Premature birth will be considered, if they occur, ranging from 22 weeks of pregnancy and up to and including 37 weeks, producing a count from the first day of the last menstrual period.
spontaneous abortion women at 22 weeks and up to and including 27 weeks falls into a separate category and is not related to premature birth.
Classification of newborn children depends on the body weight at birth.
child born with a weight of up to 2500 grams, will be considered as the result of a low birth weight;weighing up to 1500 grams - a fruit with very underweight;weighing up to 1000 grams - is the fruit of extremely underweight.This division is due to the different prognosis in groups of newborn children.
Newborn children who were born with extremely low birth weight, often there is a strong central nervous system disorders, a variety of neurological disorders, as well as dysfunctional disorders of the respiratory, urinary and digestive system;distinct visual and hearing impairment.
rate of premature birth to all sorts of up to 10% and varies according to gestational age.During 22 weeks of pregnancy and 28th week of pregnancy - it is up to 7% of all cases of premature birth, and in the period from 29 to 34 weeks of pregnancy - it's up to 40% offAll the cases of premature birth, and during the 34 weeks and 37 weeks pregnancy - it's up to 53% of all cases of premature birth.
Preterm birth causes
causes of premature birth are embedded in PROM - Premature leakage of amniotic fluid.In percentage terms, it is up to 38% of all premature births.Another reason appears high incidence of perinatal morbidity - is 30% of all premature births and intrauterine infection of the fetus.Infectious etiology of congenital and hereditary diseases of the fetus in the complex will lead to abortion.Compounding the situation and genital tract infection, hormonal disorders, pregnant women in the hemostatic system and lipid metabolism in obese women.Another reason the threat of adverse pregnancy outcomes may be such as socio - economic, occupational hazards, drug addiction and abuse of tobacco, as well as diseases such as hyperthyroidism , hypertension (high blood pressure), anemia, heart disease, Alzheimer's , a viral infection, isthmic - cervical insufficiency, available earlier in a woman in the history of prematurity, multiple congenital malformations of the uterus, fibroids, multiple pregnancy, polyhydramnios, macrosomia diabetes, surgery during pregnancy, a scar on the uterus and injuriesintra-abdominal bleeding, food poisoning, acute appendicitis.
classification of preterm birth has not been established, but identified the following intervals:
It is 22 - 27 weeks
28 - 33 Week
34 -37 week of pregnancy
mechanism of preterm birth include :
- social indicators
- artificially induced causes
- medical indications
For medical termination of pregnancy is really depending on the term, if the pregnancy and childbirth can harm the health of women and pose a threat to her life, and if the detected anomaly in the development of the fetus.This testimony establishes personally attending obstetrician-gynecologist with a physician profile.For this woman wrote a statement, which is reviewed by the Medical Commission.
Social readings affect the termination of pregnancy on term of 22 weeks, if there is a court decision that a pregnant woman was deprived of parental rights, and there is a court decision to restrict a woman of parental rights, if a woman is deprived of her liberty, and the pregnancy is the result of rape,if you have a disability groups I and II at the husband, as well as his death occurred during pregnancy.
stages of premature birth :
- threat of premature birth
- starting prematurity
- premature onset of labor
Signs of preterm labor
signs are not much different from ordinary labor.The woman there is frequent desire to urinate, visually becomes noticeably low position of the presenting part of the fetus and there are constant discharge from the genital tract.If copious, then reduced the volume of the pregnant belly and reduced GMR (the height of uterine fundus)
This is primarily an increase uterine tone and more frequent nagging pains in the abdomen and lower back.The woman has a feeling of fullness in the vagina, and nausea.In the event of illness chorioamnionitis, when inflamed fetal membranes amnion and chorion, the body responds by chills and fever
Treatment involves immediate hospitalization in the department of pathology at 22 weeks of pregnancy, which will be assigned to conduct an ultrasound.The aim is to study and the precise definition of the gestational age and fetal weight.This is necessary to make the right development of obstetric action.US will help to clarify the dynamics of the changes in the cervix, and it will reduce the vaginal secretions and reduce the infectious risk to the woman.When PROM makes ultrasonic AF evaluation index (amniotic fluid), and consider the advisability of extending the pregnancy.At present, the PROM is very often a favorable outcome, the smaller the period of the woman.Therefore adhere to wait and see.If you find that the uterus is in good shape, it is necessary to carry out ultrasound to rule out placental abruption.In the case of prolonged threat should be carried CTG (cardiotocography), which will assess the condition of the fetus, as well as doing Doppler - to investigate the blood flow in the placenta and fetus.
Medication includes tocolytic therapy (to inhibit uterine contractions introduced drug tocolysis) and symptomatic and sedation.
After arresting signs of preterm labor, the woman remains in the pathology department, where further treatment takes place.When signs of chorioamnionitis woman hospitalized in observational maternity hospital obstetric department.
patient shows bed rest, emotional, sexual and physical rest.Physical therapy techniques include electrophoresis, magnesium, acupuncture, or elektroanalgeziyu electrosleep
prevention of preterm birth
All women with the threat of 25 and 34 inclusive on the week to make prevention of glucocorticoid, which will allow the maturation of lung surfactant child.After 34 weeks the prevention of RDS (respiratory distress syndrome) is not carried out.How to avoid and how to prevent premature birth?Women are encouraged to emotional rest, bed rest, positive emotions, and if you have symptoms of the threat immediately call an ambulance
for preterm labor
Obstetrician - gynecologist in advance according to a doctor neonatologist about the birth of a premature baby, and in the meantime prepare the incubator supplyits oxygen, warm clothes, check the readiness of medical equipment and medicines for resuscitation.Doctor neonatologist should be present during the birth of the child and is obliged to render assistance to the newborn intensive care.
for a normal birth is conducted adequate anesthesia - epidural analgesia.The main objective of the first stage of labor - is to prevent the rapid flow, and thus the prevention of injuries in preterm babies.In the case of rapid flow is intravenous drip tocolytics.Tocolysis lasts up to 3 hours and is canceled at the opening of the cervix to 9 cm. It is approximately 40 minutes prior to the birth.
If labors weak, then carried her stimulation.The most valid method combines the use of oxytocin with a solution of sodium chloride.With a weak labor activity in the second stage of labor continue to be administered oxytocin.Application of Kristeller - squeezing the child's hands out of the womb is contraindicated and the use of forceps is acceptable to 34 weeks.Delivery should be very careful and gentle.
pudendal anesthesia, which provides a blockade of the pudendal nerve, should be compulsory, even when there epidural analgesia.At the time of epidural analgesia anesthetic injected into the dura of the spinal cord, and for pudendal anesthetic solution is used lidocaine or novocaine.And the question of dissection of the perineum - perineotomy (straight cut to the very rectum) or episiotomy (an incision in the side of the rectum) is decided by doctors, depending on the week of pregnancy.With a smaller period recommended perineotomy.
If mothers breech baby, it is advisable to conduct a caesarean section, but if a woman refuses, it is permissible to conduct the birth in a natural way during anesthesia and pudendal perineotomy.After birth, the baby is not recommended to lower and raise the uterus below the level of the cause of the hyper hypovolemia.Pre-prepared warm diapers for making crumbs.After stopping the pulsation of the umbilical cord, hold her office, and before that involved the release of mucus from the respiratory tract.But I want to note that all of the most sparing a baby is born in the heart sac.
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