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premature childbirth, according to the definition of the World Health Organization, are called births that occurred in the period from 22 to 37 weeks of pregnancy or on days 154 to 259 of gestation, if we count the period from the first day of the last menstruation. However, in Russia, births that occur between 28 and 37 weeks of gestation or between 196 and 259 days of gestation are considered premature. Childbirth from 22 to 27 weeks inclusive in Russia is allocated to a special category, which is considered late abortion, and not premature birth. It is the different terms of preterm birth that determine the difference in statistical data between the countries of Europe and Russia. The birth of a child from the 37th week of pregnancy inclusive is not considered premature. Thus, if a woman had a birth from 37 to 42 weeks, then they are considered urgent, that is, they began on time.

In countries former USSR registry offices for premature births that occurred at 28-37 weeks of gestation register all babies born alive or dead with a body weight of more than 1000 g. If body weight could not be measured, then newborns with a body length of more than 34 cm are registered. This means that the woman will be given a birth or death certificate for the child. If a child was born with a body weight of 500 - 999 g, then he is registered in the registry office only if he lived for more than 7 days (168 hours after birth).

In terms of survival of all premature babies born as a result of premature birth, they are divided into three categories depending on body weight:
1. Children born with low body weight from 1500 to 2500 g. These children in most cases survive, catch up with their peers by 2.5 - 3 years, and, starting from the third year of life, grow and develop according to age;
2. Children born with a very low body weight from 1000 to 1500 g. These children do not always manage to go out, about half of them die, and the rest may develop persistent disorders in the work of various organs and systems;
3. Children born with extremely low body weight from 500 to 1000 g. These children can only be discharged with specialized equipment and highly qualified neonatologists. However, even surviving children born with such a low body weight, as a rule, are not completely healthy, since they almost always develop persistent disorders of the central nervous system, digestive tract, respiratory, digestive and genitourinary systems.

Thus, premature births are dangerous, first of all, for a child who is not yet ready to be born, since he does not have the necessary functions of internal organs. The high mortality of premature babies is due to low body weight and the immaturity of internal organs, which are not able to ensure the existence of the baby outside the womb. However, for a woman, preterm birth is also dangerous, since the frequency of complications after them is much higher compared to full-term births.

The frequency of preterm birth in Russia is approximately 7%, in the USA - 7.5%, in France - 5%, in Australia and Scotland - 7%, in Norway - 8%, etc. Thus, the frequency of preterm birth does not exceed 10% in developed countries. In countries with a low standard of living and unsatisfactory quality of medical services, the frequency of preterm birth can reach up to 25%.

Depending on the mechanism of development, preterm labor is divided into spontaneous and induced. Spontaneous childbirth occurs without the use of special means capable of inducing childbirth. Induced preterm labor is specifically provoked by specialized medicines. Such induced labor is also referred to as late abortion, "filling" or induced labor. Usually they are produced according to social indications (restriction parental rights, pregnancy resulting from rape, serving a sentence in prison, the death of a husband while carrying a child), upon detection of deformities of the fetus or a threat to the health of a woman.

Premature birth - terms

Currently, in Russia and most countries of the former USSR, the entire set of preterm births is divided into three options, depending on the gestational age in which it was interrupted:
1. Early preterm birth (occur in the period from 22 to 27 weeks inclusive);
2. Median preterm birth (come in the period from 28 to 33 weeks inclusive);
3. Late preterm birth (occurs between 34 and 37 weeks of gestation).

These types of preterm births are distinguished on the basis that at the indicated terms of pregnancy, the gynecologist must apply certain obstetric tactics for a successful and minimally traumatic delivery for the woman and the fetus.

Early preterm birth in Russia is now often referred to as late abortion and is taken into account in the relevant statistical categories. Most often (in about 55% of cases) preterm birth occurs at 34 to 37 weeks of gestation. preterm birth in terms of 28 - 33 weeks are fixed in 35% of cases, and in 22 - 27 weeks - in 5 - 7%.

In world medical practice, nursing of live newborns weighing at least 500 g is carried out. Such a weight in an infant occurs already at the 22nd week of pregnancy. It is precisely because of the development of medical knowledge and technologies that allow nursing infants born not earlier than the 22nd week of pregnancy weighing at least 500 g, the World Health Organization recommends providing assisted resuscitation and nursing children who, at the time of birth, weighed at least 0.5 kg.

However, nursing babies born with a weight of 500 to 1000 g requires special equipment and a qualified neonatologist, which are far from always available in ordinary obstetric institutions in the CIS countries. Therefore, in most cases in the CIS countries, babies born no earlier than 28 weeks of pregnancy with a body weight of at least 1000 g are nursed, since this is possible with the medical equipment available in maternity hospitals and the qualifications of a neonatologist. Only in specialized central perinatal centers in last years the necessary equipment appeared, and doctors received appropriate training, allowing them to nurse newborns from 22 to 27 weeks of gestation with a body weight of 500 to 1000 g.

Preterm birth of twins

Multiple pregnancy (twins, triplets, etc.) more often than usual ends in premature birth, since the fetuses overstretch the uterine cavity, thereby provoking the development of its contractile activity, followed by the expulsion of babies. In principle, the birth of twins is considered conditionally normal, starting from 35 weeks of pregnancy. In other words, with multiple pregnancies, births that occur from 22 to 35 weeks are considered premature. Preterm birth for twins is more dangerous than for one baby, since the mass of each of them is very small. However, in preterm births that occur between 28 and 35 weeks of gestation, as a rule, both premature babies manage to go out.

