Cause premature birth. Management of preterm labor, symptoms of their onset, threat diagnosis and prevention. Signs of preterm labor

Almost every expectant mother has a lot of questions. Usually they relate to upcoming changes in the body, diet, preparation for childbirth. Many women worry about the continuation of their pregnancy.

Key question: what kind of birth is considered premature? There are two main opinions here. In the first, doctors talk about the gestational age of 28-37 weeks (inclusive). This interpretation of the term has been around for a long time. The second opinion is due to new medical advances and sets an earlier date of 22 weeks.

Statistics data. Approximately six to eight births out of a hundred occur before the estimated date. In half of these cases, the gestational age is 34-37 weeks.

preterm birth- This is an undesirable outcome of pregnancy. Only at a period of 38 weeks the fetus is considered fully full-term and viable (in the absence of anomalies and complications of pregnancy).

The main provoking factors

The causes of preterm birth are varied. Their probability in a particular woman is the higher, the more unfavorable circumstances are found in her life that interfere with the normal bearing of the fetus. It is very important for the expectant mother and her family to know what can provoke preterm labor and, if possible, eliminate all real and potential risk factors.

Age under 17 or over 35

The girl's body is fragile, often underdeveloped. After all, the skeletal system completes its development only by the age of 25! It is not surprising that very young women may simply not be able to cope with the burden that is the bearing of a baby.

After 35 years internal organs and systems undergo the first age-related changes. Even if a woman looks young and keeps herself in shape, she does not exclude hormonal and other disruptions that interfere with the full bearing of the fetus.

Somatic diseases

Hypo- and hypertension, diseases of the kidneys, heart, thyroid gland,. These and other ailments can adversely affect the course of pregnancy and lead to preterm delivery.

Alcohol, smoking, drugs

All this is the strictest taboo for the expectant mother. Unfortunately, many do not realize this. How many female remarks can be heard like: “I have toxicosis, the child asks for beer”, “the child is already used to nicotine, I will quit smoking - we will begin to break down.” Such behavior is completely incompatible with conscious, desired motherhood.

Self-treatment

Most women have their preferred remedies for pain, colds, and indigestion. With the onset of pregnancy, the possibility of taking each usual medication must be agreed with the doctors. Some drugs can cause uterine contractions, dehydrate the body, or disrupt circulation so much that labor begins.

excessive physical exercise, overwork

Expectant mothers are often full of vital activity and desire to be in time everywhere. After all, then there will be absolutely no time! Some begin repairs in the apartment, others try to do more in the country, others go on trips. On such a rise, a fidget woman often does not realize that she provokes premature birth. When feeling well, many underestimate the dangers of a few hours of sleep deprivation or the usual pre-pregnancy hiking in the mountains.

Unbalanced diet

The poverty of the diet with foods rich in protein, vitamins, minerals and fiber literally deprives a pregnant woman of the strength and ability to continue to carry the baby under her heart. It also happens that the food seems to be complete, but the liquid is in short supply. Especially often this situation develops in expectant mothers suffering from toxicosis with vomiting. And another unfavorable factor is the hot season, when dehydration of the body can develop quickly and suddenly.

Stress

The onset of labor after any incident on a nervous basis is a very common phenomenon. A strong nervous shock or small but constant experiences may well raise the risk of preterm birth to the highest point. Due to stress, sometimes so many specific hormones get into the blood of a pregnant woman that the body reacts not just early -.

Violation of the medical prohibition on sexual life

Imagine: the doctor found some alarming signs and instructed to stop intimate relationships. However, women sometimes experience increased sexual attraction to the father of the child. Or they don’t want to create the inconvenience associated with abstinence for their “half”.

In this case, the search for a compromise begins - the selection of a suitable position, the restriction of motor activity during intercourse. But the danger is not only this: during an orgasm, the hormone oxytocin is released into the blood of a woman, causing uterine contractions. And in the seminal fluid of a man there is another hormone - prostaglandin, with the same effect.

infections

Venereal diseases, rubella, bacterial lesions of the genitourinary system and much more. Any serious acute illness is a signal of danger to the body. The immune system can react in a special way and start the process of childbirth.

