How does the threat of premature birth manifest itself? Premature birth, threat of premature birth. In this case, it is assigned

The threat of premature birth appears due to early dilatation of the cervix, which occurs due to pathologies and abnormalities during pregnancy. Medical tactics in this case depend on the gestation period, the integrity of the amniotic sac and the presence of bleeding.

Basic Concepts

Threatening premature birth is the possible birth of a child before 38 obstetric weeks. The pathology negatively affects the health of the baby and the condition of the mother in labor.

Classification by terms:

1. very early. The birth of the baby begins at 22-27 weeks. On average, the weight of the fetus is no more than 1 kg. There is a high probability that the internal organs are not fully developed, the lungs will not open;
2. early - occur between 28 and 33 weeks. The child's weight reaches 2 kg. There may be a lack of spontaneous breathing;
3. premature. The baby is born from 34 to 37 weeks of pregnancy. The fruit weighs up to 2.5 kg.

Doctors care for children born over 500 grams. To do this, they are placed in special boxes that create an environment similar to the womb.

Women at risk include:

• age under 16 or over 35 years;
• with multiple births;
• with polyhydramnios;
• with the presence of HIV infections;
• with bad habits: smoking, alcohol.

Medical statistics show that premature births occur more often in women expecting their second or more children. This is due to the fact that the muscles of the uterus lose their integrity and usefulness.

Depending on the mechanism of occurrence, the process is divided into:

1. spontaneous birth;
2. artificial. Childbirth is provoked for medical or social reasons.

The cause may be abnormal development of the fetus or the serious condition of the pregnant woman. The course of labor that begins prematurely depends on the weight and maturity of the fetus. Doctors are doing everything possible to help avoid injury to mother and baby.

Causes

Depending on the manifestation of the pathology, doctors draw conclusions about the further development of events. The reasons are divided into gynecological and extragenital. The former include problems with the reproductive system, the latter – with internal organs.

• diseases of the endocrine system. Diabetes and hormone deficiency lead to polyhydramnios;
• genital infections. Stabilizing a woman's condition does not guarantee that the child will remain safe;
• endometriosis is becoming a common cause of early birth;
• lack of progesterone in the body. In this case, Utrozhestan tablets are used to increase the female hormone;
• multiple pregnancy. The weight of children puts pressure on the uterine cavity, which provokes its contractions; birth is considered premature before the 35th week;
• congenital defects of the structure of the uterus. Pathologies lead to improper attachment of the placenta, causing premature rupture of amniotic fluid;
• heart disease, kidney failure. Diseases deplete the body and prevent the fetus from fully developing.

The cause of miscarriage is often defects in the child that appear in the 1st and 2nd trimesters. A woman’s lifestyle: smoking, alcohol and drugs affect the body during pregnancy. To help give birth faster, mothers take pills that induce contractions. In the early stages, this negatively affects the process of delivery and the health of the baby.

From 22 weeks of pregnancy, isthmic-cervical insufficiency and intrauterine infections become a common cause. Stress and anxiety, heavy physical activity, and an unbalanced diet increase the risk of pathology.

Symptoms and diagnosis

Signs indicating the onset of premature labor do not differ from real ones. Rupture of the amniotic sac is accompanied by the release of more than 200 ml of water.

Signs of threat of premature birth:

1. nagging pain in the lower abdomen;
2. lack of appetite, nausea, vomiting;
3. bowel dysfunction, diarrhea;
4. pressure in the uterine area;
5. decreased or increased fetal activity;
6. change in color of vaginal discharge to brown;
7. uterine bleeding;
8. frequent urge to go to the toilet.

Contractions at the onset of labor differ from training contractions in that they do not stop. The interval between contractions decreases, and the pain may become stronger. At the same time, pulling sensations appear in the lower back and pressure in the pelvic area.

There are two types of childbirth:

• beginning;
• threatening.

In the first case, regular contractions, prolapse of the fetus and rupture of the amniotic sac are characteristic. Threatened labor is accompanied by less intense abdominal pain, bleeding, and leakage of water.

How to determine the risk of premature birth:

• assess the condition of the uterus, diagnose the degree of dilatation;
• donate blood for corticotropin levels;
• do a test for premature rupture of membranes;
• calculate the intervals between contractions.

If symptoms of a threat of premature birth appear, diagnostic procedures are prescribed. Examination of the cervix will determine the dilation in centimeters and its length. An ultrasound is necessary to clarify the period, the amount of amniotic fluid, and the condition of the placenta. A urine test will rule out the presence of infection in the body, as well as pyelonephritis and appendicitis. Kidney disease has symptoms similar to the onset of labor.

Self Help

If symptoms of labor begin at an early stage, precautions must be taken. First of all, you should not be nervous, so as not to aggravate the situation.

What to do if there is a threat of premature birth:

1. contact a gynecologist or hospital to examine the uterus;
2. The No-Spa tablet will help relieve tone and reduce pain;
3. increase bed rest. When water leaks, the legs should be 10-15 cm above shoulder level;
4. exclude sexual contacts;
5. monitor the level of female hormones before the onset of labor;
6. limit heavy physical activity and sports activities;
7. establish a balanced diet.

The shorter the pregnancy period when there is a threat, the lower the likelihood of saving the child’s life. Timely hospitalization in the prenatal department will allow you to begin preventive measures as soon as possible.

Treatment of the threat of premature birth using traditional methods is used only if it is not possible to seek help from a doctor. It is important to take into account individual intolerance to the components used to prepare infusions and decoctions.

Folk remedies:

• decoction to relieve uterine tone. To prepare it, 30 g of viburnum bark is poured into 500 ml of hot water and simmered over low heat for at least 15 minutes. Take 100 ml decoction three times a day after meals;
• Calendula flower tea is used for bleeding. For 500 ml of boiled water you need 100 g of dried inflorescences. Leave for 6 hours. Take 50 ml up to 5 times a day;
• In the early stages of pregnancy, you can eat yarrow, crushed into powder. No more than 1 teaspoon per day is allowed.

Folk remedies are used only as an addition to treatment prescribed by a gynecologist. The main thing in preventing early birth is to maintain pregnancy for as long as possible.

Drug treatment

The choice of clinical decision in case of threatening premature birth depends on whether it is necessary to stop the birth of the child or to accelerate the process that has begun. When there is a threat of premature birth, drugs are used in a hospital under the supervision of doctors. First of all, they find out the cause of the pathology, and then begin to eliminate it.

Does magnesium help with the threat of premature birth? Yes. The drug reduces the tone of the uterus, relieves spasms, and dilates blood vessels. If there is a threat of premature birth, magnesium is prescribed as a dropper 2 times a day.