Threat of preterm birth

Very often, gynecologists use the term "threat of preterm birth", which is a designation of the stage of this pathological process. Regardless of the gestational age, doctors divide preterm birth into the following clinical stages:

• Threatening preterm birth (threat of preterm birth);
• Beginning premature birth;
• Started premature birth.

Thus, the concept of "threatened preterm birth" reflects the earliest clinical stage of this pathological process. At this stage, labor has still begun, but there is a high risk of this. Therefore, with the threat of preterm labor, a woman should receive treatment aimed at reducing the risk of developing labor. In principle, the term "threat of preterm birth" is identical to the concept of "threat of miscarriage". Just to refer to the same process of termination of pregnancy, depending on its duration, the terms "abortion" and "childbirth" are used.

The threat of premature birth is manifested by severe pulling pains in the lower abdomen or lower back. When examined by a gynecologist, an increased tone and excitability of the uterus is revealed. If a pregnant woman feels severe pain in the abdomen, which is dense to the touch, then you should immediately contact an obstetric hospital ( maternity hospital Department of Pathology of Pregnancy) to receive treatment aimed at preventing preterm birth.

Risk of preterm birth

There is a risk of preterm birth in women suffering from infectious diseases of the genital area, isthmic-cervical insufficiency, severe diseases of the internal organs, chronic stress or living in unsatisfactory conditions. In general, we can say that a high risk of preterm birth is created if there is a hormonal imbalance in the woman's body, infections of the genital organs, or disorders of the blood coagulation system.

That is, premature birth develops when a woman's pregnancy occurs against the background of any factors that adversely affect the woman's physical and mental state. If these factors appear in a woman's life, then the risk of preterm birth increases significantly. And when adverse factors disappear from a woman's life, the risk of preterm birth is reduced to a minimum. This means that this risk is manageable, it can be completely reduced by applying treatment methods that can minimize or completely disable the influence of a negative factor.

The following factors increase the risk, that is, contribute to the development of premature birth:

• Stressful situations in which a pregnant woman finds herself in the family or at work;
• Unsettled personal life (a woman is not married, scandals with her husband, a state of readiness for divorce, etc.);
• Low social level;
• Unsatisfactory living conditions in which a pregnant woman lives;
• Heavy physical labor;
• Unsatisfactory, low-quality nutrition with a low content of vitamins;
• Young age of a pregnant girl (under 18 years old);
• Mature or elderly age a pregnant woman (over 35 years old);
• Any episode of fever;
• Severe chronic diseases that a pregnant woman has (hypertension, diabetes mellitus, heart disease, thyroid gland, etc.);
• Exacerbation or acute onset of any genital infections;
• Severe anemia (hemoglobin concentration less than 90 g/l);
• Drug use or smoking during pregnancy;
• Work in hazardous industries;
• Severe course of any viral infection, including SARS;
• Isthmic-cervical insufficiency;
• Malformations of the uterus;
• Overstretching of the uterus with polyhydramnios, multiple pregnancy or large fetus;
• Surgical interventions or injuries suffered by a woman during pregnancy;
• kidney pathology;
• Placenta previa or abruption;
• Intrauterine infection of the fetus;
• Anomalies in the development of the fetus;
• bleeding during pregnancy;
• Hemolytic disease of the fetus in Rh-conflict pregnancy;
• Premature rupture of membranes (PROM).

The listed conditions are risk factors for preterm birth, that is, they increase the likelihood of abortion, but are not the causes of this pathology.

Premature birth in the period of 22-27 weeks of pregnancy most often occurs with isthmic-cervical insufficiency, intrauterine infection of the fetus or PROM. Given the risks of preterm birth in terms of 22 - 27 weeks, they are most often observed in women who are carrying more than their first pregnancy. In women who are pregnant for the first time, preterm birth, as a rule, occurs in terms of 33 to 37 weeks.

Currently, obstetricians have identified the following curious pattern: the later the term of preterm birth, the greater the number of causes and possible risks that can provoke them.

Causes of preterm labor (what causes preterm labor)

The whole set of causes of preterm birth is usually divided into two large groups:
1. Obstetric and gynecological factors;
2. Extragenital pathology.

Obstetric and gynecological factors include various diseases and violations of the functions of the genital organs, as well as complications of the current pregnancy. The factors of extragenital pathology of preterm birth include any diseases of various organs and systems, with the exception of the genital ones, which negatively affect the course of pregnancy.

Obstetric and gynecological causes of preterm birth include the following factors:

• Isthmic-cervical insufficiency, which is the failure of the muscular layer of the uterus in the region of its neck, as a result of which the fetus is not retained in the uterus;
• Any infectious diseases of the genital organs. The infectious-inflammatory process provokes a violation of the normal functions of the muscular layer of the uterus, as a result of which the organ loses its usefulness. The most common direct cause of preterm birth due to sexual infections is the loss of elasticity of the uterus, which cannot expand to accommodate an ever-increasing fetus. When the uterus can no longer stretch, preterm labor occurs;
• Excessive stretching of the uterus during multiple pregnancy (twins, triplets, etc.), polyhydramnios or just a large fetus. In this case, the immediate cause of premature birth is the achievement of the maximum possible size of the uterus before the end of the pregnancy. The uterus, which has become very large, "gives a signal" that labor can begin;
• Malformations of the uterus (for example, bicornuate, saddle uterus, etc.);
• Premature placental abruption;
• Premature rupture of membranes;
• placenta previa;
• antiphospholipid syndrome;
• The presence of miscarriages, missed pregnancies or premature births in the past;
• The presence of abortions in the past;
• A small interval (less than two years) between two subsequent pregnancies;
• Large parity of births (fourth, fifth or more births);
• Anomalies in the development of the fetus;
• Intrauterine infection in the fetus;
• Hemolytic disease of the fetus in Rh-conflict pregnancy;
• Bleeding or the threat of miscarriage, noted in the earlier stages of pregnancy;
• Pregnancy resulting from the use of assisted reproductive technologies (for example, IVF, ICSI, etc.);
• Severe gestosis. In such a situation, the pregnancy threatens the woman's future life, and doctors induce an artificial premature birth in order to save the woman's life.

