Risk of preterm birth. How to recognize preterm birth. Stages of preterm birth

Dr. Wyndham is a board certified OB/GYN from Tennessee. She completed her residency at West Virginia School of Medicine in 2010, where she received the Most Outstanding Resident Award.

Number of sources used in this article: . You will find a list of them at the bottom of the page.

If you are pregnant, it is important to be able to recognize the signs and symptoms of preterm labor. By knowing the symptoms, you will be able to seek medical help in time, which may help prevent preterm labor. Premature births occur between 20 and 37 weeks of gestation; at a gestational age of up to 20 weeks, a miscarriage is possible. Preterm labor can be caused by many reasons, some of which are controllable, others are not. Be that as it may, during pregnancy, you should be able to recognize the signs of preterm labor.

Steps

Part 1

Identifying Symptoms

contractions. One of the symptoms is contractions, which feel like contraction of the muscles in the abdomen, especially around the fetus. However, contractions do not always indicate preterm labor, since false contractions, the so-called Braxton-Hicks contractions, are also possible.

Familiarize yourself with factors that contribute to Braxton-Hicks contractions. These contractions can be caused by a variety of reasons. For example, they may occur due to the fact that you or your child moved a lot. They can lead to sex or dehydration of your body. Finally, these contractions can be caused by a full bladder or even by someone just touching your stomach. If the contractions are rather weak and associated with any of the listed reasons, these are most likely false contractions, and not a sign of preterm labor.

Help ease Braxton Hicks contractions. If you are experiencing Braxton Hicks contractions, they will gradually subside. To speed up this process, try changing your posture. If you were standing or sitting, lie down, and vice versa, get up if you were lying down.

Notice the pressure in your abdomen. If you begin to feel pressure in the lower abdomen, this may indicate a premature birth. You may also feel pressure in your pelvis. If you are worried that you may go into labor prematurely, call your doctor for advice.

Pay attention to cramps in the abdomen. If you have cramps, this may indicate a premature birth. They usually resemble menstrual cramps. In addition, spasms may be accompanied by diarrhea.

Pay attention to back pain. While back pain may seem minor and unimportant, it is also a sign that labor is approaching. In particular, persistent, persistent low back pain may indicate preterm labor. This is not a sharp, but dull and aching pain.

Look closely for a change in the old or the appearance of new vaginal discharge. You may notice spots or traces of blood. Spots indicate light bleeding. Examine your underwear for these signs, although they may show up when you go to the bathroom.

Don't drink alcohol. Alcohol also increases the risk of preterm birth. In addition, drinking alcohol increases the risk of stillbirth. If, by drinking alcohol, you bring the child to the allotted time, further problems are not ruled out, such as fetal alcohol syndrome, which can lead to abnormal and delayed development.

Don't do drugs. The use of illegal drugs such as cocaine can lead to premature birth. Any illegal drugs should be avoided as they may adversely affect your child's health. Always check with your doctor before taking any medication, even natural supplements or medicines that do not require a prescription.

Avoid stress. Although it is impossible to do without stress at all, try to avoid situations that can lead to them. In addition, learn techniques that will allow you to reduce stress in the event that you do find yourself in a stressful situation.

Take a break between pregnancies. Pregnancies that follow one another can increase the risk of preterm birth. Your body needs a break to rest and recover. Before trying to get pregnant again, it is better to wait at least a year and a half after the previous birth.

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

What is called premature birth?

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

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

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

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

How common are preterm births?

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

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

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

Who is at risk for premature delivery?

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

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

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

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

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

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

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

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

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

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

Signs of preterm labor

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

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

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

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

Bleeding from the genital tract;

Any profuse vaginal discharge, which, most often, appears in the event of leakage of amniotic fluid and rupture of the walls of the amniotic sac;

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

Drawing pains in the lumbar region and lower abdomen;

Feeling of strong pressure on the perineum;

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

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

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

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

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

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

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

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

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

When pregnancy is not preserved and early labor is stimulated?

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

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

Management of preterm birth

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

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

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

Prevention of preterm birth

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

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

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

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

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

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

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

Preterm birth is the birth of a child from the 22nd to the 37th obstetric week. Before this interval, it is generally accepted that a spontaneous abortion occurred. With the development of pediatric resuscitation, the terms of preterm birth were increased - until 2012 they were counted from the 28th week of pregnancy, and the weight of a viable newborn should be at least 0.5 kilograms. According to statistics, about 7% of births in the country occur before the standard time and are considered premature.

Classification

deep prematurity (up to 1 kg) - if the birth occurred on the 22-28th week (about 5% of the total number of births);
heavy (up to 1.5 kg) - it accounts for 15%, 28-30 weeks;
the average degree of prematurity (up to 2 kg) - covers about 20%, 31-33 weeks;
mild degree (up to 2.5 kg) - children are born at 34-36 weeks.

In some maternity hospitals, the terms are still counted from 28 weeks, due to the lack of equipment for nursing this group of babies.

Possible causes of preterm labor

The refusal of pregnant women to undergo the necessary tests and tests leads to the development of diseases that are asymptomatic.

Early detection of infectious processes will help save the baby. Unplanned pregnancies, referral to IVF specialists increase the unfavorable prognosis of a possible interruption of gestation.