To prevent the onset of labor, Ginipral is prescribed. The drug reduces uterine contractions, blood pressure, and improves blood flow. Effective from 20 weeks of pregnancy. When there is a threat of premature birth, Ginipral is administered intravenously to speed up its entry into the blood.

To reduce the tone of the uterus, Papaverine injections are prescribed. The antispasmodic has an effect on the muscles, relaxes them. Injections are carried out once a day, 10-20 mg.

Dexamethasone is used to prevent the occurrence of respiratory syndrome in the fetus when there is a threat of premature birth. The drug is approved from 24 to 34 weeks. The drug is prescribed only in an emergency, when there is a possibility that the child’s lungs will not open.

How quickly do dexamethasone injections work when there is a threat of premature birth? The effects of hormones begin 48 hours after administration, lung maturity occurs on days 3-4. Dexamethasone for the prevention of premature birth is prescribed from 1 to 6 ml per day.

A common cause of the pathology is high blood pressure. In this case, the use of nifedipine for premature birth is recommended. It inhibits calcium channels and reduces uterine contractions. If there is a threat of premature birth, Nifedipine is allowed from the 18th week of pregnancy.

Complications and rehabilitation

Having a baby prematurely is dangerous and has a number of complications for the woman. This is due to the fact that the uterus is not ready for the birth of a baby. If the labor process has begun, you need to call an ambulance and do not panic.

If the gestation period is less than 34 weeks, an emergency caesarean section is performed. Rapid labor will prevent the uterus from fully opening, which will lead to ruptures of the perineum and vagina. Their main difference is that the period of contractions and pushing lasts no more than 2-3 hours.

With weak labor, the risk of developing fetal hypoxia increases. At this moment the woman feels a loss of strength and loses consciousness. A distinctive feature is rare contractions, slower opening of the uterine pharynx and a long course of the process.

Discoordination of labor is rare. Contractions with such an anomaly are very painful. The cervix remains immature for 8-10 hours from the start of the process. The fetal head does not descend to the entrance to the pelvis.

Early childbirth leads to the development of infections that cause endometriosis and rotting of the sutures. Mothers are prescribed antibiotics, and in rare cases, sepsis and peritonitis occur.

Consequences for the child:

• death;
• immaturity of the brain;
• lack of spontaneous breathing;
• frequent infectious diseases;
• neurological disorders;
• developmental defects, diagnosis of cerebral palsy.

In the future, born children may experience asthma and asthma attacks. Brain immaturity is responsible for intelligence and affects the behavior of a newborn. Children are characterized by lack of appetite, refusal to sleep, and regular crying.

The rate of premature births between 22 and 37 weeks in Russia exceeds 7%. This suggests that women need to be more attentive to pregnancy, take care of their bodies and lead a healthy lifestyle. Prevention includes giving up bad habits, reducing physical activity, and drug treatment. If signs such as contractions, rupture of amniotic fluid, or bleeding appear, it is recommended to call an ambulance to go to the maternity hospital.

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 think about it again. Unless, of course, God forbid, you happen to encounter her in person.

Premature birth is defined as birth before 38 weeks of pregnancy. For a long time, people 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 make it possible to care for children born after 22 weeks and weighing more than 500 g. Therefore, already at this stage, birth is called premature if the child was born alive and lived for at least 7 days.

Due to the fact that it is too difficult for children born before 28 weeks to be delivered, many doctors still say that premature birth is birth after 28 weeks, and before that we can only talk about miscarriage. After all, not every hospital has expensive equipment to save the lives of children weighing less than 1 kg.

However, no matter what you call the situation, doctors will be there to save the pregnancy or save the baby’s life, if the pregnancy could not be saved. Another thing is that without the appropriate equipment and medications, as well as without the ardent desire of the mother, it is very difficult to do this. That is why it is very important to go to a specialized hospital, a specialized maternity hospital.

Types of premature birth

According to the duration of pregnancy, premature birth is divided into 3 types:

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

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

In addition, the chance of survival of the child also largely depends on the period at which premature birth occurs. However, in any case, the longer the baby is in the womb, the better for him. And every day that he manages to delay childbirth will make him healthier and stronger.

Premature birth statistics

As a reassurance for women who are afraid of preterm birth, here are the general statistics on preterm birth. Please note, only 6-8% of all births are premature. Think about it, only 8 out of 100 women give birth prematurely, the rest carry their children to term safely.

And of this number, only 5-7% occur between 22 and 27 weeks. Of course, these children are the most difficult to rescue, but quite a few manage to save their lives. Between 27 and 33 weeks, just over 30% of premature babies are born. It is much easier for such children to emerge; significantly more than half of them survive.

More than 50% of all preterm births occur between 34 and 37 weeks. Babies born during this period differ from full-term ones only in size. All systems in their body are already developed enough 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 chances of a successful outcome.

Causes of premature birth

What could be the causes of premature birth? There are simply a huge number of them. In the early stages, these are usually different 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 any obstacles arise 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 testing for infectious diseases before conception. Ideally, infections should be treated before pregnancy. However, if you have not done this in advance, then the time to do it is 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 greater the chance of maintaining the pregnancy.

Premature birth at 27-29 weeks and later most often begins due to cervical pathologies, which is called isthmic-ecclesiastical insufficiency. With this pathology, the cervix is ​​too weak to support the gradually enlarging fetus. As a result, under his pressure, it begins to open, which provokes the onset of premature labor.

It is extremely rare that ICI is congenital. Most often, this pathology becomes a direct consequence of abortions and miscarriages, after which it is necessary to scrape out the uterine cavity, or other artificial interventions in this area, when it is necessary to dilate the cervix with the help of special instruments.

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

However, sometimes the cause of ICI lies in an excess amount 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 just the most common causes of premature birth. There are others too. So, multiple pregnancy or pregnancy, during which excessive stretching of the uterus occurs, can also result in premature birth.

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

In addition, it has been noted that the risk of premature birth is higher in women from disadvantaged families; hard labour, constant stress, smoking, alcohol, drugs.

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

As you can see, there are a lot of reasons. However, even if you have 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, then doctors will monitor your condition and will certainly be able to prevent an undesirable situation.

Symptoms of premature birth

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

It is indeed possible to stop the process, but only if we are talking about threatening and beginning labor. If labor has already begun and the cervix begins to dilate, then it is impossible to stop labor. All that remains is to carefully guide them and try to save the baby.

The signs of preterm labor are very important to know. Threatening premature birth make themselves felt by pain in the lower abdomen and lower back. The uterus is toned, causing the stomach to become hard. However, the cervix does not dilate.

