Content

If a woman’s pregnancy ends before the doctor’s deadline and the baby is born, premature birth occurs. The degree of threat to the health of a new person depends entirely on the number of obstetric weeks and how long the mother carried the baby under her heart. It is important to be aware of the potential causes of preterm birth in order to avoid such premature births and their dangerous consequences for child health in the future.

What is premature birth

Labor activity completed by delivery before the 38th obstetric week characterizes pathological childbirth. For the health of the baby, this is a pathological process, however, thanks to modern technologies, doctors have learned to care for children born from the 28th obstetric week onwards. However, health problems still cannot be avoided, since the fetus has not yet fully completed its intrauterine development. Therefore, if there is a threat of premature birth, the pregnant woman is urgently placed for preservation.

Signs

How longer baby resides in the mother's womb, the greater the chance of his being born strong and healthy. However, situations are different, and we should not exclude cases when a woman does not complete her pregnancy until the period established by the gynecologist. The characteristic signs of premature birth are not much different from natural labor activity, and the first warning sign is leakage amniotic fluid.

Since the baby is characterized by increased physical activity in the second half of pregnancy, diagnosis can be difficult. However, a vigilant expectant mother should pay attention to the following alarming symptoms:

• increased tone of the uterus during palpation;
• nagging or cramping pain in the lower abdomen;
• constant fetal activity;
• frequent urge to go to the toilet;
• pulling sensation in the lumbar region;
• a bursting feeling in the vaginal area.

How do they begin?

If a nagging pain in the lower abdomen occurs, and the woman detects leakage of amniotic fluid, it is necessary to immediately call ambulance or immediately contact your local gynecologist with a complaint. Early labor can provoke a miscarriage, which should not be allowed under any circumstances. Early labor begins with sharp abdominal pain, which only intensifies in different positions of the body. Pregnancy is at risk, and it is better for the woman to consent to hospitalization.

Causes

The main question most expectant mothers ask is how to avoid premature birth. In fact, the first step is to find out in detail why this pathological process is progressing, and how to reduce the risk of untimely birth of the baby. The specialist informs about this even when planning a pregnancy in order to save the woman from subsequent problems during 40 obstetric weeks. In modern obstetric practice, the following causes of premature birth are distinguished:

• previous abortions, instrumental cleaning of the uterine cavity;
• abuse of bad habits;
• infection cervix and vagina;
• Rhesus conflict;
• polyhydramnios and multiple births;
• premature aging or placental abruption;
• breech presentation of the fetus;
• intrauterine infections;
• fetal gene mutations;
• antiphospholipid syndrome;
• severe forms of gestosis;
• rupture of membranes;
• isthmic-cervical insufficiency;
• excessive sexual activity;
• the presence of hidden urinary tract infections;
• diabetes mellitus during pregnancy;
• pathologies of the thyroid gland in the expectant mother;
• preeclampsia;
• multiple pregnancy (twins);
• inflammation in women during pregnancy;
• uterine bleeding.

Classification

Premature birth is not considered a disease, but the general condition of the newborn depends entirely on the timing of early delivery. If it was not possible to carry the child to 40 obstetric weeks, a conditional classification is presented below, which gives at least a vague idea of ​​the degree of the pathological process and potential diseases in the newborn:

1. Very early birth. Premature appearance of the baby occurs at 22-27 weeks. The weight of the fetus varies between 500 - 1,000 g, the doctor diagnoses underdevelopment internal organs and systems, problems with opening the lungs.
2. Early birth. Premature birth occurs between 28 and 33 weeks. The child weighs up to 2 kg, while the natural ventilation of the lungs is impaired and the circulatory system is imperfect.
3. Premature birth at 34-37 obstetric week although they are considered pathological, they reassure parents, since all internal organs and systems are already formed. A newborn weighs about 2,500 g.

