the uterus contracts too often, progress through the birth canal is too fast. This, combined with the fact that the fetus has too small head sizes, which contributes to incorrect insertions, the head has soft bones, but is not adapted to configure (adapt to the birth canal), and the vessels are weak, can cause severe birth trauma fetus, intracranial hemorrhages, injuries of the cervical spine.

Premature baby can seriously suffer precisely because of how the birth act proceeded, and not because of prematurity. It should be noted that caesarean section does not reduce the number of complications of this kind and does not improve the prognosis for the fetus, such is the statistics.

If it was not possible to stop preterm birth, they are carried out as carefully as possible. During childbirth, a woman should try to lie more, the period of exile, the most critical for the fetus, also always passes lying down.

Techniques to protect the perineum from ruptures are not used, as they can lead to injury to the child.

Even in breech presentation childbirth most often takes place naturally, if there are no contraindications common for such childbirth, and there are only recommendations in hospitals where all conditions are created for nursing newborns, with deep prematurity, do a caesarean section in such cases.

Sometimes women in labor have discoordinated labor activity or its weakness. The cervix is ​​not ready, the body too, and all this is understandable.

Childbirth is carried out as carefully as possible, with thorough anesthesia, labor induction is used, but very carefully, controlling the condition of the fetus.

For pain relief, preference is given to epidural anesthesia, since narcotic drugs depress the sensitive respiratory center of a premature fetus.

According to indications, antispasmodics and adrenomimetics are used, these drugs relax the lower segment of the uterus, helping it open up.

During and after preterm birth, the risk of complications for the mother is high. Tears and injuries of the cervix and perineum seem like a paradox, the fetus is small, but it is precisely its small size that is the reason that incorrect head insertions are easily formed, which lead to injuries.

The risk of endometritis and postpartum hemorrhage is high, especially if the pregnancy was prolonged after the outflow of amniotic fluid.