Rus Articles Journal

Childbirth to the term of

It is known that normal pregnancy lasts about 40 weeks. However quite often happens so that the kid “falls short“ of the put term. Why there is premature birth how they proceed and what are dangerous by?

About terminology

Interruption of pregnancy in the term of 28 - 37 weeks is called premature birth. Interruption of pregnancy in term from 22 - y weeks till 28 weeks, according to rules of World Health Organization, carry to very early premature birth. In our country interruption in such term of pregnancy is not referred to premature birth, but at the same time give help in maternity hospital, but not in gynecologic hospital, take measures to nursing of deeply premature newborn. The child born as a result of such childbirth is considered a fruit within 7 days, only in a week such kid is considered not a fruit, and the child. Such feature of terminology is caused by the fact that the children born to 28 - y weeks of pregnancy, often are not able to adapt to environment conditions out of a womb even by means of doctors.

of the Reason

the Factors leading to premature birth can be divided conditionally on socially - biological and medical.

Should note

that in autumn and spring months the frequency of this complication increases. It is caused by change of weather conditions, in particular frequent change of atmospheric pressure which can influence frequency premature an izlitiya of amniotic waters. A serious catarrhal illness with high rise in body temperature and a severe cough can raise a tone of a uterus and cause patrimonial activity prematurely. Adverse influence on the course of pregnancy of a number of production factors is noted: influences of chemicals, vibrations, radiation etc. Premature birth meets at young people, the studying women who are not married at a lack of food of proteins and vitamins more often, and also at the women having addictions.

the serious infectious diseases including postponed in the childhood, abortions, inflammatory diseases of genitals belong To medical factors. Chromosomal violations of a fruit - damage of the hereditary device of a fruit under the influence of adverse external and internal factors (the ionizing radiation, production harm, reception of some drugs, smoking, alcohol intake, drugs, an unsuccessful ecological situation, etc.) - can lead to premature birth, but more often in similar cases there is an interruption of pregnancy in early terms. In most cases diseases of endocrine system, for example dysfunction of a thyroid gland, adrenal glands and ovaries, obesity at which work of all endocrine glands changes are the reason of premature birth. Genital infantility (an underdevelopment of female genitals), uterus malformations, traumatic injuries of a uterus at abortions and vyskablivaniye belong to anatomic changes in genitals, a uterus tumor. Almost in one third of cases is the reason of premature birth istmiko - tservikalny insufficiency at which as a result of mechanical influences (a uterus neck injury after abortions, the previous childbirth, other gynecologic manipulations) or a lack of certain hormones the neck of a uterus does not carry out the locking function.

Often the reason of premature birth become

sheechno - vaginal infections (a trichomoniasis, a mycoplasma, hlamidiya, etc.) and viral infections (a rubella, a cytomegalovirus, herpes, flu, the adenoviral infection, parotitis) which is especially proceeding it is hidden, Existence of a chronic genital infection promotes violation of a local protective barrier and defeat of a fruit. The severe forms of ekstragenitalny diseases (which are not connected with female genitals) and pregnancy complications can also lead to pregnancy not wearing out. Treat such diseases, for example, a hypertensive illness, it is warm - vascular diseases, anemia, chronic diseases of lungs, kidneys, a liver, etc.

Symptoms

At the begun premature birth there is a regular patrimonial activity and smoothing or disclosure of a neck of a uterus, the Beginning of patrimonial activity is followed by emergence of regular skhvatkoobrazny pains in the lower departments of a stomach which accrue on intensity eventually, intervals between fights decrease. Quite often premature birth begins with an izlitiya of amniotic waters, and their quantity can be from several drops to several liters, Besides, emergence in the woman of mucous allocations with streaks of blood or bloody allocations at premature pregnancy demonstrates the arisen structural changes in a uterus neck, i.e. its smoothing. Emergence of any of above-mentioned symptoms demands urgent hospitalization in an obstetric hospital.