Indications for artificial premature birth

In practice, there are cases when doctors deliberately insist on premature, rapid stimulation of labor. The need for this arises when diagnosing extensive pathologies in the body of a mother or child. In addition, the lives of both may be at risk. Such critical moments are the detection of the following pathologies:

• decompensated endogenous diseases of a complicated form, fraught with death for the patient;
• preeclampsia and eclampsia, as a manifestation of severe gestosis, fraught with the inevitable death of the baby;
• extensive liver pathologies in pregnant women, when the natural outflow of bile is pathologically disrupted;
• diagnosis of HELLP syndrome in the body of a pregnant woman with increased activity of liver enzymes;
• intrauterine malformations incompatible with the further viability of the fetus;
• intrauterine fetal death, fraught with infection and contamination of the blood of a pregnant woman.

How to call

If pathology is suspected or the presence of one of the above pathological factors, the pregnant woman is taken to the maternity hospital. When determining the diagnosis and the need to induce labor prematurely, doctors use separate medications, which are usually inserted into the vagina intra-amniotically. In this case we are talking about the following medications: the synthetic hormone Mifepristone in combination with Misoprostol, Oxytocin, Dinoprostone and Dinoprost. Superficial self-medication is contraindicated, since there is a high probability of death of the mother and child.

Diagnostics

If there is an internal deviation in the intrauterine development of the fetus, labor may begin earlier than the period specified by the doctor. Such thoughts are prompted by hypertonicity of the uterus, discharge of amniotic fluid, dilation of the cervix of the reproductive organ and acute pain syndrome that attacks the consciousness of the woman in labor with cyclical attacks. An additional examination method is ultrasound, which determines the condition and position of the fetus in the womb. Before relieving acute pain, the doctor may prescribe a special test to confirm the onset of labor.

Test

A special test system called Actim Partus reliably determines binding insulin-like growth factor 1 (IGFFR) in the mucus of the cervical canal. The enzyme is produced in high concentration by the membranes of the embryo several days before the onset of labor. Such laboratory research can only be carried out in a hospital setting, since it is not possible to organize collection of material at home without special equipment and tools.

How to prevent

Since in the early stages the child will be born premature, with low body weight and extensive damage to the internal organs, the doctor’s task is to stop premature births with the help of medications; alternative methods can also be used. Since labor can begin at any time, the woman first needs to be hospitalized, then examined, and then prescribed effective treatment, left under strict medical supervision. If you act correctly, the baby can be born exactly on time, without pathologies.

Dexamethasone for threatened preterm birth

To prevent the development of respiratory distress syndrome, doctors use synthetic glucocorticosteroids. If there is a threat of early labor, the drug Dexamethasone for intramuscular administration has proven itself well. Its use is strictly permitted medical indications at an obstetric period of 24 - 34 weeks. There are two schemes for using this medicine:

• 12 mg twice for 24 hours;
• 6 mg in 4 doses throughout the day.

Conservative treatment in a hospital setting

The determination of a comprehensive treatment regimen is carried out individually - according to medical indications after identifying the main cause (pathogenic factor) of the progressive pathology. In conditions of mandatory hospitalization, doctors bring together representatives of different pharmacological groups to ensure positive dynamics and prolongation of pregnancy:

• antispasmodic drugs intramuscularly or rectally: No-shpa, Drotaverine, Papaverine;
• adrenomimetics for intravenous administration: Ritodrine, Terbutaline, Ginipral;
• NSAIDs rectally: Indomethacin from 32 weeks of pregnancy;
• glucocorticosteroids, gestagens orally or intramuscularly: Progesterone, Utrozhestan, Dexamethasone.

Management of preterm labor

To avoid potential complications with children's health, intensive therapy should be carried out in a hospital setting. Positive result It will definitely happen if you strictly follow all medical instructions. There are several methods to combat such a global disorder, it all depends on the general condition of the patient and the fetus. Below are several effective tactics that are chosen by the doctor based on the complexity of the specific clinical picture:

1. Waiting tactics. The woman is provided with peace - physical and emotional, given soothing infusions, and mild sedatives and antispasmodics are used.
2. Active tactics. If the cervix dilates 3 cm or more, doctors use epidural analgesia or administer Partusisten intravenously.

Consequences for mother and child

For a woman, the consequences of premature birth are not so significant; they are more related to physiological characteristics female body. For example, the perineum may tear, or the doctor may C-section with further suturing. But for a baby, the consequences of premature birth can seem fatal. It all depends on the due date. As an option:

• severe birth injuries;
• congenital diseases;
• early mortality.