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

How does premature labor begin? In terms of symptoms, they are practically no different from ordinary ones, although they are often accompanied by various complications: weak or, conversely, excessive labor, placental abruption and bleeding. Premature labor often takes significantly less time than normal labor.

Treatment for threatened preterm birth

If you discover symptoms of premature labor, the first thing you need to do is call an ambulance. Many women have a desire to get to the maternity hospital on their own, but it is better to refrain from doing so. Extra movements and stress can speed up the birth process, and the car or taxi simply will not have the necessary drugs and equipment.

In addition, if premature birth begins in the early stages, then it is very important to go to a maternity hospital that specializes in such complications. In this case, the hospital will not only have equipment and medications to help maintain pregnancy, but also everything that is necessary to care for premature babies.

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

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

Treatment of the threat of premature birth and beginning premature birth, or rather stopping them, begins with the appointment drugs that reduce uterine tone, for example, patrusiten or genipral. While the situation remains unstable, drugs are administered intravenously. After the pregnant woman’s condition has stabilized, the injections are replaced with tablets, and they are kept for up to 37 weeks, that is, until the birth is considered full-term.

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

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

If we are talking about ICN, then treatment will also depend on the duration. Apply until 28 weeks stitch on the cervix to prevent its dilatation and maintain pregnancy. The operation is performed under local, very short-term anesthesia.

At later stages, they put it on the cervix golgi ring, which tightens the neck and performs the same function as the sutures.

Another drug that will definitely be prescribed to a pregnant woman during premature birth is dexamethasone. This drug does not help maintain pregnancy in any way; its task is to make the child more viable. The fact is that the biggest problem that makes it difficult to save the lives of premature babies is that their lungs are underdeveloped.

In the lungs of children under 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 try to preserve the pregnancy at all costs. In some cases, when the situation threatens the life of the mother or child, obstetricians will not only not stop the course of labor, but, on the contrary, will stimulate it.

This is done in case of severe forms of gestosis, exacerbation of chronic diseases of a woman’s internal organs. If amniotic fluid ruptures after 34 weeks, there is also no need to continue the pregnancy.

Management of preterm labor

Managing premature birth requires a special approach: more careful and attentive. Particular attention is paid to pain relief. It is equally important to constantly monitor the condition of the mother and fetus, since the situation predisposes to various kinds of complications.

Consequences of premature birth for mother and child

What are the consequences of premature birth? For mother the consequences will be minimal. By and large, there are not many differences from ordinary childbirth. 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 maternity 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 determine 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 the last time will be considered critical.

Besides, deadlines are considered critical:

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

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

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

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

This does not mean that the mother will not be able to 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 her and change diapers. In any case, the child really needs maternal love and care.

Babies born between 28 and 34 weeks are more viable, and the matter can be managed in an intensive care ward at a regular 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. The only problem of premature babies at this stage 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 the 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 be no different from other children.

Prevention of premature birth

How to avoid premature birth? Prevention, as we know, is always better than cure. In order to minimize the risk of premature birth, it is necessary to take care of some very important points 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 characteristics of the body will be known to doctors even before conception, which means they will be taken into account when managing pregnancy;
2. Register with the antenatal clinic in a timely manner, and also tell the doctor in detail about all your diseases and characteristics, show medical documents - in general, inform the doctor as fully as possible about the state of your health;
3. Avoid contact with infectious patients to avoid infection already during pregnancy;
4. Avoid excessive physical activity, and also try to reduce the number of stressful situations as much as possible. If a woman has a difficult and nervous profession, or the situation at home is stressful, it makes sense to take sedatives throughout pregnancy. Naturally, after consulting with your doctor;
5. Regularly undergo all necessary studies, including tests for viruses and infections, ultrasound, CHT, and so on;
6. Closely monitor your condition before and during pregnancy.

All these measures will minimize the risk of premature birth. However, the main thing is to remember that no matter what week premature birth begins, at 25, 30, 35... doctors will do everything possible to preserve 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 time at home? However, it is better to go to the hospital in a timely manner and begin 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 you will be easier and calmer at home.

I like!

Delivery at 38–40 weeks is considered timely, and the fetus born at this moment is considered full-term. However, in medical practice, there are cases where children were born at 28–38 weeks and even earlier – 22–27 weeks. According to WHO, such births are called premature, but despite this, in most cases, doctors manage to care for babies born in this way (if their weight is more than 550 grams). Considering that their recovery period then extends for 2–3 years, doctors try to prevent the risk of premature birth by giving preventive recommendations to pregnant women.

Premature birth: timing, risk factors

According to statistics from different countries, the rate of premature births in the world ranges from 5 to 7%. First of all, it is affected by infectious diseases of the mother’s urinary system, diseases of internal organs, living in unsatisfactory conditions, and low social status.

In some cases, the hormonal imbalance in a woman’s body is to blame.

Additional factors for premature birth are:

• frequent at home or at work, problems in personal life;
• great physical activity;
• poor nutrition and lack of vitamins and microelements;
• age of the expectant mother (under 18 years old or over 35 years old);
• a sharp increase in body temperature;
• , diseases of the cardiovascular system, thyroid gland, and other chronic ailments;
• hemoglobin level below 90 g/l, indicating the presence of;
• work in hazardous production;
• bad habits: smoking, alcohol, drugs;
• kidney dysfunction;
• trauma or surgery performed in an interesting position;
• , presentation;
• intrauterine infection;
• Rh conflict between mother and child;
• premature rupture of membranes.

These factors are predisposing to premature birth, however, their causes are not read. In other words, they affect the physical and psychological health of a woman, especially if she is not carrying her first pregnancy.

note

According to statistics, for primiparous women the period of premature delivery is 33–37 weeks, for multiparous women – 22–27 weeks.

Causes of premature birth

All causes of the phenomenon are conditionally divided into 2 groups:

• obstetrics and gynecology– combine diseases, malfunctions of the urinary system, complications of pregnancy;
• extragenital pathologies– these are disturbances in the functioning of other organs and systems.

Obstetric and gynecological factors include infectious processes localized in the genitals. They disrupt the functionality of the muscular layer of the uterus, as a result of which it loses its usefulness. The most common case is loss of elasticity, as a result of which it can no longer stretch, adapting to the growing fetus.

Premature birth is not uncommon with multiple pregnancies, a large baby or. This is explained by the fact that the uterus in this case, on the contrary, stretches too quickly, reaching its maximum size before the required time and, accordingly, before the required time, “sending a signal” about the necessary delivery.

Other reasons:

• pathologies of the uterus (bicornuate, saddle-shaped);
• premature, its presentation, rupture of membranes;
• antiphospholipid syndrome, which is detected in the disruption of the immune system;
• , frozen pregnancies, premature births, history of abortions;
• intrauterine infection;
• pathologies of fetal development, including hemolytic disease;
• uterine bleeding or threat of miscarriage, especially in the early stages;
• conception through the use of reproductive technologies ();
• , other conditions that threaten the health and life of a woman (in this case, doctors deliberately induce labor).