Among the extragenital pathology, the following diseases and conditions can be the causes of premature birth:

• Endocrinopathy - disorders of the endocrine glands (for example, thyroid gland, adrenal glands, ovaries, pituitary gland, etc.);
• Acute infectious and inflammatory diseases of any organs, for example, tonsillitis, pyelonephritis, influenza, etc.;
• Any kidney disease;
• Diseases of the cardiovascular system (hypertension, heart defects, arrhythmia, rheumatism, etc.);
• Diabetes;
• Joint diseases;
• Surgical operations performed during pregnancy. The most dangerous are surgical interventions on the organs of the abdominal cavity and small pelvis;
• The age of the woman. The risk of preterm birth is especially high at a young (under 17 years old) or older (over 35 years old) age. In young girls, premature births are due to the unpreparedness and immaturity of the reproductive system, and in older women, due to acquired severe chronic diseases.

In 25 - 40% of cases, preterm labor is provoked by premature rupture of the membranes (PROM).

Regardless of the specific causative factor, preterm labor can begin when one of the following three mechanisms is activated:
1. Enhanced production of biologically active substances in the inflammatory process;
2. The formation of microthrombi in the vessels of the placenta due to increased blood clotting, which leads to its death and subsequent detachment;
3. An increase in the number and activity of oxytocin receptors in the muscular layer of the uterus, which provoke the opening of calcium pumps in cell membranes. As a result, calcium ions enter the cells of the myometrium, an increased concentration of which causes labor.

Premature birth - symptoms (signs)

Symptoms of preterm labor are similar to those of normal term delivery. The most characteristic signs of preterm labor are the following:

• Drawing, cramping pain, localized in the lower abdomen and lower back;
• Feeling of pressure and fullness in the genitals;
• Urge to defecate.

If there was a premature rupture of the membranes, then the woman has a liquid discharge from the genital tract. If a lot of amniotic fluid has leaked out, then the volume of the woman's abdomen decreases so much that it becomes very noticeable.

According to the clinical stages, preterm labor can be threatening and incipient. Threatened births are characterized only painful sensations in the lower abdomen and lower back of a pulling nature. The intensity of the pain is the same, it does not increase or decrease. The abdomen is tense and hard. If childbirth begins, then the pain becomes cramping and gradually intensifies.

The correlation between the onset of symptoms and the actual risk of preterm birth is as follows:

• Painful cramping pains in the lower abdomen and regular uterine contractions - the risk of premature birth is very high;
• Drawing pains in the lower abdomen and lower back - the risk is very high;
• Bleeding from the vagina is a high risk;
• Watery vaginal discharge is an average risk;
• A sudden change in the activity of the fetus (sudden upheavals, active movements and, on the contrary, a complete cessation of movements, etc.) is an average risk.

Premature birth must be distinguished from acute pyelonephritis, renal colic, appendicitis, malnutrition of the myomatous node of the uterus, which are also accompanied by severe pain in the abdomen and lower back.

Treatment of preterm birth

Currently, the treatment of preterm labor is being carried out, the main goal of which is to stop labor and continue the pregnancy as long as possible.

With the threat of premature birth, a woman must be hospitalized in the department of pathology of pregnant women of the maternity hospital in a separate box. If childbirth has not yet begun, then tocolytic drug and non-drug therapy is carried out. And if childbirth has already begun and it is no longer possible to stop them, then the woman is transferred to the maternity ward and the neonatologist is warned about the birth of a premature baby.

Non-drug treatment of the threat of premature birth is carried out by providing a woman with sexual, physical and emotional rest, as well as bed rest. Moreover, you should lie in bed with a raised foot end. In the presence of appropriate equipment and qualified specialists, physiotherapeutic methods are used, such as magnesium electrophoresis, acupuncture and electroanalgesia.

Drug treatment of preterm birth includes the following aspects:

• Tocolysis - relaxation of the uterus and stopping labor;
• Sedative and symptomatic therapy - soothes a woman, relieves tension and relieves stress;
• Prevention of respiratory distress syndrome (RDS) in the fetus if delivery occurs approximately before 34 weeks of gestation.

Tocolysis is carried out at beginning or threatening preterm labor. The essence of tocolytic therapy is to suppress the contractile activity of the uterus and, thereby, the termination of labor. Currently, drugs from the group of beta2-agonists (Fenoterol, Hexoprenaline, Salbutamol) and magnesium sulfate (magnesium) are used for tocolysis. Adrenomimetics to enhance efficiency are recommended to be used in combination with calcium channel blockers (Verapamil, Nifedipine).

Hexoprenaline (Ginipral) to prevent preterm birth is first administered intravenously and then given in tablet form. Ginipral is administered intravenously in large doses, and after the effect is achieved, women switch to taking the drug in tablets at a low maintenance dosage.

Fenoterol and Salbutamol are used only for emergency relief of preterm labor. Administered intravenously in glucose solution. After stopping labor activity with Fenoterol or Salbutamol, a woman needs to switch to Ginipral tablet forms, which are taken in a maintenance dosage.

