Nature has conceived a certain duration of pregnancy in a woman. It is 10 lunar months or 9 calendar months - the very period that a child needs to grow up and mature, to be ready for life outside the mother's womb. The female body is given this period for optimal preparation for the birth process. Premature birth is a big risk for the mother and especially for the baby. In this article we will tell you why labor begins early, what the consequences can be, and how to avoid premature birth.
What it is?
This term refers to childbirth that begins between 22 and 37 weeks of pregnancy, inclusive. Until recently, in Russia, a child who was born from 22 to 28 weeks was considered a late miscarriage, a child in the full medical sense of the word began to be considered only when he managed to survive for a week. From that moment on, the fact of birth could be documented. In 2012, it was decided to change the criteria, since the intensive care service has stepped forward, and doctors have learned to care for seriously premature babies.
The existing classification divides early childbirth into threatening (threat state), incipient (first signs) and incipient (labor activity), and the latter option is irreversible. According to statistics, up to 13% of pregnancies are completed by the premature birth of a child. At the same time, they begin spontaneously in about 80% of cases, another 20% are childbirth that had to be provoked artificially if there were strict medical indications.
About half of preterm labor occurs with a whole fetal bladder and with contractions. Up to 40% of premature births are not accompanied by contractions, but proceed against the background of early rupture of amniotic fluid. Artificially provoked childbirth is usually prescribed for emergency indications - a serious condition of the mother with a threat to her life, aggravated and deteriorating well-being of the fetus, its death, developmental abnormalities that are incompatible with the life and further development of the child.
Statistics show that approximately 5% of all early births begin at 22-28 weeks. At the same time, children are considered deeply premature, their weight is less than a kilogram and their survival prognosis is extremely unfavorable.
15% of all premature births occur between 28 and 31 weeks. Babies are considered severely premature, but the chances of salvation are more favorable. Every fifth birth prematurely occurs, according to statistics, for the period from 31 to 34 weeks. Most preterm labor occurs between weeks 34 and 37.
Despite all the achievements of modern medicine, new drugs and precise equipment, it is not possible to reduce the percentage of premature births. Unfortunately, up to 70% of babies die in the first few days in the event of their hasty birth, despite all the efforts of resuscitators. The risk of stillbirth is 13-15 times higher than that of a full-term pregnancy. Almost half of seriously premature babies who managed to survive suffer from severe disorders of the nervous system, including such disorders - cerebral palsy, blindness and deafness, sometimes deaf-blindness, severe ailments of the heart and respiratory system.
Causes
There is no clear and unified theory explaining the reasons for the violation of natural mechanisms and the mechanisms of development of preterm labor. Since there are so many risk factors, in most cases, obstetricians-gynecologists cannot establish the true root cause. Therefore, it is not possible to predict such childbirth. But a huge number of factors that can provoke premature birth, still managed to systematize and conditionally divide into several categories:
- maternal risk prerequisites;
- prerequisites for the course of pregnancy;
- socio-biological conditions.
The first group includes a burdened obstetric history. Most often, patients who have had several abortions, who underwent curettage of the uterine cavity for therapeutic or diagnostic purposes, give birth ahead of schedule. Any operations on the uterus in the past are a potential risk of developing labor ahead of schedule. Also, very often women who have already had a premature birth give birth prematurely.
The second group is very numerous. The current pregnancy and its possible pathologies are sometimes crucial. Expectant mothers with polyhydramnios and oligohydramnios have a high risk of giving birth prematurely. Against the background of an early rupture of the fetal sac or its tear, pre-term labor begins quite often. The chances of pathological pre-term birth are also increased in patients with cervical weakness (with isthmic-cervical insufficiency), as well as in those who have cervical diseases related to precancerous.
Presentation of the "child's seat", sexual diseases (especially ureaplasmosis, cytomegalovirus infection and chlamydia), infections (rubella, chickenpox, influenza) already during pregnancy, problems with the cardiovascular system, diabetes mellitus, preeclampsia and hypertension - this is not a complete list diagnoses in which doctors first of all think about the fact that a woman has a high risk of giving birth prematurely.
Some features of the baby's condition during pregnancy are also considered dangerous and alarming, for example, the presence of genetic pathologies, hemolytic disease, which developed against the background of a Rh conflict with a mother who has a negative Rh factor.
The third group of risk factors includes the low social status of the pregnant woman, her malnutrition, chronic vitamin deficiency, the use of alcoholic beverages, smoking, and drug use during the period of gestation. This also includes constant stress, as well as the age of the pregnant woman (under 18 years old or after 40 years). A provoking factor is also the difficult working conditions of a woman during the period of bearing crumbs.