Extragenital causes are most often referred to as disruptions of the endocrine system (ovaries, thyroid, adrenal glands, pituitary gland).

These also include:

• inflammatory processes in the body (with,);
• , other diseases of the cardiovascular system;
• unpreparedness of the reproductive system organs for childbirth due to the early age of the woman in labor (under 18 years old), acquired chronic ailments (in women over 35 years old).

Surgical interventions, especially those performed on the abdominal and pelvic organs, also lead to premature birth.

note

Depending on the reasons that provoked the pathology, doctors distinguish three mechanisms for the development of events. In the first case, an inflammatory process develops in the body, as a result of which increased production of biologically active substances is observed. In the second, blood clotting increases, microthrombi form in the vessels of the placenta, which provoke its premature detachment.

A third option is also possible, when in the muscle layer of the uterus the number of oxytocin receptors increases, provoking the development of labor.

Signs of premature birth

The signs of premature birth are practically no different from the signs of timely birth.

The woman feels:

• pulling in the lower abdomen, appearing with a clear frequency and reminiscent of contractions;
• feeling of fullness and pressure below;
• frequent urination;
• urge to defecate.

In the case of premature rupture of the membranes, which, by the way, accounts for 25–40% of all cases of premature birth, the water breaks. Their total volume reaches 200 ml, so the stomach is significantly reduced, however, they do not always come out completely.

Doctors distinguish 2 types of premature birth: threatening and beginning. At first, pain is felt in the lower abdomen and lower back, although its intensity does not decrease or intensify over time. The stomach at this moment is tense and hard. The beginning of labor is characterized by the presence of cramping pain, which gradually intensifies. There is a concept of the onset of premature labor, which is characterized by regular labor with a break between contractions of 10 minutes. In this case, the presenting part of the fetus descends to the entrance to the pelvis, and the membranes rupture.

The risk is increased by watery vaginal discharge, uterine bleeding, changes in fetal activity - sudden movements and turns or, conversely, calming down, freezing.

Diagnostics

If they suspect a risk of developing premature birth, doctors first rule out pathologies of the uterine myomatous node, which have similar symptoms.

In this case it is assigned:

Prevention and management of preterm birth

Suspicion of premature birth is a reason for immediate hospitalization . When labor threatens or begins, doctors try in every possible way to prolong the pregnancy. . The woman is prescribed bed rest, taking antispasmodics (papaverine,), (, motherwort). All this relieves tension and stops.

If necessary, tocolysis can be performed. This is a therapy that comes down to suppressing contractile uterine activity, due to which labor also stops. For this purpose, magnesium sulfate and medications from the group of beta2-adrenergic agonists (salbutamol in glucose solution intravenously) are prescribed.

Physiotherapeutic treatment is also possible, which provides electrical relaxation of the uterus (amplipulse therapy).

If the period is less than 34 weeks, when the risk of nursing a newborn is low due to the underdevelopment of the respiratory system, glucocorticoids (prednisol, dexamethosone) can be prescribed. They stimulate the process of maturation of lung tissue and prevent the risk of developing respiratory failure if therapy does not give the desired results and the child is born earlier.

To prevent hypoxia, dipyridamole is prescribed. Sexual infections are an indication for antimicrobial therapy. When isthmic-cervical insufficiency is detected, a special ring is placed on the cervix, and in case of urgent need, hormonal medications are prescribed.

The onset of premature labor and extragenital infections force doctors to decide to continue labor.

A third of cases of premature birth occur abnormally, when labor is strongly or weakly expressed. In this case, doctors administer drugs that restrain or provoke uterine contractility. If severe pathologies of the fetus, its or serious diseases in the mother are detected, a decision is made to carry out the procedure. In this case, after removing the premature baby, resuscitation measures are carried out.

Complications

Premature birth indicates the immaturity of the organs and systems of the fetus, as a result of which the risk of development (intracranial hemorrhage, trauma to the cervical spine) increases. The situation is aggravated by hypoxia and the inability of the lungs to perform respiratory function. For a woman in labor, such a delivery means ruptures, cervical injuries, uterine bleeding, inflammatory processes (suture suppuration, peritonitis, sepsis).

How to minimize the risks of premature birth?

A complete examination of both partners before conception helps prevent the risk of premature birth. At this stage, factors contributing to this phenomenon are excluded. It is also extremely important to register in a timely manner, not to miss routine examinations of the gynecologist, and to listen to his advice and recommendations.

This is especially true for women who are at risk:

As a rule, pregnancy and childbirth after premature birth proceed normally, subject to a thorough examination and treatment of identified diseases. Meanwhile, during the current pregnancy, it is important to monitor your body and, if you detect the first signs of preterm labor, go to the doctor.

What is premature birth

It is generally accepted that birth is premature if it occurs at 23–37 weeks of pregnancy with a fetal weight of more than 500 g and the child was born alive, having lived for at least 7 days. In case of multiple pregnancy, premature birth is considered to occur from 22 to 35 weeks of gestation.

How often does premature birth occur?

For the peace of mind of expectant mothers, it is important to know that according to statistics, only 7–8% of babies are born prematurely, that is, only 8 births out of 100 begin prematurely.

And from this number:

• no more than 5–7% of women give birth to children at 22–27 weeks of pregnancy (early labor). Despite the difficulties in caring for such newborns, some of them manage to save lives;
• a third of preterm births occur between 27 and 33 weeks from conception (midlabor). More than half of these babies remain to live and delight their relatives;
• Almost 60% of prematurely born babies come into this world at 33–37 weeks of gestation (late birth), and differ from full-term babies only in their low weight. Their organs and systems are sufficiently developed for independent life.

About 75% of premature births during the process are natural and only 25% are artificially induced.

Premature babies are not always very small; those born at 35–36 weeks weigh up to 2.5 kilograms, and their organs and systems are already ready to function independently

Indications for artificial stimulation of labor ahead of schedule:

• serious diseases caused by irreversible dysfunction of organs or systems that pose a threat to the life of the mother;
• severe pregnancy due to gestosis, accompanied by preeclampsia or developed eclampsia - a condition in which blood pressure and protein levels in the urine significantly increase, and vision deteriorates;
• disturbances in the movement of bile accompanying pathologies of liver function - intrahepatic cholestasis of pregnant women;
• HELLP syndrome is the body’s unadaptability to pregnancy, which manifests itself in the last weeks of gestation. Characterized by pathologies in hematopoiesis, expressed in deterioration of blood clotting and disruption of liver function;
• constant deterioration of the child’s condition, despite efforts made to stabilize;
• defects in fetal development incompatible with life;
• death of a child in the womb.