Specific Causes

Here you can name multiple pregnancy, the inability of the cervix to remain closed (cervical insufficiency), placenta previa. Important point Doctors are well aware of the consequences of these adverse factors. This is their key difference from the previously listed circumstances, in which the threat of premature birth can arise suddenly.

Having identified at least one alarming indicator, the doctor will take measures that will avoid premature birth or at least extend the gestation period as much as possible.

Additional provoking factors

There are several everyday situations that are fraught with premature birth. It's just that a lot of people don't think about them. To name just a few - a bath (sauna), family and other celebrations, as well as long trips.

Many firmly believe that the steam room - the best remedy for the health of the body. During pregnancy, this is absolutely not the case. High temperatures, wet/dry steam, negative fresh air- all this is extremely harmful for the expectant mother.

Perhaps you live in a region where hygiene procedures can only be performed in a bathhouse. Then make it a rule for yourself: the room should cool slightly, and you can’t stay in it for too long. In winter, exclude jogging from the bathhouse to the house in one dressing gown and slippers, do not "earn" a cold with its various complications.

Noisy and long festivities are also not for you. Perhaps you will have fun, it’s nice to chat with family and friends, but the fetus may not like such an event at all. You can't miss it at all - show up for as short a time as possible.

Quite often women the day before maternity leave they also take the usual one - to relax properly. Indeed, the second trimester for many expectant mothers becomes a wonderful time - toxicosis has passed, your own body has not yet become so heavy that you can hardly move, your mood is excellent. Why not go somewhere?

If we are talking about a neighboring city and a short, comfortable trip by train (or in a car on a good road), then feel free to go. But long-distance trips to places with a different climate, and even more so air travel, are prohibited. In the second case, the pressure drops that occur in the cabin of the aircraft are extremely dangerous for the future baby. It is no coincidence that reports periodically appear in the press and the Internet about flight attendants who involuntarily became midwives.

Double acclimatization is no less harmful to the fetus. First, your body will have to adapt to the conditions of the new place, and then return to former regime your place of residence. Perhaps you are quite easy to adapt to new conditions. The fetus is much weaker in this respect.

Can coughing cause preterm labor? If you lightly choke on food or liquid you drink, then no. But a neglected disease, in which the cough becomes especially strong and / or protracted - yes. Multiple bouts of severe coughing provoke a rise in pressure (read about how and how to safely treat a cough during pregnancy), excessive tension in the abdominal muscles, and even vomiting. The latter means dehydration of the body (one of the provoking factors).

Symptoms

How does preterm labor begin? Do not think that it is always stormy. If a woman is inattentive to herself, then several precious hours may pass before the moment when it becomes clear for sure: pregnancy is in danger.

The most common occurrence is threatened preterm birth. The outcome of this condition directly depends on the urgency of the measures taken.

Here are the alarming "bells" that you definitely need to pay attention to:

pulling, aching pain in the lower back, in the abdomen, especially in its lower part;
sudden vomiting;
bleeding from the vagina;
frequent (more than four per hour) contractions.

The last feature needs to be discussed in more detail. It happens that a pregnant woman, even with full health and well-being, from time to time seems to tighten her stomach, and literally everything goes away right there. Scientists believe that this is a special invention of nature - training the body for future childbirth. The problem is in the inability of women to distinguish (false) from generic ones.

The table below will help avoid this problem:

There are more obvious signs of preterm labor that leave no doubt about the situation: these are uterine bleeding (typical of situations with placenta previa) and.

Very early preterm birth, when the gestational age is 22-28 weeks, is considered the most dangerous for the fetus (for more details, see the section "Consequences for the child"). If the expectant mother is able to recognize preterm labor and respond quickly, the likelihood of a favorable outcome of the situation is greatly increased.

Remember. If you have signs of preterm labor, in any combination, call the ambulance immediately!

Actions of doctors

The measures to be taken by doctors depend on the condition of the pregnant woman and the symptoms identified. The main task is to determine how possible or, on the contrary, undesirable childbirth in the patient and, depending on the result, make the right decision.

