Premature izlity amniotic waters
- Symptoms Premature izlitiya of amniotic waters
- Reasons Premature izlitiya of amniotic waters
- Treatment Premature izlitiya of amniotic waters
The Premature Rupture of Fetal Membranes (PRFM) is the complication of pregnancy which is characterized by disturbance of integrity of covers of a bag of waters and izlitiy amniotic waters (prior to patrimonial activity) on any duration of gestation.
Often waters depart in one step in a large number, and diagnosis of PRPO does not present work, but to 47%23 cases when there are microcracks or side gaps without massive an izlitiya, doctors doubt the correct diagnosis that threatens with hyper diagnosis and unreasonable hospitalization or on the contrary infectious complications at late detection.
PRPO accompanies practically every third premature births, and as a result is the reason of a considerable part of neonatal diseases and death. Three main reasons for neonatal mortality connected with PRPO at premature pregnancy are prematurity, sepsis and a hypoplasia (underdevelopment) of lungs.
Symptoms Premature izlitiya of amniotic waters:
Clinical picture PRPO depends on a damage rate of covers.
Clinical picture at massive izlitiya of amniotic waters.
If the rupture of a bag of waters took place, then:
• the woman notes allocation of the large amount of liquid which is not connected with an urination;
• height of standing of an uterine fundus due to loss of a significant amount of amniotic liquid can decrease;
• very quickly patrimonial activity begins.
Clinical picture at high side gaps.
It is more difficult when there are microscopic cracks and amniotic waters leak literally on drops. Against the background of the increased vulval secretion during pregnancy excess liquid often remains unnoticed. The woman can note that in a prone position the number of allocations increases. It is one of PRPO signs. Symptoms which owe a nastorozhit:izmeneniye of character and number of allocations - they become more plentiful and watery; in addition to pain pain in a bottom of a stomach joins iit bloody allocations (but It should be noted that pain and bloody allocations not a constant symptom and they can be absent). It is worth pricking up the ears if above-mentioned symptoms appeared after an injury or falling or against the background of polycarpous pregnancy of an iila of infectious process at mother.
But in most cases such gaps occur in the absence of explicit risk factors and in an hour clinical manifestations considerably decrease that strongly complicates primary diagnosis and demands additional methods, and delay in diagnosis and timely begun treatment for 24 hours repeatedly increases probability of perinatal incidence and mortality. Days later, and even earlier develops horioamnionit – one of the most terrible complications of PRPO which signs also indirectly say about what takes place to be a rupture of fetal membranes. This state is characterized by fervescence (higher than 38), a fever, tachycardia at mother (above 100udmin) and a fruit (higher than 160 удмин), morbidity of a uterus at a palpation and purulent discharges from a neck of uterus at inspection 40.
N.B. A leukocytosis> 18*109 and neutrophylic shift of a leukocytic formula have no predictive value for confirmation of existence of an infection. Observation of this indicator within 1-2 days is necessary. Existence of a horioamnionit is the obligatory indication to delivery and is not a contraindication to KS.
Reasons Premature izlitiya of amniotic waters:
The reasons causing PRPO up to the end are not studied, and it is impossible to answer with an accuracy what question from risk factors will lead to this pathology. The only thing about what can be claimed with an accuracy is that most often the women who had premature izlity waters at the previous pregnancy, not full-term to term handle PRPO. The risk of a recurrence in this case makes 16-32%4.
Normal the bag of waters is broken off in the first phase of childbirth. Along with maturing of a neck of uterus also fetal membranes are softened, a large amount of enzymes which are responsible for normal and timely peeling of a placenta is allocated. But at different morbid conditions this mechanism changes a little, as gives to premature an izlitiya of waters. It can occur on any duration of gestation, than and 40% of all premature rodov36 are caused. It is proved that 4–12%4,6,13 premature births with PRPO are followed by premature placental detachment, and it is fraught with profuse bleeding and the expressed fruit hypoxia.