The following factors contribute to the development of preterm birth:

constant stressful environment;
infectious and inflammatory processes
pregnancy as a result of IVF
low, compared with the average, social level;
poor living conditions for a pregnant woman (private houses with poor heating, lack of running water and sewerage, densely populated apartment);
the inability to switch to lightweight, recommended by gynecologists, physical labor;
early pregnancy before adulthood;
pregnancy after 35 years of age;
chronic diseases in the anamnesis of a pregnant woman (diabetes mellitus, hypertension, disorders in the thyroid gland, etc.);
acute stage or intensification of chronic genital infections (primary infection due to unprotected sex);
low levels of hemoglobin in the mother's blood;
the use of various drugs, alcoholic beverages or nicotine addiction by a pregnant woman;
employment in hazardous industries;
long trips and acclimatization (rest before childbirth in hot countries);
severe course of respiratory diseases with complications (dry cough can provoke uterine contractions);
various malformations of the uterus;
overstretching of the uterus with multiple pregnancy, a large amount of amniotic fluid and a large fetus;
surgical operations performed during pregnancy;
injury at work or at home;
placental abruption;
intrauterine infection of the embryo;
various bleeding;
abnormal development of the fetus;
incompatibility of the blood type of mother and child (Rhesus conflict);
rupture of the amniotic membranes, which occurred prematurely;
spontaneous dilatation of the cervix.

All of these conditions are not the direct cause of possible premature birth, but only influencing factors.

Potential causes of preterm labor include:

Obstetric and gynecological

the fetus is not retained in the uterus due to isthmic-cervical insufficiency (weakness of the muscle layer of the cervix);
infectious diseases of the genital organs - an inflammatory process that occurs in the uterus itself, provokes muscle weakening and, as a result, loss of elasticity;
excessive stretching of the uterus during multiple pregnancy, a large amount of amniotic fluid and a large fetus;
various malformations of the uterus (bicornuate, saddle, etc.);
placental abruption that occurred prematurely;
antiphospholipid syndrome;
premature births, miscarriages, missed pregnancies in the history of the woman in labor;
previous abortions;
a short period of time elapsed between two pregnancies (up to 2 years);
depreciation of the body against the background of constant childbirth (three to five in a row);
abnormal development and infection of the fetus in the womb;
bleeding or the threat of miscarriage in the early stages;
pregnancy that occurred with the help of assistive technologies (IVF, etc.);
severe toxicosis, with a threat to life, as a result of which childbirth is induced.

Extragenital

endocrinopathies - violations of functionality in the body of a pregnant endocrine glands (thyroid gland, adrenal glands, pituitary gland, ovaries, etc.);
infectious and inflammatory diseases in the acute phase (flu, tonsillitis, SARS, pyelonephritis, etc.);
diseases of the cardiovascular system (heart defects, arrhythmias, rheumatoid arthritis, hypertension, rheumatism, etc.);
diabetes mellitus of all types;
surgical interventions during pregnancy performed on the pelvic organs and abdominal surface (including surgery to remove appendicitis);
self-medication with the use of medications - in addition to the threat of the formation of possible deformities of the child, the likelihood of a miscarriage is formed. Some medications cause bleeding, uterine contractions, and dehydration;
violation of the ban on sexual life causes the release of hormones into the mother's body, provoking uterine contractions;
the physical age of the mother is pregnant before the age of 18 and after 35. Women who have crossed the age of 35 suffer from acquired chronic diseases, which leads to premature birth. The body of a young girl who becomes pregnant before full adulthood is not physically mature and provokes spontaneous abortions.

According to WHO, up to 40% of miscarriages are due to premature rupture of the amniotic membranes. In case of activation of one of the mechanisms, premature birth occurs due to:

inflammatory process that caused increased production of biologically active substances;
in the vessels of the placenta, microthrombi are formed (increased blood clotting), leading to its death and subsequent exfoliation;
an increased concentration of calcium ions in the cells of the myometrium, causing labor activity.

Symptoms of preterm labor

Signs of preterm labor are similar to those of spontaneous abortion or the onset of normal labor. A few days before the start of the process, there are warning signs that most women do not pay attention to:

pulling pains in the lower abdomen, reminiscent of primary contractions;
feeling of pressure in the genitals of a pregnant woman;
high fetal activity;
discharge from the genitals, sometimes with an admixture of blood;
frequent urge to urinate and defecate.

The main stages of preterm birth:

Threatened preterm labor - at this stage, the symptoms proceed unnoticed for most pregnant women. Unexpressed weak pains, pulling sensations in the lower abdomen are attributed to mild ailments. A slight tension, contraction of the uterus is attributed to an increase in the activity of the baby, who begins to move his legs and arms vigorously. In some cases, vaginal discharge occurs, in rare cases - with an admixture of blood. When contacting gynecology, the doctor notes a closed and dense uterus. Do not delay with an unscheduled visit to the doctor - timely detection of a threat will save the child's life.

Beginning preterm labor - the symptoms become more pronounced compared to the first stage, there is a sharp pain in the lumbar region and cramping muscle contractions. The discharge of the mucous plug, spotting and discharge of amniotic fluid are the main characteristics of the second stage. There is an incomplete opening of the cervix (1-2 fingers) and its softening, observed when examined by a gynecologist. During this period, it is possible to stop labor and extend the duration of pregnancy.

