Rus Articles Journal

Premature birth of

In modern obstetrics pregnancy is considered full-term on terms from 37 to 42 weeks. Respectively, childbirth till 37 weeks is considered as premature 1 , and the been born child calls premature.

As premature birth begins p?

Yes, as a matter of fact, as well as timely. The woman can note emergence of nagging pains in the bottom of a stomach and in a waist. Pains sometimes have skhvatkoobrazny character, i.e. it is possible to speak about the beginning of fights . In some cases childbirth begins with an izlitiya of amniotic waters or with an otkhozhdeniye of a mucous stopper . In any of these cases urgent hospitalization in maternity hospital is necessary.

What can be the cause of premature birth?

First of all infection 2 . Normal the cavity of a uterus is sterile. Any inflammatory process does a wall of a uterus defective therefore pregnancy continues until the wall of a uterus can stretch, and then the organism tries to get rid of a germ.

For this reason should not spare expense, time and forces for inspection regarding existence of an infection. Each woman - ideally even before pregnancy - has to be examined on existence of infectious diseases, especially that from them which quite often proceed asymptomatically (a carriage of a chlamydial, ureaplazmenny, mikoplazmenny, toksoplazmenny infection, virus of simple herpes, a cytomegalovirus). The women having in the anamnesis chronic and acute inflammations of appendages of a uterus and an endometriya (a mucous membrane of a body of a uterus), intrauterine interventions (abortions, diagnostic a scraping), and also cases of spontaneous interruption of pregnancy have to deserve special attention. In the presence of inflammatory process it, naturally, needs to be cured. The preparations and procedures which are picked up by the doctor will help to expel an infection from an organism even before conception. If for any reasons necessary analyses before conception were not made, then when diagnosing pregnancy it is necessary to pass by all means the corresponding medical examination and further you should not neglect regular inspections. What will reveal presence at an organism of the woman of the microbes capable to cause premature birth or potentially dangerous to a fruit earlier, - it is better for those. The modern medicine has a considerable arsenal of means to reduce risk of not incubation of pregnancy and infection of a fruit.

the Second common cause of premature birth - istmiko - tservikalny insufficiency , ITsN (isthmus - “isthmus“, place of transition of a body of a uterus to a neck of a uterus, cervix - “uterus“), that is inferiority of a muscular layer of a neck of a uterus which at normally proceeding pregnancy plays a role of the peculiar sphincter (which is holding rings), not allowing a germ “to leave“ a uterus cavity. ITsN happens congenital (very seldom) and acquired. What can cause development of ITsN? The reasons are quite banal: injuries of an isthmus and a neck of a uterus at abortions, especially at interruption of the first pregnancy, deep ruptures of a neck of a uterus in the previous labor (it can happen, for example, at childbirth by a large fruit, imposing of obstetric nippers), rough violent expansion of the tservikalny channel at diagnostic manipulations in a uterus cavity (hysteroscopy, i.e. survey of a cavity of a uterus by means of the special device - the hysteroscope; scraping endometriya), that is any injuries of a muscular layer of a neck of a uterus.

Very often ITsN is formed by

at a giperandrogeniye - the increased content in blood of male sex hormones which are produced in mother`s adrenal glands, and later - and a fruit.

of the Infection and istmiko - tservikalny insufficiency - the main, but not the only factors causing premature birth. Quite often lead of an endokrinopatiya to premature birth - not gross violations of function of endocrine glands - a thyroid gland, adrenal glands, ovaries, a hypophysis (at gross violations of the woman, as a rule, cannot independently become pregnant at all).

Also premature birth can arise at restretching of a uterus caused by polycarpous pregnancy, abundance of water, a large fruit.

the Hard physical activity , chronic a stressful situation at work or houses, any acute infectious disease (flu, ORZ, quinsy, pyelonephritis, especially with temperature increase of a body, etc.) too can provoke pregnancy interruption.

What to do at the beginning of premature birth?

At emergence of disturbing symptoms: belly-aches, dribble of amniotic waters - urgent hospitalization is necessary. Only in a hospital doctors can choose right tactics for each case.

Before arrival of crew of “ambulance“ can take 2 medicines But - shpa or if the woman accepts Ginipral, an additional tablet of this preparation.

As a rule, in a hospital pregnancy is tried to be kept as every day, carried out in mother`s womb, increases chances of the child of a survival.

What is done by doctors to stop the course of premature birth?