Pregnancy after premature birth

After a pathological birth, a woman’s body must recover properly, so rushing to conceive again is certainly not recommended. Doctors advise to be observed by a gynecologist for a year, undergo a full medical examination, promptly treat hidden diseases (if any), and only then think about the next addition to the family.

This indicates that there are some problems in the mother or child. Premature baby is not yet ready for independent life, therefore, such situations are prevented by doctors in order to prolong pregnancy as much as possible to a normal term.

What is the risk of premature birth?

If labor occurs at term from to pregnancy is premature birth.

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

More severe consequences of preterm birth for child. Often it is necessary to connect a premature baby to a camera that performs the functions of the respiratory system. After all children born before unable to breathe normally.

Such babies still poorly developed lungs, they are low in surfactants. Their deficiency is compensated for by medication, which allows saving the majority of premature babies.

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

Also the newborn is connected to the device Vital organ controls to track breathing, heart rate, oxygen saturation, blood pressure. This device prevents cardiac and respiratory arrhythmia and respiratory arrest.

When leaving prematurely born child A power supply device is also used. Initially, it may be administered intravenously. In this way, the baby’s body receives proteins, fats and carbohydrates, which are necessary for normal development.

For this purpose they use special equipment using specific blood vessels and a pump to deliver nutritional ingredients in a sterile manner.

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

Babies born prematurely often become special needs patients in the future. Chronic lung disease may make you more prone to spasticity, with an increased risk of developing it during an infection.

Besides, Premature babies don't have very mature brains. Too much sensitivity of the nervous tissue occurs as a result of mechanical damage. The brain also lacks oxygen. All this subsequently negatively affects the functioning of the child’s nervous system.

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

Treatment tactics for premature birth

Delivery is carried out with vital signs monitoring:

• monitoring the pregnant woman’s condition: blood pressure, heart rate, coagulation system parameters and diuresis testing through a urinary catheter;
• analysis of the fetus's condition through ultrasound;
• treatment of DIC syndrome;
• antishock therapy;
• oxygen inhalation.

Depending on the specific situation, choose active or conservative-expectant tactics for managing premature birth.

The last view is shown when satisfactory condition of the mother and fetus, intact amniotic sac, cervical dilatation of 2-4 cm, gestational age before , no signs of infection.

A active tactics are appropriate when regular labor, ruptured amniotic sac, presence of signs of infection, severe extragenital diseases of the woman, disruption of the vital functions of the fetus, pregnancy complications and suspected malformations in the fetus.

In this case, childbirth most often occurs through the natural birth canal, but emergencies also occur.

In case of threatening and beginning premature birth, it is carried out complex treatment to reduce excitability and suppress uterine contractions, increase the vital activity of the fetus and its “maturation”, as well as to eliminate pathological conditions that provoked premature birth.

Pregnant women with a threat of premature delivery bed rest is indicated. Electrorelaxation of the uterus, electroanalgesia, and acupuncture are appropriate.

For threatening and beginning labor, it is prescribed sedatives, drugs to reduce uterine contractions, medications to prevent respiratory distress syndrome in a newborn.

If labor does begin, use stimulants birth process(drugs that cause premature birth). During rapid labor Recommended means to inhibit labor.

Knowing the signs of premature birth and how to prevent it, calmness, confidence in the successful outcome of the pregnancy and constant contact with your doctor will allow you to minimize the risk of having a premature baby.

Premature birth in Russia occur in 7% of all cases - in the vast majority of women give birth on time. However, for the pregnant woman herself and her unborn baby, it is of fundamental importance whether she falls into this category or not. Often, the premature birth of a child can be avoided if you behave correctly at a moment that threatens pregnancy.

