Signs of preterm labor at 34 weeks gestation. Causes of preterm birth, how to prevent them, consequences for the baby. Health of the expectant mother

Update: October 2018

Even with advances in medicine, preterm births happen and will continue to happen. But I am glad that their frequency does not increase, but remains more or less at a stable level. According to statistics, the percentage of premature births in various countries is 5-20, and in Russia for the last 30 years this figure has not exceeded 7%.

What kind of birth is called premature?

According to the WHO definition, preterm births include those that occurred between 22 and 37 weeks of gestation and during which a fetus weighing 500–2500 grams was born.

• In the Russian Federation, the old classification is followed, that is, preterm births are those births that occurred from 28 to 37 weeks, and the child's body weight reaches 1 - 2.5 kg.
• If the birth occurred before 28 weeks, but not earlier than 22, and a live fetus was born weighing 0.5 kg or more, which lived exactly 7 days or more, then such cases are also counted as premature births. If one of the conditions is not met, this case will be called a late miscarriage.

Classification of preterm births

Depending on the clinical course, preterm labor is divided into 3 stages:

• threatening or threatened premature birth;
• beginning premature birth, which are characterized by structural changes in the uterine cervix (it smoothes and opens up to 3 cm, the appearance of contractions, but not more than 4 times in 10 minutes);
• preterm labor that has begun - the process can no longer be stopped.

According to the gestational age, which determine the degree of maturity of the unborn baby, the characteristics of the course of labor and the outcome of the fetus, premature births are divided into 3 groups:

• 22 - 27 weeks - very early or very early preterm labor
• childbirth occurring between 28 and 33 weeks
• childbirth that took place on terms of 34 - 37 weeks (see).

Depending on the mechanism of occurrence, preterm birth is:

• spontaneous;
• induced (artificial), which are divided into:
  • childbirth for medical reasons (gross anomalies in the development of the fetus, severe conditions of the mother)
  • childbirth for social reasons

What is the reason for premature birth?

There are many reasons for preterm birth. All factors can be divided into 4 large groups:

Group 1: factors determined by the state of health of a woman

• pathology of the endocrine glands (diseases of the thyroid gland and pancreas, changes in the pituitary gland, and others);
• acute / chronic infections (these can also be inflammatory diseases of the reproductive system, genital infections, common infectious diseases: influenza, SARS, rubella, tuberculosis, etc.)
• anomalies in the development of the uterus (septum in the uterus, one-horned, two-horned uterus);
• general and sexual infantilism;
• uterine tumors;
• complicated obstetric history (, childbirth with complications,);
• trauma;
• extragenital diseases (heart defects, hypertension, pathology of the liver and biliary tract, and others);
• isthmic-cervical insufficiency - in fact, it is the insolvency of the cervical muscles, caused by injuries, ruptures or hormonal status.

Group 2: factors due to the condition of the fetus

• multiple pregnancy;
• gross malformations of the fetus;
• in case of pregnancy with a male fetus;
• chromosomal and genetic diseases.

Group 3: factors due to the course of pregnancy

• severe gestosis;
• lack or excess of amniotic fluid;
• reproductive technologies (IVF, etc.);
• placenta previa;
• incorrect location of the unborn child in the uterus;
• Rh-conflict pregnancy;
• prenatal discharge of water.

Group 4: factors determined by the socio-economic status of women

• industrial hazards;
• alcoholism and drug addiction;
• heavy physical work;
• stress and overwork;
• unfavorable living conditions;
• age (young and "old" primiparous);
• marital status (single mother);
• unwanted pregnancy.

How do preterm births manifest?

As noted above, in its clinical course, childbirth before the term goes through three stages. And if the first 2 are a reversible process, that is, it can be slowed down and the pregnancy prolonged for the maximum possible period, or at least for the period necessary for therapy that accelerates the maturation of the fetal lungs, then it is no longer possible to slow down the onset of preterm labor (see).