It is important to know that the likelihood of early birth increases when twins or triplets are carried, with the pelvic location of the fetus in the uterine cavity. Also, most often, boys decide to be born ahead of time - the male sex of the baby is considered by specialists as a separate risk factor.
Symptoms
Since there are many risk factors identified, the clinical picture can be different, it all depends on how many factors and which of them are combined together in a single case. To understand at what stage a woman is, it is imperative to assess the contractile activity of the reproductive organ, the integrity and intactness of the membranes and changes in the birth canal.
If a woman has a threatening premature birth, then in most cases there are unpleasant, bothersome and prolonged pulling pains in the lower back, in the lower abdomen, increased tone of the muscles of the uterus and its episodic contraction. When threatened, the child begins to move more actively, he is worried, movements are almost constant and sometimes painful. Vaginal discharge may appear like ichor.
Beginning premature labor is characterized by rather strong pain in the abdomen. There are regular contractions, the cervix is ​​shortened, smoothed out ahead of schedule, a mucous plug can leave the place in the cervical canal. Pink or bloody discharge appears, often diagnosed with leakage or complete outflow of amniotic fluid. The onset of childbirth manifests itself in almost the same way as childbirth during a full-term pregnancy - the contractions increase, the interval between them decreases, the baby's head drops and presses against the exit into the small pelvis, the water leaves.
It should be noted that the waters are poured out ahead of time during such childbirth in most cases. The contractions themselves are quite often discoordinated. Childbirth can be rapid or protracted, and there is an increased risk of placental discharge before the baby is born. In this case, severe bleeding develops. Babies in such births often experience hypoxia, and complications after the end of labor are more likely for the mother and fetus than for a full-term pregnancy.
Diagnostics
Since there are no specific symptoms in principle, and there are many factors that cause early labor, it is difficult to diagnose pathological labor ahead of time. The only way, a kind of "gold standard" of diagnosis is to determine the presence of fibronectin in secretions from the genital tract. If a woman does not threaten early childbirth, then this substance is not found in the secretions. Fibronectin usually appears in the early stages and before childbirth, when the body begins to prepare for the birth of a baby.
For a long time in Russia, a special test for the determination of fibronectin was not used due to its absence, while in Europe the technique has been known for a long time. Today in our country there is a test system "Aktim Partus". It is this system for determining the readiness of the cervix that is able to catch traces of the desired substance in the vaginal discharge. The downside is that a woman cannot conduct a test at home, it is done in a hospital.
A positive result does not at all mean that childbirth will occur in the near future. It may well be several weeks before the start of the fights, and therefore the accuracy of Aktim Partus leaves much to be desired. Also, tests for rupture of the membranes are used - PRPO.
Home systems are not very accurate, but special tests for amniosensitivity in a gynecological hospital or maternity hospital can give a more accurate answer to the question of whether there is a threat of premature birth, whether it begins.
In addition to tests, a woman with complaints resembling a clinical picture, similar to giving birth ahead of time, is shown a transvaginal ultrasound to determine the length of the cervix. If the ultrasound examination reveals the length of the cervix of 3 centimeters or more, the probability of giving birth within a week does not exceed 1%. But already with a length of 2.5 centimeters, the risk of childbirth rises to 6%.
If pain in the lower back and in the lower abdomen appears for a period of 22 to 37 weeks, the woman should be immediately taken to the hospital, and already there the doctors will find out what these pains may be associated with. It should be noted that in more than 60% of pregnant women, such signs have nothing to do with the threat of premature delivery. They can be caused by problems with the intestines, kidneys and urinary system, and the threat of rupture of the uterus along the old scar after a cesarean section or surgery, if any.
Help
If a woman suspects any of the stages of premature pathological childbirth, she cannot be at home - she must go to a hospital and be under round-the-clock supervision of medical specialists. If a threat or early labor is established, it is still quite possible to preserve and prolong the pregnancy in order to give the necessary time for the baby's lungs to ripen. It depends on whether they can open up whether the child will live, whether he can be saved.
With the onset of labor, prolongation of pregnancy is impossible, they begin to urgently choose the tactics of delivery.
If the situation allows, and a decision is made to prolong the pregnancy, the woman is shown strict bed rest. She is given light sedatives to eliminate anxiety, worries, stress. It is supposed to take antispasmodics that will help prevent increased uterine tone. To help the child's lungs mature faster, glucocorticoids ("Dexamethasone", for example) are injected. Such treatment has its own contraindications, and therefore cannot always be applied.