Premature babies

Pregnancy is considered fully mature from 37 weeks. The onset of labor before this period is called premature. But there is one very important clarification: childbirth (and not miscarriage) is supposed to be called the birth of a child from . Moreover, if the weight of the fetus reaches at least 500 g, doctors are forced to desperately fight for its life. This is prescribed by law. But in practice, unfortunately, things often don’t look quite like that. Saving and supporting such a baby is a very expensive, responsible process and requires highly qualified medical personnel. The organs and systems of such a tiny baby are not yet formed and developed properly; he cannot even breathe on his own. That is why, given the existing threat of premature birth, literally every day matters, which will help the baby, at least a little, but still grow and get stronger in the mother’s tummy: this, of course, increases the chances of survival in the event of childbirth. Therefore, be responsible if your doctor tells you that hospital monitoring is necessary due to the high risk of preterm birth.

Causes of premature birth

Mothers who are at risk for giving birth ahead of schedule need to be especially vigilant. And there can be many reasons for the premature birth of a baby.

First of all, these are genital infections. An infected uterus is unable to complete the job. She stretches as long as she can, after which she simply rejects the fetus.

Childbirth also occurs earlier than expected with isthmic-cervical insufficiency (ICI), when the cervical canal of the uterus cannot hold the fetus in the womb due to its muscular incompetence.

Other obstetric and gynecological causes of premature birth include placental abruption or previa, premature rupture of membranes, congenital malformations of the uterus, as well as too much stress on it during gestation: multiple pregnancies, very large fruit. An intrauterine device that is not removed in time, or its intrauterine death, also results in premature birth. If you have had abortions in the past or had a previous pregnancy with the threat of premature birth or there were cervical ruptures, then the risks increase markedly.

Doctors may decide to induce premature birth in severe cases, when there is a real threat to the life of the woman and the fetus.

In addition, there are many other factors that can trigger earlier onset of labor: heavy physical labor of a pregnant woman, poor nutrition, unfavorable psycho-emotional conditions in the family or previous history of endocrinopathies, heart or kidney dysfunction, etc. Pregnancy at a very young or mature age also poses some risk.

It must also be said that often births perceived as premature actually occur on time; a mistake was simply made in determining the expected date of birth. Therefore, it is important to determine the date of conception as accurately as possible and calculate your gestational age.

How a woman reacts to the diagnosis of a threat of premature birth is also of great importance. Because worries and worries only make the situation worse. Therefore, you need to learn to relax and set yourself up in a positive way. But still, do not lose your vigilance and, if necessary, act accordingly.

Guide to action

The harbingers of premature birth are no different from the onset of labor at term with only one difference - they appear much earlier than expected. Initially, the woman feels a nagging pain in the lower abdomen, radiating to the lower back, which indicates increased activity of the uterus, that is, it contracts inappropriately. The child’s motor activity will change: he either freezes or makes himself felt very strongly. At the next stage, the mucous plug and even the amniotic fluid may recede - there is nothing to think about here, hospitalization is necessary as soon as possible. This indicates that the uterus begins to open, and cramping pain becomes more frequent and intensifies.

If the cause of premature birth is a weak cervix, then the entire process can be virtually asymptomatic. The only thing a woman feels is heaviness in the vagina - this is the descent of the amniotic sac.

In general, premature birth is faster and easier because the baby is still very small. Therefore, you need to act quickly.

If you have been diagnosed with a threat of premature birth, but still remain at home, you should be extremely careful and attentive. Any physical activity must be excluded, including walking and. Do not lift anything heavy, do not make sudden movements, and go on a diet that excludes heavy and provoking foods.

As soon as you feel the first signs of labor, take a sedative (motherwort or valerian), 2-3 tablets of No-shpa, call an ambulance and lie down comfortably, preferably on your side.

What awaits a woman in the hospital?

Further events can develop in several variations. If the woman's condition is critical, doctors will have to deliver the baby. No attempts are made to prolong the pregnancy even if the amniotic fluid breaks during the postnatal period. At the same time, during premature birth, the doctor constantly monitors the fetus using a heart monitor. If the baby's vital signs are unsatisfactory, a caesarean section will be performed.

In all other situations (when it is too early and impractical to give birth), doctors should make every effort to maintain the pregnancy and delay the date of premature birth. If it works out, then up to 37 weeks.

First of all, doctors will calm the uterus and normalize blood circulation in the placenta by introducing medicinal solutions by staging, and later they will switch to tablets.