Diagnostics

If there is no bleeding and amniotic fluid does not drain, the expectant mother will have to be examined. The doctor will check the condition of the cervix, fetal bladder, prescribe blood and urine tests. The anamnesis should be as complete as possible.

It is possible that a test for preterm birth will be carried out. This is a specific express study - chromatographic analysis of the secret of the cervical canal. The test result shows the so-called degree of maturity of the cervix, that is, the readiness of the body for childbirth.

If the result is negative, then the likelihood of labor in the next two weeks is almost zero. A positive test result is a signal that you need to prepare for an upcoming event. It is not excluded that the woman will be discharged from the hospital together with the born baby.

If childbirth has begun

Whenever possible, doctors prefer to stop preterm labor. The main measures in this case are medication. A woman can be prescribed antispasmodics, sedatives or hormonal drugs, whose action will “convince” the body of the need to stop labor.

There is no special pill for premature birth. Often medical measures are complex, involving acupuncture or electrorelaxation of the uterus. Any remedy aimed at maintaining pregnancy is prescribed only by a doctor.

Situations are not excluded when termination of labor activity is impossible. In any case, when circumstances threaten the life of the child and / or mother, doctors choose the so-called active tactics. This means that the birth will take place - either through.

Consequences for the mother

Even timely delivery is a huge stress. The birth of a child long before the expected date can turn into a real psychological trauma. Especially if the woman in labor blames herself for what happened - she got nervous for no reason, did not obey any medical prohibitions.

In some cases, the mother may develop severe postpartum depression. Emotional pain is often accompanied by physical pain associated with a caesarean section, episiotomy, or perineal lacerations.

How to deal with similar situation? This is where the support of loved ones is needed. Plus your own attitude: it is important to understand that a premature baby needs a lot of care and careful care. And for this you need strength and composure.

Physical complications of preterm birth for the mother are the threat of miscarriage of subsequent pregnancies, the possible adverse consequences of previous surgical interventions.

Many women ask: how long can you get pregnant after a premature birth? Doctors recommend not planning the next conception earlier than at least a year or a year and a half has passed. But the state of health of the mother and the need for increased attention to the older child who was born ahead of time, may require an increase in the specified period.

Consequences for the child

It all depends on at what stage of fetal development the mother had an early birth. Indicative data is below.

22 - 28 weeks

The lower limit of the indicated period is the most controversial, since it is here that the concepts of premature birth and late miscarriage can be confused. What exactly the doctors will talk about will show the weight of the fetus.

When there is hope. In recent years, doctors have learned to nurse even very early born babies. There are enough cases of survival of newborns weighing 500 grams.

The survival of a child at such an early birth is a difficult task. The little man has practically no subcutaneous fat, which is very important for maintaining body temperature. The nervous system is largely underdeveloped, as is the brain. In particular, there is no regulation of periods of wakefulness and sleep. The hormonal background is practically not formed. Bones and rudiments of teeth are insufficiently mineralized.

But the main problem is the lack of so-called respiratory readiness. This is a medical term for the ability of a child to breathe independently. The danger is due to a lack of light surfactants (surfactants). These complex compounds prevent lung sacs from sticking together during breathing.

29 - 37 weeks

At this time, the fetal body is busy with the most important thing: preparing for the birth of a child. So, at 30 weeks, in general, the formation of almost all internal organs and systems is completed. Only the genital organs may be somewhat underdeveloped, especially in boys.

31st week of pregnancy is marked by perfection nervous system fetus. This applies to neural connections and the development of nerve endings (responsible for sensitivity). At the 32nd week of pregnancy, the weight of the fetus reaches an average of 1.7 kg (if twins are expected, then their body weight is slightly less - about 1.5 kg each). But the endocrine system is still not ready for full-fledged work, like the brain.

At 33 weeks and beyond, the baby grows intensively and gains weight (on average 15 - 25 grams per day). Until the very birth, the most important processes continue: the formation of surfactant in the lungs, an increase in the number of convolutions of the cerebral cortex, and the improvement of the endocrine and nervous systems.