Threatened preterm birth

Signs of threatened preterm birth include:

• anxiety of the fetus, it begins to move too actively
• increased urination, frequent urge to urinate
• there is sipping in the lower abdomen, in the lumbar region.

As a rule, these symptoms go unnoticed by the woman. Whether the emerging periodic hypertonicity of the uterus (“it hardens like a stone”) can alert the patient. During an external obstetric examination, the uterus very easily comes into tone, and the presenting part is pressed against the entrance to the small pelvis. Further, when conducting an internal study, a preserved cervix is ​​\u200b\u200bdetermined, the external os is closed or passable for the fingertip in women giving birth again.

Incipient preterm labor

In the absence of treatment in the first stage, the process progresses, and pulling pains turn into cramping or even regular contractions. But their frequency is no more than 4 in 10 minutes. The doctor, conducting a vaginal examination, notes that the lower segment of the uterus has turned around (it becomes thinner and softer), the cervix is ​​shortened and smoothed. The opening of the uterine pharynx reaches three centimeters. Premature discharge of amniotic fluid is possible.

Started premature birth

This stage is already irreversible. Regular labor activity is noted, and the cervix continues to open (up to 3–4 cm), cases of rupture of the membranes are not uncommon.

As a rule, preterm birth occurs with a number of complications:

• frequent prenatal outpouring of water;
• often there are anomalies of tribal forces (discoordination or weakness);
• childbirth often proceed quickly or even rapidly;
• the risk of intrauterine fetal hypoxia increases;
• high risk of bleeding in the first 2 hours after birth and afterbirth;
• there are frequent cases of infectious complications during childbirth (chorioamnionitis) or after childbirth.

How to prevent premature birth?

When a woman enters the maternity ward, the doctor immediately assesses the situation and takes into account a number of factors, on the basis of which further tactics for managing the pregnant woman will be chosen. These moments include:

• gestational age;
• presence or absence of a fetal bladder;
• how the fetus is located and presented;
• condition of mother and child;
• the condition of the cervix, the presence / absence of disclosure;
• whether or not there is an infection;
• the presence of regular contractions: yes or no;
• there is a severe obstetric or extragenital pathology.

If the gestational age is less than 36 weeks and there are favorable factors listed, a conservative-expectant tactic is indicated, which has the following goals: weakening excitability, inhibition of the contractile activity of the uterus, increasing the "viability" of the fetus (that is, the prevention of respiratory disorders aimed at the "maturation" of the lungs of the fetus) , treatment, if possible, of the cause that caused premature birth and prevention of infection.

• First of all, the patient is prescribed bed rest, as well as psycho-emotional peace.
• As a sedative therapy, sedatives are prescribed (motherwort, valerian, novopassitis), it is possible to use trioxazine, nozepam or valium.
• Hypnosis and psychotherapy are also effective.
• It is important to prescribe painkillers (analgin, ketorol) and antispasmodics (baralgin,).

Then they begin to conduct tocolysis or relieve excitability and contractile activity of the uterus. There are 5 groups of drugs - tocolytics:

Beta-agonists

The action of these drugs is based on a decrease in the concentration of calcium in the cell, which contribute to uterine contractions, which causes its relaxation. Frequently used beta-agonists: ginipral, salbutamol, partusisten. To quickly block uterine contractions, they begin to “drip” intravenously (0.5 mg of the drug is diluted in 0.5 liters of isotonic solution and dripped, starting with 5-6 drops per minute, then gradually increase the dose until the contractions stop completely). This infusion can last 4 to 12 hours. But, given that after the cessation of the introduction of veta-agonists intravenously, the uterus begins to contract again, they continue to be taken in tablet form. Beta-agonists also have a number of side effects (lowering blood pressure, increased sweating, chills, headaches, increased gas formation, and others).

Calcium channel blockers

These drugs are calcium antagonists, so they also inhibit the contractile activity of the uterus. Nifedipine (Corinfar) is prescribed at 0.01 g. four times a day, and verapamil (Isoptin) 0.04 g.

