Cause premature birth. Premature birth - causes, symptoms, treatment and prevention

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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 sexually transmitted infections is the loss of uterine elasticity, 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 preterm labor 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 may be the death of the 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.

Preterm birth: resuscitation, nursing and rehabilitation
premature baby - video

Before use, you should consult with a specialist.

- delivery at a gestational age of 28 to 37 weeks, accompanied by the birth of a premature and physically immature fetus weighing 1000-2500 g and 35-45 cm long. Premature birth can be threatening, incipient and incipient. Depending on this, the clinical manifestations and obstetric tactics in preterm labor will be different. With threatening and beginning childbirth, they tend to prolong the pregnancy. Preterm labor that has begun with the development of regular labor activity is carried out under the control of the state of the mother and fetus.

ICD-10

O60

General information

Premature birth ends in 5-12% of pregnancies. According to WHO definition, termination of pregnancy at terms of 22-28 weeks, which ended with the birth of a fetus weighing 500-1000 g and lived for at least 7 days, is considered as early premature birth with an extremely low fetal weight. If a child born from premature birth dies before the 7-day period, such an outcome of pregnancy is regarded by obstetrics and gynecology as a late miscarriage.

Premature births are always associated with a high risk of complications for the newborn. Premature birth that develops at 22-27 weeks is prognostically less favorable in terms of fetal viability, since by this time the lungs of the newborn have not yet reached the required degree of maturity to ensure respiratory function. The outcome of preterm birth at 28-34 or more weeks of gestation is potentially more favorable for the newborn.

Causes

Causes related to the health of the pregnant woman, the condition of the fetus, the course of pregnancy, socio-biological conditions can lead to premature birth. Among the "maternal" factors, STDs (mycoplasmosis, chlamydia, ureaplasmosis, herpes, cytomegalovirus infection, etc.), acute viral infections (rubella, influenza, viral hepatitis, etc.), chronic pathology of a pregnant woman (tonsillitis, pyelonephritis, heart defects, diabetes mellitus, hypertension), endocrinopathies (Addison's disease, Cushing's syndrome, hypothyroidism, obesity).

The term of pregnancy largely depends on the state of the reproductive organs. Premature birth is often found in women with diseases and abnormalities of the uterus - endometriosis, fibroma, uterine hypoplasia, bicornuate uterus, intrauterine septum, intrauterine synechia. The development of cervical insufficiency, leading to premature birth, is facilitated by damage to the uterus during diagnostic curettage, artificial abortions and childbirth, operations (conization, amputation of the cervix), etc.

The causes of preterm birth due to the condition of the fetus include, first of all, genetic disorders, severe congenital anomalies, malformations, intrauterine diseases (hemolytic disease) and fetal infections. In some cases, invasive prenatal diagnostics - cordocentesis, amniocentesis - can lead to premature birth.

The so-called combined factors of preterm birth associated with the course of pregnancy include immunological conflicts (Rhesus conflict), gestosis, placenta previa or its premature detachment, transverse position of the fetus, breech presentation, multiple pregnancy, multiple pregnancies and childbirth, etc.

The frequency of development of preterm birth directly depends on the socio-biological conditions in which the pregnancy proceeds. Premature birth can be provoked by heavy physical labor, excessive mental stress, stress, poor nutrition, and bad habits.

Symptoms of preterm labor

According to the clinical course, preterm labor can be threatening, beginning and beginning. When determining the stage of preterm labor, they are guided by an assessment of the contractile activity of the uterus, the state of the fetal bladder and the birth canal. In the case of a threatening nature of premature birth, a pregnant woman develops aching, nagging pains in the lower back and abdomen, tension of the uterus and its contractions, an increase in the motor activity of the fetus, and sometimes sanious discharge from the genital tract. Such symptoms require an urgent appeal to an obstetrician-gynecologist.

For beginning preterm labor, severe pain in the lower abdomen, regular contractions, a symptom of cervical plug discharge, the appearance of sanious discharge, and often leakage or outpouring of amniotic fluid are typical. With the onset of preterm labor, regular labor activity develops with an interval between contractions of less than 10 minutes, sanious discharge is noted, the presenting part of the fetus descends to the entrance to the pelvis and the rupture of the fetal bladder occurs.