Major Complications

Dictated by the gestational age at which the premature birth occurred. The key problem is the absence of the main reflexes - respiratory and. Add to this the insufficient temperature regulation of the child's body, the high vulnerability of the skin, and the weakness of the bones.

These problems in the future may result in diseases of the respiratory system, small stature and weight of the child, neuroses. However, modern medicine and the full care of parents allows us to fully help the little "hurry" to become healthy and strong.

Prevention

What can every expectant mother do to protect her baby from the threat of preterm birth? If you keep in mind the provoking factors, then the answer to the question of how to prevent preterm birth is basically received.

And here are some more tips:

Plan pregnancy, and even before conception, carry out the maximum sanitation (improvement) of the whole organism. The future father should do the same.
Have you already had an abortion, or a premature birth? You are at risk, be careful.
Find out from the closest relatives whether they gave birth to their children on time or earlier. Many second cases? Notify the antenatal clinic doctor.

There is also medical prevention of preterm birth. We are talking about cases where a woman initially falls into the risk group. In most cases, doctors recommend a sparing daily routine, intensify monitoring, including sending the patient to the hospital. With cervical insufficiency, the doctor puts special stitches or rings on the cervix. The choice of remedy depends on the duration of pregnancy - less or more than 28 weeks, respectively.

Remember: while expecting a baby, your whole life should be devoted to caring for the health and well-being of a tiny man. Complete nutrition, exclusion harmful factors and regular visits to doctors will help you almost 100% avoid premature birth.

It is known that a normal pregnancy lasts approximately 40 weeks. However, it often happens that the baby "does not live up" to the due date. Why do premature births occur, how do they proceed and why are they dangerous?

About terminology

Termination of pregnancy in the period of 28-37 weeks is called premature birth. Termination of pregnancy in the period from 22 weeks to 28 weeks, according to the rules of the World Health Organization, is classified as very early preterm birth. In our country, termination at this stage of pregnancy is not considered a premature birth, but at the same time, they provide assistance in a maternity hospital, and not in a gynecological hospital, and take measures to care for a very premature newborn. A child born as a result of such childbirth is considered a fetus for 7 days, only after a week such a baby is considered not a fetus, but a child. This feature of the terminology is due to the fact that children born before the 28th week of pregnancy are often unable to adapt to the conditions environment outside the womb, even with the help of doctors.

Causes of preterm birth

Factors leading to preterm birth can be divided into socio-biological and medical.

It should be noted that in the autumn and spring months the frequency of this complication increases. This is due to changing weather conditions, in particular the frequent change in atmospheric pressure, which can affect the frequency of premature rupture amniotic fluid. Severe colds with a high rise in body temperature and a strong cough can increase and cause tribal activity prematurely. An adverse effect on the course of pregnancy of a number of production factors was noted: chemical substances, vibration, radiation, etc. Premature births are more common in young, unmarried, studying women, with a lack of protein and vitamins in food, as well as in women with bad habits.

Medical factors include severe infectious diseases, including those suffered in childhood, abortions, and inflammatory diseases of the genital organs. Chromosomal disorders of the fetus - damage to the hereditary apparatus of the fetus under the influence of adverse external and internal factors (ionizing radiation, industrial hazards, taking certain medications, smoking, drinking alcohol, drugs, unfavorable environmental situation, etc.) - can lead to premature birth, but more often in such cases, abortion occurs in the early stages. In most cases, the cause of premature births are diseases of the endocrine system, such as dysfunction of the thyroid gland, adrenal glands and ovaries, obesity, in which the work of all endocrine glands changes. Anatomical changes in the genital organs include genital infantilism (underdevelopment of the female genital organs), malformations of the uterus, traumatic damage to the uterus during abortions and curettage, tumors of the uterus. In almost one third of cases, the cause of preterm birth is isthmic-cervical insufficiency, in which, as a result of mechanical influences (trauma of the cervix after abortion, previous childbirth, other gynecological manipulations) or a lack of certain hormones, the cervix does not perform its obturator function.