Premature birth is in progress - it is impossible to stop the process during this period, contractions become more frequent, become regular, the cervix is completely dilated and the fetus begins to move towards the exit into the small pelvis.

Diagnosis of preterm birth

Blurring of specific symptoms, combined with many factors, makes it impossible to accurately determine the fact of preterm birth. In practice, a preliminary diagnosis is made according to the following criteria:

collection of anamnesis by the gynecologist leading the pregnancy - complete information about all the factors that influenced the condition of the pregnant woman. Subjective assessment of sensations by the expectant mother (pain, activity of the child, pulling sensations);
examination by a gynecologist in order to detect uterine tone and cervical dilatation. A vaginal examination in the mirrors will determine whether the cervix is shortened, the degree of its smoothness and opening of the pharynx;
the appointment of an ultrasound examination to determine the level of cervical dilation and possible separation of the placenta, the estimated weight of the fetus, its presentation and position, the integrity of the amniotic sac, the general condition of the placenta, the exclusion of its presentation;
clinical blood and urine tests;
cervical maturity test (correct prognosis up to 95% of cases);
fibronectin test (to determine substances in secretions present during childbirth);
registration of the fetal heartbeat;
tests for STDs.

Treatment Methods

If preterm birth is suspected, mandatory hospitalization is carried out in a hospital, where a number of manipulations are performed:

prolongation of pregnancy - an attempt to artificially continue pregnancy with the use of drugs. Patients need a strict regimen with a state of rest, the appointment of sedatives, antispasmodics, electrorelaxation of the uterus, acupuncture and electroanalgesia. If insufficiency (softening and opening of the cervix) is detected, sutures or an obstetric ring (pessary) are applied to the cervix to prevent further disclosure;
in case of detection of infectious diseases or the threat of infection due to amniotic fluid, antimicrobial therapy is prescribed;
additionally, the maturation of the fetal lungs is accelerated with the help of glucocorticoids (prevention of respiratory distress syndrome).

If all of the above manipulations did not work, then the process of obstetrics begins.

Preterm birth in most cases proceeds rapidly, as a result of which the risk of complications in the woman in labor and the fetus increases.

During such childbirth, the fetus suffers from hypoxia - uterine contraction occurs with a high frequency and advancement through the birth canal is accelerated. Weak vessels, soft bones of the skull and small size of the fetal head cause birth injuries, intracranial hemorrhages and injuries of the cervical spine. A premature baby is traumatized due to rapid delivery, a caesarean section also does not exclude injuries.

If it is impossible to maintain pregnancy, obstetric care is carried out with the utmost care. Preventive measures against possible ruptures of the cervix and perineum are not used to avoid damage to the fetus. The risk of complications in childbirth in the mother increases - the paradox is that the size of the fetus is small, but the wrong passage through the birth canal causes a high degree of traumatism. Artificial prolongation of pregnancy after the outflow of amniotic fluid increases the risk of postpartum hemorrhage and endometritis.

Childbirth carried out after 35 weeks of pregnancy proceeds in the usual manner. At this time, the fetus is viable and no additional measures are required to save it.

with signs of internal infection;
in case of deep prematurity of the fetus;
with a frozen pregnancy.

Preventive measures to prevent early birth

Medical:

Cervical suturing - used for high-risk women, not for multiple pregnancies.
The appointment of progesterone - effectively reduces the possibility of premature birth.
Antibacterial prophylaxis - timely treatment of STDs.
Removing the tone of the uterus.

Independent:

drinking at least 8-10 glasses of water (excluding carbonated drinks and strong coffee) daily to prevent dehydration (when there is a lack of fluid in the body, labor pains will begin);
emptying the bladder every 2-3 hours (additional pressure on the walls of the uterus will cause it to contract);
it is forbidden to lift weights and overstrain, do sharp bends and squats;
it is advisable to take small breaks for additional rest during the day, if possible - in a prone position, on the left side;
stimulation of the breast and nipples, intimate activity should be avoided.

In case of any ailments, an urgent appeal to the antenatal clinic to the doctor leading the pregnancy is necessary. Timely detection of the threat of preterm birth increases the chances of having a healthy baby by 30 percent.

Childbirth that occurs before 28 weeks of gestation is called a miscarriage.
The highest percentage of spontaneous termination of pregnancy falls on the terms of 34-37 weeks of pregnancy (55.3%), for an earlier period - 10 times less often.

1. Isthmic-cervical insufficiency (ICN) - failure of the cervix, in connection with which there is an inability to keep the ovum in the uterus. The most common causes of CI are:

Injuries of the cervix during previous pregnancies - childbirth with a large (more than 4 kg) fetus, fast and rapid labor, use of obstetric forceps or vacuum, cervical ruptures during childbirth;

Previously performed operations on the cervix - conization, amputation;

Intrauterine interventions - abortion, curettage, hysteroresection;

Gene defects leading to impaired synthesis of the connective tissue of the cervix (collagenopathy) - Ehlers-Danlos, Marfan, Rendu-Osler syndrome and others;

Infectious diseases, female genital organs, causing inferiority of the cervix - candidiasis, bacterial vaginosis, ureaplasmosis, chlamydia, mycoplasmosis, herpes and megalovirus infection;

Endocrine disorders (decrease in ovarian function, or hyperandrogenism - an increased content of male sex hormones), leading to changes in the structure of the cervix, its shortening and expansion of the cervical canal;

Malformations - hypoplasia of the cervix, genital infantilism;

Increased load on the cervix during pregnancy with multiple pregnancy, polyhydramnios, large fetus;

Placenta previa or its low location.