Drugs that inhibit the synthesis of prostaglandins

Indomethacin is usually prescribed in tablets or rectally, but it is also possible to use naproxen, sulindac, aspirin.

Magnesium sulfate

Magnesium sulfate is administered intravenously in a dose of 4 g. This drug is safe for the fetus, lowers blood pressure in women, has a sedative effect. After intravenous administration, they switch to taking tablets in the form of magne-B6 4 times a day.

ethanol

Currently, ethyl alcohol is not so widely used. A 10% solution of ethanol is diluted in 500 ml of isotonic solution, and dripped for two hours (20 - 30 drops per minute). Ethanol inhibits the action of oxytocin and accelerates the synthesis of surfactant, which prevents the development of respiratory distress syndrome (RDS) in the fetus.

How to avoid the development of respiratory disorders in a child?

To this end, in parallel with tocolysis, the prevention of RDS is carried out. The appointment of glucocorticoids is shown, which contribute to the formation of surfactant and the faster maturation of the baby's lungs. Surfactant is formed in large alveoli and coats them, it promotes the opening of the alveoli on inspiration and prevents them from collapsing.

Dexamethasone is usually used (4 mg twice a day / m for 2 to 3 days or 2 mg in tablets: 4 times on the first day, 3 times on the second day and 2 times on the last day). Dexamethasone is given to all women who are given tocolytics. An accelerated course of prophylaxis with prednisolone is possible (for two days, 60 mg daily).

If tocolysis has a positive effect, then the course of treatment with corticosteroids is repeated after a week. Also, for the prevention of RDS, a surfactant is administered intramuscularly at 100 IU twice a day for three days. No less effective drug compared to glucocorticoids is lazolvan. It is administered intravenously in a dose of 800-1000 mg for 5 days.

And, of course, the treatment of threatened or beginning preterm labor includes antibiotic therapy.

• First, antibiotics suppress infection in the mother, which is often the main causal factor in this pregnancy complication.
• Secondly, they prevent the development of purulent-septic diseases after childbirth.

Management of preterm birth

How preterm labor will proceed and what their outcome will primarily depend on the gestational age and maturity of the child. If the gestational age corresponds to 22 - 27 weeks, then the birth ends quickly, with incomplete opening of the uterine os, and also without the provision of obstetric benefits. In the case of 28 - 33 weeks of gestation, such births are almost timely, often using obstetric aids and operations, including abdominal delivery. In the case of pregnancy for a period of 34 to 37 weeks, childbirth proceeds as timely.

When conducting labor before the term, careful control of the dynamics is carried out, the nature of the birth forces, insertion and fix how the presenting part of the baby is moving forward. Spasmolytics and gentle anesthesia are widely used, and narcotic analgesics are not recommended as pain relief during contractions, since they depress the respiratory center, and the lungs of the fetus, as indicated above, are already immature. Also, correction of labor activity is carried out in a timely manner. With caution, oxytocin is used in the development of weakness of contractions.

It is important to carry out the prevention of birth injuries of the baby in the period of attempts. Therefore, in the straining period, childbirth is carried out without protection of the perineum, and an episiotomy is also done in a timely manner. Surgical interventions (forceps, caesarean and others) are used only for vital indications of the mother. In addition, it is necessary to regularly repeat the prevention of fetal hypoxia. The newborn is taken in heated diapers, and the umbilical cord is cut during the first minute, and not immediately after birth, and the baby must be at the level of the woman's perineum (otherwise the blood will “leak” back into the placenta).