Often the cause of premature birth is cervico-vaginal infections (trichomoniasis, mycoplasma, chlamydia, etc.) and viral infections (cytomegalovirus, herpes, influenza, adenovirus infection, mumps), especially those that are hidden. The presence of a chronic genital infection contributes to the disruption of the local protective barrier and fetal injury. Severe forms of extragenital diseases (not associated with the female genital organs) and pregnancy complications can also lead to preterm pregnancy. Such diseases include, for example, hypertonic disease, cardiovascular diseases, anemia, chronic diseases of the lungs, kidneys, liver, etc.

Symptoms of the onset of labor

With the onset of preterm labor, regular labor activity and smoothing or opening of the cervix appear. The onset of labor is accompanied by the appearance of regular cramping pains in the lower abdomen, which increase in intensity over time, the intervals between contractions decrease. Quite often, premature birth begins with the outflow of amniotic fluid, and their amount can be from a few drops to several liters. In addition, the appearance of a woman's mucous discharge with streaks of blood or bloody discharge during a premature pregnancy indicates structural changes in the cervix, i.e. e. its smoothing. The appearance of any of the above symptoms requires urgent hospitalization in an obstetric hospital.

At the slightest suspicion of a deviation from the normal course of pregnancy, it is necessary to seek qualified help.

If these symptoms appear, you should immediately call an ambulance, which will deliver future mother to the hospital. In some cases, it is possible to prolong the pregnancy; if this is not possible, then in the hospital conditions are created for careful delivery - childbirth, during which a still very fragile baby experiences the least possible load.

Features of the course of childbirth

In preterm birth, premature rupture of amniotic fluid, weakness and dysfunction of labor, rapid or impaired regulatory mechanisms, and fetal hypoxia are more often observed.

Premature rupture of amniotic fluid is more often manifested in isthmic-cervical insufficiency or the presence of infection. The lower pole becomes infected, and as a result of inflammation, the membranes are easily torn. Normally, the fetal bladder ruptures closer to the full opening of the cervix, that is, already with the development of labor. The sensations of a woman can be different: from a small wet spot on her underwear to a large amount of water flowing from the vagina and flowing down the legs. The water should be clear, but can be cloudy and dark brown (in the presence of infection). Premature births very often proceed quickly or even rapidly. A woman has rather painful contractions, their frequency increases, the intervals between contractions are less than 5 minutes and quickly decrease to 1 minute, the first stage of labor (until the cervix is fully dilated) is reduced to 2-4 hours. Due to the fact that the head of a premature fetus is smaller, the expulsion of the fetus begins when the cervix is not fully opened. A smaller baby passes through the birth canal faster.

Premature baby

A child born as a result of premature birth has signs of prematurity, which are determined immediately after birth. The body weight of such a newborn is less than 2500 g, the height is less than 45 cm, there is a lot of cheese-like lubricant on the skin, the subcutaneous tissue is not sufficiently developed, the ears and nasal cartilages are soft. The nails do not go beyond the tips of the fingers, the umbilical ring is located closer to the bosom. In boys, the testicles are not lowered into the scrotum (this is determined by touch), in girls, the clitoris and labia minora are not covered by the labia majora, the cry is squeaky. It should be noted that the presence of one sign is not an indisputable proof of the prematurity of the child, the prematurity of the fetus is determined by the combination of signs.

Unlike timely births, there are more complications in preterm births. Firstly, the baby's head does not have time to adapt to the mother's pelvic bones and reconfigure. The configuration of the head is the possibility of displacement of the bones of the fetal skull during childbirth to reduce its volume when passing through the birth canal. This mechanism allows you to reduce pressure on the head and cervical spine of a newborn baby. The bones of the skull of a premature baby are rather soft and cannot provide protection for the brain, the risk of trauma, hemorrhages under the membranes in the brain tissue of the fetus during childbirth increases. As a result, the child may experience hemorrhages, he does not have time to adapt to changes in the environment, his regulatory system is disturbed. Secondly, often a woman gets ruptures of the birth canal (cervix, vagina and external genitalia), as the tissues do not have time to adapt to stretching.

With threatening and beginning childbirth, a woman is urgently hospitalized.