Table: differences in the processes of natural and artificial childbirth

What is the risk of premature birth?

A few weeks before the expected date of birth, false contractions may be felt - nagging pain in the lower back and lower abdomen. Sometimes they are accompanied by active movements of the fetus in the uterus and bloody discharge from the vagina. Such symptoms require immediate medical attention. A vaginal examination reveals an unchanged state of the uterine cervix. This condition is called the threat of premature birth, and correctly prescribed and carried out treatment allows you to carry the baby to term.

Pregnant women with threatened labor are advised to remain in bed and avoid physical or sexual activity. It is equally important to protect the expectant mother from psychological shocks. To reduce stress levels, sedatives are prescribed; if necessary, the woman is consulted by a psychologist; in particularly severe cases, psychotherapy may be needed.

If a child is at risk of premature birth, he or she is certainly prescribed preventive actions aimed at reducing the symptoms of respiratory failure - distress syndrome. To do this, the mother is prescribed hormonal drugs that promote the production of surfactant, a substance necessary for the maturation of the fetus’s lungs.

If the threat arises due to the inability of the cervix to hold the fetus (isthmic-cervical insufficiency), two treatment methods are used:

• surgical. A circular suture is placed on the cervix and tightened like a pouch to prevent it from opening prematurely;
• non-surgical. Using a plastic ring (obstetric pessary), which takes on a partial load of the uterus and fetus, the uterine cervix is ​​fixed.

The rupture of amniotic fluid requires special attention when there is a threat of premature labor in the absence of other signs of the onset of labor. During pregnancy from 28 to 34 weeks, they try to extend gestation if the discharge of water from the membranes is not accompanied by infection. A favorable combination of circumstances even in this case allows you to delay childbirth for several weeks. The gained time is spent maturing the fetal systems, especially the respiratory and digestive systems. Since the fetal membrane no longer protects the baby from infections, the pregnant woman is prescribed a course of antibiotics and drugs that block uterine contractions.

Be sure to measure the pregnant woman’s body temperature twice a day so as not to miss the onset of infection of the birth canal. For the same purpose, general urine and blood tests, bacterial cultures and vaginal smears are taken. Carefully monitor the child's condition. If the slightest signs of infection are detected, artificial stimulation of labor begins.

Multiple pregnancies especially often end prematurely and the more children in the womb, the less each of them weighs

Reasons for the onset of premature labor from the mother and fetus

The most common reasons causing premature resolution of the burden on the maternal side include the following:

• unsatisfactory living conditions and insufficient nutrition;
• drinking alcohol, drugs and smoking during pregnancy;
• refusal of the expectant mother to be monitored by a doctor;
• age under 17 and over 40 years (due to underdevelopment of the reproductive system or acquired chronic diseases and abortions in the past);
• anemia;
• pneumonia, sexually transmitted and infectious diseases suffered during pregnancy;
• isthmic-cervical insufficiency;
• polyhydramnios;
• miscarriages and premature births in the past;
• uterine polycystic disease;
• acute attack of appendicitis;
• improper formation of the placenta;
• intrauterine infections that provoke premature rupture of membranes;
• excessive physical activity;
• a state of severe nervous tension.

On the part of the fetus, premature birth is caused by:

• congenital brain damage;
• malformation of the digestive system;
• impairment of kidney function.

Video: top 3 causes of premature birth

Do you think that premature birth occurs only among those who have had health problems or violated the pregnancy regime? You are wrong. All 6 months from the moment of registration at 8 weeks, I regularly took tests (without deviations), walked every day for 2 hours (the warm season allowed for most of the pregnancy), ate properly and followed all the doctor’s instructions. But the stress from the crisis that happened in the fall of 2008 hit our family, affecting me greatly.

Risk factors for preterm birth

There are several factors that give grounds to classify a pregnant woman as at risk of giving birth prematurely:

• late gestosis;
• multiple pregnancy;
• incorrect presentation of the fetus;
• placental abruption;
• defects of the uterus and uterine appendages;
• gene mutations;
• injuries of internal genital organs;
• fetal malformations;
• uterine fibroids;
• Rhesus conflict with the child.

Video: what is intrauterine infection of the fetus

Signs of premature birth

The symptoms of early preterm labor are the same as those that begin at term:

• nagging, cramping pain felt in the lower abdomen;
• frequent urge to urinate and defecate;
• feeling of fullness and pressure in the genitals.

Video: how to understand that contractions have begun

Table: symptoms of premature birth by stage

On November 22, 2008, there was a month left before my son's expected due date. The day before, my husband and I were at my sister-in-law’s birthday party, and we had to walk up to the fifth floor and down as well, since the elevator didn’t work. And Ira’s sausage was delicious, I couldn’t resist and ate 2 pieces. And the salmon - a small piece went with the sausage. Saturday morning began at 4 o'clock with nagging pain in the lower abdomen, I already thought that I was poisoned or that my stomach, which had been accustomed to healthy food for 8 months, did not like the fatty food, when suddenly the painful sensations subsided on their own. Puzzled by this phenomenon, Lena went to bed and slept for another 2.5 hours. When the situation repeated itself exactly, a guess struck me - these were contractions. But somehow, I put off getting married until the last minute, until in October the father of my child dragged me to the registry office, and we were registered within 10 days - a certificate from the maternity hospital helped. But I waited a whole month for my passport and I didn’t have it in my hands that morning. But we collected things for the maternity hospital (thanks to mom!) and an exchange card for my maiden name. Having pushed my husband aside with the words “I’m having contractions, let’s go to the passport office,” I barely dissuaded him from calling an ambulance. Meanwhile, contractions came every 2 hours, but the passport department politely sent me to give birth, promising to issue a passport to my husband at 12 noon. At home, during my next trip to the toilet, I noticed strange mucus on my underwear. Having called my husband’s sister, who had recently become a mother herself, I found out that the plug had come off and I urgently had to go to the maternity hospital. Despite the still infrequent contractions, I lay down like Danae in my father-in-law’s car and went to give birth.

How is premature birth treated?

When a pregnant woman with suspected premature birth is admitted to the maternity hospital, the obstetrician-gynecologist on duty conducts an examination:

1. Oral survey identifying risk factors for preterm birth.
2. Examination of a woman to determine if there is leakage or leakage of amniotic fluid (amniotic fluid).
3. If there is no leakage, inspect the os and uterine cervix for dilatation. If no external changes are detected or they are insignificant, the inspection is repeated every 30 minutes for the next 4–6 hours. When signs appear or the opening increases, a diagnosis of preterm labor is made.
4. Assessment of the condition of the fetus, amniotic fluid, membranes and placenta using ultrasound and CTG.
5. Collection of microbiological analyzes of the os of the uterus and uterine smear.

