Premature birth
Premature birth is a birth that occurred during pregnancy from 22 to 37 weeks. At the same time, the average weight of the fetus is usually from 500 to 2500 grams. As a result of premature birth, a premature baby may be born. To prevent this from happening, you need to know and be able to identify their signs, because in this case it will be possible to contact the clinic in a timely manner. For a long time, when asked what premature birth is, they answered that it was a birth that occurred no earlier than 28 weeks. But today, thanks to the introduction of modern medical technologies, it has become possible for the fetus to survive at an earlier stage.
The content of the article:
Obstetric tactics of preterm labor management
Causes of premature birth
Symptoms of premature birth
Diagnosis of premature birth
Complications of premature birth
Treatment for fear of premature birth
Prevention of premature birth
Premature birth
Obstetric tactics of preterm labor management
Obstetric tactics of preterm labor management includes their timely and adequate anesthesia. In addition, it should be borne in mind that many complications in the mother and fetus are the result of violations of the contractile activity of the uterus. In this regard, during pregnancy, it is necessary to monitor the contractions of the uterus and the condition of the fetus. In addition, infections and viruses are very dangerous for the fetus.
It is also worth paying attention to the fact that the duration of premature birth is significantly less than timely. Of course, the obstetric tactics of conducting preterm labor are individual in each case. But in most cases, it involves natural labor activity with anesthesia. At the same time, doctors use wait-and-see tactics. Of course, doctors during pregnancy should constantly monitor the condition of the pregnant woman and the fetus, since premature birth can cause various complications.
Causes of premature birth
Before considering what provokes premature birth, it should be noted that experts classify them into several types. Namely: premature birth can begin spontaneously or may be caused by medications. Doctors can cause premature birth according to indications from the mother (if she has a serious life-threatening disease) and according to the indications of the fetus: incurable malformations, progressive deterioration of the condition, intrauterine death. Premature birth can begin at different dates: at 22-28 weeks: the baby weighs no more than 1000 g, at 28-30 weeks: the weight of a newborn can reach 1500 g, at 31-33 weeks: prematurity of moderate severity, at 34-36 weeks: almost full-term children.
Premature birth can begin for various reasons. First of all, maternal factors of premature birth are distinguished, which are due to the state of a woman’s health, these include abortions and curettage of the uterus, operations on the cervix, as well as previous premature births. In addition, premature birth may begin for reasons due to the course of pregnancy. They can be very diverse: alcohol abuse, nicotine and drugs, chronic stress or depression, the age of a woman under 18 or over 35 years old, injuries, genital infections, placenta previa, isthmic-cervical insufficiency, as well as an insufficient amount of trace elements and vitamins in the body.
It is worth paying special attention to such a reason as placenta previa. The fact is that 50% of women may begin premature labor in the presence of this pathology. Normally, the placenta should be attached to the top of the uterus. But sometimes it shifts to the uterine pharynx, blocking it. The main symptom of placenta previa is painful bleeding, which should be urgently seen by a doctor. By the way, with placenta previa, labor is possible only by Caesarean section.
Symptoms of premature birth
There are several stages of premature birth. Threatening premature birth can be recognized by intermittent pain in the lower back and lower abdomen, the tone of the uterus is increased, although its neck remains closed. For the beginning of premature labor, cramping pains in the lower abdomen are characteristic. At the same time, regular contractions occur, and the cervix gradually shortens and opens. Sometimes at this stage there is an outpouring of amniotic fluid. If preterm labor can still be stopped at both of these stages, then the process that has begun is already irreversible.
In order to recognize premature birth in time, you need to be able to determine their signs, which include the following:
contraction of the uterine muscles (contractions) with a frequency of every 10 minutes;
incessant dull pain in the lower back;
colic in the lower abdomen;
significant increase in vaginal discharge;
increased pressure in the vagina and pelvis;
stabbing pain;
reduction of fetal movements;
vaginal bleeding.
Diagnosis of premature birth
It is worth noting that the diagnosis of premature birth is complicated by a huge number of factors that can provoke them, as well as the absence of specific symptoms. If you want to know how to stop premature birth, pay attention to the fact that this can only be done by diagnosing them at an early stage. The most effective method of diagnosing premature birth is transvaginal ultrasound, during which the length of the cervix is determined.
If the examination showed an elongation of the cervical canal by more than 3 centimeters, the risk of premature birth next week may be as low as 1%. At the same time, if at the time of examination its length was 2.5 centimeters, the risk increases to 6%. In addition, to predict the onset of labor, a uterus maturity test is often used, the accuracy of which is about 94%.