2. Large uterine fibroids or submucosal uterine fibroids.

3. Malformations of the uterus, leading to a violation of the implantation of the fetal egg - intrauterine septum, bicornuate uterus.

4. Common infectious diseases of the mother - influenza, viral hepatitis, rubella, chronic tonsillitis.

5. General diseases in the stage of decompensation - heart defects, hypertension, diseases of the blood, liver, kidneys, diabetes mellitus.

6. Neuro-endocrine diseases - adrenal insufficiency (Addison's disease), excessive production of hormones of the adrenal cortex (Cushing's syndrome), hypothyroidism.

7. Late preeclampsia (dropsy, nephropathy, preeclampsia, eclampsia). If swelling begins to be observed in the later stages, this is an alarming symptom. If not only the legs begin to swell, but also the stomach, face, you should immediately consult a doctor. In general, with gestosis, a triad of symptoms is distinguished: initially, swelling occurs, to which arterial hypertension first joins, and then proteinuria (increased protein in the urine). However, the triad is not always clearly diagnosed.

8. Rhesus conflict - develops if a woman has Rh-negative blood, and the fetus has Rh-positive blood. The consequences can be tragic - there is a risk of developing a hemolytic disease in a child, pregnancy often ends in premature birth, more often operative (caesarean section), in severe cases, the child may die.

At risk for a possible onset are pregnant women:

Under 18 and over 40 years old,

With Rh negative blood

Practicing unprotected sex

Those who have undergone in vitro fertilization (risk of multiple pregnancies),

Suffering from decompensated chronic general somatic diseases,

Having excessive height and other markers of collagenopathy (mitral valve prolapse, tracheobronchial dysfunction, varicose veins, myopia),

Having a history of miscarriages, premature and rapid births,

Previously undergone intrauterine interventions (abortion, curettage, hysteroresection) or ruptures of the cervix during previous births,

Previously undergone surgery on the cervix (amputation, partial removal),

Surgical treatment for isthmic-cervical insufficiency (ICI) in previous pregnancies.

Preterm labor can be threatening and begun. Important: if there is a threat, abortion can be prevented, but labor that has already begun cannot be stopped.

Threatening preterm labor is characterized by periodic mild pain in the lower back and lower abdomen against the background of increased uterine tone. But the cervix remains closed.

With the onset of preterm labor, which cannot be stopped, the cervix shortens and opens, often there is an outpouring of amniotic fluid.

If your pregnancy has not reached 37 weeks, pay attention to the following complaints:
- Pain in the lower abdomen or lower back
- fights,
- premature discharge of water,
- blood secretions.

Why are premature births dangerous?

A serious test for the baby is his birth ahead of time. The organs and systems of a premature baby are not ready for extrauterine existence. Enormous efforts are required to create conditions in which the child will be able to compensate for the negative consequences of such an early birth.

As a result of preterm birth:

1. there is a rupture of the membranes surrounding the fetus, the outflow of amniotic fluid that protects the baby from the effects of the external environment, after which the infection joins;

2. premature babies are born with "immature" lungs, who cannot fully breathe, because they do not have surfactant - a special substance that is produced in the pulmonary alveoli (lung cells) and prevents them from "falling off";

3. in the process of expulsion of the fetus from the uterus and during contractions, hemorrhages may occur in the brain of the baby;

4. during passage through the birth canal, the still unhardened bones of the child's skull are injured;

5. ruptures and injuries of the cervix in the mother.

If your pregnancy is less than 37 weeks, you have characteristic complaints, then be sure to consult a doctor, but rather call an ambulance.
Before the arrival of the team of doctors, the expectant mother should lie down, take sedative tinctures (valerian, motherwort) and drink 2-3 No-shpy tablets.

The doctor chooses the tactics of managing a pregnant woman depending on the duration of pregnancy, the fact of amniotic fluid discharge, the condition of the mother and fetus. In obstetric hospitals for women with:

1. Assign bed rest.

2. Monitor the health of the mother and fetus.

3. Carry out therapy to reduce the excitability of the uterus and suppress its contractile activity - sedatives, beta-agonists and tocolytics - substances that specifically affect receptors and cause relaxation of the uterus.

4. Antibacterial therapy in case of a threat of infectious complications, while expectant tactics are chosen with control over the possible development of infection.

5. Prevention of pulmonary complications in a child, developing as a result of immaturity of the lung tissue - during childbirth up to 34 weeks of pregnancy.

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premature childbirth, according to the definition of the World Health Organization, are called births that occurred in the period from 22 to 37 weeks of pregnancy or on days 154 to 259 of gestation, if we count the period from the first day of the last menstruation. However, in Russia, births that occur between 28 and 37 weeks of gestation or between 196 and 259 days of gestation are considered premature. Childbirth from 22 to 27 weeks inclusive in Russia is allocated to a special category, which is considered late abortion, and not premature birth. It is the different terms of preterm birth that determine the difference in statistical data between the countries of Europe and Russia. The birth of a child from the 37th week of pregnancy inclusive is not considered premature. Thus, if a woman had a birth from 37 to 42 weeks, then they are considered urgent, that is, they began on time.

