Premature births - the causes of preterm labor

According to the medical guide, premature birth is a birth that occurred before the due gestation period( between 28 and 37 weeks).In this case, the fetus born at such births is usually premature, but viable.

The sooner a child is born, the more likely that his health will suffer because of an insufficient level of "maturation" in the womb. After all, only after the 28th week does the crumb begin to gain weight faster, increase in height, and even react to the external light by blinking the eyes. He already sees, hears, discerns smell and taste. But most importantly, it is at this time that his brain and lungs begin to develop rapidly( that is, he can breathe on his own if he suddenly has to appear).

Early birth at 32 weeks or later gives more chances to the child to grow up healthy( his internal organs will already be well formed, and the lungs are prepared for breathing).Born at this time, kids, most likely, will be able to suck on their own breast milk or milk formula.

Contractions or contractions of

During the third trimester, the frequency and soreness of the contractions of Braxton-Hicks intensifies, causing any woman to worry. But unlike the true birth pains that have a certain sequence, the contractions of BH do not differ in periodicity and are capable of "disappearing", it is only necessary to change the position of the body. If the bouts continue for at least 1 minute with a constant interval between them within an hour, then you have started deliveries, and you should immediately call the ambulance and go to the hospital.

Also, such births can begin with the outflow of the waters of the amniotic bladder or the passage of the mucous plug even before the onset of contractions. No less dangerous are sudden bouts of pain, "giving" back, or cramping pressure in the pelvic region, which you did not feel before.

Early signs of preterm births "give" time to allow a pregnant woman to reach the maternity hospital, and doctors - to suspend the labor activity.

Before the arrival of the ambulance, it is necessary to drink two no-shpa tablets and wait for the doctor to lie on the bed to slow the onset of labor. If possible, report the incident to a gynecologist who supervises you and follow all his instructions exactly.

Causes of preterm births

Causes of labor are very diverse.

1. Infection that infects the woman before or during pregnancy. The inflammatory process prevents the walls of the uterus from stretching, and as a result, there is a release from the fetus, which does not have the ability to fully develop and grow. The fact that infectious diseases can be present in the body will indicate the transferred diseases of the uterus or endometrium, abortions, scraping according to medical indications, as well as miscarriages. Therefore, before getting pregnant, it is better for every woman to undergo a complete examination and cure all the detected infectious diseases.
2. ICS( ischemic-cervical insufficiency), expressed in the inability of the cervix to remain all the time of pregnancy in a tightly compressed state, preventing the penetration of infection, as well as "squeezing out" the fetal bladder under the action of gravity to the outside.

Causes of NIs are:

1. Congenital( very rare);
2. Acquired - cervical injury in abortion( especially during the first pregnancy), in previous births at the time of the birth of a large child or their rapid course, and even with rough medical procedures for performing various procedures directly inside the uterus( eg, scraping endometrium).
3. Disturbances in the work of endocrine glands( ovaries, thyroid, pituitary).
4. Uterine overgrowth caused by too heavy a woman's fetus, or a multiple pregnancy.
5. Heavy physical work during pregnancy.
6. Strong or prolonged stress( at work or at home), as well as bad habits( smoking, drug addiction, alcoholism) and poor nutrition.
7. Acute respiratory disease, which required an internal "redistribution" of the protective capabilities of the body to save life for a woman.

In addition to the listed reasons related to the health of the woman herself, there are several other factors that can cause unplanned births:

• abnormalities and various malformations of the fetus, as well as genetic diseases( that is, a kind of "culling" of an unviable fetus takes place);
• immunological disorders that cause rejection of the fetus, as a woman alien to the body;
• gestosis, "blocking" the exit from the uterus, placenta previa, as well as a number of other pregnancy complications( pelvic presentation, polyhydramnios, premature placental abruption, etc.).

Pregnant women are not recommended to perform sharp physical movements, and also to lift and carry heavy objects, which can provoke early childbirth. Stressful factors include driving a car in difficult urban conditions, both because of the increased likelihood of falling into an accident due to the dissipation of attention during pregnancy, and because of the nervous stress that occurs when driving a car.

Also for a woman any falls are dangerous, even from a small height( so be especially careful when going down the stairs).

Stages of premature birth

Any early delivery "passes" three stages:

• threatening early births - a woman feels aching, pulling pains in the lower abdomen and around the waist, stress and contraction of the uterus, as well as sometimes increased fetal movements and the appearance of suppositories -an urgent medical attention is required;
• starting - there are cramping pains, the mucous plug comes off, and also the outflow( full or partial) of the amniotic fluid may occur;shortens and opens up to one or two centimeters of the cervix( determined by vaginal examination);
• started - as with normal timely delivery, characterized by rhythmic contractions( more often than every 10 minutes), smoothing and opening the neck by 4 cm or more.