At the same time, the doctor must find out the reason why labor began ahead of schedule in order to eliminate it if possible. If a woman’s water breaks, antibacterial therapy will begin, since the path for infections to the fetus is now open. The same should be done if the cause of premature labor is an infection.

The woman will certainly be given Dexamethasone, which accelerates the development of the baby’s pulmonary system in case labor does begin earlier. As a rule, it is also impossible to do without sedatives: firstly, it could provoke the onset of labor, and secondly, a woman’s fear of losing a child involuntarily brings the uterus into. Homeopathic medicines are predominantly prescribed.

If the cause of the threat or onset of premature labor is the development of ICI, then stitches must be placed on the cervix (which is done under internal anesthesia). And if the situation arose after the 28th week of pregnancy, a special Golgi support ring is inserted into the vagina.

After childbirth

A child born prematurely, as we have already said, requires increased attention, help and special care. His mother will probably be kept in the maternity hospital longer than usual, and even after discharge she will need to follow the doctors’ recommendations for caring for the baby. The postpartum woman herself will have to undergo a series of studies to prevent the development of postpartum complications. And in the future, if there are others after this pregnancy, be under the close supervision of doctors, especially during critical periods during gestation.

But that will come later. And now mom will enjoy the happiness of motherhood.

Especially for- Elena Kichak

The threat of premature birth - a false forecast or a dangerous reality?

“I was leading my usual active lifestyle, and suddenly, completely unexpectedly, labor began at 34 weeks of pregnancy. The child was born immature, and we had to stay in the hospital with him for almost a month. Why, when visiting the antenatal clinic in the last two months of pregnancy, did no one ever suggest that I do a cervical examination? It turns out that the threat was there all along, and I didn’t even know about it.”

“The doctor diagnosed “threat of premature birth” and prescribed bed rest. I spent a whole month at home without walking or moving. The eldest child had to be given to his grandmothers. And, in the end, she passed her due date by a whole week and a half! Even intense walks did not help provoke labor. We were already talking about planned stimulation. Thank God, I gave birth on my own.”

These contrary realities of medical practice are errors in medical diagnosis. In the first case, the risk of a threat of premature birth is underestimated, and in the second, it is overestimated by the specialist. The consequences of incorrect diagnosis can be unpleasant in both cases.

Can pregnant women themselves help specialists in making a competent prognosis for childbirth in order to reduce the risk of getting into these extreme unpleasant situations?

It turns out yes! To navigate the situation, let’s arm ourselves with clinical thinking skills and analyze both opposite options according to the scheme:

1. possible consequences,
2. reasons for occurrence,
3. risk prevention methods.
4. diagnostic signs
5. treatment methods,

First let's let's decide on the timing. The normal average duration of pregnancy falls within fairly wide boundaries: 40 weeks from the first day of the last menstruation (or 38 weeks from the day of conception) plus or minus two weeks. Since most women cannot accurately indicate the day of conception, it is customary to focus on the norm - 40 weeks, counted from the first day of the last menstruation. To be completely precise, from 37 to 42 weeks of pregnancy, childbirth is not considered early or late. The 36th week of pregnancy is borderline in this regard. Of course, this range is generalized to a large number of genera, and in each specific case it is required individual approach. For example, for a woman who would normally give birth at 38 weeks, giving birth at 41 weeks will be considered postmaturity. And vice versa, if a woman gives birth to all her children at 41 weeks, then a child born to such a mother at 37 weeks will have obvious signs immaturity.

Individual limits of normal term of birth, or your lower limit of normal, can be determined based on the following signs:

1. If an individual menstrual cycle is less than 28 days (from the first day of one menstruation to the first day of the next), then there is a tendency to carry a pregnancy for less than 40 weeks - and this is normal. In this case, there is a dependence: than less days in the menstrual cycle, the earlier you can give birth without fear. Those. in women with short cycles (less than 28 days), a pregnancy lasting 37-40 weeks will be considered normal.
2. If in the family the expectant mother had a tendency towards earlier births without complications, then with a high probability this can be expected in the woman herself. There is a hereditarily determined biorhythm for the development of an intrauterine child, and therefore for the onset of childbirth.
3. If a woman has a mature birth canal (according to manual examination), and the child plans to be large and has mature lungs (according to ultrasound), then more early start childbirth does not pose a danger to mother and baby.