According to the results of the examination, a woman is prescribed additional symptomatic drugs - "Nifedipine" at high pressure, vitamin preparations with a deficiency of key vitamins in the body, "Utrozhestan" with a low level of the hormone progesterone, which is responsible for the safety of pregnancy and the well-being of the fetus, antibiotics when infections are detected. With isthmic-cervical physical inconsistency and weakness of the cervix, unable to hold the fetus in the uterus, an obstetric pessary or surgical sutures can be applied to the cervix.
They can help even in case of leakage or drainage of water. If the child is still too early to be born in time and there are high risks that it will not be possible to save him, and childbirth has not begun, the woman is also put to bed. She is in a separate clean room. The liners are changed every two hours, only sterile preparations are used. Treatment is aimed at maintaining the ability of the amniotic membrane of the fetal bladder to produce aminotic fluid and partially compensating for the "leak".
At any time, doctors will be ready to deliver if the treatment is unsuccessful. The generic process will also have its own specifics.
Features of conducting
Clinical recommendations for the management of the labor process, which began earlier than the due date, include several important stages. First of all, doctors need to soberly assess the current situation and weigh all the risks. Then choose the method of obstetrics. There are three options: the patient is not provided with obstetric benefits, they are simply monitored for the development of labor, active intervention or a caesarean section for emergency indications.
Much of this choice depends on the duration of pregnancy, because childbirth at 7 months will differ significantly from childbirth at 35 weeks. But in any case, at any time, a woman must be installed CTG sensors in order to monitor the condition of the baby.
Statistics say that more than a third of all generic processes that begin early, proceed with complications and abnormalities: contractions do not have clear coordination, they are very strong or very weak. Therefore, it is allowed to use antispasmodic drugs with them, which will allow to achieve a certain degree of muscle relaxation, as well as epidural anesthesia. It is permissible to use hormonal drugs that will intensify the contractions if they are weak, and also give the woman drugs that will somewhat restrain the uterine contractions if they are very strong. Quite often, with premature birth, there is a justified need for an episiotomy - dissection of the perineum.
The choice in favor of a cesarean section is taken in cases when the child is in an incorrect presentation, when uterine bleeding has opened, there are signs of placental abruption, during the rapid labor that began, the parts of the baby's body, the umbilical cord, fell out of the uterus into the birth canal. Fetal hypoxia is also the basis for an operative delivery.
Potential problems and complications
In a full-term baby, a surfactant is intensively produced in the lungs in the lungs of the mother's last weeks of pregnancy - an active substance that prevents the alveoli from sticking together. The ability of the alveoli to expand and deflate and provides full gas exchange. If the surfactant has not been developed enough (and at 28, 30 weeks of pregnancy this is exactly the case), then the risk of developing distress syndrome - acute respiratory failure, in which spontaneous breathing will be impossible, increases.With each next week, the amount of surfactant increases, and therefore the prognosis for saving a child at 31-32 weeks is higher than at 28 weeks, and at 36 weeks is significantly higher than at 34.
But the probable problems are not limited to distress syndrome alone. Alas, brain disorders are often diagnosed in premature babies, because the structures of the brain also did not have time to mature, and cerebral hemorrhage is often found. The consequences can be very different, it all depends on the severity and depth of the hemorrhage: from mild neurological disorders to severe mental and nervous diseases that will lead to disability. The risk of injury to the cervical spine during physiological childbirth is also increased.
The likelihood of postpartum complications is higher in women in labor. With early birth of a baby, serious ruptures of the perineum, neck, vaginal walls often occur, and after childbirth, such puerperas are more often diagnosed with infectious inflammatory processes in the uterine cavity, infection and long healing of sutures.
If the child was born prematurely
A premature baby can survive and be completely healthy. But even in this case, the first days and weeks of his life will still pass in intensive care. The resuscitation team is present in the delivery room and, when the baby appears, immediately begins to provide him with the necessary set of auxiliary measures. In addition to the distress syndrome, a premature baby is threatened by a rapid loss of heat, because the baby has not yet managed to gain weight and needs an amount of subcutaneous fat. Therefore, the first measures are considered to be the provision of artificial ventilation and warming: the baby is placed in a special incubator, in which a certain humidity and temperature is maintained.