Case Study: A 38-year-old woman was under observation at the antenatal clinic. Pregnancy was the 3rd, desired. At 33 weeks, the woman enters. Well, I think, maybe nothing else, we can stop. During vaginal examination, it turns out: the opening of the uterine os is complete, the fetal bladder is absent, and, worst of all, the legs are presented. That is, we do not have time for a caesarean, I call a pediatrician and an intensive care specialist, since there are no specially trained neonatologists in our hospital. And then - the legs, the pelvic end and the body, we gave birth, and the head, as usual, got stuck (this is the largest part of the newborn). And I don't have the strength to take it out. I resorted to the famous Maurice-Levre-LaChapelle technique: I lay the child lengthwise on the left hand, while the index finger is inserted into the mouth to ensure maximum flexion of the head (this way it is easier to remove), and with the index and middle fingers of the right hand I grab the child’s neck with a fork. It felt like an eternity had passed. As it turned out later, only 2 minutes. And we gave birth. Dead, but alive! The child, of course, was heavy. But nothing. He and his mother were discharged home from the children's department in a satisfactory condition.

Danger for the baby

Only 8-10% of healthy premature babies, weighing more than 2000 g, are discharged home from the maternity hospital. at birth, the rest go to specialized institutions for the 2nd stage of nursing.

The most severe consequence for the child remains:

• hyaline membrane disease (in other words, respiratory distress syndrome)
• premature babies often have attacks of asphyxia, often developing respiratory failure
• they have impaired thermoregulation
• bilirubin conjugation (jaundice of the newborn)
• in the general mass, such children often suffer from infectious diseases
• premature babies have a higher risk of developing physical and mental disabilities than full-term babies:
  • 10 times more likely to be diagnosed with malformations
  • 15-30% of these children develop severe psychoneurological disorders - decreased intelligence, cerebral palsy, impaired vision and hearing, epileptic seizures
• in addition, premature babies are more prone to stress

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. Nevertheless, the practice of nursing such crumbs is quite successful, and premature babies 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, more than one future mother is not insured from the birth of a premature baby. 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, a strong shock at work, a tragedy in the family, illness or death of a loved one knocks the expectant mother 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 a little man is the least of all the sad consequences of such a 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 keep 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 factors in the birth of a premature baby can 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 of intrauterine development is considered conditionally normal. Whereas early they can be called if they happened in the period from 22 to 35 weeks of pregnancy.

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 prematurely. 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 a healthy lifestyle, say goodbye to harmful addictions, and before planning a child, it is advisable to take care of 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 take the necessary measures for the relatively successful completion of labor.

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 profuse vaginal discharge, which, most often, appears in the event 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" obstetrician-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 the threat to the life of the woman in labor. For example, with severe 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 a term in a correctional colony, if she is limited in parental rights or agreed to a late abortion, and 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 with an increased risk of injury to 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. Transient delivery is fraught with placental abruption and heavy bleeding, in which case there is a real threat to the life of the mother. The critical moment for the child is the period of exile itself.

Considering all the nuances of such a process, an obstetrician-gynecologist must be experienced and competent enough to not only delicately carry out the entire 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 domestic 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.

✔ When confirming a uterine pregnancy, you should go to the territorial antenatal clinic as early as possible, 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 your health and pay attention to all the signals of your body, because a timely visit to a doctor with suspicious symptoms will help to avoid the development of negative consequences, including nullifying the risk of preterm birth.

Pregnancy is a wonderful period that ends with childbirth. But in some cases, for various reasons, labor 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 various types of 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 a premature birth of a child. There are many more reasons and very often, they depend on the individual characteristics of the woman 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. It is too vulnerable, as there is an immaturity of the nervous and endocrine systems, and some reflexes are also absent. 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.

With such 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 most difficult consequences of early childbirth endure 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 eliminate problems, specialists use 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 of painful sensations that resemble menstruation, 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 delivery of all necessary tests for infectious diseases and the control of chronic pathologies.

Every expectant mother, being in a wonderful position, worries about the health and life of her unborn baby. A woman initially gives herself the installation to take care of herself, follow all the instructions of the attending gynecologist and bring the pregnancy to the due date. Unfortunately, despite prevention, the right lifestyle and adherence to recommendations, there are cases when the pregnancy ends prematurely. For example, sometimes it happens that childbirth occurs at 34 weeks.