To enhance the effectiveness of Fenoterol, Salbutamol or Ginipral to stop the onset of preterm labor, they are used in combination with Verapamil or Nifedipine (calcium channel blockers). Moreover, Verapamil or Nifedipine is taken half an hour before the intravenous administration of adrenomimetics. Calcium channel blockers are used only at the stage of stopping the threat of preterm labor, and when switching to maintenance therapy with Ginipral tablets, they are canceled.

Magnesium sulfate (magnesia) for the relief of premature birth is administered intravenously in the form of a 25% solution. However, the effectiveness of magnesia is lower than that of adrenomimetics. Therefore, magnesia for tocolysis is used only if adrenomimetics are contraindicated or inaccessible to a woman for any reason.

Sedative therapy in the complex treatment of preterm birth is necessary to eliminate psychological and emotional stress in a pregnant woman. Currently, Oxazepam or Diazepam are used as the most effective drugs that relieve stress and relieve anxiety in preterm birth. If necessary, antispasmodic drugs are administered - No-shpu, Papaverine or Drotaverine. To reduce the production of prostaglandins, which can trigger the mechanism of premature birth, Indomethacin is used in the form of rectal suppositories, which are injected into the anus daily in the evening from 14 to 32 weeks of pregnancy.

Prevention of fetal respiratory distress syndrome (RDS). If there is a threat of preterm labor between 25 and 34 weeks of gestation, then glucocorticoids are administered to prevent RDS, which are necessary for the accelerated maturation of the surfactant in the lungs of the infant. If a baby is born without surfactant covering the lungs, the alveoli will collapse and will not open when inhaled. The result of RDS can be the death of a newborn. Glucocorticoids lead to an accelerated synthesis of surfactant, as a result of which even a very premature baby will be born without RDS. Currently, for the prevention of RDS, Dexamethasone and Betamethasone are used, which are administered intravenously several times over two days. If necessary, glucocorticoids can be re-administered after 7 days.

Prevention of preterm birth

The best prevention of preterm birth is preparation for pregnancy, which includes the diagnosis and treatment of infectious diseases and the achievement of a stable controlled course of the existing chronic pathology. After the onset of pregnancy, the prevention of preterm birth consists in regular monitoring of its course, timely treatment of detected complications or diseases, and hospitalization in a hospital at "critical times" (4-12 weeks, 18-22 weeks and days on which menstruation would go), when the risk is highest. The hospital provides preventive therapy aimed at maintaining pregnancy.

Pregnancy after preterm birth

It is advisable to plan pregnancy after premature birth in advance, having passed a detailed examination of all internal organs, and not just the genitals, before this crucial moment. It is imperative to donate blood to determine the concentration of thyroid hormones, the deficiency of which can provoke repeated preterm birth. In addition, it is recommended to do an ultrasound of the abdominal organs, examine the heart and donate blood to determine the concentration of hormones and immunity indicators. If a woman has any serious diseases of the internal organs (for example, diabetes mellitus, hypertension, pancreatitis, etc.), then a course of treatment should be taken before pregnancy, which will control the course of the pathology. In addition, it is recommended to create the most comfortable domestic, psychological and emotional conditions for the future bearing of a child. Careful monitoring of the course of pregnancy and timely treatment of complications, as a rule, leads to normal gestation after preterm birth. Pregnancy after premature birth occurs quite normally and quickly.

Childbirth after preterm birth

Childbirth after preterm birth usually proceeds normally. If the cause of premature birth has been eliminated, then the next pregnancy is quite normal and with a high degree of probability the woman informs to the end and will give birth to a full-term, healthy baby. The risk of complications during childbirth after preterm birth is not higher than the average.

How to induce preterm labor

In order to induce premature birth, the following drugs are used:

• Dinoprostone;
• Dinoprost;
• mifepristone + misoprostol;
• Oxytocin.

These drugs provoke labor activity, as a result of which the baby is born prematurely. To induce premature birth, it is necessary to administer drugs in certain dosages and according to strict schemes, taking into account changes in the woman's condition, which is possible only in a hospital setting. Due to the fact that premature birth for a woman is much more dangerous than timely ones, you should not try to cause them yourself.

Premature birth test

Currently, there is a test system for determining the onset of preterm labor, which is called Aktim Partus. This test is based on the detection of insulin-like growth factor-1 (IGFFR) in the mucus of the cervical canal, which is secreted by the fetal membranes of the fetus in in large numbers a few days before the upcoming birth. The test at home cannot be performed, since so far it is available in modification only for a qualified medical staff. Unfortunately, the accuracy and sensitivity of this test for preterm birth is not very high, so you cannot absolutely rely on its results.

Today, there is a test for preterm rupture of membranes (PROM) that can also be used to diagnose preterm birth. The PROM test can be used at home and is fairly accurate. If the test for PROM is positive, then the woman is at high risk of preterm birth and should be admitted to the maternity hospital immediately.

Preterm birth: resuscitation, nursing and rehabilitation
premature baby - video

There are contraindications. Before use, you should consult with a specialist.

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 driven by new medical advances and establishes more early term- 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.

Premature birth 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 exercise, fatigue

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, restriction 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 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, lack of 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 the previous mode of 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. Repeated 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 future mom is able to recognize preterm birth 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 such a situation? This is where the support of loved ones is needed. Plus your own attitude: it is important to understand that premature baby needs a lot of care and attention. 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 born prematurely may require an increase in this 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. Hormonal background practically unformed. Bones and rudiments of teeth are insufficiently mineralized.