Based on these studies, the doctor makes a decision on treatment tactics to stop labor or assist in obstetrics.

What should a woman do if she suspects preterm birth?

First of all, you need to calm down. Take medications based on motherwort or valerian and, before the ambulance arrives, it is advisable to drink some antispasmodics to reduce uterine tone. Preparations containing drotaverine or papaverine are suitable.

Do not get up without your doctor's permission, and only lie on your left side.

A woman arriving by ambulance with suspected premature birth must be examined by the doctor on duty at the maternity hospital in the first minutes.

Features of the process of premature birth

The small size of the fetus makes premature labor rapid and the natural birth canal often does not have time to prepare.

This is the difficulty of the early birth of a child:

• in premature babies, the cranial bones have not yet formed enough, so they cannot protect the brain from pressure during contractions and being pushed out of the mother’s womb;
• The birth canal threatens to compress the baby’s head, as it does not have time to stretch and may rupture during childbirth.

Therefore, measures to reduce active contractions and adequate pain relief are necessarily present in the tactics of managing the process of premature birth. It is prohibited to use forceps or provide other assistance in removing the child, who must certainly leave the birth canal on his own.

In case of incorrect position - obliquely, breech presentation of the fetus, and so on - a caesarean section is used.

The newborn is held at the same level with the mother's uterus for a minute, then the umbilical cord is cut and immediately transferred to the neonatologist.

The entire process from the onset of regular contractions to the birth of the child takes up to 4 hours for those giving birth prematurely, and rapid labor is even faster.

Having given an interview at the sanitary checkpoint and allowing myself to be examined, I went with my things to the ward, where there was already a girl with contractions. “Lord, another first-time mother,” the nurse on duty greeted me warmly. I was given an injection of drotaverine (no-shpa) intravenously and ordered to lie on my left side. An hour later, we were allowed to walk down the corridor to the CTG and listen to our son’s heartbeat. I had an ultrasound 2 weeks ago and the results satisfied the obstetrician-gynecologist. At the 36th week, the baby was fully formed, and I was ready for the fact that he would weigh no more than 2500. The husband and son of his half-sister were born at term weighing 2400 grams, but grew up quite strong. Ilya is now 20 years old and almost 2 meters tall. So, I digress. The next 4 hours passed with jokes from the nurse on duty, who in every possible way distracted Tanya and me from the pain, and periodic trips to the CTG machine, the baby sank lower and lower. At 17-20 I sat on the gynecological chair, the doctor examined me and decided to puncture the amniotic sac so that the waters would finally pour out, because the uterus was already sufficiently dilated. It was at 17–25 that I felt what real contractions were like. I was immediately led by the arms into the delivery room opposite the examination room. There I climbed onto the chair again, from excitement and rolling contractions I could not figure out how to hold on to the vertical rails, I loudly promised to die and asked to take care of my baby. The doctor stroked my head and reminded me to breathe correctly. At 5:55 pm I heard my son’s first cry. But my husband still brought me a passport, and in the line with the date of issue my Seniya’s birthday is indicated. I don’t even want to change the document when the deadline comes.

Possible consequences and complications for mother and child

Women who give birth ahead of schedule often develop postpartum depression and other psychological problems due to feelings of guilt about the baby. You shouldn’t torment yourself with worries, because the baby needs your love and care, and paying attention to your child will help you quickly restore your physical and mental health.

Due to insufficient development of organs, premature babies initially have to breathe and receive nutrients through tubes

The consequences of premature birth for a newborn become much more severe:

• if the lungs are not yet sufficiently developed, the baby is connected to an artificial respiration apparatus. Babies born before the 35th week of pregnancy have a small amount of surfactants in their underdeveloped lungs and the deficiency must be replenished with medication, which saves the lives of most premature babies. But sometimes it is still not possible to do without artificial pulmonary ventilation (ALV);
• Children with immature lung tissue often develop chronic forms of lung disease. They are prescribed drugs that stimulate the growth of lung tissue;
• Severely premature babies need to be connected to devices that perform the functions of most body systems:
  • respiratory;
  • cardiac;
  • circulatory;
• Often premature babies are placed on a feeding machine or given nutrients intravenously. Then the fats, proteins and carbohydrates necessary for full development enter the child’s body.

At an older age, premature babies face a particularly complex course of respiratory diseases. They have an increased risk of developing asthma, and an increased tendency to bronchospasm and shortness of breath during infectious diseases.

An insufficiently mature brain during childbirth often suffers from hypoxia, which negatively affects the performance of its functions by the nervous system. Such people usually have a very low pain threshold, and the nervous tissue is unusually sensitive to mechanical damage.

Video: recommendations from a neonatologist to parents of premature babies

Table: forecasts for children born at different stages of prematurity

Postpartum rehabilitation

Rehabilitation after premature birth lasts from three months to two years. At first, you need to be especially attentive to vaginal discharge as the uterus contracts and returns to normal size. In the case of premature birth, they last longer than in those who gave birth at term. It is necessary to control the consistency, color, and smell so as not to miss the sudden onset of bleeding.

Some mothers may require psychological rehabilitation due to a guilt complex for not being able to carry the baby to term, especially if this caused serious health problems for the baby. During this period, the support of loved ones plays a very important role, who will help with everyday affairs, but will not allow the woman to withdraw into herself.

Be sure to regularly visit a gynecologist to eliminate the possibility of advanced diseases leading to premature birth. Those planning a new pregnancy are advised to wait until the body has completely recovered.

Breastfeeding should begin when your doctor approves, but to maintain lactation you need to pump as soon as your milk starts to come in.

Mothers are allowed to visit their children even in intensive care; it is very useful for children to feel maternal love and care

How long does it take to be discharged after premature birth?

No one will tell you the exact deadline; each case is considered individually. The length of stay in the maternity hospital depends on the condition of the mother and child and the degree of prematurity. They may be discharged in 2-3 weeks, but the baby will be sent to the neonatal pathology department for a long time. Or you can be home in a week or two with your child.

My son had the only problem besides his low weight - his thermoregulation was malfunctioning and we spent 6 days in the maternity hospital, the little one was in the same room with me, but slept in a heated incubator.

Prevention of premature birth

The likelihood of premature birth can be identified during registration, so you need to honestly answer questions about previous or chronic diseases and the presence of bad habits.

