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Symptoms, features of the course of preterm labor
Last reviewed: 19.10.2021
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In modern obstetrics, the problem of miscarriage remains relevant, so the obstetrician should be well aware of the risk factors for the threat of abortion, the methods of its treatment with modern medicines, and the specifics of giving birth in such a contingent of pregnant women and parturient women.
The incidence of miscarriage varies from 7-10% to 25%, and these rates do not tend to decline over the past 20 years.
Premature birth in general is different from the timely monotony of the rhythm of fights and greater speed of opening the cervix and therefore correction of violations of contractile activity of the uterus is a way of intranatal fetal protection. It is believed that further work is needed to assess the state of preterm birth in labor. For intranatal protection of the fetus, the authors recommend the use of antioxidants and substances that improve the energy supply of the fetus. With the use of ultrasound methods of research, attempts are made to study the features of the biomechanism of labor in preterm pregnancy.
In the structure of perinatal mortality, the proportion of children born prematurely reaches 70%. It should be borne in mind that in premature infants in the future can occur severe psychomotor disorders, so the problem of miscarriage is not only medical, but also social.
Premature birth means abortion for a period of 28 to 38 weeks, when a premature baby weighing from 1000 g to 2500 g and height (length) is less than 45-47 cm.
Particular attention should be paid to the early diagnosis of the threat of termination of pregnancy, because if it is late, and it remains so, and now in 80-84% of cases, then therapy aimed at preventing premature births can not be effective.
With the goal of preclinical diagnosis of the threat of miscarriage. It is proposed to determine the phosphatidylinositols in the serum of a pregnant woman (one of the most active fractions of phospholipids). Thus, the content of phosphatidylinositol in the blood serum at the gestation period of 12-15 weeks is normally 0.116 ± 0.00478, and in case of the threat of termination of pregnancy at the same time - 0.299 ± 0.0335; at pregnancy of 29-37 weeks accordingly 0,134 ± 0,01 mmol / l and 0,323 ± 0,058 mmol / l.
It is necessary to more actively identify a contingent of pregnant women with a high risk of premature birth, and also to know the peculiarities of their course and management. In this case, the following points should be taken into account: in the group of women with high risk of premature birth, one in every tenth notes the presence of edema of pregnant women, one in five has Rh-negative blood, and one-fourth has nephropathy. Half of women have untimely outflow of amniotic fluid, every tenth woman gives birth in a breech or leg presentation.
Less frequent complications are anemia of pregnant women, anomalies of placenta attachment, polyhydramnios, partial detachment of normal or low-lying placenta. Among the causative factors of miscarriage, the pathological course of the latter is detected in half of the women. It is important to note that only 1/2 pregnant women were registered in the antenatal clinic for up to 12 weeks, 1/2 - after 12 weeks of pregnancy. The majority in the anamnesis noted habitual miscarriage, prolonged infertility, artificial abortions, uterine myoma, gynecological operations, genital infantilism, etc.
Every third woman has an accompanying extragenital pathology. Among the chronic somatic diseases, pyelonephritis, hypertension I-II stage, bronchial asthma, allergic diseases, etc. Were most often detected.
The onset of premature birth should be considered as a consequence of many causes, and it is sometimes difficult to decide which one is leading. Clarification of the cause of premature birth is important not only for more justified management of premature births and the application of measures to prevent possible complications for the mother and fetus, but also to prevent premature termination of pregnancy in the future. When clarifying the cause of premature birth, the obstetrician usually encounters not one etiologic factor, but their combination, among them some are predisposing, others are permissive. Thus, the doctor with preterm labor often has to deal with a combined, multiple pathology, often leading to complex and various complications. Therefore, in the etiology of preterm labor, the following main factors should be distinguished: the main cause, secondary causes and, finally, the conditions for their action.