To talk about possible future prospects (although doctors try not to do this, because the situation is, in fact, unpredictable), neonatologists assess the degree of prematurity of the baby. There are four of them:
- the first - the most favorable (childbirth took place at 36-37 weeks, the baby weighs more than 2 kilograms);
- second - the most unpredictable (childbirth took place between 32 and 35 weeks, the baby weighs about 2 kilograms);
- third - heavy (childbirth took place at a period of 28 to 31 weeks, the weight of the child is more than a kilogram);
- fourth - extremely severe, extreme (the child was born earlier than 28 weeks, weight less than a kilogram).
Outwardly, children look disproportionate (the head is large), lanugo can be observed, the skin is wrinkled and red, subcutaneous fat is absent or is present in insufficient quantities. The fontanelles on the head are open and soft.
But the main danger lies not in how the child looks, but in how his internal organs work. They are immature, not ready for independent work. All premature babies are characterized by narrow airways, chest compliance. Breathing, if any, is uneven, shallow.
Due to the immature heart, the baby has an unstable pulse, deafness of heart sounds. Vessels are fragile and very fragile, this becomes the cause of hemorrhages, including into internal organs. Muscle tone is very weak, reflexes are reduced or absent. Such children are more prone to anemia, edema and dehydration (due to immaturity and functional unpreparedness of the kidneys for full-fledged activity), the risk of sepsis is high.
The immunity of premature babies is very weak. If the battle for life in the hospital is won, then in the first 2-3 years, parents will have to provide such children with adequate care in order to prevent frequent viral diseases that can negatively affect the child's health.
Next pregnancy - risks and projections
If a woman has a premature birth, then she should plan her next pregnancy especially carefully and responsibly. Of course, it is still advisable to find and eliminate the reasons that caused early labor, this will increase the likelihood of successful gestation and quite urgent, timely delivery next time. But in practice, it is not always possible to find the cause.
Nevertheless, it is still necessary to undergo a detailed medical examination before planning conception. Due attention should be paid to the health of all organs and systems, not just the sexual health. It is recommended to do an analysis for thyroid hormones, it is their lack that sometimes is the reason for both the first and repeated premature births. It is necessary to do an ultrasound of the abdominal cavity and blood vessels, pelvic organs, ECG, make an analysis for genital infections and other infectious ailments.
According to statistics, the risk of repeated premature birth is high - about 40%. But it is quite possible to reduce it if a woman visits a doctor, takes all the necessary tests on time, goes to a hospital on demand for observation and treatment, and monitors weight gain and blood pressure.
According to the established practice, the same terms are considered dangerous. If a woman suffers from habitual miscarriages, she knows that subsequent miscarriages are most likely exactly at the same time as the previous ones. The same is true for early birth. If a woman gives birth at 30 weeks, then when carrying the next pregnancy, even in the absence of signs of a threat, she will be recommended to spend her 30th week in the hospital, where she will be monitored, provide supportive treatment aimed at preventing possible repetition of a negative scenario.
A woman can become pregnant after a premature birth of a child without any particular difficulties; the pathological end of a previous pregnancy does not have much effect on fertility.
Prevention
It is recommended to pay special attention to the prevention of the development of premature labor. Moreover, all preventive areas are divided into several groups.
- Primary. It is advisable to implement it before pregnancy occurs. It includes contraception, avoidance of curettage and abortion, including vacuum and medication. Women must be informed that they have the prerequisites for premature birth, if such are found at the stage of pregnancy planning. Patients who are planning to conceive using in vitro fertilization should be warned of the high risks. Taking vitamins before conception and in the first months of the onset of pregnancy, according to the latest data from the Ministry of Health, is not considered an effective measure for the prevention of premature birth.
- Secondary. This set of measures is implemented already during pregnancy. It is important to convince a woman not to smoke or take alcoholic beverages while carrying a baby. You should also eliminate the emerging risk factors as they arise: when cervical weakness is detected, make an informed decision on the use of a pessary or suture, with an increased uterine tone, prescribe antispasmodics and hospitalize the pregnant woman in a gynecological hospital for constant monitoring.
Progesterone prophylaxis is considered effective, for women at high risk, drugs containing this hormone in different forms of release can be shown up to 36 weeks of pregnancy.
Reviews of women
According to women, preterm labor often starts unexpectedly. It's not the process itself that scares you, but the possible consequences for the child. According to mothers who nursed such babies, parents will need a huge supply of faith, patience and great love for a newborn. If they believe in a child, then he usually copes, survives and grows to the delight of mom and dad. Refusenik children and babies of desperate mothers survive worse and often become disabled due to the irreversible consequences of prematurity.
For more information on the causes of premature birth, see the next video.
