PREMATURE GENERATIONS

PREMATURE GENERATIONS - births occurring at the gestational age from 28 to 37 full weeks, counting from the first day of the last menstruation. Spontaneous termination of pregnancy during this period is called miscarriage, while spontaneous termination of pregnancy in the period from conception to 37 full weeks - miscarriage. Premature birth results in the birth of a premature baby. The frequency of preterm birth, according to different data, is 4-16% of the total number of births.

In addition to those reasons that are characteristic for miscarriage, pregnancy complications take a big place: pregnancy toxicoses , placenta previa , premature detachment of the normally located placenta, improper position of the fetus, etc. Premature onset of labor is also promoted by uterine overgrowth in multiple pregnancy, polyhydramnios, menstrual cycle disorders in Anamnesis, as well as spontaneous and induced abortions.

Distinguish threatening, beginning and started premature birth . With threatening births, pains in the lower back and lower abdomen, increased excitability and tone of the uterus. When a vaginal test is characteristic of labor, changes in the cervix are not detected, the external uterine sores are closed (the tip of the finger passes through the re-degenerated ones). With the onset of premature birth, cramping pains in the lower abdomen or regular contractions are usually observed. Using vaginal examination, a shortened or smoothed cervix of the uterus is determined. For the beginning of premature births are characterized by regular labor and the opening of the cervix for 2-3 cm.

In 30 - 50% of cases, premature birth begins with premature discharge of amniotic fluid. About 35% of premature births occur quickly or swiftly, i.e., they last less than 6 hours in primiparas and less than 4 hours in moles, while at the same time there is a weakness or discoordination of labor due to immaturity of the cervix and unpreparedness of the mechanisms of regulation of the ancestral forces. In comparison with timely deliveries, premature births are characterized by an increase in the rate of opening the cervix, a decrease in the duration of the active phase of childbirth (the period from the moment of opening the cervix to 3-4 cm until the end of labor) and the monotony of the rhythm of labor. With rapid childbirth, the length of the intervals between contractions also decreases, the intensity, duration, and pain of contractions increase.

The most common complication is uterine bleeding that occurs before the onset of labor activity as a result of detachment of the normally located placenta (see Premature placental abruption) or placenta previa. Often there are infectious complications: chorioamnionitis (inflammation of the membranes), postpartum inflammatory diseases. In childbirth, fetal hypoxia is often observed.

When the symptoms of premature birth appear, the woman should be hospitalized. During the examination it is necessary to determine the possible cause of the threat of termination of pregnancy, the duration of pregnancy and the estimated weight of the fetus, its position, presentation, peculiarities of the heartbeat, the nature of the discharge from the genital tract of the woman (amniotic fluid, blood), the condition of the cervix and bladder (whole, opened) The presence or absence of signs of infection, to evaluate generic activity, to determine the stage of premature birth (menacing, beginning, started).

Conservative-expectant management is indicated with a whole fetal bladder, gestation period up to 36 weeks, a good mother and fetus condition, opening of the cervix by no more than 2 -4 cm, no signs of infection. At the same time, complex treatment is carried out aimed at reducing excitability and suppressing the contractile activity of the uterus, increasing the vital activity of the fetus and "maturing" it, as well as eliminating the pathological conditions that caused premature birth. Assign bed rest, sedatives (preparations valerian, motherwort, trioksazin), drugs that have spasmolytic effects (no-shpu, baralgin, metacin) and reduce the contractile activity of the uterus (magnesium sulfate, partusisten , terbutaline , indomethacin). To reduce the contractile activity of the uterus, electroanalgesia, acupuncture, electrorelaxation, magnesium electrophoresis with sinusoidal modulated currents can also be used.

In case of premature rupture of amniotic fluid and lack of labor during the gestation period of 28 to 34 weeks, a good state of the mother and fetus, absence of severe extragenital and obstetric pathology and signs of infection, conservative-expectant management should also be adhered to due to the unreadiness of the uterus, especially its neck, To childbirth and caused by this difficulty in the induction. In the first 3 to 5 days after the outpouring of amniotic fluid, spasm of the vessels in the utero-placental circulation system can occur and, as a result, hypoxia of the fetus , the risk of infection develops. In this regard, careful monitoring of the condition of the woman and the fetus is necessary. Pregnant should be hospitalized in a special ward. Linen must be changed daily, sterile pads - 3 - 4 times a day. Recommended thermometry (every 3 hours), determination of the number of leukocytes in the blood and ESR (2 times a day), a clinical blood test (every 5 days), bacteriological examination of the discharge from the genital tract, assessment of the vital functions of the fetus. When there are signs of infection, rhodocomposition and antibiotic therapy are shown.

Active tactics of conducting labor is used with the opening of a fetal bladder, regular labor, the presence of signs of infection, impaired fertility, severe extragenital diseases of the woman, complications of pregnancy (toxicosis of pregnant women, polyhydramnios, etc.) that do not respond to therapy, with suspected fetal malformations. Genera , as a rule, lead through the natural birth canal, except in cases when there are emergency indications from the mother or fetus to the caesarean section. To stimulate labor, oxytocin and / or prostaglandins are used in the same regimen as with timely delivery. Means that stimulate uterine contractions should be administered cautiously, strictly controlling the nature of the contractile activity of the uterus. With rapid and rapid premature birth, use of drugs that inhibit generic activity (tocolytics), - partusisten , terbutaline .

For the prevention of uterine bleeding intravenously injected 1 ml of a 0.02% solution of methylergometrine in 20 ml of 40% glucose solution. Analgesia, prematurity, analgesia, baralgin, electroanalgesia, reflexology, nitrous oxide are used to anaesthetize premature labor. In childbirth, the fetal hypoxia is routinely prevented. In the second stage of labor, a median or lateral incision is made - the perineotomy.

In women's consultations, it is necessary to organize monitoring of pregnant women at risk for premature birth (menstrual disorders, endocrinopathies, habitual miscarriages , chronic infectious diseases, malformations of the genital organs). It should be explained the danger of acute infectious diseases of pregnancy, occupational hazards, smoking and alcohol intake. It is important to carefully examine women who have had premature births in the past, to eliminate the cause of the interruption of the previous pregnancy, and, if necessary, to rehabilitate before pregnancy. Throughout pregnancy, a careful monitoring of its course, and at the time of termination of a previous pregnancy a woman is hospitalized in an obstetric hospital and prescribed pathogenetic therapy.

Premature birth can be induced artificially (induced premature birth) due to severe pathology of the pregnant and fetus, death of the fetus. To excite them apply oxytocin, prostaglandins (prostaglandins can be administered intravenously, intra- and extraamnially). In a number of cases (for example, in the absence of the effect of induction), a cesarean section is used.