If you are at risk:

• Follow your doctor's recommendations exactly and take prescribed medications. All infectious diseases must be cured at the stage of pregnancy planning, and then take precautions, avoiding sources of infection. Visits to the doctor should not be missed, and all hardware and laboratory tests must be carried out on time;
• Familiarize yourself with the symptoms of impending labor in advance and immediately visit your gynecologist if you notice any signs. Timely prescribed therapy will allow you to postpone the date of birth, and the baby will develop enough to be born;
• abstain from sexual relations if the doctor insists on it;
• try not to overwork;
• get rid of bad habits, including nutrition;
• do not self-medicate.

Video: how to avoid premature birth

Features of pregnancy management after premature birth

If a woman has already had premature birth, all her subsequent pregnancies will be under the close attention of doctors. These expectant mothers are advised to:

• early registration in order to pass all the necessary tests as early as possible;
• extended list of proposed examinations:
  • hormone tests;
  • antibody titers;
  • thorough examination of smears and bacterial cultures;
  • blood pressure control;
  • other tests, depending on the reasons that provoked early labor the previous time;
• involvement of highly specialized specialists in monitoring the pregnant woman - a cardiologist, endocrinologist and others;
• planned hospitalization at a critical time for preventive therapy;
• placement in a hospital before birth in specialized departments of perinatal centers.

There are women who by nature give birth prematurely, and this will always be the case and this is normal. A premature pregnancy does not pose any dangers or threats to the next pregnancy.

Childbirth in the next pregnancy

If preventive measures have been taken before conception and during pregnancy, the next birth will begin on time and proceed without problems. An exception may be conditions that cannot be corrected, but they are extremely rare.

Video: how to carry and give birth to a healthy baby

What is premature birth? It refers to births that occur after 22 weeks and before 37 weeks of pregnancy. They are divided into two periods:

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

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

Premature birth is considered an unfavorable outcome of pregnancy, since a premature baby, due to the immaturity of organs and systems to varying degrees, is not able to independently control most vital processes. The immaturity of the central nervous and respiratory systems, endocrine organs, and the absence of certain reflexes make such a child too vulnerable. The earlier the pregnancy is terminated, the more often babies develop vision problems, severe neurological disorders, etc.

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

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

Classification

Premature births include births that occur between the 28th and 37th weeks of pregnancy. The weight of the fetus in this case is 1 – 2.5 kg. Depending on the stage of pregnancy, prematurely born children are classified into:

• born extremely prematurely (before the 28th week),
• those born significantly prematurely (28 – 32nd week),
• those born moderately or slightly prematurely (32–37 weeks).

Causes

What could be the causes of premature birth? There are simply a huge number of them. In the early stages, these are usually various inflammations and infectious diseases. Any inflammation in the uterine cavity affects the muscle tissue and prevents them from stretching. But as the baby grows and develops, the uterus must constantly stretch. If any obstacles arise 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 testing for infectious diseases before conception. Ideally, infections should be treated before pregnancy. However, if you have not done this in advance, then the time to do it is 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 greater the chance of maintaining the pregnancy.

Premature births at 26, 28, 30 weeks and later most often begin due to cervical pathology, which is called isthmic-cervical insufficiency. With this pathology, the cervix is ​​too weak to support the gradually enlarging fetus. As a result, under his pressure, it begins to open, which provokes the onset of premature labor.

It is extremely rare that ICI is congenital. Most often, this pathology becomes a direct consequence of abortions and miscarriages, after which it is necessary to scrape out the uterine cavity, or other artificial interventions in this area, when it is necessary to dilate the cervix with the help of special instruments.

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

However, sometimes the cause of ICI lies in an excess amount 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 just the most common causes of premature birth. There are others too. Thus, a multiple or polyhydramnios pregnancy, during which the uterus is excessively stretched, can also result in premature birth.

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

In addition, it has been noted that the risk of premature birth is higher in women from disadvantaged families, which is also influenced by hard work, constant stress, smoking, alcohol, and drugs.

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

As you can see, there are a lot of reasons. However, even if you have 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, then doctors will monitor your condition and will certainly be able to prevent an undesirable situation.

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

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

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

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

Such features have a very adverse effect on the outcome of childbirth, since full maturity of the fetal lungs is not achieved. This does not allow the newborn's respiratory system to function fully. In some cases, lung maturation can be accelerated with medication.
There may be many more reasons causing premature birth in the period 28–33 weeks. However, although at this point the fetal lungs have also not reached full maturity, this process can be effectively accelerated by medication. With even longer periods of premature birth, the prognosis for a favorable outcome improves.

Signs

The most common sign of preterm labor is abdominal tension. Depending on the stage of pregnancy, it can manifest itself in different ways. In the first months there are nagging pains in the abdomen and lower back, in the last months there is a feeling of petrification of the abdomen, accompanied by painful sensations in the lower back. To avoid overdiagnosis, it is necessary to differentiate pain from stretching of the abdominal muscles, pain in the intestines and manifestations of osteochondrosis or urolithiasis from signs of premature birth.

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

Bloody vaginal discharge scares women the most, and it can be a sign of premature birth, traumatic erosion of the cervix, or appear during the expected period of menstruation.

Signs indicating the onset of premature labor are:

• heaviness and nagging pain in the lower abdomen,
• discharge of bloody or clear fluid from the vagina,
• prolonged (more than 30 seconds) cramping pain,
• feeling of fetal movements.

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

Symptoms

Preterm birth is classified into:

• threatening,
• starting,
• started.

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

When premature labor begins, cramping pain in the lower abdomen or regular contractions are usually noted. Using a vaginal examination, a shortened or flattened cervix is ​​determined.

The onset of premature labor is characterized by regular labor and opening of the cervix by 2-3 cm.

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

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

In case of premature birth, the patient experiences:

• untimely discharge of amniotic fluid,
• labor disturbances (weak, excessively strong, incoordination),
• increase or decrease in labor time,
• bleeding (in some cases the cause is placental abruption, in others – retention of parts of the placenta),
• inflammatory complications,
• fetal hypoxia.

Deadlines

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

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

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

Prevention

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

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

Studies have shown that weekly injections of this hormone, starting at 16–20 weeks and continuing until 36 weeks, significantly reduce the risk of recurrent preterm birth for women in this situation. But for a woman with a multiple pregnancy, such treatment will be ineffective, since twins are almost always born ahead of schedule.

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

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

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

How to avoid

The likelihood of a positive outcome of preterm birth strongly depends on the initiation of preventive measures. That is why the first place in importance is such a preventive measure as regular and comprehensive medical observations.

