Update: October 2018
Even considering that medicine has stepped forward, premature
childbirth happen, and will happen. But glad that their frequency is not
increases, and remains more or less at a stable level. According to
statistics, the percentage of preterm birth in various states
is 5 – 20, and in Russia the last 30 years, this figure is not
What childbirth is called premature?
According to the WHO definition, maternity
which occurred on the terms of 22 – 37 weeks of gestation and in the process
which was born fruit weighing 500 – 2500 grams.
- In the Russian Federation, they adhere to the old classification,
there are preterm births are those births that occurred from 28 to
37 weeks, and the body weight of the child reaches 1 – 2.5 kg.
- If a же childbirth случились раньше 28 недель, но не ранее 22, и
born living fruit weighing 0.5 kg or more, which lived exactly 7
days or more, such cases are also counted as
preterm labor. If one of the conditions is inconsistent
the case will be called a miscarriage at a later date.
Classification of childbirth occurring before the deadline
Depending on the clinical course of preterm labor
divided into 3 stages:
- threatening or threatened preterm labor;
- incipient preterm labor characterized by
structural changes of the uterine cervix (it is smoothed and
opens up to 3 cm, the appearance of contractions, but no more than 4 times in 10
- started preterm labor – the process has already stopped
On terms of gestation, which determine the degree of maturity of the future
childbirth is divided into 3 groups:
- 22 – 27 weeks – very early or very early premature
- childbirth, случившиеся от 28 до 33 недель
- childbirth, свершившиеся на сроках 34 – 37 недель (см. калькулятор
calculation of the approximate date of delivery).
В зависимости от механизма возникновения преждевременные childbirth
- induced (artificial), which are divided into:
- childbirth по медицинским показаниям (грубые аномалии развития плода,
mother’s severe conditions)
- childbirth по социальным показаниям
- childbirth по медицинским показаниям (грубые аномалии развития плода,
What is the cause of preterm labor?
Вызывают преждевременные childbirth многочисленные причины. Everything
factors can be divided into 4 large groups:
Group 1: factors related to health
- pathology of endocrine glands (diseases of the thyroid gland and
pancreas, pituitary changes, dysfunction
adrenal glands and others);
- acute / chronic infections (it can be inflammatory
diseases of the reproductive organs, genital infections, common
infectious diseases: influenza, ARVI, rubella, tuberculosis and
- developmental anomalies of the uterus (septum in the uterus, one-horned,
- general and sexual infantilism;
- uterine tumors;
- осложненный акушерский анамнез (невынашивание of pregnancy,
childbirth с осложнениями, аборты (осложнения и последствия);
- extragenital diseases (heart defects, hypertension,
pathology of the liver and biliary tract and others);
- cervical insufficiency – in fact it is
failure of the neck muscles caused by injuries, tears or
Group 2: factors caused by the state of the fetus
- multiple births;
- gross fetal malformations;
- в случае of pregnancy плодом мужского пола;
- chromosomal and genetic diseases.
3 группа: факторы, обусловленные течением of pregnancy
- severe preeclampsia;
- lack or excess of amniotic fluid;
- large fruit;
- reproductive technologies (IVF, etc.);
- placenta previa;
- improper location of the unborn baby in the womb;
- placental abruption;
- rhesus conflict pregnancy;
- prenatal rupture of water.
Group 4: factors associated with socio-economic
- occupational hazards;
- alcoholism and drug addiction;
- hard physical work;
- stress and overwork;
- unfavorable housing conditions;
- age (young and “old” primiparas);
- marital status (single mother);
- unwanted pregnancy.
Как проявляются преждевременные childbirth?
Как было отмечено выше, в своем клиническом течении childbirth до
Term pass three stages. And if the first 2 are process
reversible, that is, it can slow down and roll over
pregnancy for as long as possible or at least for the period
necessary for the treatment of accelerating the maturation of the lungs
плода, то начавшиеся преждевременные childbirth затормозить уже
impossible (see pain relief during labor).
Угрожающие преждевременные childbirth
Signs of threatened preterm labor include:
- anxiety of the fetus, it starts too actively
- frequent urination, frequent urge to
- there is a lower abdomen, in the lumbar region.
As a rule, these symptoms remain unnoticed by the woman.
To alert the patient whether the occurring periodic hypertonus
uterus (“it hardens like a stone”). During the outdoor
obstetric examination uterus very easy to come to tone, and
The prelying part is pressed to the entrance to the pelvis. Further, when
conducting internal research is determined by the saved neck
the uterus, the external pharynx is closed or pass for the tip of the finger
women who give birth again.
