What is preterm labor
Unfortunately, premature birth is not uncommon, but today the capabilities of the children’s neonatological service allow you to nurse babies, even in the most difficult cases. However, the threat itself, as before, scares any woman, since it is obvious that it is much better for a child to grow and develop in the mother’s womb than even in the most adapted incubator.
Stories of unconventional childbirth are always stories about the struggle for survival, about many months of difficult, costly path to the health of the newborn, but not always the stories end safely. Vision problems, severe neurological disorders occur more often than in the earlier period of pregnancy was interrupted.
The risk to the child can not be overestimated, because he is simply not ready. His lungs are not ready, but he needs to breathe on his own, the gastrointestinal tract is not ready, but a child must digest his food, the child is not even able to maintain body temperature.
In some obstetric situations, preterm labor is necessary. These are cases when it is necessary for medical reasons, or the situation is interrupted by the woman’s wish.
In our country, according to the new abortion law, interruption is possible up to 22 weeks. This is not an abortion, but preterm birth. Although they are classified as a late miscarriage, if the child survives after them for 7 days, they are classified as very early childbirth.
If the birth canal is not ready, and late toxicosis, eclampsia and convulsions, despite the almost complete lack of chances for the child’s survival, are being performed by a caesarean section, which is life-threatening for the woman.
The fear of having a premature baby for a woman is completely natural. But do not tell yourself, I’m afraid of preterm labor, you just need to know what their causes are, how they start, and take timely measures to prevent this from happening.
Knowing that it can provoke a delivery, you can avoid such situations and prevent your rush into the world too early.
Early birth, statistics
Statistics, in fact, is not comforting. Every year, prematurely born from 5 to 12% of children.
The World Health Organization classifies these cases not quite as in Russia.
In Russia, childbirth is considered premature for a period of 28 to 37 weeks, with a fetus weight of more than 1 kg, while WHO expands the boundaries from 22 weeks to 37.
Please note that in Russia up to 22 weeks you can terminate a pregnancy, in the USA, let’s say, at 22 weeks this is a newborn that is to be resuscitated and cared for. If a child is born in Russia for a period from 22 weeks to 28, and has a body weight from 500 grams to 1 kg, he will be called a child only after he can stay alive for 7 days. There is not even a law that would oblige to care for children in these periods of gestation. Until the newborn lives its first 7 days of life, it is simply called a late miscarriage …
If childbirth has begun, in the period that the child’s possibility of survival determines, in Russia it starts from 27-28 weeks, at an earlier term, at 22 weeks – 26 weeks, the cases of nursing of children mostly abroad are described, but they are still children having a lot of health problems.
22 weeks – 24 weeks is the birth of a child weighing from 500 to 700 grams. Cases of nursing children at such a time are rare, described in medical journals and often widely reported in the media, if this happens.
25 weeks – 27 weeks – this is the routine of the neonatal service, unfortunately, not always these cases end well. Despite the fact that, according to the law, doctors are obliged to fight for the life of a child, if he has a body weight of more than a kilogram, and was born on the 28th week and later, everything possible is done for those babies who have not gained this weight.
29, 30, 31 weeks – it is almost always the weight of a child over a kilogram, relatively light lungs prepared for breathing, and high chances of survival.
However, a premature baby is not the only problem; hypoxia during and before birth, natal trauma and other diseases often cause the death of children.
Causes of Preterm Birth
Why do preterm labor occur? The answer to this question hides the same answer to the question of how to prevent preterm birth. Let’s try to understand the variety of possible reasons.
1. Endocrine pathology and pregnancy. The likelihood is higher for those women who suffer from endocrine diseases. And it does not necessarily have to be such endocrine diseases as hormonal disorders in the sexual sphere, thyroid diseases, diabetes mellitus also increase the risk of problems.
2. Genital infections. Chlamydia during pregnancy, ureaplasmosis, and other infections can not only provoke the onset of labor, but also cause disease and developmental defects in a child. The danger is also erosion of the cervix, chronic salpingitis, endometritis, bacterial vaginosis.