Consequences premature birth, i.e. births occurring before 36-37 weeks of pregnancy are a serious problem for practical obstetrics, pediatrics, parents and sometimes for the child himself.

For a child, the risk of premature birth is associated with the immaturity of its systems: primarily the respiratory, nervous and immune systems. The immaturity of the respiratory system is fraught with acute and chronic hypoxia (oxygen starvation), which the child sometimes cannot cope with on his own, and success depends on the availability of resuscitation equipment for premature babies in the maternity hospital where the birth took place. The immaturity of the nervous system can lead to poor coordination between other systems and organs of the newborn’s body, which creates difficulties in adapting to new living conditions. For example, due to the immaturity of the nervous system, a baby may have involuntary breathing pauses, an inhibited sucking reflex, digestive difficulties, poor sleep, etc. The immaturity of the immune system makes the child more vulnerable to infections, both external and internal.

Premature birth is often complicated by the need for medication and surgical interventions during its course due to the immaturity of the hormonal systems of the mother and child, as well as due to the immaturity of the mother’s birth canal. This, in turn, is an additional burden for the child. In addition, for a premature baby, even an uncomplicated birth is a more difficult ordeal than for a child born at term.

For mother, premature birth is complicated by the fact that the immaturity of the cervix and hormonal factors create more favorable conditions for long, difficult labor: the risk of primary (during contractions) and secondary (during pushing) weakness of labor, high pain component of labor, and cervical rigidity increases , no separation of placenta, postpartum hemorrhage.

For the whole family the birth of a premature baby turns out to be an unexpected burden associated with anxiety for his life and health and additional costs of effort and time for rehabilitation.

Causes of premature birth and prevention of such complications.

We will divide the reasons into predisposing factors or risk factors, which are not an immediate threat, but with a careless lifestyle can lead to it, and for real warning signs premature birth, the appearance of which requires urgent treatment.

Medical science identifies four groups risk factors:

1. socio-biological reasons: mother’s age under 18 years, work involving heavy physical or nervous stress, bad habits, certain living conditions (for example, frequent and prolonged exposure to the sun, breastfeeding during pregnancy, etc.);
2. obstetric and gynecological history: short menstrual cycle, history of abortions, miscarriages, premature births, a large number of births, some gynecological diseases (especially infections of the birth canal) and pathologies of the development of the uterus and cervix;
3. extragenital diseases: acute infections during pregnancy, pathologies of organs and systems of the mother’s body;
4. complications of the current pregnancy: placenta previa, premature aging of the placenta, polyhydramnios, oligohydramnios, Rh sensitization, severe gestosis.

The combination of several risk factors at the same time is a reason for more vigilant self-diagnosis and a more cautious lifestyle in the last trimester of pregnancy.

The experience of practicing doctors and obstetricians shows that the following reasons from the group of risk factors most often lead to premature birth:

Reason 1: As perinatal practice shows, greatest number All premature births occur due to premature rupture of the membranes and rupture of water. And cases of premature damage to the membranes, in the vast majority of cases, occur due to untreated vaginal infections. Sometimes a simple thrush, which is firmly entrenched in the mother’s vaginal flora, can lead to looseness of the membranes and cause their premature damage.

Prevention: Therefore, timely diagnosis of birth canal infections and treatment is the prevention of premature births that occur due to premature rupture of water.

Reason 2: Another common cause of early labor is the so-called “short” cervix. Normally, by 35-36 weeks of pregnancy (i.e. before the birth canal begins to mature for childbirth), the length of the cervix is ​​about 2-3 cm. If the cervix is ​​shorter than 2 cm at an earlier stage of pregnancy, then there is a predisposition to the threat premature birth.

Prevention: Predisposition is not a threat itself, but a signal for a more cautious lifestyle until 37 weeks of pregnancy. You should not: lift weights, stand for a long time, walk up the stairs, intensify intimate communication with your husband, perform exercises to strengthen the abdominal muscles, breastfeed, take hot baths and showers, use drugs that shorten the cervix (for example, No-shpu) , be nervous.