Incipient preterm labor
In the absence of treatment in the first stage, the process
progresses and nagging pains go into cramping or even
in regular bouts. But their frequency is no more than 4 for 10
minutes The doctor, conducting a vaginal examination, notes that the lower
the uterine segment is unfolded (it becomes thin and soft),
the neck is shortened and smoothed. Disclosure of uterine throat
reaches three centimeters. Premature rupture is possible.
Started preterm labor
This stage is already irreversible. Marked regular generic
activity, and the cervix continues to unfold (up to 3 – 4
cm), there are frequent cases of rupture of membranes.
Generally, preterm labor proceeds with a number of
- frequent prenatal discharge of water;
- there are often anomalies of generic forces (discoordination or
- childbirth often proceeds quickly or even rapidly;
- the risk of fetal hypoxia increases;
- high risk of bleeding in the first 2 hours
childbirth and afterbirth period;
- frequent cases of infectious complications during childbirth
(chorioamnionitis) or after childbirth.
How to prevent preterm labor?
When a woman enters the maternity ward, the doctor immediately
assess the situation, and takes into account a number of factors on the basis of which
further tactics of management of the pregnant will be chosen. To the data
- gestational period;
- there is either no fetal bladder;
- how the fruit is located and presented;
- the state of the mother and child;
- condition of the cervix, the presence / absence of disclosure;
- whether or not there is an infection;
- the presence of regular bouts: is or not;
- there is a heavy obstetric or extragenital
If the gestation period is less than 36 weeks and there are favorable
listed factors shown conservatively expectant
tactics that pursue the goal: the weakening of excitability,
inhibition of uterine contractile activity, increase
�“Vitality” of the fetus (that is, the prevention of respiratory
disorders, aimed at “ripening” of the lungs of the fetus), treatment,
whenever possible, the reasons which caused premature labor and
- First of all, the patient is assigned bed rest, and
also psycho-emotional peace.
- Calming sedatives are prescribed as sedative therapy.
drugs (motherwort, Valerian, Novopassit), possibly
use of trioxazine, nozepam or valium.
- Hypnosis and psychotherapy are also effective.
- It is important the appointment of painkillers (analgin, ketorol) and
antispasmodics (baralgin, papaverine).
Then proceed to the tocolysis or removal of excitability and
contractile activity of the uterus. Known 5 groups of funds –
The effect of these drugs is based on reducing the concentration
calcium in the cell that contribute to uterine contractions, which is what
causes its relaxation. Commonly used beta adrenomimetics:
ginipral, salbutamol, partusisten. For quick blocking
contractions of the uterus, their introduction begins to drip intravenously (0.5 mg
the drug is diluted in 0.5 liters of isotonic solution and drip,
Starting from 5 to 6 drops per minute, then gradually increase the dose.
until the complete cessation of contractions). This infusion may continue 4
– 12 hours. But, given that after the cessation of the introduction
veta-adrenergic intravenous uterus begins to contract again,
their reception is continued in tablet form. Beta adrenomimetics
have some side effects (reduction of arterial
pressure, increased sweating, chills, pain in the head, increased
gas formation and other).
Calcium channel blockers
These drugs are calcium antagonists, therefore also
inhibit the contractile activity of the uterus. Nifedipine (Corinfar)
appointed by 0.01 grams. four times a day, and verapamil (isoptin) on
Drugs that inhibit the synthesis of prostaglandins
Indomethacin is usually prescribed in pills or rectally, but
Naproxen, sulindac, aspirin can also be used.
Magnesium sulfate is administered intravenously in a dose of 4 grams. The
the drug is safe for the fetus, lowers blood pressure in
women, has a sedative effect. After intravenous
the introduction of move to taking the tablets in the form of Magne-B6 4 times a
Currently, ethyl alcohol is not widely used. ten%
the ethanol solution is diluted in 500 ml of isotonic solution, and
drip for two hours (20 – 30 drops per minute). Ethanol
inhibits the action of oxytocin and accelerates the synthesis of surfactant, which
prevents the development of respiratory distress syndrome (SDR) in
How to avoid the development of respiratory disorders in a child?
To this end, in parallel with the tocolysis prophylaxis
RDS. The purpose of glucocorticoids, which contribute to
education surfactant and faster maturation of the lungs of the baby.
