Peculiarities of conducting preterm labor
Jun 11, 2018
Premature birth is defined as a spontaneous or artificially induced termination of pregnancy at terms from 28 to 37 weeks.
Tactics of conducting women with preterm labor
The modern tactic of leading women in preterm labor is aimed at improving the fetal condition in the womb of a woman and preventing complications that often occur during the birth and in the early days of the life of a premature baby. With premature birth more often than with urgent birth, the state of hypoxia of the fetus develops. Due to the increased fragility of the vessels and the greater permeability of their walls, preterm births often produce hemorrhages in various parts of the body and in various organs during birth. Especially dangerous for life and health are hemorrhages in the cranial cavity with brain tissue damage, in the spinal cord, liver and adrenal glands. To prevent hemorrhages, premature births are conducted in such a way that the effect of mechanical factors at the birth of the premature fetus is minimized, and especially at the birth of its head, which is the largest and dense part.
Features of conducting
1. All women with prematurely started births are widely prescribed spasmolytic drugs( gangleron, no-shpa, dimecolin, etc.) that help to reduce resistance from the soft tissues of the birth canal, especially when the head is born.
2. To reduce the resistance of the pelvic floor muscles and reduce their effect on the fetal head, at the end of the opening period or at the beginning of the expulsion period, the mother gives pudendal anesthesia.
3. In the absence of proper effect from the produced pudendal anesthesia or in the presence of excessively high and poorly stretched perineum resort to perineotomy.
4. The head of the fetus when it is inserted and erupted is removed without protection of the perineum and without any attempts to bend it and withdraw it with a small oblique size, as is done with normal urgent labor and occipital presentation of the fetus.
In preterm labor, anomalies of the ancestral forces, premature or early discharge of amniotic fluid, bleeding in the consecutive and early postpartum periods are noted more often than with urgent births. To stop the already begun premature birth, if the uterine pharynx has not opened more than 4 cm and there has been no outflow of amniotic fluid, use tocolytics: partusisten, ritodrin, yutopar, isoptin, etc.
Tocolytic drugs are administered as solutions intravenously, and then insideform of tablets in maintenance doses. A solution of any drug of tocolytic action is administered intravenously drip, slowly( no more than 20 drops per minute), because with rapid administration, there may be side effects: lowering blood pressure, increasing heart rate, unpleasant sensations in the heart, etc. The midwife is required to monitor the effectiveness of the applicationof these drugs( a change in the character of the contractile activity of the uterus in the form of its weakening or complete cessation) and in case of side effects, immediately stop the further administration of the drug andlive your doctor.