In the maternity hospital

The threat of such births is not the birth itself. Arriving at the hospital, the woman falls into the hands of specialists who are able to stop the fights, if the fetus does not threaten anything( that is, the amniotic fluid surrounding the baby has not moved away, and the infection has not penetrated into the uterus).Prescribe in this case, drugs that reduce the tone of the uterus( for example, ginipral).

The next step is to eliminate the cause that caused the onset of labor. If it is an infection, antibacterial drugs will be prescribed;if the nervous stress - soothing. The process of treatment is complicated by the increased excitement of a woman about the fate of her baby, which again leads to the appearance of the tone of the uterus.

If the cause of early birth can become an NIH, manifested for up to 28 weeks, the cervix is ​​sewn up under intravenous anesthesia( the safest for the baby), preventing the prolapse of the fetal bladder.

For a period of more than 28 weeks, doctors resort to another method: a special ring is placed on the cervix, blocking its further opening and supporting the fetus, preventing it from "resting" on the neck. Rings come in several sizes and are selected individually for each woman. However, the installation of the ring is not yet a 100% guarantee that the fights will not begin again. Therefore, a woman is recommended not only to significantly reduce her physical activity, but also prefer bed rest( better in a hospital and under the supervision of doctors).At the same time, any hard physical work, long standing or sitting is excluded. Once in such a situation, working women will have to immediately leave the place of their work( regardless of its complexity) in order to preserve the life and health of the child( even if the gynecologist did not consider it necessary to leave the future mother in the hospital, but simply wrote out the sick leave sheet).In addition, the slightly open cervix can become a "gateway" for infection and therefore constant medical supervision of the condition of the pregnant woman is required.

Treatment of premature births is usually supplemented with microdoses of dexamethasone( a hormonal drug that stimulates the development of a child's lungs in this case).

Another variant of early delivery is a partial outpouring of amniotic fluid up to 34 weeks. This option is considered more difficult from a medical point of view and requires the appointment of antibacterial drugs( to prevent infection through a fetal bladder that has lost integrity), under the condition of suppression of labor and without worsening the condition of the child and his mother. After all, every week of a saved pregnancy increases the child's chances of surviving, as well as avoiding any physical illnesses.

But sometimes the symptoms of premature birth are not "suppressed" by the doctors. This happens if there is a threat to the life of a woman or a child. For example, with severe forms of toxicosis or chronic diseases of internal organs. Also, do not stop labor activities if the amniotic fluid burst after 34 weeks of pregnancy, regular fights with the opening of the cervix more than 4 cm( "natural" birth) have begun. In such cases, the main task of doctors is to carry out the delivery most gently, which is very often complicated by the inappropriate position of the baby( head up, not down).

Child

And yet the baby has a chance to survive, especially if his weight exceeded 1 kilogram and this maternity center is provided with the appropriate equipment.

The very process of childbirth is dangerous for the child due to hypoxia( due to placental insufficiency or premature aging of the placenta), as well as birth trauma( intracranial hemorrhage, spine injury in the cervical region) caused by strong pressure of the tissues of the mother's body during childbirth on the baby's head. Avoid injury can help change the "habitual" for childbirth pose "on the back" to the position "on the side."But for this, you first need to make an ultrasound to determine exactly how the baby lies, because the mother should lie on its side, opposite its back. Reduce the pressure in the process of childbirth on the head of the baby can be applied by cutting the perineum.

In pelvic presentation of the fetus, doctors can choose a cesarean section, but only with a highly professional neonatal service( for babies weighing less than 1500 g).

Preventing premature births

Every pregnant woman who does not have a physical predisposition to spontaneous abortion should take care to inform the child before the full term. General prophylaxis of such births is to perform a few fairly simple actions:

• provide yourself during pregnancy and during labor( maybe paid, but high-quality) professional medical care;
• discard such harmful habits as smoking and drinking alcohol before pregnancy;
• prepare your body physically, beginning to attend sports before planning your pregnancy, and in the absence of contraindications, continue to have small and short physical activities during the carrying out of the child( walking, attending special classes and swimming);
• eat variedly and correctly;
• , try not to use any medicines without emergency and without their appointment as a doctor;
• , if there is a high probability of a stressful situation at your workplace due to the forthcoming departure to the decree, try to "protect" yourself by going to "sick leave", or( if there is such an opportunity), change your place of work at the planning stage of pregnancy.

Remember that about 90% of pregnant women with no complications wear a child at least up to 37 weeks.