Surfactant forms in the large alveoli and covers them, it
contributes to the disclosure of the alveoli inhale and does not allow them to subside.
Dexamethasone is usually used (4 mg twice daily i / m for
for 2 – 3 days or 2 mg tablets: on the first day 4
times, on the second 3 and on the last day 2 times). Dexamethasone
appointed to all women who are administered tocolysis. Available
an accelerated course of prevention with prednisone (for two days
60 mg daily).
If tocolysis has a positive effect, then the course of treatment
corticosteroid repeat after a week. Also for prevention
RDS is administered surfactant in / m of 100 IU twice a day for
three days. No less effective drug compared to
glucocorticoids is also a lazolshan. It is administered intravenously.
drip in dosage 800 – 1000 mg for 5 days.
And, of course, treating a threat or beginning labor before term
includes antibiotic therapy.
- First, antibiotics suppress the infection in the mother, who
quite often acts as the main causative factor of this complication
- Second, they prevent the development of purulent-septic
diseases after childbirth
Management of preterm labor
How will preterm labor proceed and what is their outcome in
primarily depends on the period of gestation and the maturity of the child. If a
срок of pregnancy соответствует 22 – 27 неделям, то childbirth
end quickly, with incomplete disclosure of uterine throat, and
also without obstetric benefits. In the case of 28 – 33 weeks
gestation, such birth is almost timely, often
use obstetric benefits and surgeries, including abdominal
delivery В случае of pregnancy сроком от 34 до 37 недель
childbirth proceeds as timely.
When conducting childbirth before the term is carried out careful monitoring.
the dynamics of the opening of the neck, the nature of the tribal forces, the insertion and
fix how the presenting part of the baby moves. Wide
apply antispasmodics and careful anesthesia, and as
Anesthesia during contractions is not recommended narcotic
analgesics, since they inhibit the center of respiration, and the lungs of the fetus,
as stated above, and so immature. Also timely conducted
correction of labor. It is applied with caution
oxytocin in the development of weak contractions.
It is important to prevent the birth trauma of the baby in
period of attempts. Therefore, the labor period is also performed without protection.
perineum, as well as timely do episiotomy. Operative
interventions (forceps, caesarean and others) are applied
only by vital indications of the mother. It is also necessary
регулярно повторять профилактику гипоксии fetus. Newborn baby
take in heated diapers, and cut the umbilical cord throughout
first minute, and not immediately after birth, and the baby should
to be at the level of the perineum of the woman (otherwise the blood will “leak
back to the placenta).
Пример из практики: В женской консультации под
My observation was a 38-year-old woman. Pregnancy was
3rd desired. For a period of 33 weeks, the woman arrives with contractions.
Well, I think, maybe we can still stop. With vaginal
examination it turns out: the opening of the uterine mouth full, fetal bladder
absent, and that the most terrible, put forward legs. That is, on
Caesarean do not have time, I call a pediatrician and resuscitator, because
There are no specially trained neonatologists in our hospital. So what is next –
the legs, the pelvic end and the body we gave birth, and the head, as usual,
stuck (this is the largest part of a newborn). And withdraw
I don’t have enough strength. I resorted to the famous reception
Maurice-Levre-Lyashapel: on the left hand of the child I lay along, with
this index finger is inserted into the mouth to ensure
maximum bending of the head (so it is easier to display), and
the forefinger and middle finger of my right hand wrap my neck with a fork
baby It seemed to me that an eternity had passed. As it turned out
only 2 minutes. And we gave birth. Dukhlenky, but alive! Child,
of course was heavy. But nothing. He and mom were sent home from
children’s department in satisfactory condition.
Danger to the kid
Из родильного дома только 8-ten% домой выписывают здоровых
premature babies weighing over 2000 grams. at birth, the rest
enter specialized institutions for stage 2
The most serious consequence for the child remains:
- hyaline membrane disease (otherwise respiratory
- Premature babies often suffer from asphyxia, often
respiratory failure develops
- their thermoregulation is impaired
- conjugation of bilirubin (jaundice of newborns)
- In general, such children often suffer from infectious diseases.
- premature babies have a higher risk of developing physical and mental
inferiority than term babies:
- 10 times more likely to be diagnosed as malformations
- 15-30% of these children have severe neuropsychiatric
disorders – reduced intelligence, cerebral palsy, impaired vision and hearing,
- In addition, premature babies are more prone to stress