Etiology and pathogenesis spontaneous abortion to date remain insufficiently studied. This is apparently explained by the fact that the causes of this pathology are extremely diverse. In a complex biological process such as pregnancy and childbirth, a whole range of factors interact, each of which, to one degree or another, can have an impact bad influence during pregnancy.
The frequency of premature spontaneous abortion, according to various authors, ranges from 10 to 13% (S. M. Becker, 1964). According to N. S. Baksheev (1972), spontaneous termination of pregnancy (abortion) occurs in 2.5-4.5% of women, premature birth- in 3.5-4.5%.
Among the causes of spontaneous abortion, endocrine disorders occupy a large share (I. I. Benediktov, 1962; E. I. Kvater, 1967; L. A. Mozzhukhina, 1967; V. I. Bodyazhina, 1972; I. S. Rozovsky, 1972, etc.).
Hypofunction of the ovaries, often in combination with underdevelopment of the uterus (infantilism, hypoplasia), is the most common cause of recurrent miscarriages (in 68% of cases, according to I. S. Rozovsky). Pregnancy in such women is usually terminated in the early stages due to reduced excretion of sex hormones (estrogens and progesterone). It is known that the main source of these hormones in the first half of pregnancy is the ovaries, in the second - the fetoplacental system.
It has now also been established that during the physiological course of pregnancy there are certain relationships between hormones that ensure the formation and development of the embryo. Their violation leads to developmental abnormalities of the fetus, its death and expulsion. In the diagnosis of endocrine disorders during miscarriage, determining the excretion of sex hormones is of great importance. Threatening prematurity is characterized by a significant decrease. A decrease in the excretion of pregnanediol in the first trimester of pregnancy to 4-5 mg indicates significant endocrine disorders (T. D. Ferdman, 1963; I. S. Rozovsky, 1971, etc.). Furuhjelm (1962) believes that a decrease in the concentration of estriol in daily urine to 7.5 mg or more is an indicator of fetal death. With timely administration of hormonal therapy (estrogens and progesterone) in certain proportions to such patients, pregnancy can be maintained.
Habitual miscarriages often occur when the function of the adrenal cortex is impaired, characterized by a disorder in the processes of synthesis of steroid hormones (I. S. Rozovsky, 1966). The management tactics for such pregnant women should be different than for patients in whom the main cause of miscarriage was ovarian hypofunction. The use of progesterone in this group of patients leads to increased bleeding, and signs of termination of pregnancy appear (L. S. Persiapinov, 1962; Piver et al., 1967, etc.). Therefore, the only treatment for miscarriage in this pathology is corticosteroid therapy.
According to N. S. Baksheev and A. A. Baksheeva (1955), the cause of miscarriages can also be a dysfunction of the thyroid gland. In areas where goiter is endemic, where there is iodine deficiency, premature termination of pregnancy, but according to the authors, is observed much more often than in other regions of Ukraine. N. S. Baksheev (1953), Mink (1959) emphasize that functional insufficiency of the thyroid gland predisposes to spontaneous miscarriage, and the administration of thyroidin prevents it.
As studies by V.F. Levanyuk et al. have shown. (1967), hypofunction of the thyroid gland during pregnancy leads to a decrease in the intensity of metabolic processes in the muscle of the uterus, placenta and fetal tissue, as well as to disruption of the protein structure of the myometrium. These data, to a certain extent, make it possible to explain the role of thyroid hormone deficiency during pregnancy in the mechanism of spontaneous miscarriage or fetal death. According to T.P. Barkhatova and E.A. Andreeva (1965), severe thyrotoxicosis can also be the cause of miscarriage.
A common cause of prematurity is disturbances in the structure and function of the isthmic part of the uterus and pathological changes in the endometrium. Insufficiency of the obturator function of the cervix most often occurs due to damage to the area of ​​the internal os (abortion, childbirth) or against the background of existing functional insufficiency of this section (V. I. Bodyazhina, 1972; N. S. Baksheev, 1972, etc.).
Among the causes leading to functional isthmicocervical insufficiency, infantilism, hypoplasia and malformations of the uterus occupy a prominent place. In approximately 10% of women, according to I. S. Rozovsky (1971), suffering from recurrent miscarriage due to neuro-endocrine disorders, progressive isthmicocervical insufficiency is detected.
During pregnancy, isthmicocervical insufficiency manifests itself in the progressive opening of the cervical canal, which leads to protrusion of the membranes, its rupture and miscarriage. The insufficiency of the obturator function is especially clearly determined from the 14-16th week of pregnancy.