3. Somatic infections. Tonsillitis, viral hepatitis, and even SARS and unhealed teeth are a source of infection for the fetus and create a risk.
4. Malformations and anomalies of the uterus and its tumors, changes in the cervix after abortion and childbirth, adhesions in the uterus after childbirth and abortion. Damage to the endoscopic apparatus of the uterus, the circular muscles of its isthmus, a kind of lock that does not allow the cervix to open, during childbirth and abortion, leads to isthmic-cervical insufficiency, ICN. With it, the cervix is not able to resist the mass of the growing fetus and begins to open gradually from a period of 16-17 weeks. In addition to cervical injuries, uterine abnormalities and hormonal factors lead to ICN. Under the weight of the child, the cervix gradually opens slightly, the fetal bladder bulges into it, becomes infected, and sooner or later its rupture and the onset of early childbirth occur.
5. Somatic noncommunicable diseases of the mother. Diseases of the kidneys, liver and heart, general exhaustion, weight loss and nutritional deficiencies weaken the body and make it difficult for you.
6. Malformations in the child himself and his genetic diseases. Usually in such cases there is a threat in 32 weeks and earlier, this is the mechanism that nature has foreseen, there is natural selection and a strong and full-fledged child survives.
7. Features and complications of pregnancy. If a woman has twins, preterm birth often occurs, the reason for overstretching the uterine wall, the same happens with polyhydramnios. Complications such as late gestosis, fetoplacental insufficiency, presentation of placenta and detachment are frequent causes of the need to cause the appearance of a martysh to light.
8. Injuries to the abdomen.
9. The age of a woman under 18 years of age (biological immaturity) and age over 30 years old are also risk factors.
10. Bad habits, including drug addiction, smoking and alcoholism.
11. Poor nutrition and living conditions.
12. Heavy physical labor, lack of sleep, stress, mental overload.
13. Unwanted child, single-parent families.
Early birth and gestational age
What causes premature birth at different stages of pregnancy? It turns out that each period of pregnancy has its main reasons.
Premature delivery at 22-27 weeks.
This group of premature babies has the saddest statistics of survival, because the lungs are not mature at all, and the weight of the fetus is extremely low, only 500-1000 grams.
The main cause of birth at this time – is cervical insufficiency, infection of the membranes and rupture.
If a child was born at 22-23 weeks, there is almost no chance for him, even those who survive, mostly cases of nursing in European countries and in the USA, are further disabled children.
Children born from 24 to 26 a week survive more often and the prognosis for their health is better. Fortunately, giving birth at this time is only 5% of all cases.
Premature birth at 28-33 weeks
The level of development of neonatal care helps to ensure the survival of most children in this group, although not for all prematurity passes without consequences.
The weight of newborns on average from 1000 to 1800 grams.
The reasons for this period are varied and numerous: various complications, Rh-conflict and much more. These children have lungs that are almost ready to breathe, and the use of medications, oxygen support, and incubators help to get out most of them.
Premature delivery at 34-36 weeks
Deliveries at this time are almost not dangerous for the child, of course, it will be bad if he is born outside the hospital, but a healthy premature baby born in the maternity hospital has all the chances for successful adaptation and health in the future.
The weight of children usually exceeds 2 kilograms, in most cases their lungs are almost ready for spontaneous breathing and only a small amount of medication support is required in order to accelerate their maturation.
The main causes are maternal somatic diseases, pregnancy complications and intrauterine hypoxia due to feto-placental insufficiency.
Symptoms and signs of preterm labor
Signs resemble the threat of abortion at an earlier date.
In most cases, childbirth begins with the outpouring of amniotic fluid, but even a few days before this, a woman may feel the harbingers of preterm labor, only now no one pays attention to them.
1. Threatening preterm delivery.
This is a period of forerunners, which you may not notice. Weak nagging pain in the lower back and lower abdomen, the appearance of contractions, tension of the uterus, which can be noted simply by placing a hand on the stomach (the stomach turns to stone, tenses).