At the slightest suspicions on a deviation from the normal course of pregnancy needs to ask for the qualified help.

At emergence of these symptoms needs to call immediately “ambulance“ which will bring future mother in a hospital. It is in certain cases possible to prolong pregnancy; if there is no such opportunity, then in a hospital conditions for a careful rodorazresheniye - childbirth during which absolutely still the weak kid experiences the smallest strain from possible are created.

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of Feature of a course of childbirth

At premature birth more often observe premature izlity amniotic waters, weakness and dysfunction of patrimonial activity, fast or prompt childbirth, violation of mechanisms of regulation, a fruit hypoxia.

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Premature izlity amniotic waters it is more often shown at istmiko - tservikalny insufficiency or existence of an infection. The lower pole of a fetal bubble is infected, and as result of an inflammation, covers are easily torn. Normal the fetal bubble is broken off closer to full disclosure of a neck of a uterus, that is already at the developed patrimonial activity. The woman can have different feelings: from a small wet spot on underwear to the large amount of waters following from a vagina and flowing on legs. Waters have to be light, but happen muddy and is dark - brown (in the presence of an infection). The childbirth which happened before term very often proceeds quickly or is even prompt. The woman has quite painful contractions, their frequency amplifies, intervals between fights make less than 5 minutes and quickly decrease till 1 minute, the first period of childbirth (before full disclosure of a neck of a uterus) is reduced till 2 - 4 o`clock. Because the head at a premature fruit of the smaller sizes, exile of a fruit begins at the uterus neck which did not reveal up to the end. The child of the smaller size passes through patrimonial ways quicker.

the Premature child

the Child born as a result of premature birth has prematurity signs which are defined right after childbirth. The body weight of such newborn is less than 2500, height less than 45 cm, on skin is a lot of syrovidny greasing, hypodermic cellulose is developed insufficiently, ears and nasal cartilages soft. Nails do not come for finger-tips, the umbilical ring is located closer to a bosom. At boys testicles are not lowered in a scrotum (it is defined to the touch), at girls the clitoris and small vulvar lips are not covered with big vulvar lips, shout squeaky. It should be noted that existence of one sign is not the indisputable proof of prematurity of the child, prematurity of a fruit is determined by set of signs.

Unlike timely childbirth, at premature birth more complications, In - the first happen, the head of the child does not manage to adapt to bones of a basin of mother and to configure. A configuration of a head is called the possibility of shift of bones of a skull of a fruit at the time of delivery for reduction of its volume when passing in patrimonial ways. This mechanism allows to reduce pressure upon a head and cervical department of a backbone of the born kid. Bones of a skull premature quite soft also cannot provide protection of a brain, the risk of a travmatization, hemorrhages under covers in fruit brain tissue at the time of delivery increases. At the child hemorrhages can result, he does not manage to adapt to changes of environment, he breaks system of regulation. In - the second, often the woman receives ruptures of patrimonial ways (a neck of a uterus, a vagina and genitalia) as fabrics do not manage to adapt to stretching.

At the menacing and beginning childbirth the woman is urgently hospitalized.

Much less often at premature birth weakness of patrimonial activity meets. Weakness can be shown by weak, rare or short contractions. Time of childbirth significantly increases, the woman is tired, the child begins to suffer too. Other anomalies of patrimonial activity, for example force and frequency of fights sufficient are possible, and disclosure of a neck of a uterus does not happen. All this is connected with violation of systems of regulation at premature birth, there is no sufficient hormonal preparation for childbirth. Infectious complications in labor and the postnatal period meet much more often both at mother, and at a fruit. Among such complications - suppuration of seams (at their existence), a postnatal metroendometritis (an inflammation of a mucous membrane and a muscular layer of a uterus), peritonitis (a peritoneum inflammation) and the maximum distribution of an infection (sepsis). It is connected with existence of the latent or obvious infection which was available before childbirth for the pregnant woman who often and is the reason of not wearing out of pregnancy. The infection can join at the time of delivery, from - for their duration (at weakness), for example horioamnionit (an inflammation of covers of a germ). Premature children have the reduced immunity and, respectively, are more subject to infections.

the Forecast for the child

Due to the features of obstetric tactics and the different result of childbirth for a fruit, is considered expedient division of premature birth into three periods taking into account terms of a gestation (pregnancy): premature birth in 22 - 27 weeks, premature birth in 28 - 33 weeks, premature birth in 34 - 37 weeks of a gestation.