In the countries of the former USSR, the registry offices for premature births that occurred at 28–37 weeks of gestation register all babies born alive or dead with a body weight of more than 1000 g. If body weight could not be measured, then newborns with a body length of more than 34 cm are registered This means that the woman will be given a birth or death certificate for the child. If a child was born with a body weight of 500 - 999 g, then he is registered in the registry office only if he lived for more than 7 days (168 hours after birth).

In terms of survival of all premature babies born as a result of premature birth, they are divided into three categories depending on body weight:
1. Children born with low body weight from 1500 to 2500 g. These children in most cases survive, catch up with their peers by 2.5 - 3 years, and, starting from the third year of life, grow and develop according to age;
2. Children born with a very low body weight from 1000 to 1500 g. These children do not always manage to go out, about half of them die, and the rest may develop persistent disorders in the work of various organs and systems;
3. Children born with extremely low body weight from 500 to 1000 g. These children can only be discharged with specialized equipment and highly qualified neonatologists. However, even surviving children born with such a low body weight, as a rule, are not completely healthy, since they almost always develop persistent disorders of the central nervous system, digestive tract, respiratory, digestive and genitourinary systems.

Thus, premature births are dangerous, first of all, for a child who is not yet ready to be born, since he does not have the necessary functions of internal organs. The high mortality of premature babies is due to low body weight and the immaturity of internal organs, which are not able to ensure the existence of the baby outside the womb. However, for a woman, preterm birth is also dangerous, since the frequency of complications after them is much higher compared to full-term births.

The frequency of preterm birth in Russia is approximately 7%, in the USA - 7.5%, in France - 5%, in Australia and Scotland - 7%, in Norway - 8%, etc. Thus, the frequency of preterm birth does not exceed 10% in developed countries. In countries with a low standard of living and unsatisfactory quality of medical services, the frequency of preterm birth can reach up to 25%.

Depending on the mechanism of development, preterm labor is divided into spontaneous and induced. Spontaneous childbirth occurs without the use of special means that can provoke a birth act. Induced preterm labor is specifically provoked by specialized medicines. Such induced labor is also referred to as late abortion, "filling" or induced labor. Usually they are produced for social reasons (restriction of parental rights, pregnancy resulting from rape, serving a sentence in prison, the death of a husband while carrying a child), when fetal deformities are detected, or when a woman's health is threatened.

Premature birth - terms

Currently, in Russia and most countries of the former USSR, the entire set of preterm births is divided into three options, depending on the gestational age in which it was interrupted:
1. Early preterm birth (occur in the period from 22 to 27 weeks inclusive);
2. Median preterm birth (come in the period from 28 to 33 weeks inclusive);
3. Late preterm birth (occurs between 34 and 37 weeks of gestation).

These types of preterm births are distinguished on the basis that at the indicated terms of pregnancy, the gynecologist must apply certain obstetric tactics for a successful and minimally traumatic delivery for the woman and the fetus.

Early preterm birth in Russia is now often referred to as late abortion and is taken into account in the relevant statistical categories. Most often (in about 55% of cases) preterm birth occurs at 34 to 37 weeks of gestation. Premature births at 28-33 weeks are recorded in 35% of cases, and at 22-27 weeks - in 5-7%.

In world medical practice, nursing of live newborns weighing at least 500 g is carried out. Such a weight in an infant occurs already at the 22nd week of pregnancy. It is precisely because of the development of medical knowledge and technologies that allow nursing infants born not earlier than the 22nd week of pregnancy weighing at least 500 g, the World Health Organization recommends providing assisted resuscitation and nursing children who, at the time of birth, weighed at least 0.5 kg.

However, nursing babies born with a weight of 500 to 1000 g requires special equipment and a qualified neonatologist, which are not always available in ordinary obstetric institutions of the CIS countries. Therefore, in most cases in the CIS countries, babies born no earlier than 28 weeks of pregnancy with a body weight of at least 1000 g are nursed, since this is possible with the medical equipment available in maternity hospitals and the qualifications of a neonatologist. Only in specialized central perinatal centers in recent years have the necessary equipment appeared, and doctors have received appropriate training, allowing them to nurse newborns from 22 to 27 weeks of pregnancy weighing from 500 to 1000 g.

Preterm birth of twins

Multiple pregnancy (twins, triplets, etc.) more often than usual ends in premature birth, since the fetuses overstretch the uterine cavity, thereby provoking the development of its contractile activity, followed by the expulsion of babies. In principle, the birth of twins is considered conditionally normal, starting from 35 weeks of pregnancy. In other words, with multiple pregnancies, births that occur from 22 to 35 weeks are considered premature. Preterm birth for twins is more dangerous than for one baby, since the mass of each of them is very small. However, in preterm births that occur between 28 and 35 weeks of gestation, as a rule, both premature babies manage to go out.

Threat of preterm birth

Very often, gynecologists use the term "threat of preterm birth", which is a designation of the stage of this pathological process. Regardless of the gestational age, doctors divide preterm birth into the following clinical stages:

Threatening preterm birth (threat of preterm birth);
Beginning premature birth;
Started premature birth.

