Premature births

Description:

Abortion between the 21st and 37th week is considered premature births. At the same time the viable, but premature child is born. Do not bear pregnancy to 25% of women, make premature births of these cases of 5-10%.

Premature births are dangerous to mother and a fruit as they are the reason of heavy complications (perinatal incidence and mortality, sepsis, internal hemorrhages, etc.)

Symptoms of Premature births:

The woman can note emergence of nagging pains in the bottom of a stomach and in a waist. Pains sometimes have skhvatkoobrazny character, i.e. it is possible to speak about the beginning of pains. In some cases childbirth begins with an izlitiya of amniotic waters or with an otkhozhdeniye of a mucous stopper. In any of these cases urgent hospitalization in a maternity home is necessary.

Reasons of Premature births:

First of all infection. Normal the cavity of the uterus is sterile. Any inflammatory process does a wall of a uterus defective therefore pregnancy continues until the wall of a uterus can stretch, and then the organism tries to get rid of a germ.

For this reason it is not necessary to spare expense, time and forces for inspection regarding existence of an infection. Each woman — ideally even before pregnancy — has to be inspected on existence of infectious diseases, especially those from them which quite often proceed asymptomatically (a carriage of a chlamydial, ureaplazmenny, mycoplasmal, toksoplazmenny infection, virus of a herpes simplex, a cytomegalovirus). The women having chronic and acute inflammations of appendages of a uterus and an endometria (a mucous membrane of a body of the womb), intrauterine interventions in the anamnesis (abortions, diagnostic a scraping), and also cases of spontaneous abortion have to deserve special attention. In the presence of inflammatory process it, naturally, needs to be cured. The drugs and procedures which are picked up by the doctor will help to expel an infection from an organism even before conception. If for some reason necessary analyses before conception were not made, then when diagnosing pregnancy it is necessary to undergo by all means the corresponding medical examination and further you should not neglect regular inspections. What will reveal presence at an organism of the woman of the microbes capable to cause premature births or potentially dangerous to a fruit earlier — it is better for those. The modern medicine has a considerable arsenal of means to reduce risk of not incubation of pregnancy and infection of a fruit.
The second common cause of premature births — istmiko-cervical insufficiency, ITsN (isthmus — "isthmus", place of transition of a body of the womb to a neck of uterus, cervix — "uterus"), that is inferiority of a muscular layer of a neck of uterus which at normally proceeding pregnancy plays a role of the peculiar sphincter (which is holding rings), not allowing a germ "to leave" a cavity of the uterus. ITsN happens inborn (very seldom) and acquired. What can cause development of ITsN? The reasons are quite banal: injuries of an isthmus and a neck of uterus at abortions, especially at interruption of the first pregnancy, deep ruptures of a neck of uterus in the previous labor (it can happen, for example, at childbirth by a large fruit, imposing of obstetric nippers), rough violent expansion of the cervical channel at diagnostic manipulations in a cavity of the uterus (hysteroscopy, i.e. survey of a cavity of the uterus by means of the special device — the hysteroscope; endometria scraping), that is any injuries of a muscular layer of a neck of uterus.

Very often ITsN forms at a giperandrogeniya — the increased content in blood of male sex hormones which are produced in mother's adrenal glands, and later — and a fruit.

Infections and istmiko-cervical insufficiency — the main, but not the only factors causing premature births. Quite often lead endocrinopathies to premature births — not gross violations of function of hemadens — a thyroid gland, adrenal glands, ovaries, a hypophysis (at gross violations of the woman, as a rule, cannot independently become pregnant at all).

Also premature births can arise at the uterus restretching caused by polycarpous pregnancy, a hydramnion, a large fruit.

Hard physical activity, chronic stressful situation at work or houses, any acute infectious disease (flu, ORZ, quinsy, pyelonephritis, especially with fervescence, etc.) can provoke abortion too.

Treatment of Premature births:

At the premature beginning of pains first of all, appoint tokolitichesky (that is the uterus reducing a tone) drugs — Partusistenum, giniprat. At first these drugs are administered intravenously, and at the termination of pains transition to the tableted forms is possible. This medicine is taken, as a rule, up to 37 weeks of pregnancy. As the means reducing a uterus tone sulfate magnesia, 10% solution of alcohol and some other drugs are also used.

At the second stage of treatment try to remove the cause of premature births. At detection of an infection appoint antibacterial drugs (depending on a type of an infection), sedative (that is calming) therapy — to break off a vicious circle: to the objective factors raising a uterus tone the fear to lose the child who, in turn, raises a uterus tone even more increases.

At development of ITsN on term up to 28 weeks of pregnancy on a neck of uterus put the "pulling together" stitches which do not give to fetal fall out egg from a uterus. Stitches are put under a short-term intravenous anesthesia, at the same time the drugs exerting the minimum impact on the child are used.

On term more than 28 weeks at a defective neck of uterus enter the special supporting Golgi's ring into a vagina: it, without narrowing a neck of uterus, holds the prelying part of a fruit, without allowing it to press on a neck. At the same time, if pains stopped, further opening of a neck of uterus does not happen.

The treatment complex always includes hormonal drug dexamethasone (microdoses of this hormone so side effects are almost excluded are appointed). Its action is directed not to prevention of premature births, and to stimulation of "maturing" of lungs at the child (that he was able to breathe independently if after all is born before term).

The woman shall observe a bed rest, and in the conditions of a hospital. In food it is better to avoid the irritating, spicy, greasy food hard to digest.

The situation is more difficult at premature izlitiya of amniotic waters. On duration of gestation up to 34 weeks if it was succeeded to suppress patrimonial activity, a condition of the woman and a fruit normal, there is no fervescence, there are no inflammatory changes in blood, preservation and prolongation of pregnancy with obligatory purpose of antibacterial drugs for prevention of infectious complications is possible. (The matter is that the bursting of waters demonstrates disturbance of integrity of a bag of waters. Means, the vagina is reported with a cavity of the uterus now, that is the way of an infection is open, and acceptance of antibacterial drugs — a vital measure.)