But the main problem- 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 endocrine system 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:

1. Plan pregnancy, and even before conception, carry out the maximum sanitation (improvement) of the whole organism. The future father should do the same.
2. Have you already had an abortion, or a premature birth? You are at risk, be careful.
3. 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. Good nutrition, exclusion of harmful factors and regular visits to doctors will help you almost 100% avoid preterm birth.

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. The most common causes of CI 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. Large uterine fibroids or submucosal 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 mellitus.

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 a hemolytic disease in a child, pregnancy often ends in premature birth, more often operative (caesarean 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 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 the possible development of infection.

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.

In accordance with the definition, preterm births are those that occur between 22 and 36 weeks of gestation at the birth of a fetus weighing 500 grams or more, lived for more than 7 days.

The frequency of preterm birth is from 6 to 15%. The highest frequency of preterm births is observed in economically developed countries due to the widespread use of assisted reproductive technologies (in vitro fertilization - test-tube babies, artificial insemination - the introduction of the partner's sperm into the uterus), the older age of pregnant women, the presence of more stress in everyday life .

Classification of preterm birth

Preterm birth is divided into threatening, beginning and begun.

- Threatened preterm birth characterized by the absence of regular labor activity, periodic or constant increase in the tone of the uterus, the absence of structural changes in the cervix (smoothing, opening).
- Incipient preterm labor are characterized by weak regular labor activity (less than 4 contractions in 10 minutes), leading to structural changes in the cervix, as a result of which it is smoothed out, and the opening is less than or equal to 3 cm.
- Started premature birth characterized by active labor activity (10 contractions in 10 minutes), opening of the cervix more than 3 cm.

Risk factors for preterm birth

Causes of preterm birth

At the current level of development of medical science, it is not possible to fully elucidate the causes of preterm birth, however, it is believed that the development mechanism depends on the hormonal status and the presence of infections in the mother's body. Unfortunately, in most cases it is not possible to find out the mechanism for the development of preterm labor, therefore it is generally accepted that in each individual case there is a combination of several factors.

Signs of preterm labor

Clinically, the threat of preterm labor is manifested by complaints of pain in the lower abdomen (sometimes patients describe them as menstrual pain) and pain in the lower back of a aching nature, a feeling of tension in the uterus may appear (“the stomach becomes like a stone”). Often there are complaints of frequent urination and increased motor activity of the fetus. With an external obstetric examination, the uterus is easily excitable, the presenting part is pressed against the entrance to the small pelvis. The discharge may be copious, mucous, clear, sometimes brown (cervical mucus), which may also be the main complaint and, from the point of view of the pregnant woman, the only symptom. If treatment is not started at this stage, then an increase in the tone of the uterus will lead to the development of weak labor activity (less than 4 contractions in 10 minutes), smoothing and opening of the cervix up to 3 cm inclusive, i.e. to incipient preterm labor. Further, in the absence of treatment or with its ineffectiveness, active labor activity develops, the cervix opens by more than 3 cm, and they are already talking about the onset of premature birth, the result of which is the birth of a premature fetus.

Diagnosis of threatened preterm birth

To make a diagnosis, it is necessary to conduct external and internal obstetric studies. Of the additional research methods, ultrasonic assessment of the length of the cervix, the width of the cervical canal and the shape of the internal os using a transvaginal (vaginal) sensor, as well as cardiotocography (simultaneous graphic recording of uterine contractions and fetal heartbeat) are very important.

Treatment aimed at maintaining pregnancy

Treatment, as a rule, is carried out in a hospital and is aimed at prolonging (preserving) the pregnancy. Fetal malformations that are incompatible with life are a contraindication to prolongation of pregnancy. In other cases, they try to save the pregnancy.

The duration of hospitalization is individual in each individual case, and depends on: the activity of labor at the time of treatment, the degree of opening of the cervix, the integrity of the membranes, the intrauterine state of the fetus, the presence of pregnancy complications and, of course, the effectiveness of treatment. Usually at least 2 weeks.

In the case when the continuation of pregnancy is not advisable, i.e. it can lead to serious complications, both on the part of the mother and the fetus, the doctor, having previously informed the patient, decides on the method (through the natural birth canal or caesarean section) and the timing of delivery. The approach to the method of delivery, again, is individual in each case and depends on many reasons: the condition of the birth canal, the condition of the fetus and its position in the uterus, the presence of intrauterine malformations, the gestational age, the presence or absence of rupture of amniotic fluid and the duration of anhydrous gap, the presence of diseases or anomalies in the development of the uterus or other soft tissues of the birth canal, concomitant diseases of the mother.

Treatment of preterm birth should include 4 components:

1. Tocolytic therapy, i.e. treatment aimed at reducing uterine contractile activity. There are several groups of tocolytic (removing contractile activity of the uterus) drugs:
- β-agonists: ginipral, partusisten, terbutaline, salbutamol. Currently, the most effective and safe drug of this series is ginipral. The drug exists in forms for intravenous administration and oral administration. In emergency cases, to relieve increased tone, the drug is used intravenously for 4-12 hours, after which they switch to a tablet form.
- calcium channel blockers: nifedipine. The drug exists in tablet form for oral administration. In emergency cases, appoint 10 mg (1 tablet) every 20 minutes 4 times, then switch to a maintenance dose of 10 mg (1 tablet) every 8 hours.
- magnesium sulfate 25% solution of magnesium sulfate, which is used only intravenously. Due to the presence of side effects to relieve the contractile activity of the uterus, it is used in extreme cases, when for one reason or another other drugs are contraindicated.
- inhibitors of prostaglandin synthetase: indomethacin. It is prescribed mainly rectally, the course dose is 1000 mg. Applied from 16 to 31 weeks of pregnancy due to the presence of certain side effects.

