Symptoms, peculiarities of the course of preterm labor

In modern obstetrics, the problem of miscarriage remains relevant, so the obstetrician must be well aware of the risk factors for the threat of termination of pregnancy, methods of its treatment with modern medications, as well as the features of labor management in such a contingent of pregnant women and women in labor.

The incidence of miscarriage ranges from 7-10% to 25%, and these figures have not shown any tendency to decrease over the past 20 years.

Premature births generally differ from timely births by the monotony of the contraction rhythm and the greater speed of cervical dilation, and therefore correction of uterine contractile dysfunction is a method of intranatal fetal protection. It is believed that further work is needed to assess the condition of premature fetuses during labor. For intranatal fetal protection, the authors recommend the use of antioxidants and substances that improve the energy supply of the fetus. Using ultrasound research methods, attempts are being made to study the characteristics of the biomechanics of labor in premature pregnancy.

In the structure of perinatal mortality, the proportion of children born prematurely reaches 70%. It should be taken into account that premature children may subsequently develop severe psychomotor disorders, so the problem of miscarriage is not only medical, but also social.

Premature birth is understood as the termination of pregnancy between 28 and 38 weeks, when a premature baby is born weighing from 1000 g to 2500 g and with a height (length) less than 45-47 cm.

Particular attention should be paid to early diagnosis of the threat of termination of pregnancy, because if it is late, and it remains so at present in 80-84% of cases, then therapy aimed at preventing premature birth cannot be effective.

For the purpose of preclinical diagnostics of the threat of miscarriage. It is proposed to determine phosphatidylinositols (one of the most active fractions of phospholipids) in the blood serum of a pregnant woman. Thus, the content of phosphatidylinositol in the blood serum at 12-15 weeks of pregnancy is normally 0.116 ± 0.00478, and with a threat of miscarriage at the same time - 0.299 ± 0.0335; at 29-37 weeks of pregnancy, respectively 0.134 ± 0.01 mmol / l and 0.323 ± 0.058 mmol / l.

It is necessary to more actively identify the contingent of pregnant women with a high risk of premature birth, as well as to know the features of their course and management. In this case, it is necessary to take into account the following points: in the group of women with a high risk of premature birth, every tenth woman has edema of pregnancy, every fifth woman has Rh-negative blood, and every fourth woman has nephropathy. Half of the women have premature rupture of membranes, and every tenth woman gives birth in breech or foot presentation.

Less frequent complications are anemia of pregnancy, abnormalities of placental attachment, polyhydramnios, partial detachment of a normally or low-lying placenta. Among the causal 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 of the pregnant women were registered at the antenatal clinic before 12 weeks, 1/2 - after 12 weeks of pregnancy. The majority of them have a history of habitual miscarriage, long-term infertility, artificial abortions, uterine fibroids, gynecological operations, genital infantilism, etc.

Every third woman has concomitant extragenital pathology. Among chronic somatic diseases, the most frequently detected were pyelonephritis, hypertension stage I-II, bronchial asthma, allergic diseases, etc.

The onset of premature birth should be considered as a consequence of many causes, and sometimes it is difficult to decide which of them is the leading one. Finding out the cause of premature birth is important not only for more justified management of premature birth and the use of measures to prevent possible complications for the mother and the fetus, but also for preventing premature termination of pregnancy in the future. When finding out the cause of premature birth, the obstetrician usually encounters not one etiological factor, but a combination of them, and among them some are predisposing, others are resolving. Thus, during premature birth, the doctor often has to deal with combined, multiple pathologies, often leading to complex and varied complications. Therefore, in the etiology of premature birth, the following main factors should be highlighted: the main cause, secondary causes and, finally, the conditions of their action.