What is preterm birth?

The birth of a child before 37 weeks is considered premature. After this conditional line, pregnancy can be considered full-term. And the child in most cases is born fully developed and healthy. Children who were born before 37 weeks (lower threshold - 28) with a weight of 1000 to 2500 kg are considered premature. This data is up to 1993. After the All-Russian Health Organization adopted a new lower level of prematurity of children who are subject to resuscitation - 500 gr. And if such a child survives within a week after birth, then such childbirth is called premature. The mass of the fetus in this case can be extremely low.

Premature birth at 34 weeks of gestation is not as scary as, for example, at the 28th. Usually, by this time, the child already weighs about 2200 grams, his height reaches 43-45 cm. He is developed and, most likely, after birth he will breathe on his own - there will be no need for resuscitation. Also by this time the child takes the position in which he will move along the birth canal. The mother's body is preparing for the upcoming birth, but, despite the seemingly satisfactory facts for the birth, 34 weeks is not enough time for a full-fledged birth.

Causes of preterm birth

Childbirth at 34 weeks can be caused by various reasons. They largely depend on the health of the future mother, external factors, lifestyle, as well as genetic changes in the body of the fetus. The main causes of preterm birth are:

• Infections and pathologies of the cervix and uterus in general.
• Multiple pregnancy. Often such a pregnancy is delivered before the due date.
• Polyhydramnios.
• endocrine disorders.
• Diseases of organs and systems of the mother's body - cardiovascular, gastrointestinal and others.
• Malformations in the fetus, including genetic diseases.
• Colds and inflammation during pregnancy.
• Bad habits - smoking, alcohol, drugs.
• accommodation in
• Difficult working conditions.
• Psychological experiences, stress.
• Injuries received during pregnancy.

Signs of preterm labor

At this time (34 weeks), the pregnant woman's body begins to prepare for childbirth. “False” or, as they are also called, “training” contractions appear. A pregnant woman may feel unpleasant, even painful sensations in the lumbar region, sacrum, and pelvis. And also in the stomach. If these symptoms do not cause any particular inconvenience and are not permanent and growing, you can not worry too much.

If there is aching pain in the abdomen, which does not go away for a long time and is not removed by auxiliary drugs, or if intermittent contractile movements in the uterus become regular, you should consult a doctor. If you do not stop these symptoms, then childbirth can occur for a period of 34 weeks.

Treatment for threatened preterm birth

Suppose a woman has a threat of premature birth: 34 weeks is an incomplete period, so it is clear that the expectant mother is worried. Do not panic ahead of time. The threat may not necessarily turn into childbirth. At this time, it is quite possible to carry out successful treatment and save the pregnancy. First of all, the girl needs to ensure complete rest and, of course, call an ambulance. To maintain pregnancy, mandatory hospitalization will follow. Before the arrival of doctors, you can drink the simplest sedatives - motherwort, valerian. And a simple antispasmodic. For example, "No-shpu" ("Drotaverin"). After hospitalization, if there is a possibility of maintaining the pregnancy, the attending physician will prescribe the necessary drugs. Most often, these are drugs to relieve the tone of the uterus, sedative medications.

But, if preterm labor at 34-35 weeks has already begun, it is quite possible that they will not be stopped. Especially if the amniotic fluid has broken. Since at this time the child, although not yet grown up to standard parameters, is quite viable. Most often, he does not even need resuscitation. As a last resort, a hormonal drug will be administered to prepare the baby's lungs for independent breathing. Here we are talking about a purely individual approach.

Features of the management of preterm labor

Most often, premature births at terms close to natural pass without any excesses. But a distinctive feature is the reduction in the time of the process itself. Preterm births often go much faster than usual. If there is any serious pathology or emergency, then a caesarean section is performed. Recently, epidural or spinal anesthesia has been used for pain relief. Less often and for special indications - general anesthesia. Anesthesia or conventional painkillers taken by mouth are also used to manage the natural course of labor. It is also necessary to constantly monitor the condition of the mother and child.