Complications of premature birth
In the case of premature birth, there are complications for the health of the mother and child. As for the mother, the consequences for her will be minimal, since premature birth is not much different from timely. Moreover, during them, perineal ruptures occur less often. Nevertheless, a woman will still have to undergo a comprehensive health examination. This is more necessary to determine the causes of the problem and prescribe treatment that could prevent possible premature birth in the future.
As for the child, the consequences of premature birth may be more significant for him. Obstetric tactics of childbirth provides, first of all, protection of the fetus from infections and viruses. But in any case, the complications depend on the time at which the baby was born. For example, a baby born at 28 weeks of term is immediately transferred to a specialized hospital, where there is all the necessary medical equipment to care for him.
Children born between 28 and 34 weeks of gestation tolerate labor better, so they are transferred to the intensive care unit. Babies born after 34 weeks of pregnancy can breathe independently, digest food, and remove waste products. Their only problem that doctors will need to solve is insufficient weight.
Treatment for fear of premature birth
After diagnosing such a process, differentiated treatment is prescribed. It can be carried out only during the initial labor activity to preserve pregnancy. Treatment in this case may include four components:
Antibiotics.
During the selection of the treatment method, the cause of the disease is taken into account. For example, if the cause of premature birth is an infection, a woman will be prescribed a course of antibiotics. They are also prescribed if, before the 33rd week of pregnancy, a woman’s amniotic fluid departs or their leakage begins. In the event that, for the same reason, premature birth occurs at the 34th week of pregnancy, they will most likely not be stopped. Antibiotics are also prescribed for prevention, since this measure helps to avoid infection of the fetus and inflammatory postpartum diseases in the mother.
Tocolytic therapy
To reduce the excitability of the uterus and its active contractility, the doctor may prescribe tocolytic drugs. Today, the most effective and safe remedy is ginipral, with the help of which, in emergency cases, it is possible to effectively remove the increased tone of the uterus. They can also prescribe nifedipine, indomethacin, magnesium sulfate, a 25% solution of magnesium sulfate.
Sedative therapy
If a woman has a threatening or incipient stage of premature birth, she may be prescribed painkillers and antispasmodic drugs. The most effective remedy is epidural anesthesia. In the event that its use is impossible due to contraindications in the patient, other types of analgesics and antispasmodics are prescribed: no-shpa, analgin, atropine, papaverine and others.
Prevention of fetal respiratory distress syndrome (RDS)
After infection of the fetus, RDS is the second most important cause of death of premature babies who were born before 34 weeks. This is due to the fact that the fetal lungs are not yet able to breathe independently before this period. Therefore, doctors prescribe intramuscularly or intravenously drugs from the group of corticosteroids. It is also worth noting that in the case of isthmic-cervical insufficiency of the cervix before the 28th week of pregnancy, a suture can be placed on the cervix, which will prevent its disclosure. Doctors may not stop premature birth at 34 weeks, because in this case their outcome is more favorable compared to labor at an earlier date.
Isthmic-cervical insufficiency of the cervix is a common cause of premature birth. This disease is a pathological condition of the cervix, during which it is unable to resist intrauterine pressure and keep the fetus in the uterine cavity. At 16-18 weeks, it is possible to get rid of isthmic-cervical insufficiency surgically. It is worth noting that in this case, complications are possible up to rupture of the cervix, sepsis, cervical stenosis. A less traumatic way of treating isthmic-cervical insufficiency is the use of supportive obstetric pessaries.
The treatment of patients directly depends on the stage of premature birth. For example, at the threatening stage, tocolytic drugs, antispasmodics, antibiotics for the treatment of infections and sedatives are prescribed orally or rectally. Outpatient treatment is possible at this stage. Patients with the beginning stage of premature birth are treated exclusively in inpatient conditions. In this case, they try to prolong the pregnancy as long as possible. Women with the onset of premature labor are hospitalized and fetal lungs are prepared. In this case, the use of tocolytic drugs is already ineffective.
Prevention of premature birth
Of course, the prevention of premature birth is better than their treatment. Specialists distinguish two types of prevention: primary, which is advisable before pregnancy, and secondary — during pregnancy. The methods of primary prevention include restrictions on intrauterine manipulations, which, for example, include abortions. In addition, it is desirable for a woman to undergo a comprehensive medical examination aimed at identifying chronic gynecological diseases, the presence of infections and individual characteristics of the body.
Secondary prevention may involve the introduction of anti-nicotine programs among pregnant women, as well as prescribing progesterone. In addition, a woman needs to register for a women’s consultation in a timely manner and inform the doctor about her health status as accurately as possible. During pregnancy, it is worth avoiding contact with sick people, so as not to catch any infection. In addition, a woman should not be subjected to physical exertion, stress and overstrain. She should regularly undergo all necessary examinations, take tests for infections and viruses, and closely monitor her health.