Thus, the concept of "threatened preterm birth" reflects the earliest clinical stage of this pathological process. At this stage, labor has still begun, but there is a high risk of this. Therefore, with the threat of preterm labor, a woman should receive treatment aimed at reducing the risk of developing labor. In principle, the term "threat of preterm birth" is identical to the concept of "threat of miscarriage". Just to refer to the same process of termination of pregnancy, depending on its duration, the terms "abortion" and "childbirth" are used.

The threat of premature birth is manifested by severe pulling pains in the lower abdomen or lower back. When examined by a gynecologist, an increased tone and excitability of the uterus is revealed. If a pregnant woman feels severe pain in the abdomen, which is dense to the touch, then you should immediately contact the obstetric hospital (maternity hospital, pregnancy pathology department) to receive treatment aimed at preventing premature birth.

Risk of preterm birth

The risk of preterm birth exists in women suffering from infectious diseases of the genital area, isthmic-cervical insufficiency, severe diseases of the internal organs, chronic stress or living in unsatisfactory conditions. In general, we can say that a high risk of preterm birth is created if there is a hormonal imbalance in the woman's body, infections of the genital organs, or disorders of the blood coagulation system.

That is, premature birth develops when a woman's pregnancy occurs against the background of any factors that adversely affect the woman's physical and mental state. If these factors appear in a woman's life, then the risk of preterm birth increases significantly. And when adverse factors disappear from a woman's life, the risk of preterm birth is reduced to a minimum. This means that this risk is manageable, it can be completely reduced by applying treatment methods that can minimize or completely disable the influence of a negative factor.

The following factors increase the risk, that is, contribute to the development of premature birth:

Stressful situations in which a pregnant woman finds herself in the family or at work;
Unsettled personal life (a woman is not married, scandals with her husband, a state of readiness for divorce, etc.);
Low social level;
Unsatisfactory living conditions in which a pregnant woman lives;
Heavy physical labor;
Unsatisfactory, low-quality nutrition with a low content of vitamins;
Young age of a pregnant girl (under 18 years old);
Mature or old age of a pregnant woman (over 35 years old);
Any episode of fever;
Severe chronic diseases that a pregnant woman has (hypertension, diabetes mellitus, heart disease, thyroid gland, etc.);
Exacerbation or acute onset of any genital infections;
Severe anemia (hemoglobin concentration less than 90 g/l);
Drug use or smoking during pregnancy;
Work in hazardous industries;
Severe course of any viral infection, including SARS;
Isthmic-cervical insufficiency;
Malformations of the uterus;
Overstretching of the uterus with polyhydramnios, multiple pregnancy or large fetus;
Surgical interventions or injuries suffered by a woman during pregnancy;
kidney pathology;
Placenta previa or abruption;
Intrauterine infection of the fetus;
Anomalies in the development of the fetus;
bleeding during pregnancy;
Hemolytic disease of the fetus in Rh-conflict pregnancy;
Premature rupture of membranes (PROM).

The listed conditions are risk factors for preterm birth, that is, they increase the likelihood of abortion, but are not the causes of this pathology.

Premature birth in the period of 22-27 weeks of pregnancy most often occurs with isthmic-cervical insufficiency, intrauterine infection of the fetus or PROM. Given the risks of preterm birth in terms of 22 - 27 weeks, they are most often observed in women who are carrying more than their first pregnancy. In women who are pregnant for the first time, preterm birth, as a rule, occurs in terms of 33 to 37 weeks.

Currently, obstetricians have identified the following curious pattern: the later the term of preterm birth, the greater the number of causes and possible risks that can provoke them.

Causes of preterm labor (what causes preterm labor)

The whole set of causes of preterm birth is usually divided into two large groups:
1. Obstetric and gynecological factors;
2. Extragenital pathology.

Obstetric and gynecological factors include various diseases and dysfunctions of the genital organs, as well as complications of the current pregnancy. The factors of extragenital pathology of preterm birth include any diseases of various organs and systems, with the exception of the genital ones, which negatively affect the course of pregnancy.

Obstetric and gynecological causes of preterm birth include the following factors:

Isthmic-cervical insufficiency, which is the failure of the muscular layer of the uterus in the region of its neck, as a result of which the fetus is not retained in the uterus;
Any infectious diseases of the genital organs. The infectious-inflammatory process provokes a violation of the normal functions of the muscular layer of the uterus, as a result of which the organ loses its usefulness. The most common direct cause of preterm birth due to sexual infections is the loss of elasticity of the uterus, which cannot expand to accommodate an ever-increasing fetus. When the uterus can no longer stretch, preterm labor occurs;
Excessive stretching of the uterus during multiple pregnancy (twins, triplets, etc.), polyhydramnios or just a large fetus. In this case, the immediate cause of premature birth is the achievement of the maximum possible size of the uterus before the end of the pregnancy. The uterus, which has become very large, "gives a signal" that labor can begin;
Malformations of the uterus (for example, bicornuate, saddle uterus, etc.);
Premature placental abruption;
Premature rupture of membranes;
placenta previa;
antiphospholipid syndrome;
The presence of miscarriages, missed pregnancies or premature births in the past;
The presence of abortions in the past;
A small interval (less than two years) between two subsequent pregnancies;
Large parity of births (fourth, fifth or more births);
Anomalies in the development of the fetus;
Intrauterine infection in the fetus;
Hemolytic disease of the fetus in Rh-conflict pregnancy;
Bleeding or the threat of miscarriage, noted in the earlier stages of pregnancy;
Pregnancy resulting from the use of assisted reproductive technologies (for example, IVF, ICSI, etc.);
Severe gestosis. In such a situation, the pregnancy threatens the woman's future life, and doctors induce an artificial premature birth in order to save the woman's life.