A baby may behave restlessly, often kicking, and from the genital tract mucous secretions, which may even be admixed with blood streaked, often amplify.
The doctor during the inspection does not detect changes in the cervix, it is dense and closed. If you consult a doctor during this period, it may be enough to minimize the medication effect and ensure rest to a woman to prevent it.
2. How do preterm labor begin?
Pain in the lower back and lower abdomen become pronounced, cramping in nature. The mucus plug comes off, there may be bloody discharge from the genital tract, and often water is poured out.
On examination, the doctor finds shortening and softening of the cervix, it is ajar and freely misses 1-2 fingers.
3. Began preterm delivery.
If the birth began, they are unlikely to stop.
In 30% of cases, delivery proceeds rapidly, in primigranous for 6 hours, with repeated births, the periods can be even less.
The pains become intense, acquire the nature of contractions, which follow regularly, at intervals of less than 10 minutes, the cervix smoothes and quickly opens, the waters drain, the fetus descends to the entrance to the small pelvis.
How to avoid preterm labor?
What you should pay attention to in your position: the appearance of menstrual-like pain, a feeling of heaviness in the lower abdomen, a change in fetal activity, or too violent, or on the contrary, its weak activity, a feeling of pressure on the lower bladder and vagina, the appearance of any unusual discharge from the genital tract.
These are the first signs and reason to immediately consult a doctor.
Knowing how to recognize preterm birth, you will not make mistakes, stay home when you can still stop, and prevent the baby from being born before term.
Treatment of the threat of preterm delivery
The threat of premature birth, the symptoms of which are described above, is a reason to immediately consult a doctor. In any case, even if it seemed and nothing really happens, it is better to be safe than to miss the dangerous symptoms.
If you address at the stage of threat, you may be offered hospitalization at the maternity hospital, but this is not always necessary. In any case, with such complaints, you will receive a detailed gynecological examination and tests, it is very important to assess the condition of the cervix, the condition of the child, to identify infections, if any, in a woman.
Particularly noteworthy is the leakage of amniotic fluid. This is a feeling of constant dampness, aggravated by movements. Many women are afraid to go to the reception if the water is gone, but there is no labor. This is fundamentally not true. No one will immediately terminate the pregnancy if she has not reached at least 34-35 weeks, if there are no signs of infection, you will simply be put into the hospital, the lungs will be prepared for several days, you will be protected from infection with antibiotic therapy and sterile conditions, and childbirth will occur when the baby is ready to breathe on its own.
The timing of prolongation of pregnancy in case of rupture of the membranes of fetus is determined by the timeliness of the treatment and the state at the time of treatment.
If there are no infectious complications, the pregnancy may well be extended for 5-7 days or even more, which allows doctors to do everything possible to ensure that everything goes as well as possible and the child is ready to be born.
The threat of premature birth at 35 weeks and more with the outpouring of the amniotic fluid is not a reason to try to prolong the pregnancy, women give birth, because almost always the children at these times are quite mature and easily adapt to extrauterine life.
If the amniotic bladder is intact, treatment is reduced to the cessation of the onset of labor activity and the carrying out of therapeutic measures regarding the causes of complications.
If a woman has only a threat, outpatient treatment is possible in some cases, but still midwives prefer hospitalization, often the simple withdrawal of a woman from the stressful environment at home and on the robot, hospitalization ceases generic activity, and the pregnancy continues.
With the whole fetal bladder, tocolytic (relaxing uterus) and sedative (sedative) therapy are prescribed, physiotherapy is performed, bed rest and complete rest are prescribed.
In order to prepare the lungs of the fetus for breathing, glucocorticoids or dexamethasone are prescribed to all women during hospitalization in the hospital.
If such treatment does not have any success, the clashes continue and grow in strength, the question arises of the inevitability of the appearance of the rush to the light.
If you have a birth at week 32, as well as at an earlier period, measures are required for the preparation of light fetuses.