The cause of prematurity can also be malformations of the uterus. So, according to II. L. Piganova (1972), in 10.8% of women with uterine developmental anomalies, pregnancy ends in spontaneous miscarriages and premature birth. Premature termination of pregnancy due to malformations of the uterus occurs as a result of a combination of ovarian hypofunction and infantilism, anatomical and functional inferiority of the myometrium, as well as due to a violation of its vascularization and innervation.
Of great importance in the etiology of miscarriage is the combination of a malformation of the uterus with insufficiency of its obturator function and peyro-endocrine disorders.
Induced abortions and accompanying inflammatory diseases of the internal genital organs contribute to an increase in the percentage of prematurity (I. S. Rozovsky, 1966; M. A. Petrov-Maslakov, 1972). It has been established that after induced abortions, signs of defective endometrial secretion and disruption of the processes of glycogen formation develop (V.I. Bodyazhina, 1966).
Among the causes of spontaneous abortion, production factors of industrial enterprises, especially chemical ones, deserve attention.
When studying the nature of industrial hazards, it was found that the most adverse effects on the course of pregnancy and its outcome are mercury, lead, benzene vapors, cyclohexane, nitro paints, resins, and lactam dust (P. G. Demina et al., 1971; Ya. P. Solsky and al., 1971; I. I. Grishchenko et al., 1971, etc.). Women's work in foundries is also associated with a number of unfavorable factors - high temperature, dust, noise, vibration. The possibility of mutagenic effects of ionizing radiation and various medicinal substances deserves special attention.
The cause of miscarriage is quite often various infections, especially acute ones. Among them, according to B.V. Kulyabko (1965), the main place is occupied by influenza (50%). The influenza virus easily penetrates the placenta and membranes and, having a certain tropism for lung tissue (Flamin, 1959), causes inflammatory changes in the fetal lungs and placenta, which in turn leads to fetal death or premature termination of pregnancy.
The role of adenovirus infection in premature termination of pregnancy, as well as influenza, is great. Opa is transmitted transplacentally and can cause inflammatory changes in the fetal lungs and placenta. When the disease occurs in the early stages of pregnancy (up to 3 months), embryo death and abortion often occur; in later stages, antenatal fetal death and premature birth occur.
Premature termination of pregnancy due to chronic infection (toxoplasmosis and listeriosis) is explained by the effect of the infectious onset on the developing fetus and uterus (A.G. Pap, 1966, etc.). It should be noted that the influence of acute and chronic infection and other harmful environmental factors on the maternal body especially affects the development of the fetus during the implantation period. According to A. A. Dodor (1964), when an acute infectious disease occurs in the mother (influenza, tonsillitis, etc.) in the first 3 months of pregnancy, stillbirths were observed in 14.5% of women, and prematurity in 19%.
The fetus is especially sensitive to viral infections in the first 2 months of pregnancy (Flamm, 1959).
The role of extragenital diseases (A.G. Pap, L.B. Gutman, 1966, etc.) in the occurrence of spontaneous miscarriages and premature births has been well studied. Extragenital diseases often contribute to the development of toxicosis in pregnant women, which worsens the course of the underlying disease and can cause premature termination of pregnancy. Prematurity due to extragenital diseases is a consequence of general pathological changes in the pregnant woman’s body associated with the underlying disease.
At present, there is not yet sufficiently convincing data to determine the proportion of immunological conflicts among other causes of prematurity. Blood incompatibility according to the ABO system and the Rh factor is of known importance. An immunological conflict arises as a result of immunization of the mother with fetal antigens, which leads to the production of corresponding antibodies in the pregnant woman's body, which then penetrate the placental barrier to the fetus.
Due to antigenic incompatibility of the blood of mother and fetus, the normal course pregnancies occur spontaneous miscarriages, premature birth and stillbirth (L. V. Timoshenko, V. E. Dashkevich, M. V. Bondar, 1968). According to V.E. Dashkevich, 27% of the examined women suffering from prematurity were found to have Rh-negative blood.
In the occurrence of habitual prematurity, emotional factors also play a certain role.
In 1.6-9.7% of women, the cause of termination of pregnancy is mechanical injury (A. A. Nikolskaya et al., 1967, etc.).
As can be seen from the above data, the list of reasons that can cause premature termination of pregnancy has expanded significantly in recent years.
Prematurity may manifest itself as various forms. There are spontaneous abortions up to 28 weeks: early abortion - up to 16 weeks and late abortion - at 16-27 weeks. Termination of pregnancy at 28-37 weeks of pregnancy is called premature birth. If prematurity is observed during the first and subsequent pregnancies, it is called habitual.
The highest frequency of prematurity, according to E. Novikova et al. (1971), N. S. Baksheeva (1972), observed in women young(up to 25 years) having a first or second pregnancy.