The states leading to PRPO:
The American board of obstetricians and gynecologists (ACOG) points to the following reasons and risk factors leading to PRPO4.
• Inflammatory diseases of generative organs of mother and intraamniotichesky infection
It is most often observed at premature pregnancy. In this case there is a premature maturing of a neck of uterus, are emitted enzymes, an otslaivayushchy placenta and the softening covers of fetal egg. Extremely dangerous and life-threatening swear at a state also a fruit. Communication between the ascending infection of generative organs of mother and PRPO is proved. Every third patient with premature pregnancy with PRPO has positive crops on bakkultura from generative organs. Moreover, during the researches it was revealed that bacteria can get also through the unimpaired covers, infecting the child. Also it is necessary to carry to this group of risk factors horioamnionit. It can become both the investigation of a rupture of fetal membranes, and its reason. And the duration of gestation is less, the risk razryva37,38,39 is higher.
• Clinically narrow basin and anomalies of presentation and provision of a fruit
In this case PRPO is characteristic of the full-term pregnancy and gives to early an izlitiya of amniotic waters (when patrimonial activity already began, but disclosure of a neck of uterus did not reach 7–8 cm). Normal the prelying part of a fruit densely adjoins to pelvic bones of the woman in childbirth and forms a contact belt, conditionally dividing amniotic waters on front and back. At a narrow basin and anomalies of presentation this belt is not formed, and the most part of amniotic waters appears in the lower part of a bubble, leading to a rupture of its covers. Harmful influence on health of mother and fruit minimum.
• Istmiko-tservikalnaya insufficiency
PRPO as a result of cervical insufficiency (IMT less than 19,8) 4bolshe is characteristic of premature pregnancy though meets also on later terms. Insolvency of a neck of uterus leads to protrusion of a bag of waters in this connection its lower part is easily infected and broken off even at small exercise stresses.
• Tool medical intervention
It should be noted that only the procedures connected with a tool research of amniotic liquid or chorion are followed by risk, and survey in mirrors or sexual intercourse cannot be led to PRPO at all. But at the same time repeated bimanulny researches can provoke a rupture of covers.
• Addictions and diseases of mother
It is noted that the women suffering from general diseases of connecting fabric, deficit of body weight, anemia, avitaminosis with the insufficient use of copper, ascorbic acid, and also it is long the accepting hormonal drugs, are more subject to risk of development of PRPO. Also it is worth carrying the women with the low social and economic status abusing nicotine and narcotic substances to the same group.
• Anomalies of development of a uterus and polycarpous pregnancy
Here existence of a uterine partition, conization of a neck of uterus, shortening of a neck of uterus, istmiko-cervical insufficiency, placental detachment, a hydramnion and polycarpous pregnancy belongs.
Most often lead stupid injuries of a stomach during the falling of mother or blow to a gap.
Treatment Premature izlitiya of amniotic waters:
For drawing up an algorithm of maintaining pregnant women with PRPO it is necessary to have clear idea of an obstetric situation, to resolve an issue of the place and time of delivery and need of prevention of infectious complications of an iila respiratory a distress syndrome. For this purpose the following is necessary.
• To confirm the diagnosis of a rupture of fetal membranes.
• To define exact duration of gestation and estimated mass of a fruit. At term less than 34 weeks and fruit weight till 1500 гр, the pregnant woman is necessary to hospitalization in a hospital of the third level.
• To define sokratitelny activity of a uterus.
• To estimate a condition of mother and a fruit;
• To reveal existence of an intramniotichesky infection.
• To define existence of contraindications for waiting tactics
• To choose tactics of maintaining the pregnant woman or a way of delivery.
• To carry out infection prevention.
In case of conservative vedeniya1, the patient is placed in specialized chamber with germicidal lamps where wet cleaning 3-4 times a day has to be carried out. Daily shift of bed linen and change of sterile podkladny diapers 3-4 times a day. Continuous monitoring of a condition of a fruit and mother is carried out, the drug treatment corresponding to term and a high bed rest is appointed.