2. Prevention of fetal respiratory distress syndrome(RDS), which is the second most important (the first - intrauterine infection) cause of death in preterm infants born before 34 weeks of gestation. Until this time, the fetal lungs are "immature" and unable to breathe spontaneously. For this purpose, drugs from the group of corticosteroids (adrenal hormones) are used intravenously or intramuscularly, namely: betamethasone, dexamethasone, celeston, dexazone, etc. It takes at least 48 hours to achieve the desired effect.

3. Pain relief and sedation therapy(sedative). With threatening and beginning preterm labor, analgesics are prescribed (painkillers, such as: analgin, ketorol), possibly in combination with antispasmodics (no-shpa, baralgin, papaverine). With the onset of preterm labor, for the purpose of pain relief, the appointment of epidural anesthesia is indicated, which is the most effective method. For this purpose, local anesthetics such as lidocaine, naropin, marcaine are used. Unfortunately, epidural anesthesia is not always possible, which may be due to the patient's contraindications for this method of anesthesia, or the lack of obstetric conditions (too much opening of the cervix). In such cases, antispasmodics and analgesics are used: analgin, no-shpa, baralgin, baralgetas, atropine, papaverine. Of the sedatives, the use of valerian is possible.

4. Antibiotics prescribed for prophylactic purposes, tk. most common cause preterm birth is the presence of infection in the mother's body. This precaution helps to avoid inflammatory postpartum diseases in the mother and helps to prevent infection of the fetus / start treatment if infection has already occurred.

Treatment at different stages and for different reasons is different; yes, if available threatening preterm birth tocolytic drugs are administered orally or rectally, antispasmodics, sedatives(e.g. valerian), treat existing/new infections. At this stage, both outpatient and inpatient treatment is possible, depending on the situation in each case.

With isthmicocervical insufficiency, it is possible to suture the cervix to avoid its premature opening.

Treatment incipient preterm labor carried out only in the hospital. It is necessary to use tocolytic drugs (which can be prescribed both in the form of an infusion (dropper), followed by the transition to tablets, and initially in the form of a tablet form with a special dosing regimen), preparation of the fetal lungs. It is possible to use antispasmodic drugs and analgesics (see above). They try to prolong pregnancy for at least 48 hours from the moment of prophylaxis of fetal RDS.

Patients with initiating preterm labor are hospitalized, prepare the lungs of the fetus and prepare for delivery. The use of tocolytic drugs at this stage in some cases is inappropriate and ineffective due to the patient's too late seeking medical help from the patient's visit to the doctor.

The success of treatment directly depends on the obstetric situation, the duration of pregnancy, the presence of pregnancy complications, the presence of rupture of amniotic fluid, the presence of a live fetus and the timeliness of the patient's visit to the doctor. Other things being equal, the chances of giving birth to a practically healthy baby with adequate preparation for childbirth increase dramatically from 34 weeks of pregnancy.

The course of preterm labor and tactics of management

The peculiarity of preterm birth is that up to 36 weeks there is an "incorrect" contractile activity of the uterus. Due to certain circumstances, labor anomalies are more common, such as uterine hypertonicity and discoordination (irregular contractions of different strength). With hypertonicity, contractions are frequent (more than 4 in 10 minutes), more intense, the interval between them is very short, as a result of which the uterus does not have time to completely relax. The consequence of this is a shorter duration of labor, which is also associated with the smaller size of the fetus. In the early postpartum period, uterine bleeding is common due to over-relaxation of the uterus.

Why preterm birth is dangerous: due to the immaturity of organs and systems, the fetus often experiences hypoxia during childbirth, and damage to the fetal brain is one of the most common complications of preterm birth.

In connection with the foregoing, the tactics of conducting preterm labor is individual in each case, but for the most part, preterm labor is carried out through the natural birth canal with anesthesia (the most effective method- epidural anesthesia, which, moreover, has a normalizing effect on contractions), using expectant tactics. An episiotomy (dissection of the perineum) is mandatory, which reduces the risk of birth injury to the fetus.

Obstetrician-gynecologist Kondrashova D.V.

Nowadays, preterm births have become quite common. Despite modern medical equipment that allows us to nurse premature babies even in very severe cases, we all understand that it is better if the growth and development of the child to the physiological norm occurs in the mother's womb, and not in an incubator, albeit an ultramodern one. That is why the threat of preterm birth is the number one fear among the "pregnant audience".

The problem of premature birth is quite serious, of course, that talking about this will not raise the mood of the expectant mother! But you should not worry and be afraid ahead of time either, because the probability of a successful delivery is much higher than the birth of a baby prematurely. In addition, if you know the signs of the onset of preterm labor and take the necessary measures in time, then the baby can be prevented from being born ahead of schedule. We'll talk about this a little lower.

What is preterm birth?
Premature birth is always associated with the struggle for survival, with a long, difficult and expensive treatment aimed at the recovery of the baby. I note that such cases do not always have a happy ending. The earlier the period at which the pregnancy was interrupted, the more often babies have vision problems, severe neurological disorders, etc. It is difficult to overestimate the risk of an early birth for a baby, because his body is simply not ready for independent functioning: the lungs, the gastrointestinal tract are not ready, his body cannot maintain body temperature, etc.