In general, preterm labor is characterized by an untimely discharge of the waters; weak, sometimes strong or discoordinated labor activity; rapid or protracted course; placental abruption and bleeding; postpartum complications; fetal hypoxia.

Diagnostics

To establish the fact of preterm labor and their stage, an important criterion is the assessment of the condition of the cervix and fetal bladder. Vaginal examination and examination of the cervix in the mirrors are carried out to determine the degree of opening of the uterine os, the length and consistency of the cervix. With threatening childbirth, the examination reveals an unchanged neck, a closed external uterine os; at the beginning of childbirth, the cervix is ​​shortened, the uterine os is ajar by 1-2 cm; at the beginning - smoothing of the cervix and opening of the uterine os by 2-4 cm is determined. The gynecological examination must be repeated in dynamics after 30-60 minutes.

To exclude urogenital infections and latent bacteriuria, cervical discharge is cultured for pathogens (staphylococcus, chlamydia, ureaplasma, gonococcus) and bacteriological examination of urine. With the help of ultrasound, the gestational age, the estimated weight of the fetus, its position and presentation, the integrity of the fetal bladder, the condition and localization of the placenta are specified, placenta previa is excluded. Auscultation and instrumental registration of the fetal heartbeat (fetal phonocardiography, cardiotocography) during preterm birth are necessary to detect signs of hypoxia.

Additionally, in order to determine the obstetric status, the Baumgarten tocolysis index is used, calculated by the sum of the points obtained by evaluating a number of objective parameters (presence of contractions, rupture of membranes, bleeding, opening of the cervix). At the same time, the lower the score, the more effective tocolytic therapy can be.

In some cases, with a slow opening of the cervix, premature birth must be differentiated from the pathology of the urinary tract and abdominal organs: pyelonephritis, cystitis, urolithiasis, gastroenteritis, spastic colitis, acute appendicitis.

Treatment for preterm birth

If preterm birth is suspected, immediate hospitalization of the pregnant woman in an obstetric hospital is necessary. If, with the threatening or incipient nature of preterm labor, the tactics of prolonging pregnancy is acceptable, then in the case of early labor, leakage of amniotic fluid, signs of infection or severe extragenital diseases, active labor management is resorted to.

Therapy for threatening and beginning preterm labor requires the appointment of bed rest, sedatives (motherwort, valerian, diazepam) and antispasmodics (drotaverine, metacin, papaverine); physiotherapeutic effects - electrorelaxation of the uterus (amplipulse therapy), electroanalgesia, acupuncture.

In order to accelerate the maturation of the lung tissue of the fetus and prevent respiratory failure of the newborn with the threat of premature birth for up to 34 weeks of pregnancy, glucocorticoid drugs (dexamethasone, prednisolone, betamethasone) are prescribed. Therapy with glucocorticoids is contraindicated in the presence of a pregnant gastric ulcer or duodenal ulcer, endocarditis, circulatory failure III stage, nephritis, active tuberculosis, osteoporosis, severe forms of diabetes mellitus, preeclampsia.

Carrying out tocolytic therapy allows to achieve the removal of contractile activity and tone of the uterus. In preterm birth, the introduction of magnesium sulfate, beta-mimetics (ipratropium bromide, terbutaline, fenoterol, etc.), prostaglandin inhibitors (naproxen, indomethacin) is indicated. Prevention of fetal hypoxia and placental insufficiency is carried out by the appointment of dipyridamole, pentoxifylline, vitamin E.

If streptococcal, gonococcal, chlamydial infections, bacterial vaginosis, trichomonas vulvovaginitis are detected, antimicrobial therapy is prescribed. If isthmic-cervical insufficiency is detected, a special ring is applied to the cervix - the introduction of an obstetric pessary, according to indications (in case of insufficiency of the adrenal glands and thyroid gland) - hormonal correction.