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

• 2 – 3 weeks (fertilized egg is fixed in the uterine mucosa),
• 4 – 12 weeks (the placenta is formed),
• 18 – 22 weeks (the uterus rapidly increases in size),

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

1. Contact a gynecologist at the antenatal clinic in the earliest stages of pregnancy for registration and observation. Regular visits to the doctor create many more opportunities for the expectant mother to undergo physical examinations, receive dietary advice and be educated about the entire process that she must go through.

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

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

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

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

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

In this case, the doctor will diagnose the condition of the cervix on an ultrasound and may need to place circular stitches around the cervix (known as a “cerclage”) early in pregnancy. In addition, women should also inform their doctor about the presence of any health problems (they may have diseases such as diabetes, asthma, hypertension and seizures), to ensure proper monitoring in order to reduce the likelihood of problems such as premature childbirth.

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

8. Follow the rest and drinking regime. Adequate rest and sufficient fluids promote good circulation of blood, oxygen, vitamins and nutrients to the growing fetus.

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

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

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

Harbingers

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

• Nagging pain in the lower abdomen, similar to menstrual pain.
• Heaviness in the lower abdomen, it seems to you that something is pressing hard on the bladder and vagina.
• Bloody discharge from the genital tract.
• Cramping pain that lasts more than 30 seconds. Just don’t confuse them with training contractions (how to distinguish training contractions from real ones - see the article “Labor Begins”).
• Leakage of clear fluid from the vagina.
• You have stopped feeling fetal movements.

The doctor will assess your condition and may suggest hospitalization in a maternity hospital. But don’t panic ahead of time - in many cases, labor can be slowed down with the help of special medications, psychotherapy, an electric uterine relaxer, acupuncture, etc.

Consequences

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

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

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

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

But still, in some cases, it is not possible to survive without artificial ventilation for a month. Sometimes such children develop chronic lung diseases due to the immaturity of the lung tissue. Therefore, the doctor prescribes drugs to stimulate the growth of this tissue.

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

When caring for a prematurely born child, a feeding apparatus is also used. Initially, it may be administered intravenously. In this way, the baby’s body receives proteins, fats and carbohydrates, which are necessary for normal development.

For this purpose, a special technique is used using specific blood vessels and a pump to deliver nutritional ingredients in a sterile manner.

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

Babies born prematurely often become special needs patients in the future. Due to chronic lung disease, there may be an increased tendency to spastic bronchitis, an increased risk of developing asthma, and shortness of breath during infection.

In addition, premature babies do not have very mature brains. Excessive sensitivity of the nervous tissue occurs as a result of mechanical damage. The brain also lacks oxygen. All this subsequently negatively affects the functioning of the child’s nervous system.

Such children are often prone to neuroses, more emotional, active, whiny and need a special approach. They are not easy to deal with, they sleep little and eat poorly. As you grow older, these unpleasant consequences disappear.

What can cause premature birth

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

Therefore, everyone who is preparing to become a mother, already in the early stages, needs to study in detail information about what can affect the duration of pregnancy and cause premature birth. It would also help to know what an obstetric pessary is and what other ways to prevent premature birth exist. In fact, there are a lot of these reasons; below are just their main groups.

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

There are many other factors - unfavorable pregnancy conditions, injuries, a certain age. There is no need to be scared in advance - after all, calmness during pregnancy is vital. However, we need to be prepared to prevent those situations that depend on us and can cause premature birth.

Management of preterm labor

Therapy depends on the stage. So, for threatening and beginning labor, treatment includes:

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

When premature labor begins, the doctor’s main task is to deliver the baby as carefully as possible to reduce possible injuries. The longer the gestational age, the better the prognosis for a premature baby. At the moment, there are methods for prolonging pregnancy when amniotic fluid has leaked in the absence of infection.

Scheme for managing the onset of premature labor:

How to call

How to induce premature labor? Artificial induction of premature labor is called labor induction. It should be carried out only in the absence of contraindications for childbirth naturally. Labor induction is recommended when:

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

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

The most commonly used form for prostaglandid-based drugs is a gel. It is inserted into the posterior vaginal fornix and cervical canal. In this case, it is necessary that the amniotic sac is intact (this condition prohibits the use of the gel in case of premature rupture of water). The onset of labor occurs several hours after the introduction of the gel, depending on the maturity of the uterus. If there is no effect, two repeated injections of the gel are allowed.

What to do in the event of a threat

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

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

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

Whenever there is a threat of premature birth, a pregnant woman is prescribed a special hormonal drug that accelerates the maturation of the fetus’s lungs. The drug is prescribed for reinsurance; if the baby is born prematurely, then thanks to the drug he will be able to breathe on his own.

In addition, treatment includes bed rest and avoidance of indigestible, spicy, and fatty foods.

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

Diagnostics

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

Cervical length measurement with ultrasound
Your doctor may assess the length of your cervix at your first prenatal visit. If he has any doubts, he will order an ultrasound to more accurately measure the length of the cervix and look for signs of changes in it. If the cervix begins to smooth out or widen (open), then there is a very high probability that the woman will develop premature labor.

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

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

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

Fetal fibronectin screening
This test is only performed on women who have obvious symptoms of preterm labor, especially if they have started having contractions. Fetal fibronectin (FFN) is a protein produced by the membranes of the fetus. If it (even in small quantities) is detected in cervical mucus or vaginal secretions between the 24th and 34th weeks of pregnancy, then the woman is considered to be “pregnant at increased risk of preterm birth.”

But although this test is very accurate, it will not be able to accurately predict what day you will give birth. Therefore, a positive FFN result may prompt your doctor to give you medications to delay labor, as well as corticosteroids to help your baby's lungs mature more quickly.

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

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

Pregnancy after premature birth

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

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

In most cases, the reason why labor began earlier than expected remains unclear. As a rule, labor always begins without warning and often cannot be stopped. In addition, there are cases when doctors themselves recommend that a woman give birth early if her health (or the health of her child) is in danger.

• Typically, preterm birth is recommended by doctors when:
• severe bleeding that cannot be stopped;
• severe form of gestosis and severe preeclampsia (eclampsia) in the mother;
• worsened diseases in the mother, especially such as: hypertension; pyelonephritis and other serious kidney diseases; severe anemia; chronic liver diseases; diabetes mellitus (especially if the woman had it before pregnancy); bronchial asthma; adrenal gland diseases;
• intrauterine fetal death;
• progressive deterioration of the condition of the fetus in the mother's womb;
• developmental defects incompatible with life in the fetus.

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

Dangers for baby and mother

Premature birth can cause the following dangerous complications:

• premature rupture of the membranes and premature discharge of amniotic fluid,
• oxygen starvation (hypoxia) of the child,
• infection of the uterus or baby,
• rapid progress of labor,
• weak labor activity,
• ruptures or injuries of the child and mother,
• bleeding in a woman in labor.

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