Among the extragenital pathology, the following diseases and conditions can be the causes of premature birth:

Endocrinopathy - disorders of the endocrine glands (for example, thyroid gland, adrenal glands, ovaries, pituitary gland, etc.);
Acute infectious and inflammatory diseases of any organs, for example, tonsillitis, pyelonephritis, influenza, etc.;
Any kidney disease;
Diseases of the cardiovascular system (hypertension, heart defects, arrhythmia, rheumatism, etc.);
Diabetes;
Joint diseases;
Surgical operations performed during pregnancy. The most dangerous are surgical interventions on the organs of the abdominal cavity and small pelvis;
The age of the woman. The risk of preterm birth is especially high at a young (under 17 years old) or older (over 35 years old) age. In young girls, premature births are due to the unpreparedness and immaturity of the reproductive system, and in older women, due to acquired severe chronic diseases.

In 25 - 40% of cases, preterm labor is provoked by premature rupture of the membranes (PROM).

Regardless of the specific causative factor, preterm labor can begin when one of the following three mechanisms is activated:
1. Enhanced production of biologically active substances in the inflammatory process;
2. The formation of microthrombi in the vessels of the placenta due to increased blood clotting, which leads to its death and subsequent detachment;
3. An increase in the number and activity of oxytocin receptors in the muscular layer of the uterus, which provoke the opening of calcium pumps in cell membranes. As a result, calcium ions enter the cells of the myometrium, an increased concentration of which causes labor.

Premature birth - symptoms (signs)

Symptoms of preterm labor are similar to those of normal term delivery. The most characteristic signs of preterm labor are the following:

Drawing, cramping pain, localized in the lower abdomen and lower back;
Feeling of pressure and fullness in the genitals;
Urge to defecate.

If there was a premature rupture of the membranes, then the woman has a liquid discharge from the genital tract. If a lot of amniotic fluid has leaked out, then the volume of the woman's abdomen decreases so much that it becomes very noticeable.

According to the clinical stages, preterm labor can be threatening and incipient. Threatening childbirth is characterized only by pain in the lower abdomen and lower back of a pulling nature. The intensity of the pain is the same, it does not increase or decrease. The abdomen is tense and hard. If childbirth begins, then the pain becomes cramping and gradually intensifies.

The correlation between the onset of symptoms and the actual risk of preterm birth is as follows:

Painful cramping pains in the lower abdomen and regular uterine contractions - the risk of premature birth is very high;
Drawing pains in the lower abdomen and lower back - the risk is very high;
Bleeding from the vagina is a high risk;
Watery vaginal discharge is an average risk;
A sudden change in the activity of the fetus (sudden upheavals, active movements and, on the contrary, a complete cessation of movements, etc.) is an average risk.

Premature birth must be distinguished from acute pyelonephritis, renal colic, appendicitis, malnutrition of the uterine myoma, which are also accompanied by severe pain in the abdomen and lower back.

Treatment of preterm birth

Currently, the treatment of preterm labor is being carried out, the main goal of which is to stop labor and continue the pregnancy as long as possible.

With the threat of premature birth, a woman must be hospitalized in the department of pathology of pregnant women of the maternity hospital in a separate box. If childbirth has not yet begun, then tocolytic drug and non-drug therapy is carried out. And if childbirth has already begun and it is no longer possible to stop them, then the woman is transferred to the maternity ward and the neonatologist is warned about the birth of a premature baby.

Non-drug treatment of the threat of premature birth is carried out by providing a woman with sexual, physical and emotional rest, as well as bed rest. Moreover, you should lie in bed with a raised foot end. In the presence of appropriate equipment and qualified specialists, physiotherapeutic methods are used, such as magnesium electrophoresis, acupuncture and electroanalgesia.

Drug treatment of preterm birth includes the following aspects:

Tocolysis - relaxation of the uterus and stopping labor;
Sedative and symptomatic therapy - soothes a woman, relieves tension and relieves stress;
Prevention of respiratory distress syndrome (RDS) in the fetus if delivery occurs approximately before 34 weeks of gestation.

Tocolysis is carried out at beginning or threatening preterm labor. The essence of tocolytic therapy is to suppress the contractile activity of the uterus and, thereby, the termination of labor. Currently, drugs from the group of beta2-agonists (Fenoterol, Hexoprenaline, Salbutamol) and magnesium sulfate (magnesium) are used for tocolysis. Adrenomimetics to enhance efficiency are recommended to be used in combination with calcium channel blockers (Verapamil, Nifedipine).

Hexoprenaline (Ginipral) to prevent preterm birth is first administered intravenously and then given in tablet form. Ginipral is administered intravenously in large doses, and after the effect is achieved, women switch to taking the drug in tablets at a low maintenance dosage.