At premature, the beginning of fights first of all, is appointed topolitichesky (that is the uterus reducing a tone) preparations - partusisten, giniprat. At first these drugs are injected intravenously, and at the termination of fights transition to the tableted forms is possible. This medicine is taken, as a rule, till 37 weeks of pregnancy. As the means reducing a uterus tone sulfate magnesia, 10% solution of ethyl alcohol and some other preparations are also used.

At the second stage of treatment try to remove the cause of premature birth. At detection of an infection appoint antibacterial preparations (depending on a type of an infection), sedative (that is calming) therapy - to break off a vicious circle: to the objective factors raising a uterus tone the fear to lose the child who, in turn, raises a uterus tone even more increases.

At development of ITsN on term till 28 weeks of pregnancy on a neck of a uterus are imposed by the “pulling together“ seams which do not give to fetal fall out egg from a uterus. Seams impose under a short-term intravenous anesthesia, at the same time the preparations exerting the minimum impact on the child are used.

On term more than 28 weeks at a defective neck of a uterus enter the special supporting Golgi`s ring into a vagina: it, without narrowing a uterus neck, holds the prelying part of a fruit, without allowing it to press on a neck. At the same time, if fights stopped, further opening of a neck of a uterus does not happen.

the hormonal preparation dexamethasone always enters a treatment complex (microdoses of this hormone so side effects are almost excluded are appointed). Its action is directed not to prevention of premature birth, and to stimulation of “maturing“ of lungs at the child (that he was able to breathe independently if all - is born before term).

the Woman surely has to observe a bed rest, and in the conditions of a hospital. In food it is better to avoid the irritating, spicy, greasy food hard to digest.

the situation is More difficult at premature izlitiya of amniotic waters. On pregnancy term till 34 weeks if it was succeeded to suppress patrimonial activity, a condition of the woman and a fruit normal, there is no temperature increase of a body, there are no inflammatory changes in blood, preservation and prolongation of pregnancy with obligatory purpose of antibacterial preparations for prevention of infectious complications is possible. (The matter is that the otkhozhdeniye of waters demonstrates violation of integrity of a fetal bubble. Means, the vagina is reported with a uterus cavity now, that is the way of an infection is open, and acceptance of antibacterial preparations - a vital measure.)

Always doctors try to stop premature birth?

Is not present

, not always.

the situations demanding an early rodorazresheniye in connection with the menacing condition of the woman Happen. At severe forms of late toxicosis (gestoz), chronic diseases of internals doctors quite often cause premature birth for rescue of life and mother, and a fruit.

On term at an izlitiya of waters pregnancy is not kept more than 34 weeks too, and try to carry out very softly and carefully childbirth.

What happens to the woman after premature birth? the Current of the postnatal period of 3 at premature birth, as a rule, differs in nothing in

from that after timely childbirth. Happens that the woman is detained in maternity hospital longer than the put term, however it is connected in most cases with a condition of the child, but not the woman.

to All women after premature birth the complex inspection including analyses on existence of infectious diseases and a carriage of causative agents of an infection, research of the hormonal status is desirable to take place

. At ITsN it is necessary to make a gisterosalpingografiya (radiological research of a uterus and uterine tubes after introduction to their cavities of X-ray contrast substance); at a serious somatic illness - to be examined by the corresponding experts. Naturally, at identification of violations it is necessary to receive medical treatment.

during the subsequent pregnancies hospitalization in maternity hospital in so-called “critical terms“ is desirable

. The greatest fears are caused by the term of interruption of the previous pregnancy. Besides, as critical terms are considered: the first 2 - 3 weeks (fixing of fetal egg in a mucous membrane of a uterus); 4 - 12 weeks (formation of a placenta); 18 - 22 weeks (intensive increase in volume of a uterus); the days corresponding to periods.

What happens to the child after premature birth? 4

is possible

Now nursing of children whose body weight at the birth more than 1 kilogram, but, unfortunately, such malovesny kids survive only in 50% of cases. Sometimes nurse children with the body weight from 500 to 1000 grams, but it happens extremely seldom, besides, it very much and very expensive process. It is easier to nurse the children born weighing more than 1500 grams to pediatricians as all bodies at them more “mature“.

At the second stage of nursing of premature kids is quite often sent to children`s hospitals.

Elena Nesyaeva, the doctor the obstetrician - the gynecologist
Maternity hospital at No. 20 GKB, Moscow