Diagnosis of spontaneous abortion

Diagnosis of miscarriage itself is not difficult.
The most common symptom of a threatening condition is pain in the lower abdomen and lumbar region, or a vague feeling of heaviness, discomfort in the pelvic area. If pain, although mild, is felt periodically, then it can be attributed to uterine contractions. Obvious cramping pain indicates that the pregnancy has been terminated.
The second symptom of threatening spontaneous abortion is bleeding from the uterus. With early abortions, in contrast to late abortions that occur in the second half of pregnancy, the main symptoms are bleeding and pain. The presence of pain indicates contraction of the uterus and dilation of the cervix. The intensity of bleeding is directly dependent on the degree of detachment of villi from the uterine wall and the degree of myometrial contraction. Data from studies of the condition of the uterus are of decisive importance for recognizing pregnancy breakthrough. This condition is characterized by high excitability of the uterus, and even with normal internal examination, its contraction occurs.
In case of threatening termination of pregnancy, dilatation of the cervix even by one finger diameter in the absence of smoothing allows us to evaluate the changes that have occurred as reversible. In such cases, attempts should be made to prevent termination of pregnancy.

Prevention and treatment of spontaneous abortion

In the prevention and treatment of premature termination of pregnancy, complex treatment of pathological conditions that result in spontaneous miscarriages is of great importance.
In cases where the pregnancy is still disrupted, it is necessary to stop the further development of the threatening miscarriage. First of all, it is necessary to create complete physical and mental peace. The patient must observe strict bed rest.
To resolve the issue of the need to use complex hormonal therapy, especially if there is a history of miscarriages in very early stages pregnancy, determining the excretion of sex hormones is of great importance. Low levels of pregnanediol and estriol are grounds for prescribing hormones.
Considering the important role of the corpus luteum for nidation of a fertilized egg and the normal development of pregnancy, it is advisable to use progesterone in the form of intramuscular injections of at least 15 mg per day for 8-10 days. At the same time, estrogens are administered at a dosage of 0.5-1 mg per day. The course of treatment is 8-10 days. Estrogens enhance uteroplacental blood circulation, increase the secretory activity of the trophoblast, normalize the excretion of pregnanediol (N. S. Baksheev and E. T. Mikhailenko, 1964; Schmidt and Poliwoda, 1965, etc.).
The use of estrogen and progesterone in certain ratios before 14-15 weeks of pregnancy is justified, since these hormones potentiate the action of each other, which leads to the activation of a number of complex chemical and morphological processes that ensure the preservation of pregnancy (II. S. Baksheev, 1965; I. S. Rozovsky, 1971; Martin, 1964; Zander, 1967, etc.). In more late dates during pregnancy, estrogens introduced from outside help to increase the metabolism of the corpus luteum hormone and remove it from the body, resulting in increased excitability of the uterine muscles (L. T. Volkova, 1966). In this regard, estrogen therapy in case of threat of prematurity is indicated only in the early stages of pregnancy.
Some authors (V. Shulovich et al., 1961; I. S. Rozovsky, 1966; Froewis, 1961, etc.) for the treatment of patients suffering from habitual prematurity associated with ovarian hypofunction and infantilism, recommend the combined use of progesterone, estrogens and HG. As a result of this treatment, implantation processes are normalized and uteroplacental circulation is improved. Hormonal therapy is usually combined with the prescription of drugs that reduce neuropsychic excitability (Pavlov's mixture, caffeine, trioxazine, antihistamines - pipolfen or suprastin), as well as vitamins.