Much less often in preterm birth, weakness of labor activity occurs. Weakness can be manifested by weak, infrequent or short contractions. The time of childbirth increases significantly, the woman gets tired, the child also begins to suffer. Other anomalies of labor activity are possible, for example, the strength and frequency of contractions is sufficient, and the cervix does not dilate. All this is associated with a violation of regulatory systems in preterm birth, there is no sufficient hormonal preparation for childbirth. Infectious complications in childbirth and the postpartum period are much more common in both the mother and the fetus. Among these complications are suppuration of the sutures (if any), postpartum metroendometritis (inflammation of the mucous membrane and muscular layer of the uterus), peritonitis (inflammation of the peritoneum) and the maximum spread of infection (sepsis). This is due to the presence of a latent or overt infection that was present before childbirth in a pregnant woman, which is often the cause of miscarriage. Infection can join during childbirth, due to their duration (with weakness), for example, chorioamnionitis (inflammation of the membranes of the embryo). Premature babies have reduced immunity and, accordingly, are more susceptible to infections.

Prognosis for a child

Due to the peculiarities of obstetric tactics and the different outcome of childbirth for the fetus, it is considered appropriate to divide preterm birth into three periods, taking into account the timing of gestation (pregnancy): preterm birth at 22-27 weeks, preterm birth at 28-33 weeks, preterm birth at 34- 37 weeks of gestation.

Premature birth at 22-27 weeks (fetal weight from 500 to 1000 g) is most often caused by isthmic-cervical insufficiency (due to trauma in previous births), infection of the lower pole of the fetal bladder and premature rupture of the fetal bladder. Therefore, in this group of women, as a rule, there are few primigravidas. The presence of infection in the genital tract excludes the possibility of prolonging pregnancy in most pregnant women. The lungs of the fetus are immature, and accelerate their maturation by prescribing medications mother fails in a short period of time. Such children belong to the high-risk group and are more often subject to urgent resuscitation. They are in incubators, under the strict supervision of a neonatologist and qualified nurses. Children almost always need a further stage of nursing and are registered for a long time in perinatal centers or clinics at the place of residence.

Premature birth at a gestational age of 28-33 weeks (fetal weight 1000-1800 g) is due to more diverse causes than earlier preterm birth. There are more than 30% of primigravidas in this category of childbirth.

More than half of women carry out expectant management and maintain pregnancy. In such children, the lungs do not have time to "ripen", the production of surfactant is disrupted. Surfactant is a mixture of fats and proteins that is synthesized in the large alveoli (the building block of the lungs), coating them, promoting their expansion and preventing them from collapsing when inhaled. In the absence or deficiency of this substance, the child's breathing is disturbed. A surfactant preparation can be administered to neonates as needed and greatly facilitates breathing, but this preparation is very expensive and not readily available. Therefore, in order to prevent respiratory failure, women are prescribed glucocorticoids. They stimulate the production of surfactant and the "maturation" of the lungs in the fetus for 2-3 days with the threat of preterm birth. With the onset of labor, glucocorticoids are administered intravenously at intervals of 3-4 hours.

Premature births at a gestational age of 34-37 weeks (fetal weight 1900-2500 g or more) are due to even more diverse reasons, the percentage of infected women is much less than in the previous groups, and primigravidas - more than 50%. However, due to the fact that the lungs of the fetus are almost mature, it is not necessary to administer drugs that stimulate the maturation of the surfactant.

Children are less likely to be transferred to the intensive care unit, but round-the-clock care and supervision are necessary in all cases until the child's condition is completely stabilized.

Nursing features

Premature babies, after examination by a neonatologist, are most often immediately transferred to the intensive care unit, and if necessary, to the intensive care unit. They are monitored around the clock, cared for and treated, as well as preventive measures are taken. possible complications. Premature babies have imperfect thermoregulation, they can be in an incubator, where temperature, humidity, oxygen, etc. are strictly controlled. They have a tendency to respiratory disorders, reduced resistance to environmental factors, so it is necessary to have round-the-clock duty not only of nursing staff, but also of a neonatologist. In most cases, premature babies, after certain efforts of a group of neonatologists, are transferred to the second stage of nursing in a specialized hospital. In the presence of perinatal center in the city, the second stage of nursing is carried out in the same hospital where the birth took place, and the children are not transported. It should be noted that often premature babies stabilize rather quickly, and there is no need for a second stage of nursing.