Fenoterol and Salbutamol are used only for emergency relief of preterm labor. Administered intravenously in glucose solution. After stopping labor activity with Fenoterol or Salbutamol, a woman needs to switch to Ginipral tablet forms, which are taken in a maintenance dosage.

To enhance the effectiveness of Fenoterol, Salbutamol or Ginipral to stop the onset of preterm labor, they are used in combination with Verapamil or Nifedipine (calcium channel blockers). Moreover, Verapamil or Nifedipine is taken half an hour before the intravenous administration of adrenomimetics. Calcium channel blockers are used only at the stage of stopping the threat of preterm labor, and when switching to maintenance therapy with Ginipral tablets, they are canceled.

Magnesium sulfate (magnesia) for the relief of premature birth is administered intravenously in the form of a 25% solution. However, the effectiveness of magnesia is lower than that of adrenomimetics. Therefore, magnesia for tocolysis is used only if adrenomimetics are contraindicated or inaccessible to a woman for any reason.

Sedative therapy in the complex treatment of preterm birth is necessary to eliminate psychological and emotional stress in a pregnant woman. Currently, Oxazepam or Diazepam are used as the most effective drugs that relieve stress and relieve anxiety in preterm birth. If necessary, antispasmodic drugs are administered - No-shpu, Papaverine or Drotaverine. To reduce the production of prostaglandins, which can trigger the mechanism of premature birth, Indomethacin is used in the form of rectal suppositories, which are injected into the anus daily in the evening from 14 to 32 weeks of pregnancy.

Prevention of fetal respiratory distress syndrome (RDS). If there is a threat of premature birth in the period of 25-34 weeks of pregnancy, then for the prevention of RDS, glucocorticoids are administered, which are necessary for the accelerated maturation of the surfactant in the lungs of the infant. If a baby is born without surfactant covering the lungs, the alveoli will collapse and will not open when inhaled. The result of RDS can be the death of a newborn. Glucocorticoids lead to an accelerated synthesis of surfactant, as a result of which even a very premature baby will be born without RDS. Currently, for the prevention of RDS, Dexamethasone and Betamethasone are used, which are administered intravenously several times over two days. If necessary, glucocorticoids can be re-administered after 7 days.

Prevention of preterm birth

The best prevention of preterm birth is preparation for pregnancy, which includes the diagnosis and treatment of infectious diseases and the achievement of a stable controlled course of the existing chronic pathology. After the onset of pregnancy, the prevention of preterm birth consists in regular monitoring of its course, timely treatment of detected complications or diseases, and hospitalization in a hospital at "critical times" (4-12 weeks, 18-22 weeks and days on which menstruation would go), when the risk is highest. The hospital provides preventive therapy aimed at maintaining pregnancy.

Pregnancy after preterm birth

It is advisable to plan pregnancy after premature birth in advance, having passed a detailed examination of all internal organs, and not just the genitals, before this crucial moment. It is imperative to donate blood to determine the concentration of thyroid hormones, the deficiency of which can provoke repeated preterm birth. In addition, it is recommended to do an ultrasound of the abdominal organs, examine the heart and donate blood to determine the concentration of hormones and immunity indicators. If a woman has any serious diseases of the internal organs (for example, diabetes mellitus, hypertension, pancreatitis, etc.), then a course of treatment should be taken before pregnancy, which will control the course of the pathology. In addition, it is recommended to create the most comfortable domestic, psychological and emotional conditions for the future bearing of a child. Careful monitoring of the course of pregnancy and timely treatment of complications, as a rule, leads to normal gestation after preterm birth. Pregnancy after premature birth occurs quite normally and quickly.

Childbirth after preterm birth

Childbirth after preterm birth usually proceeds normally. If the cause of premature birth has been eliminated, then the next pregnancy is quite normal and with a high degree of probability the woman informs to the end and will give birth to a full-term, healthy baby. The risk of complications during childbirth after preterm birth is not higher than the average.

How to induce preterm labor

In order to induce premature birth, the following drugs are used:

Dinoprostone;
Dinoprost;
mifepristone + misoprostol;
Oxytocin.

These drugs provoke labor activity, as a result of which the baby is born prematurely. To induce premature birth, it is necessary to administer drugs in certain dosages and according to strict schemes, taking into account changes in the woman's condition, which is possible only in a hospital setting. Due to the fact that premature birth for a woman is much more dangerous than timely ones, you should not try to cause them yourself.

Premature birth test

Currently, there is a test system for determining the onset of preterm labor, which is called Aktim Partus. This test is based on the determination of binding insulin-like growth factor - 1 (IGFFR) in the mucus of the cervical canal, which is secreted by the fetal membranes of the fetus in large quantities a few days before the upcoming birth. The test at home cannot be performed, since so far it is available in modification only for qualified medical personnel. Unfortunately, the accuracy and sensitivity of this test for preterm birth is not very high, so you cannot absolutely rely on its results.

Today, there is a test for preterm rupture of membranes (PROM) that can also be used to diagnose preterm birth. The PROM test can be used at home and is fairly accurate. If the test for PROM is positive, then the woman is at high risk of preterm birth and should be admitted to the maternity hospital immediately.