Among the vitamins, vitamin E (tocopherol) deserves special attention. Our observations, as well as literature data, indicate the high therapeutic effectiveness of vitamin E in the treatment of prematurity. Lack of vitamin E in the body leads to fetal death and termination of pregnancy. Externally administered vitamin E enhances the production of the corpus luteum hormone or potentiates its activity. There is also evidence that vitamin E activates cell division processes. This contributes proper development embryo, and also affects the trophism of the placenta, increasing the functional capacity of this organ, which is necessary to maintain pregnancy and carry it to term (L. V. Knysh, 1966). Vitamin E is prescribed 30-50 mg daily in the form of a concentrate per os or a 30% oil solution intramuscularly. The total dose ranges from 210 to 3000 mg, depending on the severity of symptoms.
Treatment is continued after the symptoms of threatened miscarriage have been eliminated to prevent possible relapses. Along with vitamin E, intramuscular injections of progesterone 10 mg are prescribed once a day for 8-10 days. In cases of habitual prematurity, vitamin E is combined with progesterone even before the onset of signs of miscarriage. To treat this pathology, it is also recommended to use nicotinic acid in an amount of 100 mg per day (V.F. Gorvat, 1966).
It is also advisable to prescribe vitamins C and PP. It has been established that the concentration of vitamins C and PP in the blood and urine of women suffering from prematurity is reduced and the provision of these vitamins to the fetus depends on their content in maternal body(V.F. Gorvat, 1966). The role of hypovitaminosis C in the etiology of prematurity can be confirmed by data on the influence of seasonality on the incidence of preterm birth. In the winter-spring months, there is a tendency towards a slight increase in the frequency of premature births (L. I. Shinkarenko, 1966): in January - 7%, in September - 3.8%. Vitamin C is prescribed in the form of ascorbic acid 3 times a day, 0.2 g, or in the form of products that contain this vitamin (rose hip paste), especially during the autumn-winter period. The use of nicotinic acid in an amount of 100 mg per day when there is a threat of miscarriage has a positive therapeutic effect: the excitability of the uterus decreases and pain stops.
As mentioned above, one of the reasons for preterm pregnancy is isthmicocervical insufficiency, associated with anatomical disorders in the isthmus and upper cervix or with the functional characteristics of these sections.
Currently, in our country, the surgical method of treating insufficiency of the obturator function of the uterus is widely used (A. I. Lyubimova, 1966; S. M. Soskipa, 1966, 1969; N. S. Baksheev, 1972, etc.). It consists of narrowing the lumen of the cervical canal closer to the internal call by applying a circular suture. For the first time such an operation was performed by Shirodkar (1951). There are several options for eliminating isthmicocervical insufficiency. The operation is performed under local infiltration anesthesia. All pregnant women after surgery are prescribed progesterone 10 mg daily for 5-7 days. If pregnancy continues and its normal course, the ligature is removed 1-2 weeks before birth. If the water breaks prematurely and labor begins, the suture must be removed.
It is extremely important to maintain a strict medical and protective regime. The doctor must instill in the patient confidence in the successful outcome of the pregnancy. M. Ya. Miloslavsky recommends resorting to psychotherapy without the use of any therapeutic measures. The patient is explained that her fears and concerns are unfounded, they are given advice regarding the lifestyle that is most suitable for her, and the effectiveness of those measures is noted. medicinal products that are prescribed to her. Observing pregnant women with signs of threatening miscarriage, the author showed that such women have functional disorders in the higher parts of the central nervous system, which are expressed in a decrease in the excitability of the brain. Under the influence of treatment using the method of verbal influence, these disorders are removed.