Management of preterm labor

With threatening and beginning childbirth - when there is no cervical dilatation or it is insignificant - tactics are aimed at prolonging pregnancy. The woman is urgently hospitalized, strict bed rest is created, sedatives are prescribed, and the causes that led to premature birth are eliminated (if possible). For example, suturing of the cervix is performed for isthmic-cervical insufficiency, treatment of vaginal infections, restoration of the natural microflora of the vagina or antibiotics in the presence of an infectious process, treatment is carried out in conjunction with a therapist or endocrinologist (if necessary). An obligatory component is drugs that reduce the tone of the uterus (tocolytics), improve the functioning of the placenta, increase immunity, vitamin therapy, as well as drugs that improve intrauterine nutrition of the child and accelerate the "maturation" of the lungs of the fetus.

In each case it is necessary individual approach, however, not always the efforts of doctors lead to desired results, and the process goes into the onset of premature birth.

Round-the-clock care and supervision are necessary in all cases until the child's condition is completely stabilized.

Premature birth requires a qualified obstetrician-gynecologist, nurse and neonatologist. It is necessary to constantly monitor the woman and the condition of the fetus. A woman is regularly examined, pressure, body temperature are measured, urine and blood tests are monitored. In addition to data from cardiac monitoring, they control the development of labor, listen to the fetal heartbeat, and determine the position of the fetus. Fetal heart rate monitoring is a study of the heart rhythm. It is carried out on a special apparatus at rest, in the position of the pregnant woman on her side for 30-60 minutes. On the anterior abdominal wall of a pregnant woman, with the help of an elastic band, there are recording sensors that record the heartbeats of the fetus, as well as the frequency and strength of contractions.

Most of the complications in childbirth, both on the part of the mother and the fetus, are due to a violation of the contractile activity of the uterus. To identify the features of the contractile activity of the uterus during preterm labor, it is recommended to maintain a partogram (a graphical representation of the frequency and strength of contractions) and record the contractile activity of the uterus. A partogram can be carried out without any technique, by touch, with a stopwatch, to fix the frequency, strength and duration of contractions, and then depict them on a graph. However, all specialized centers have cardiomonitor monitoring, which clearly displays the condition of the child during the birth process, as well as the tone of the uterus and the effectiveness of contractions in dynamics, which allows you to correct and provide qualified medical care for any deviations.

To determine the degree of cervical dilation, the doctor examines the woman on the gynecological chair. Because of the possible negative impact on the condition of the fetus, labor stimulation or inhibition of labor is carefully considered, and often the issue needs to be resolved within a short time, with the decision being made by several doctors. Prevention of fetal hypoxia (lack of oxygen) is carried out; in most cases, narcotic painkillers are refused (since they adversely affect the fetal respiratory center). Childbirth is carried out in the supine position, because it is easier to control childbirth in this position, the head does not move quickly along the birth canal, the woman and fetus feel satisfactory, in contrast to the supine position, in which the pregnant uterus compresses large venous vessels, worsens maternal and fetal circulation. Pain and epidural anesthesia speed up the process of opening the cervix, which is often too fast. The fetal head does not have time to adapt to the birth canal, and often poorly extensible perineum exacerbates the situation, so they are approached individually.

It is in the power of the woman herself to reduce the likelihood of preterm birth. There is no need to hide previous abortions and inflammatory processes in the past from the doctor with whom the woman is registered. It is necessary to immediately inform the doctor about all changes in your body, go to special classes in preparation for childbirth. When a pathology is detected, one should not refuse the treatment prescribed by the doctor. It is necessary to limit physical activity, monitor the diet, which should be varied and well balanced. Excessive consumption of spicy, salty or fatty foods leads to exacerbations of chronic diseases of the digestive system, which can cause premature birth. If symptoms of pregnancy appear, sexual activity should be avoided during the last two months of pregnancy. If there is the slightest suspicion of a deviation from the normal course of pregnancy, it is necessary to seek qualified help.