There are cases when induction of premature birth is simply necessary (for medical reasons or at the request of the pregnant woman). According to Russian legislation in our country, abortion can be carried out up to 22 weeks, this is no longer considered an abortion, but premature birth, despite the fact that they are classified as a late miscarriage. If a week after such an interruption of pregnancy, the child remains alive, then such births are classified as early premature, and the surviving fetus is considered a child.

The method of carrying out premature birth is determined by an obstetrician-gynecologist, taking into account the reasons that caused them. If the birth canal is not ready, and if the causes are late toxicosis, which is a threat to the life of the mother, eclampsia or convulsions, a caesarean section is performed, despite the almost complete absence of a chance that the child will survive.

If time does not play a role or abortion is carried out for social reasons, doctors perform the usual preparation of the birth canal using drugs that cause premature birth.

What kind of birth is considered premature?
Premature births are considered to occur before 37 weeks of gestation. In obstetric practice, there are intervals in which preterm birth can occur:

• for a period of 22 weeks;
• for a period of 22-27 weeks;
• for a period of 28-33 weeks;
• for a period of 34-37 weeks.

Since January 1, 1993, in our country, according to the adopted new criteria for a live birth, recommended World Organization health care, intensive and resuscitation care is provided to newborns with a weight of 500 g, born from the 22nd week of pregnancy. Until 1993, preterm births were considered those that occurred after the 28th week of pregnancy, and resuscitation was only for newborns weighing 1000 g or more.

Babies born at 29, 30, 31 weeks of pregnancy almost always weigh more than a kilogram, their lungs are relatively well prepared for breathing, so they initially have a good chance of survival. But prematurity is not the only problem, often it is associated with hypoxia in labor and before childbirth, natal (birth) trauma (which often leads to the death of babies) and other diseases that caused preterm birth.

Causes and symptoms of preterm labor.

• Endocrine diseases in a pregnant woman increase the risk of preterm birth and problems during pregnancy. These include hormonal imbalance in the genital area, thyroid disease, diabetes mellitus.
• Sexual infections (chlamydia, ureaplasmosis, etc.) that a woman has during the period of bearing a child double the risk of preterm birth. In addition, they can cause disease and malformations in a child. Cervical erosion, chronic salpingitis, endometritis, bacterial vaginosis also pose a threat.
• Somatic infections (SARS, tonsillitis, viral hepatitis, untreated teeth) are a source of infection for the fetus and can provoke premature birth.
• The presence of malformations, anomalies and tumors of the uterus, changes in the cervix and adhesions due to childbirth and abortion in most cases are the factor that provokes the onset of premature birth. Damage to the circular muscles of the isthmus of the uterus (usually during childbirth or during abortion), which prevent its disclosure during the bearing of the baby, leads to the occurrence of isthmic-cervical insufficiency (ICI). With this phenomenon, the cervix, under the weight and pressure of the fetus, begins to open slightly from 16-17 weeks of pregnancy, the fetal bladder “bulges” into it, which becomes infected, as a result, breaks, provoking premature birth.
• Somatic diseases of a non-infectious nature in a pregnant woman (diseases of the kidneys, heart and liver, exhaustion, malnutrition) contribute to the weakening of the body and complicate the course of pregnancy. In this situation, preterm birth occurs very often.
• Malformations of the fetus and the presence of genetic diseases provoke premature birth. Usually the threat occurs already at 32 weeks of gestation.
• Various complications and features of pregnancy are also a risk factor. This includes the expectation of twins (premature births occur against the background of uterine hyperextension), polyhydramnios, complications in the form of preeclampsia in the later stages, feto-placental insufficiency, placenta previa and abruption. All this can also cause premature birth.
• genetic features.
• Abdominal injury.
• The presence of bad habits in the mother.
• Female age under 18 and age over 30 are risk factors.
• Heavy physical labor, lack of sleep, chronic stress, mental strain.
• Poor nutrition and living conditions.
• Incomplete family, unwanted pregnancy.

Premature birth and gestational age

Premature birth at 22-27 weeks.
Children born at this stage of pregnancy have the lowest survival rate, since their lungs are not yet mature, and their weight is in the range of 500-1000 g. The main factors that provoked premature birth at this stage of pregnancy are isthmic-cervical insufficiency, infection of the fetal bladder and his break. A child born at 22-23 weeks has practically no chance of survival, and those few who could survive (and there have been such cases in obstetric practice) become disabled in the future. Those born between 24 and 26 weeks are more likely to survive, and the prognosis for their health is much better. Premature births between 22 and 27 weeks of gestation occur in only five percent of cases.

Premature birth at 28-33 weeks.
Most children born at this term survive safely, which is largely due to the high level of development of neonatological care, however, it is worth noting that not all children have the fact of prematurity without consequences. Typically, children in this group weigh from 1000 to 1800 grams, their lungs are practically prepared for breathing. On the this period Premature birth can occur for a variety of reasons, ranging from pregnancy complications to Rh conflict.

Premature birth at 34-36 weeks.
To be born at this stage of pregnancy for the child is not dangerous. A healthy, but premature baby born in a maternity hospital has every chance of quick adaptation and excellent health in the future. The weight of babies born at this time is usually more than two kilograms, the lungs are ready for independent work, a little support with medicines is required to accelerate their maturation. The main culprits of premature birth at this time are somatic diseases of the expectant mother, various complications of the course of pregnancy and intrauterine hypoxia against the background of feto-placental insufficiency.

Symptoms and signs of preterm labor.
Signs of preterm labor can be compared with the threat of termination of pregnancy in the early stages. Most often, their onset is indicated by the outflow of amniotic fluid, but a few days before this, a woman usually has symptoms-harbingers, to which she usually does not pay attention.