Optimally, if given dexamethasone, and childbirth is not delayed at least for several days, but even for 3-6 hours the medicine received by the mother helps the maturation of the surfactant, the substance that helps the lungs of the newborn to open for the first breath.
Tactics of preterm labor
Conducting the procedure depends largely on how the delivery proceeds.
In any case, these genera cannot be called physiological, but they can proceed with the normal contractile activity of the uterus during the finished birth canal, and they can occur with the discoordination of the labor activity, with poorly prepared birth canal.
In 30% of cases, labor is swift. They take no more than 6 hours for primiparous people, 4 hours for multiparous ones.
How dangerous premature birth, if they proceed rapidly?
At such birth, the fetus suffers from hypoxia, since the uterus contracts too often, the progression through the birth canal is too fast. This, combined with the fact that the fetus has too small head sizes, which contributes to improper insertions, the head has soft bones, but is not adapted to configure (adapt to the birth canal), and the vessels are weak, can cause severe birth injuries of the fetus, intracranial hemorrhages, injuries of the cervical spine.
A premature baby can seriously suffer precisely because of how the generic act proceeded, and not because of prematurity. It should be noted that cesarean section does not reduce the number of complications of this kind and does not improve the prognosis for the fetus, such is the statistics.
If you stop the early delivery failed, they are carried out as carefully as possible. During labor, the woman should try to lie more, the period of exile, the most critical for the fetus, also always lies down.
Methods of protection of the perineum from ruptures do not apply, as they can cause injury to the child.
Even in the breech presentation, childbirth most often takes place in a natural way, if there are no normal contraindications for such births, and there are only recommendations in hospitals, where all conditions are created for nursing infants, to do a caesarean section in deep prematurity in such cases.
Sometimes in women giving birth, a coordinated labor activity or its weakness is observed. The cervix is not ready, the body too, and all this is explainable.
Births are carried out most carefully, with thorough anesthesia, labor induction is applied, but very carefully, controlling the condition of the fetus.
When anesthesia is preferred, epidural anesthesia is preferred, since narcotic drugs inhibit the sensitive respiratory center of the premature fetus.
According to the indications, antispasmodics and adrenomimetics are used, these drugs relax the lower segment of the uterus, helping it to open up.
During and after preterm birth, the risk of complications for the mother is high. Tears and injuries of the cervix and perineum seem to be a paradox, the fetus is small, but its small size is the reason for the incorrect insertions of the head, which lead to injuries.
There is a high risk of endometritis and postpartum hemorrhage, especially if the pregnancy was prolonged after the use of amniotic fluid.
Delivery at 35 weeks and later occurs in the same way as usual, the baby is already quite large and complications are rare. Caesarean section is not applicable for preterm labor:
– if there are clear signs of chorioamnionitis and intrauterine infection, and the fetus is deeply premature. – if the child has already died in utero.
In these situations, you will give birth yourself to the victorious end, albeit for two days, since in such cases independent labor is safer, and a caesarean section is a threat to the life and health of the mother, and not justified.
After preterm labor
If there are coming early childbirth and found time to look in the Internet, the first thing you will look for reviews. This is understandable and justified. But the most important thing is to choose the right maternity hospital. There should be a neonatology service specializing in non-traditional births. Each city has its own such hospital, your gynecologist or an ambulance are obliged to identify you exactly there, if the child is alive and has chances to live.
Hospital for preterm labor
A hospital is calculated as a normal maternity leave, if there are complications, add up 70 days before giving birth (84 if there were multiple births) and 84 after giving birth (110 if you had twins). Such a hospital is issued if the child is alive and was discharged with his mother.
Prevention of preterm labor
Prevention is reduced to the elimination of possible factors provoking them, at the planning stage. It is necessary to enter into a pregnancy as healthy as possible, and if it happened by chance – register early in the antenatal clinic and be examined.
Premature labor video
In the video, a newborn premature girl born at 27 weeks, weighing just over 800 grams. It should be noted that girls have a higher chance of survival, for some unknown reason, this is the statistics.