Premature birth

Premature birth is usually called termination of pregnancy between 28 and 37 weeks; in this case, the fetus is premature, but viable.
According to the definitions adopted in our country, a newborn born after 28 weeks of pregnancy and weighing at least 1000 g and height of at least 35 cm is considered viable. If a child was born before 28 weeks of pregnancy with a weight bearing less than 1000 g or a height of less than 35 cm, his classified as late miscarriages, but if he is alive at the end of the perinatal period, he is considered prematurely born.
Much literature and clinical observations indicate high perinatal mortality in premature infants. The stillbirth rate during premature birth is more than 5 times higher than that during normal birth (N.F. Lyzikov, 1971, etc.). The mortality rate of premature babies is also high.
The incidence of preterm birth varies greatly. In recent years, there has been a tendency towards more frequent complications of pregnancy with premature birth. The causes of premature birth are varied: infantilism, extragenital diseases, pregnancy complications (toxicosis, polyhydramnios, multiple births, premature placental abruption, etc.). Often, not one, but several reasons are discovered. According to L.V. Timoshenko, B.K. Kvashenko et al. (1972), premature birth occurred in 10.1% of pregnant women with uterine fibroids.
There are also conflicting data regarding the comparative frequency of premature births in certain months of pregnancy. Thus, according to Yu. F. Krasnopolskoi (1954), premature births occur mainly in the VII-VIII lunar month, according to the observations of E. Ch. Novikova (1971), in the last 2 months of pregnancy.

Premature birth clinic

The clinical course of preterm birth is characterized by a number of features. V.I. Konstantinov (1962) believes that premature births, as a rule, are shorter than urgent ones. At the same time, A.I. Petchenko notes the long duration of premature birth and explains this phenomenon by the insufficiency of neuro-humoral factors, unpreparedness of the cervix and, as a result, ineffective labor.
Primary and secondary weakness of labor during prematurity are observed, according to L.V. Timoshenko et al. (1966), in 5.57o, V.I. Konstantinov (1962), in 10.2% of women. The development of weakness of labor is largely associated with a disorder of complex neuro-humoral factors that regulate labor. And finally, infantilism, which is one of the causes of prematurity, also adversely affects the course of childbirth.
Despite the low birth weight of children, there is significant trauma to mothers during childbirth. Thus, according to V.I. Konstantinov (1962), perineal ruptures during premature birth occur in 9.7-14.6% of women. This can be explained by the fact that the perineal tissue is not sufficiently prepared for stretching. In the postpartum period, more often than after term birth, fever, subinvolution of the uterus, endometritis, and retention of membranes are observed.
In case of premature birth, early and premature passage amniotic fluid (according to I.M. Lyandres, 1961; N.F. Lyzikova, 1963, etc., within 12-34%). Many authors consider premature discharge of amniotic fluid as a manifestation of the functional failure of the woman’s body. According to Z. A. Simonenko (1959) and others, this pathology often occurs in pregnant women with symptoms of infantilism. K. A. Kirsanova (1966) and others associate premature rupture of water with the morphological and biophysical characteristics of the membranes, their strength and extensibility.
Many researchers point to the role of infection in the etiology of this complication, as well as gynecological diseases, previous abortions, mechanical factors, abnormal fetal position, etc.
It is known that the frequency of death of children increases as their weight and maturity decrease. Therefore, prolonging pregnancy with the threat of termination in the last months, at least for a short period, increases the viability of the fetus. That is why, in the fight against perinatal mortality, the issue of managing premature pregnancy with premature rupture of amniotic fluid is of particular importance.