Effects of preterm birth on the baby

Preterm birth at 34 weeks for the baby has less consequences than at earlier dates. At this stage, the fetus is developed enough to begin to live a full life. Most often, a child born at this time has already developed a respiratory system, as well as digestive organs. The problem arises only with a small weight. If it is not critical, then the child is in the hospital with his mother. If problems arise with the weight of the baby, they can be transferred to the neonatal pathology department. Also, as with any other pronounced deviations from the health and development of the crumbs. In general, after 34 weeks, with proper care and nutrition, it quickly catches up with the development of full-term children.

Effects of preterm birth on the mother

For a woman in labor, premature birth at 34 weeks is not particularly dangerous. They practically do not differ from the usual process on time. With earlier births, the number of ruptures decreases: both internal and external. The only thing worth paying close attention to is the causes of premature birth. By identifying and subsequently eliminating them, similar risks are prevented in future pregnancies. The second time, special attention should be paid to exactly the period at which the threat or premature birth occurred the previous time.

Prevention of preterm birth

It is better to take care of a healthy and fulfilling pregnancy in advance. After all, it is well known that it is better to prevent any harmful consequences than to reap sad fruits. It is advisable to plan pregnancy in advance. During this, it is necessary to abandon bad habits, heavy loads, psychological experiences. Be sure to undergo a complete examination of both the body as a whole and the reproductive system. And this applies not only to the future mother, but also to the father. If there were any chronic diseases or problems of genetic origin in the family, a mandatory consultation with a specialist is necessary. Also, when planning and during pregnancy, it is necessary to avoid contact with infectious patients, follow all the prescriptions of doctors, and undergo routine examinations.

Of course, not every case and situation can be predicted. But there are plenty of opportunities when giving birth at 34 weeks can be prevented. Or make sure that they cause minimal harm to the health of the mother and child. To do this, you need to take care of yourself, not neglect medical care and, in general, be responsible for the health of the unborn child.

The urgency of such a problem as preterm birth has now increased, especially in countries with developed economies. This is due to the fact that women first strive to ensure a decent existence for their unborn child, and are engaged in a career, thereby postponing the time of the first birth, while their body, alas, is not getting younger and accumulates many chronic diseases; disturbed ecology and the development of assisted conception technologies. The percentage of premature births reaches 5 - 15 of the total number of births.

What kind of birth is called premature?

Premature births are those that occurred in terms of 22 to 37 weeks with the condition of the birth of a live baby weighing from 500 to 2500 grams. Not so long ago, preterm births were called births that occurred at 28 or later weeks of pregnancy. However, medicine does not stand still, and today there is special equipment that allows you to leave a child born in the period from 22 to 28 weeks. The only condition that allows us to consider the birth of a child in these terms as premature birth is its viability for 7 days.

Classification of preterm birth

According to the course, preterm births are divided into:

• threatening;
• beginners;
• begun.

According to the gestational age, when the birth occurred, they distinguish:

• very early (22 - 27 weeks);
• early (28 - 33 weeks);
• premature birth with the birth of an almost full-term baby (34 - 36 weeks).

In addition, there are spontaneous preterm births (started on their own), which are divided into births with regular contractions and a whole amniotic bladder and births without regular contractions and prenatal outflow of water; and childbirth induced (artificially caused) for various medical reasons. Induced preterm labor is classified according to indications. If there are complications on the part of a woman (a chronic pathology that threatens to be fatal), then the indications are called maternal. In the event of complications from the fetus (intrauterine malformations or antenatal death), the indications are called fetal.