Premature birth in 22 - 27 weeks (mass of a fruit from 500 to 1000 g) is most often caused by

istmiko - tservikalny insufficiency (from - for injuries in the previous labor), infection of the lower pole of a fetal bubble and a premature rupture of a fetal bubble. Therefore in this group of women, as a rule, there are not enough pervoberemenny. Existence of an infection in a sexual path excludes a possibility of prolongation of pregnancy at most of pregnant women. Fruit lungs unripe, and it is not possible to achieve acceleration of their maturing by purpose of medicamentous means of mother for the short period of time. Such children treat group of high risk, are subject to urgent reanimation more often. They are in couveuses, under strict control of the doctor - a neonatolog and the qualified nurses. Children practically always need a further stage of nursing and long are registered in the perinatal centers or policlinics for the residence.

Premature birth at gestation term 28 - 33 weeks (mass of a fruit of 1000 - 1800) are caused by more various reasons, than earlier premature birth. Pervoberemenny women in this category of childbirth more than 30%.

More than at a half of women carry out by

waiting tactics and preservation of pregnancy. At such children lungs do not manage “to ripen“, production of surfactant is broken. Surfactant is a mix of fats and proteins which is synthesized in big alveoluses (compound unit of lungs), covering them, promoting their disclosure and interfering with fall at a breath. At absence or a lack of this substance at the child breath is broken. Newborns can inject a drug of surfactant if necessary, it significantly facilitates breath, however this preparation very expensive and is not always available. Therefore for the purpose of breath violation prevention to women appoint glucocorticoids. They stimulate production of surfactant and “maturing“ of lungs at a fruit within 2 - 3 days at threat of premature birth. From the beginning of patrimonial activity glucocorticoids enter intravenously with an interval of 3 - 4 hours.

Premature birth at term gestatsin 34 - 37 weeks (the mass of a fruit of 1900 - 2500 and more) are caused by even more various reasons, percent of the infected women much less, than in the previous groups, and pervoberemenny - more than 50%. However because fruit lungs almost mature, maintaining the means stimulating surfactant maturing is not required.

Children are less often transferred to

to intensive care unit, but the round-the-clock leaving and supervision are necessary in all cases before full stabilization of a condition of the child.

Premature children after survey neonatology most often are transferred at once to

of Feature of nursing to an intensive care unit and if there is a need, then to the intensive care unit. Behind them the round-the-clock control, leaving and treatment are exercised, and also prevention of possible complications is carried out. At premature children thermal control is imperfect, they can be in the couveuse where temperature condition, level of humidity, oxygen etc. is strictly controlled. They have a tendency to breath violations, resilience to influence of factors of environment therefore the round-the-clock watch not only average medical personnel, but also a neonatolog is necessary is reduced. In most cases premature children after certain efforts of group of doctors - neonatolog are transferred to the second stage of nursing in a specialized hospital. In the presence of the perinatal center in the city the second stage of nursing is carried out in the same hospital in which childbirth was carried out, and children are not exposed to transportation. It should be noted that often premature children are stabilized quickly enough, and in the second stage of nursing there is no need.