Prevention and physician tactics during preterm birth

The doctor’s tactics for this pathology can be twofold. Most obstetricians in such cases recommend initiating labor. Some authors prefer conservative expectant tactics (N. S. Baksheev, 1964; S. M. Becker, 1964; T. A. Mironova, 1966; S. P. Pisareva, 1967; N. F. Lyzikov, 1971; Gillibrand, 1967, etc.). They believe that conservative expectant management of a premature pregnancy with premature rupture of water is a biologically appropriate method that has no harmful effect on the mother and fetus. In this case, not only the time that has passed since the water began to break must be taken into account, but also factors such as body temperature, absence of signs of infection, gestational age, position of the fetus, and its condition.
In all cases when labor is limited by pain in the abdomen or lower back, increased excitability of the uterus, the issue is resolved positively. You should not give up trying to stop labor even during regular contractions, since sometimes in such cases it is possible to prevent premature birth.
In order to maintain pregnancy at 28-37 weeks in case of premature rupture of amniotic fluid, strict bed rest is prescribed, which is best provided in a hospital setting, vitamin, oxygen and psychotherapy; complete, easily digestible and sufficiently high-calorie food. Observe the state of body temperature, pulse, the nature of vaginal discharge, and fetal heartbeat. In case of increased excitability of the uterus, antispasmodics are used: magnesium sulfate (25% solution, 10-20 ml intramuscularly 2 times a day), tropacin (0.01 g 3 times a day), no-shpu (2 ml of 2% solution), etc. The use of vitamin E is indicated, as well as the administration of antibiotics, taking into account their tolerability and the sensitivity of the microbial flora to them. Drugs are prescribed to prevent intrauterine asphyxia of the fetus (5% glucose solution, cocarboxylase - 50-100 mg, ascorbic acid - 5%, vitamin B, sodium bicarbonate - 5%, ATP and other drugs). The course of treatment is 2 weeks.
Frequent changes of linen and sterile pads are provided. It is necessary to monitor the function of the gastrointestinal tract. For constipation, an appropriate diet and mild laxatives are prescribed. The given set of therapeutic measures makes it possible to prolong pregnancy in some women up to 78 days (S. P. Pisareva, 1967). According to the author, perinatal mortality during conservative treatment of pregnant women with premature rupture of amniotic fluid is 7.8%, while with active management it reaches 25% (N. F. Lyzikov, 1971, etc.).
Practice has shown that in 70-75% of women with a threat of premature birth, it is possible to prolong pregnancy to a more favorable period if pregnant women are in specialized departments (N. S. Baksheev, 1972).
If the body temperature rises, signs of endometritis appear, or fetal asphyxia begins, it is necessary to abandon further pregnancy and induce labor. Special attention should be given to measures for intrapartum fetal protection and infection prevention.
The peculiarities of premature birth require appropriate management techniques. The obstetrician's tactics from the very beginning should differ from those used for urgent birth. By using appropriate means during childbirth, the doctor has the opportunity to eliminate the main causes of death of the fetus and newborn: oxygen deficiency, which develops due to impaired placental circulation; increased fragility of brain capillaries, characteristic of unripe fruits; compression of the fetal head by the pelvic floor muscles, which are not yet prepared for childbirth, and intrauterine infection of the fetus.
Therefore, it is advisable, for the purpose of prevention, to use during childbirth drugs that can increase the fetus’s resistance to oxygen deficiency and partially compensate for its deficiency.
Sufficient provision of the mother with oxygen, the widespread use of estrogens, glucose, and vitamins can and should be used to increase the supply of oxygen to the fetus both in the first and second stages of labor. To increase the extensibility of the pelvic floor muscles and reduce compression of the fetal head advancing in the second stage of labor, pudendal anesthesia with novocaine with lidase is indicated.
To prevent asphyxia and traumatic brain injury of the fetus, it is very important to regulate attempts, trying in some cases to slow them down (remove the hands of the woman in labor from the “reins”, force her to breathe deeply.). Childbirth should be carried out without perineal protection. If the perineum is high and there is a delay in the advancement of the head at the moment of its eruption, a non-rhineotomy is performed. In the maternity room during premature birth, the temperature should be maintained at 26-27°.
Since premature newborns (especially those with low weight) are extremely sensitive to environmental conditions, in the first minutes after birth the most favorable conditions should be created for them (the surface of the changing table should be insulated, the diapers should be warmed, and humidified oxygen should be provided). Premature newborns often die in the first days after birth from aspiration pneumonia and pulmonary atelectasis. Therefore, you should be especially careful to clear the airways of mucus (preferably using a device).
All manipulations with a premature newborn must be performed with the greatest care. After initial treatment, suction of mucus and restoration of breathing, the newborn, wrapped in warm underwear and covered with heating pads, is transferred to the nursery. There he is placed in an incubator.
Thanks to premature births using this technique and subsequent nursing of newborns, it is possible to reduce mortality by 40%.
The fight against prematurity is a special section of the work of antenatal clinics. The focus should primarily be on women who have had premature birth or spontaneous miscarriage; they are taken into special registration and undergo a thorough examination and treatment in the period between pregnancies.
Of great importance in the fight against prematurity are monitoring the correct physical development girls, thorough examination and treatment outside of pregnancy of women suffering from infantilism, menstrual dysfunction, implementation of legislation on the protection of women's labor, early coverage of all pregnant women, timely detection and treatment of internal pathology of women and complications of pregnancy, observance of personal hygiene rules, rational nutrition.