The presence of a short and soft cervix in the absence of increased tone and in the absence of vaginal infections is not a serious prerequisite for the onset of premature labor. Women who have reached 37 weeks with a diagnosis of a “short cervix” should gradually change their lifestyle to a more active one, otherwise the opposite risk may arise - the risk of post-term pregnancy due to the mother’s body inhibiting the development of prenatal processes.

The diagnosis of “isthmic-cervical insufficiency” (open cervix) is included in this group of causes and often requires a gentle lifestyle, mastering relaxation techniques, and often surgical correction for early stages pregnancy.

Reason 3: Early increased uterine tone is a reason that often worries specialists, but is not very often the real cause of premature birth. The presence of increased uterine tone with a dense and long cervix, as well as with a posterior bend of the cervix, is not a serious cause for concern. Increased uterine tone is dangerous in combination with a short cervix and infections of the birth canal.

There is a self-diagnosis method that allows you to distinguish the background increased tone of the uterus from the progressive one, which can develop into untimely real labor - the maternity test.

The mammary test allows you to determinereadinessbfemale body for childbirth. The test is considered positive if, after three minutes from the start of finger stimulation of the nipples, one contraction occurs, and within ten minutes of stimulation there are at least three. Normally, this test can be positive for3-10 days before giving birth.

If a woman has increased uterine tone, but the maternity test is negative, then there is no risk that the tone may develop into labor contractions in the near future. But if the test is positive, and the period is still far from 37 weeks of pregnancy, this is a reason to quickly contact a specialist. Bed rest and pharmacological therapy may be required.

So, threatening signs of premature birth are:

- increased uterine tone,

- softening and shortening of the cervix,

- the appearance of bloody discharge (the so-called red mucus plug),

- increasing cramping pain

(symptoms are listed in order of increasing risk of preterm birth).

The appearance of several signs or the last two signs before the 37th week of pregnancy is a signal to immediately contact a specialist.

Methods of treatment (correction) threats of premature birth are medical and psychological. Exclusively psychological methods are used in cases of low threat. In other cases, they are combined with a medical approach. Medical tactics for prolonging pregnancy are used when the amniotic sac is intact, the pharynx is open to 4 cm, there are no signs of infection and the child is in good condition.

The complex for correcting the threat of premature birth includes:

1. gentle or even bed rest,
2. a light, vitamin-rich diet,
3. medications (sedatives, antispasmodics, antiprostaglandins, tocolytics),
4. muscle relaxation method,
5. auto training,
6. psychotherapy.

Parents can do an infinite amount on their own if they combine their efforts to support their child in a difficult situation. Careful and loving touches, parental words, mental communication with the baby, changes in lifestyle, and sometimes in the way of thinking, constructive interaction with specialists are the main means of overcoming the risk of early birth.

And as you approach the 37-week mark, don't forget to give yourself permission to give birth! Let the onset of labor be a timely and pleasant surprise for everyone!

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

What is called premature birth?

Premature birth is usually understood as the process of delivery that begins before 38 weeks - the period when the fetus is considered full-term and fully formed. The World Health Organization (WHO) has established the timing of premature birth, namely from 28 to 38 weeks of pregnancy.

However, new technologies do not stand still and modern maternity hospitals are able to care for babies born at 22 weeks weighing from 550 g. The recovery period for such babies is an order of magnitude longer than for children born a little earlier than their due date, but still However, the practice of nursing such babies is quite successful, and premature babies quickly catch up with their peers in development by 2.5-3 years.

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

World practice calls premature birth the process of labor that begins at 22 weeks of intrauterine development of the fetus.

How often does preterm birth occur?

Unfortunately, more than one expectant mother is not immune from the birth of a premature baby. Indicators in the USA, according to statistical data, are about 7% of the total number of births per year; in France this figure is slightly lower: about 5%.

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

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

Who is at risk of delivering prematurely?

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

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

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

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

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

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

One of the factors in the birth of a premature baby may be infectious-inflammatory processes and sexually transmitted infections in the mother’s body. Abdominal injuries during pregnancy at any stage often result in spontaneous or induced labor before the due date.