Tactics of conducting premature birth

At the menacing and beginning childbirth - when does not have

of disclosure of a neck of a uterus or it insignificant - tactics is directed to pregnancy prolongation. The woman is urgently hospitalized, create a high bed rest, appointed soothing, remove the causes which led to premature birth (if it is possible). For example, carry out suture on a uterus neck at istmiko - tservikalny insufficiency, treatment of vaginal infections, restoration of natural microflora of a vagina or prescription of antibiotics in the presence of infectious process, treatment is carried out together with the therapist or the endocrinologist (if necessary). An obligatory component are the preparations reducing a tone of a uterus (tokolitika), improving work of a placenta, increasing immunity, the vitamin therapy, and also the preparations improving pre-natal food of the child and accelerating “maturing“ of lungs of a fruit.

the individual approach is necessary for

In each case, however not always efforts of doctors lead to desirable results, and process turns into the begun premature birth.

the Round-the-clock leaving and supervision are necessary for
in all cases before full stabilization of a condition of the child.

Premature birth demands presence of the qualified obstetrician`s the doctor - the gynecologist, the nurse and a neonatolog. Continuous supervision over the woman and a condition of a fruit is necessary. The woman is regularly examined, take pressure, body temperature, control analyses of urine and blood. Except data of cardiomonitor supervision, control development of patrimonial activity, listen to heartbeat of a fruit, define the provision of a fruit. Cardiomonitoring of a fruit is a research of a warm rhythm. It is carried out on the special device at rest, in position of the pregnant woman on one side within 30 - 60 minutes. On a forward belly wall of the pregnant woman by means of an elastichesky tape raspthe registering sensors which fix warm reductions of a fruit, and also the frequency and force of fights olagatsya.

the Majority of complications in labor, both from mother, and from a fruit, are caused by violation of sokratitelny activity of a uterus. For detection of features of sokratitelny activity of a uterus at premature birth maintaining a partogramma (a graphic representation of frequency and force of fights) and record of sokratitelny activity of a uterus is recommended. Partogramma can be seen off without any equipment, to the touch, with a stop watch to fix the frequency, force and duration of fights then to represent them on graphics. However in all specialized centers there is a cardiomonitor supervision which visually displays a condition of the child during patrimonial process, and also a tone of a uterus and efficiency of fights in dynamics that allows to correct and provide the qualified medical care at any deviations in time.

For definition of extent of disclosure of a neck of a uterus the doctor examines the woman on a gynecologic chair. From - for possible negative influence on a condition of a fruit the rodostimulyation or braking of patrimonial activity carefully is considered, and often it is necessary to resolve an issue within a short period of time, at the same time the decision is made by several doctors. Carry out prevention of a hypoxia (a lack of oxygen) of a fruit, in most cases refuse narcotic anesthetics (as they adversely influence the respiratory center of a fruit). Childbirth conducts in a prone position on one side because it is easier to control childbirth in such situation, the head moves ahead on patrimonial ways not quickly, the health of the woman and a fruit remains satisfactory, unlike a prone position on a back in which the pregnant uterus squeezes large venous vessels, blood circulation of mother and a fruit worsens. Anesthesia and epiduralny anesthesia accelerate process of disclosure of a neck of a uterus which and so often too fast, the Head of a fruit does not manage to adapt to patrimonial ways, and often badly extensible crotch aggravates a situation therefore approach labor pain relief individually.

In forces of the woman to reduce probability of approach of premature birth. There is no need to hide the previous abortions and inflammatory processes in the past from the doctor at whom the woman consists on the account. It is necessary to report immediately to the doctor about all changes in the organism, to go to special classes of preparation for childbirth. At detection of pathology it is not necessary to refuse the treatment appointed by the doctor. It is necessary to limit physical activities, to watch a food allowance which has to be various and well balanced. Overconsumption of spicy, salty or greasy food leads to exacerbations of chronic diseases of a gastrointestinal tract which can become the reason of premature birth. At emergence of symptoms of threat of interruption of pregnancy it is necessary to refuse sex life within the last two months of pregnancy. At emergence of the slightest suspicions on a deviation from the normal course of pregnancy it is necessary to ask for the qualified help.