Causes of preterm birth

The exact cause of preterm birth has not yet been established. But obstetricians have identified groups of factors that predispose to the birth of a child prematurely. These include:

Factors related to maternal health

• the presence of endocrine pathology (problems with the thyroid gland, diabetes mellitus, diseases of the adrenal glands, pituitary gland, and others);
• hidden sexual infections (human papillomavirus, ureaplasma infection, cytomegalovirus and others);
• chronic infectious diseases of the genitourinary tract (pyelonephritis, endometritis, inflammation of the appendages);
• hormonal disorders in the reproductive sphere (in particular, hyperandrogenism);
• extragenital diseases (pathology of the cardiovascular system, lungs);
• uterine factors (malformations of the uterus, uterine tumors, fibroids, cervical surgery - amputation and others, isthmic-cervical insufficiency - cervical incompetence);
• aggravated obstetric and gynecological history - OAHA (numerous and curettage, endometrial pathology, history of premature birth);
• age (under 18 and over 30);
• surgical interventions on the abdominal organs during gestation.

fruit factors

• antenatal fetal death;
• gross malformations of the fetus;
• multiple pregnancy.

Factors related to pregnancy itself

• excess water or lack thereof;
• severe course;
• Rh-conflict pregnancy;
• immunological problems (antiphospholipid syndrome);
• bleeding during pregnancy (either);
• SARS during pregnancy.

Socio-economic factors

• low income;
• bad habits (smoking, alcohol, drug addiction);
• constant and prolonged stress;
• unsettled personal life;
• unwanted pregnancy;
• poor-quality nutrition, passion for diets;
• poor living conditions, etc.

Clinic and signs of premature birth

The clinical picture of preterm labor depends on the stage of the process:

Threat of preterm birth

At this stage, the pregnant woman complains of sipping or drawing pains both in the lower abdomen and in the lumbar region. The uterus "hardens" after any, even minor physical activity or without it, which is due to its increased excitability (this symptom is called hypertonicity). The fetus begins to move actively, which is also associated with uterine hypertonicity. There is an increase in vaginal discharge, which may be watery, mucous, or mixed with blood. Often, women note an increased amount of whiter as the only sign. When conducting a vaginal examination, the length and consistency of the cervix is ​​​​preserved, only in multi-pregnant women can a slightly open external pharynx be diagnosed. During an external obstetric examination, the presenting part of the fetus is palpated, which is tightly pressed against the entrance to the small pelvis. If you do not provide medical assistance at this stage, preterm labor goes into the next stage.

Beginning preterm labor

At this stage of the birth process, pain in the lower abdomen becomes more intense, irregular labor activity develops (4 or less contractions in 10 minutes). The cervix begins to smooth out, soften and open (up to 1 - 2 cm). Early discharge of water is possible (a very unfavorable symptom).

Started premature birth

This stage is characterized by regular labor activity (at least 3 contractions in 10 minutes), outpouring of water and opening of the uterine os by 3 cm or more. Premature labor that has begun is an irreversible process, it is impossible to stop the birth process and the doctor is forced to take delivery.

Actions for (threatened) preterm birth

Women with threatening and incipient preterm labor are hospitalized in the department, where they are prescribed mandatory bed rest, a special diet (restriction of spicy, fatty, salty foods and foods that cause constipation and flatulence) and tocolytic therapy. For this purpose, solutions of ginipral, partusisten, magnesia, and alcohol are injected intravenously. At the same time, they are treated with Corinfar (calcium channel blocker), which also suppresses uterine hypertonicity, placental insufficiency (vitamins, metabolic drugs - riboxin, actovegin, vascular and antiplatelet agents - aspirin, chimes). It is also mandatory to carry out the prevention of respiratory distress syndrome (acceleration of the maturation of the lungs of the fetus) for two days and antibiotics are prescribed for prophylactic purposes (especially when water is poured out).

The onset of preterm labor should be taken by the obstetrician-gynecologist himself. The woman in labor is laid on her side, which is opposite to the back of the fetus, there is no protection of the perineum during the period of exile (reducing the risk of trauma to the fetus), an episiotomy is mandatory. Monitoring the condition of the baby is carried out by conducting CTG.