Women with multiple pregnancy More often than others, they give birth to premature babies due to overstretching of the uterus. However, the norms for twins and triplets coming into this world are somewhat different. The birth of twins and triplets from the full 35th week of intrauterine development is considered conventionally normal. Whereas they can be called early if they occurred in the period from 22 to 35 weeks of pregnancy.

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

If you do have any chronic diseases or other features, be sure to tell the doctor who is observing you about them, such awareness can save your life and the life of your unborn child, because doctors will be prepared for force majeure circumstances. It is very important to adhere to healthy image life, say goodbye to harmful addictions, and before planning a child, it is advisable to take a close look at your health and treat all ailments.

Signs of premature birth

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

Women who have given birth can identify signs of premature labor by sensations similar to those during a normal period, or similar to the threat of miscarriage in the first weeks.

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

So, the obvious symptoms of the onset of labor ahead of schedule are:

Bleeding from the genital tract;

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

Tense stone belly, cramping muscle contractions accompanied by pain;

Nagging pain in the lumbar region and lower abdomen;

Feeling of strong pressure on the perineum;

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

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

It is important to seek medical help if any of the above symptoms occur. As a rule, premature birth can be avoided with timely measures taken. Similar symptoms in the form of nagging pain in the lower back can occur if kidney disease is suspected, in particular acute pyelonephritis or an exacerbation of its acute form, and acute pain in the abdominal area can be a consequence of poor nutrition, appendicitis and other disorders.

The threat of having a premature baby and its treatment

As mentioned earlier, the threat of premature birth can be prevented, and in the case of the beginning of the birth process, with the necessary medical care promptly stop them, allowing the woman to carry the child to term and give birth on time.

By the term “threat of premature birth,” obstetricians-gynecologists understand processes in the body of a pregnant woman that activate the onset of labor at an inappropriate time. When making this diagnosis, future mom receives certain treatment in a hospital setting and is under medical supervision. Typically, the state of threat is accompanied by pain in the pelvic area, vaginal discharge of varying intensity and color, and hypertonicity of the uterus.

Treatment is carried out inpatiently, the woman is given complete rest. First of all, drugs are introduced that reduce uterine tension and bring it to a normal state of rest. Sedative sedatives can be prescribed as auxiliaries to normalize the woman’s condition and eliminate the possibility of new stressful shocks. If the amnion ruptures, a course of antibiotics is prescribed to protect the baby from infection and allow the fetus to be carried to a safe term. Also, antibiotic therapy is prescribed when inflammatory processes are detected in the mother’s body.

If the cause of the threat of early birth of a baby is isthmic-cervical insufficiency, then after eliminating the danger of intensifying labor under local anesthesia A suture is placed on the cervix, preventing the cervix from opening under the weight of the fetus and water. At 28 weeks and beyond, a special Golgi constriction ring is installed on the cervix, which is removed after reaching the full 38 weeks of pregnancy.

As an effect on the fetus, a course of glucocorticoids is administered, which reduces the risk of developing respiratory distress syndrome (RDS) in the newborn, which can cause his death. Such drugs prepare the baby's lungs, and if born prematurely, he can take his first breath without threat to life.

When is pregnancy not maintained and early labor stimulated?

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

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

Management of preterm labor

Undoubtedly, the management of early delivery requires special skills from the doctor and must be accompanied by constant monitoring. condition women and readiness for prompt action.

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

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

Prevention of premature birth

To reduce the likelihood of developing rapid birth earlier than expected A pregnant woman must follow some rules, because the successful course and completion of pregnancy depends on her attitude towards herself and her unborn child.

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

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

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

✔ You should not, unless absolutely necessary, appear in crowded places, especially during epidemics of viral diseases, and avoid contact with infectious sick people and animals.

✔ If possible, do not postpone pregnancy and childbirth at work for no apparent reason, because fatigue, both physical and mental , can have a negative impact on your health.

✔ Closely monitor your health and pay attention to all signals from your body, because timely consultation with a doctor in case of suspicious symptoms will help avoid the development of negative consequences, including reducing the risk of premature birth.