In obstetric practice, there are several stages of preterm birth:

• Threatening premature birth. During this period, the symptoms of premature birth may not even be noticed. These include pulling pains in the lower back and lower abdomen of a weak nature, tension or contraction of the uterus, which can be seen by placing a hand on the stomach (usually it tenses), restless behavior of the baby (kicks more often), the appearance of mucous secretions from the genital tract, sometimes with an admixture of blood (on examination, the uterus is dense and closed). Contacting a doctor at this stage will help to avoid premature birth, usually minimal medication is prescribed and absolute rest is recommended for the pregnant woman.
• Beginning premature birth. Symptoms are more pronounced, in particular, pain in the lower back and lower abdomen become more intense, cramp-like. At this time, the mucous plug often leaves, discharges from the genital tract of a bloody nature are observed, and water is often poured out. During the examination, the specialist reveals the shortening and softening of the cervix, its opening by 1-2 fingers.
• Started premature birth. Usually, if the process of childbirth has begun, it can no longer be slowed down. Often, premature births have a rapid course, for example, in primiparas they pass in 6 hours, with repeated births this time can be halved. The pains become very intense, acquiring a cramping character, and the contractions become regular (every ten minutes or less), the cervix quickly opens, the water leaves, the fetus is pushed to the entrance to the small pelvis.

So, if there are pains resembling pain during menstruation, a feeling of heaviness in the lower abdomen and pressure on the bottom, the activity of the fetus has increased significantly or vice versa weakened, unusual discharge from the genital tract has appeared, you should know that these are the first signs of premature birth. In this situation, in order to “calm down” your “hurry”, you need to seek medical help immediately. Any delay can cost you dearly. In any case, it is better to play it safe in advance than to regret your short-sightedness and carelessness later.

Treatment of threatened preterm birth.
Usually, if a pregnant woman sees a doctor at the stage of threatening preterm labor, she is recommended to be hospitalized in a maternity hospital, but this is not so necessary in all cases. Of course, first a gynecological examination is performed, tests are taken, the condition of the cervix, the child is assessed, the presence or absence of an infection in a woman is revealed.

It is worthwhile to dwell on the leakage of amniotic fluid in more detail. Very often, because of fear, women do not go to the doctor if the water has broken, and the contractions have not yet begun, but in vain. In this case, no one will immediately terminate the pregnancy (there is nothing to be afraid of), especially if its terms have not reached 34 weeks. If there are no signs of infection, the pregnant woman is simply placed in the maternity hospital, where for several days (five to seven or more) specialists will prepare the lungs of the fetus for independent work (glucocorticoids are usually prescribed), while the pregnant woman herself will be protected from infection by antibiotic therapy and the creation of sterile conditions . Delivery will occur only after the lungs of the fetus are ready so that the baby can breathe on its own. Prolongation of pregnancy in case of premature rupture of the membranes is carried out based on the timeliness of treatment and the condition of the pregnant woman at the time of treatment.

With the threat of premature birth for a period of 35 weeks or more with the outflow of amniotic fluid, the pregnant woman is delivered, because the adaptation of such children to extrauterine life is, as a rule, successful. If the amniotic sac is preserved, treatment is aimed at stopping the onset of labor and eliminating the cause that caused it. If there is only a threat of preterm birth, outpatient treatment is sometimes possible, but hospitalization is recommended in most cases. Often, creating a calm environment for a pregnant woman is enough to stop labor activity and continue the pregnancy.

Once the birth process has begun, it cannot be stopped. If the fetal bladder is intact, then drugs are used as therapy, the action of which is aimed at relaxing the uterus, as well as sedative therapy, physiotherapy and bed rest.

If the treatment was unsuccessful, the contractions did not stop, but increase each time, the question of delivery arises.

Danger of rapid premature birth.
As a rule, premature labor, which is of a rapid nature, is always associated with hypoxia, which is due to frequent uterine contractions and too rapid progress of the fetus through the birth canal. Soft bones and small sizes of the fetal head, as well as weak vessels, in combination with the above, can provoke severe birth trauma fetus, intracranial hemorrhage and trauma to the cervical spine. By the way, it is precisely because of the way the birth process proceeded, in the case of premature birth, that a premature baby may suffer, and not because of the fact of prematurity.

If the specialists could not stop the premature birth, then they do everything to ensure that the birth takes place as carefully as possible. No methods are used to protect the perineum from ruptures, as this can cause injury to the fetus. Even in the case of breech presentation of the fetus, childbirth is carried out naturally (in the absence of contraindications), and in hospitals all conditions have been created for nursing newborns. In the case of deep prematurity, a caesarean section is performed.

In the case of discoordinated labor activity or its weakness, gentle labor is performed with thorough anesthesia, careful stimulation with simultaneous monitoring of the fetal condition.

If the pregnancy was prolonged after the outflow of amniotic fluid, there is a high probability of developing endometritis and postpartum hemorrhage. Preterm birth at 35 weeks has virtually no complications.

Caesarean section for preterm birth is not used if the fetus is not deeply full-term, and there are clear signs of chorioamnionitis and intrauterine infection, as well as in the case of intrauterine death of the fetus.

In these situations, natural childbirth is necessary, a caesarean section poses a threat to the life and health of a woman.

Prevention of preterm birth is to eliminate the factors that cause them even at the stage of pregnancy planning. Therefore, it is very important to be healthy at the time of pregnancy, or if it happened by chance, it is necessary to register and undergo an examination as soon as possible.