Nadezhda Egorova,
obstetrician-gynecologist, assistant of the department of obstetrics and gynecology,
Astrakhan State Medical Academy, Astrakhan

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. Most common causes ICI 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. Uterine fibroids large sizes or submucous 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.

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 on later dates puffiness begins to be observed - 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 hemolytic disease in a child, pregnancy often ends in premature birth, more often operative ( C-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 possible development infections.

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.

Premature birth obstetricians call the birth of a baby weighing 1-2.5 kg, which occurred at a period of 28 to 37 weeks of pregnancy. The birth of a baby before this period is considered only if he lived for more than seven days.

Premature births always carry a certain danger, and the greater the shorter the period in which they took place. So, premature birth at week 28 has a high risk of ending badly, because the immune, respiratory systems and internal organs of the baby are not yet ripe to perform their functions. The risks decrease closer to the expected date of delivery, but even preterm labor at 36 weeks is best avoided if possible.

In the arsenal of doctors, there are many ways and schemes for prolonging pregnancy that have been worked out over the years, which ended up under. But it is possible to extend the bearing of a child who is still too early to be born only if the birth has not yet begun. In this light, it is very important that a pregnant woman can independently recognize the signs of preterm labor and go to the hospital without delay if this happens.

How does the expectant mother feel?

About the risk of having a baby ahead of time, a woman can be told by signs that she feels even before the onset of premature birth:

frequent painful uterine contractions;
pain in the abdomen as with menstruation or diarrhea (aggravated by movement);
upset stool, sometimes vomiting;
dull pain or change pain in the back, sacrum, lower back, hips;
feeling of pressure on the perineum and coccyx;
change in the nature of vaginal discharge (spotting bloody, transparent watery).

Already in the presence of any of these signs or several of them, you should consult a doctor for advice.

However, often everything starts suddenly and rapidly - and the birth process can no longer be stopped (the risk of events developing according to this scenario increases if the woman's pregnancy is not the first in a row).

The following signs indicate the onset of labor:

increased and increased contractions (more than 8 times per hour);
discharge of amniotic fluid;
expulsion of the mucous plug.

When departing, childbirth must certainly take place, because the child is already in danger - he is deprived of a nutritious living environment.

In such a situation, it is extremely important to arrive at the hospital on time so that the doctors can accept a premature birth and help the baby adapt to the birth. Keep in mind that these babies need special care and specialized care, in the absence of which the outcome of preterm birth can be unfavorable.

What can doctors notice?

We want to urge you not to worry about this. Firstly, even in the event of preterm delivery, doctors know perfectly well what to do and how to do it. Secondly, if you do not miss scheduled examinations and examinations, then there is no reason to worry, because doctors may suspect the risk of such a pregnancy outcome based on the results of the examination of the pregnant woman and laboratory tests. This can be indicated to them by the location and behavior of the fetus, shortening and softening of the cervix (as seen on ultrasound and on the gynecological chair).

But still, never stop listening to yourself and your own feelings. And if something worries you - do not be afraid to disturb your doctor once again. Your own feelings remain the main guarantee, because even a pregnancy under strict medical supervision can end prematurely.

Often, women experience the so-called, which they take for premature birth. In this case, you should drink half a liter of water or juice, calm down and lie on your left side. If the alarm turned out to be false, the contractions will stop. At the same time, spasms that increase with movement in the event of the onset of labor will stop with a change in body position in the event of false contractions, and the child will move at this time (which does not occur during childbirth).

Remember also that a lot depends on our thoughts and mood. Think only about the good, and most importantly, learn to calmly respond to any situation, because in a state of panic and think adequately, it is not always possible.

Everything will be ok! Millions of women have gone through this - and now they are enjoying their continuation in beautiful kids!

Specially for Elena Kichak

Premature 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 distension of the uterus 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 dilatation and possible separation of the placenta, the estimated weight of the fetus, its presentation and position, integrity 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. Premature baby traumatized due to rapid childbirth, 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 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.