Management of preterm birth

Taking into account the obstetric situation, the management of the onset of preterm labor can be expectant-conservative or active. In the first case, the progress of labor activity is monitored without the provision of special obstetric benefits. More often in preterm birth, there is a need for active intervention in the course of natural childbirth or a caesarean section.

The tactics of preterm labor are influenced by the gestational age, the stage of labor, the condition of the fetal bladder, the degree of cervical dilatation, the presence of infection, the severity of labor, the presence and nature of bleeding. The management of preterm labor is accompanied by constant cardiomonitoring.

30% of preterm births are abnormal - with excessive, weak or discoordinated labor activity. Therefore, in the management of preterm labor, antispasmodic drugs and epidural anesthesia during childbirth are widely used. With excessive labor activity, drugs are administered that inhibit the contractile activity of the uterus; with the weakness of the patrimonial forces, rhodostimulation is performed. In order to protect the fetus during passage through the birth canal, they resort to dissection of the perineum - perineotomy.

Indications for caesarean section in preterm birth are severe pathology of the mother and fetus, breech presentation of the fetus. After the birth of a premature fetus, if necessary, they immediately begin to carry out the entire volume of resuscitation.

Complications

In children born from premature birth, due to the immaturity of all anatomical structures, the presence of birth injuries (intracranial hemorrhages, injuries of the cervical spine) is often noted; hypoxia; functional unavailability of the lungs. For a woman, premature birth can be complicated by ruptures and injuries of the cervix, postpartum hemorrhage, infections (suppuration of sutures, postpartum metroendometritis, peritonitis, sepsis).

Prevention

When planning a pregnancy, all women are recommended to undergo a full examination by a gynecologist and narrow specialists to exclude potential risk factors. Prevention of preterm birth is facilitated by early registration and management of pregnancy under the supervision of an obstetrician-gynecologist. Special medical control is required by pregnant risk groups for the development of preterm birth - women with sexual infantilism, menstrual irregularities, endocrinopathies, recurrent miscarriage, chronic infections, who have undergone IVF, with Rh-negative blood, etc.

Signs and causes of the onset of preterm labor, the consequences for the woman and the child. What to do if preterm labor begins.

The mother-to-be is looking forward to the birth of her baby. But joy can be overshadowed if premature birth suddenly begins. Let's figure out how to avoid premature birth and what should be your actions if they do start.

What can cause preterm labor? Causes of preterm birth

Births from 37 to 42 weeks of pregnancy are considered full-term. If labor begins before 37 weeks, this is preterm labor, the baby is born prematurely.

Causes of preterm birth:

1. Infectious diseases (trichomoniasis, mycoplasmosis, colpitis, chlamydia, ureaplasmosis, vaginosis, etc.)
2. Diseases of the genitourinary system and kidneys (pyelonephritis)
3. Heart diseases
4. Nervous shocks and physical stress
5. Isthmic-cervical insufficiency (ICN) - improper functioning of the muscular layer of the uterus. This layer acts as a sphincter during normal functioning, it helps to keep the fetus inside the uterus
6. Features of the structure of the uterus
7. Multiple pregnancies often lead to uterine hyperdistension
8. Sometimes SARS

It is important to be healthy at the time of conception. If it so happened that you did not have time to cure infectious and other diseases, register as soon as possible. A competent doctor will select the appropriate treatment.

Abortion and premature birth

If a woman had an artificial termination of pregnancy before pregnancy, then this may be the cause of premature birth. Premature birth is considered one of the possible complications of abortion. As a result of an abortion, the uterus and its cervix can be injured, which further leads to the risk of conception and normal gestation.

Symptoms of preterm labor

Main symptoms:

• Uterine contractions
• Drawing pains in the lower abdomen
• Bloody issues
• Frequent urination to the toilet
• Drainage of amniotic fluid
• Immobility of the child

Sometimes there are training contractions, which is very scary for pregnant women. Training contractions - contractions of the uterus up to 1 minute. May be seen several times a day. They appear after the 20th week of pregnancy.

The threat of premature birth. How to recognize danger?

The threat of premature birth can be avoided if you take care of your health and monitor the course of pregnancy. A pregnant woman may be in danger, and the symptoms may not be noticeable.

To avoid the threat of preterm birth, you need to know their symptoms. In case of even slight suspicions or changes, contact your gynecologist immediately.

Types of preterm birth

Preterm births are classified by gestational age:

• 22-27 weeks- very early
• 28-33 weeks- early
• 34-37 weeks- premature

The weight of a child born at 27-27 weeks is from 500 to 1000 g; at 28-33 weeks - from 1 to 2 kg; at 33-37 weeks - up to 2.5 kg.

The survival of the child depends on the period at which the birth takes place. The probability of survival of a newborn during childbirth at 34-37 weeks is almost 100%.

The consequences of preterm birth for a woman

The difference between preterm birth and normal birth is only in time. Therefore, the woman is not subjected to special treatment. Nevertheless, in the case of premature birth, it is necessary to be examined for the presence of pathogens of infectious diseases, to investigate the hormonal background. A study of the uterus and tubes is also required. If deviations are found, it is necessary to undergo a course of treatment.

In cases of premature birth, women are delayed in the maternity hospital. This is due for the most part not to the health of the woman in labor, but to the condition of the newborn.

In further pregnancies, to avoid premature delivery, you need to be especially careful at certain times:

• 2-3 weeks
• 4-12 weeks
• 18-22 weeks

Effects of preterm birth on the baby

The consequences of premature birth for a newborn are much more dangerous. First of all, it is about the survival of the newborn. The survival of the newborn largely depends on the time at which the birth occurred.

1. Those born at 22-27 weeks have a small chance of survival. But in practice there are few cases when such children survived.
2. Those born at 28-33 weeks have a chance to survive and adapt. Nursing of these newborns depends on a high level of neonatal care.
3. Those born at 34-37 weeks have every chance of quick adaptation. In such children, all organs are formed, their difference from full-term ones in weight

A premature baby remains in the hospital, where he is given special medical care. Sometimes newborns are left in the ward with their mother (born at 34-37 weeks).

Signs of the onset of preterm labor

If you experience any of the following symptoms, seek medical attention:

1. Cramping pain for longer than 30 seconds
2. Bloody issues
3. Pain in the lower abdomen, similar to menstrual pain
4. Lack of baby movement
5. Pressure in the vagina and bladder

Call an ambulance and wait for her arrival. Some try to get there themselves, sometimes it is fatal, because extra loads can speed up the process. Before the ambulance arrives, take a sedative and antispasmodic, wait in a calm position, no physical exertion.

Hospitalization for preterm birth

The doctor conducts an examination and, if threatened, suggests hospitalization. Premature birth can be prevented. For this, apply:

1. Therapy that reduces uterine contractions
2. Antibacterial therapy to avoid complications from infection
3. Sedative drugs that help normalize the psychological state of a pregnant woman
4. Glucocorticoid drugs to avoid pulmonary complications in the fetus (if the period is less than 34 weeks)

Sometimes hospitalization is not necessary. A pregnant woman takes medications at home, adheres to a regime of rest and tranquility.

If it is not possible to stop the process, the woman is prepared for childbirth. Doctors carry out the process in the most gentle way for the fetus and mother.

Natalia, 25 years old: “I gave birth exactly at 36 weeks. The day before, I lifted a three-liter jar of compote. And the tone of the uterus was already in the middle of the term. A girl was lying next to us, she gave birth at 29 weeks by caesarean section and the baby came out.

Elena, 29 years old: “My two previous pregnancies ended in miscarriage. For the third time, she spent almost the entire pregnancy in the hospital, as a result she gave birth prematurely, but the doctors were ready for this. Now we are already 2 years old and I am a happy mother.

Irina, 30 years old: “I gave birth to my son at 33 weeks in 2.5 hours. Weight - 2200. The son was in the department of pathology and prematurity for 3 weeks. Gained weight. I was very scared. Now everything is fine, a healthy child.

Plan your pregnancy, take care of your health. At the slightest sign of premature birth, contact your doctor.

Video: Symptoms and causes of preterm labor

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.