Miscarriage

Premature pregnancy is a serious social problem. The frequency of this pathology ranges from 10 to 25%. Premature pregnancy is a pregnancy that ends in premature birth or abortion.

The causes of prematurity are varied and numerous. Conventionally, they can be divided into two groups: diseases of the pregnant woman and obstetric anomalies. Among the diseases of a pregnant woman, infectious diseases such as influenza, herpes, taxoplasmosis, and rubella come first; as well as diseases of the kidneys, gastrointestinal tract, liver, blood, toxicosis of pregnancy. Obstetric anomalies include abnormal fetal position, multiple pregnancies, hemolytic disease, and premature rupture of water. Deficiency of vitamins and microelements and the harmful influence of the external environment also play a certain role. The state of the pregnant woman’s nervous system and negative emotions are of great importance in this pathology.

Among the causes of miscarriage, a woman’s profession is also important. This pathology is more often observed in working women (34%), less often in housewives (24%).

Signs of threatening miscarriage include pain in the lower abdomen and lower back, copious mucous and mucous-bloody discharge from the vagina. In such cases, the pregnant woman should be urgently hospitalized in a hospital.

For the unborn child, it is important to preserve every week of intrauterine development. The days corresponding to the period of menstruation are especially dangerous. On such days, special care must be taken. If a woman has had cases of miscarriage, hospitalization is necessary until the period when the termination occurred the previous time.

Premature birth means that the child loses a significant period of intrauterine development, and therefore its further development changes dramatically.

In premature babies, the body's resistance to various infections is reduced, and the immaturity of the lungs contributes to the rapid development of pneumonia. Even a normal birth for premature baby may be traumatic. The closer to the physiological end of pregnancy premature birth occurs, the more viable the premature baby is. The weight of a premature baby is less than 2500 g, and the height is less than 45 cm, their skin is covered with small hairs, the nails do not completely cover the terminal phalanges of the fingers, the fontanelles are very large, in boys the testicles may not be descended into the scrotum, the subcutaneous fat layer is poorly developed, therefore Such children do not tolerate temperature changes well. The movements of the premature baby are inactive, the cry is weak or absent at all, the eyes are closed, he does not take the breast well, so such children require special care and attention to themselves.

Post-term pregnancy

Post-term pregnancy is a pregnancy whose duration exceeds the physiological period (280 days) by 10-15 days. The incidence of post-term pregnancy ranges from 3 to 7%.

A post-term pregnancy ends in delayed birth.

The reasons for post-term pregnancy are complex and have not yet been sufficiently studied. A certain role is played by changes in the uterus that reduce its contractile activity due to previous abortions, inflammatory and other diseases. Post-term pregnancy is observed more often in primigravidas over 30 years of age and can be inherited or observed several times in the same women. Postmaturity can also be caused by mental trauma. Most often it is observed in the spring, mainly in women with menstrual dysfunction.

There are true post-term and imaginary (prolonged pregnancy). With prolonged post-term pregnancy, the gestational age increases, but the baby is born mature and without signs of post-term pregnancy. This may be due to the reasons that caused the slowdown in fetal development, and is considered as an adaptive phenomenon that promotes fetal maturation. When pregnancy is carried beyond term, the fetus often becomes large and large sizes heads and long nails. The bones of the head of a post-term baby are dense, and the fontanelles are small. Changes in the placenta also occur, making it difficult for the child to receive the required amount of oxygen and other substances necessary for normal life. This placenta is called old.

The effect of postterm pregnancy on the fetus is unfavorable, since the course of delayed labor is often complicated, and an overripe fetus is poorly adapted to postpartum stress; exceptions are cases when post-term pregnancy is not accompanied by pronounced over-maturity, which is observed with a slight increase in gestational age.

Usually, with this pathology, labor does not occur on its own, and it is necessary to induce labor, that is, to prepare the pregnant woman for childbirth. For this purpose, agents are used that increase the contractility of the uterus, and medications that prepare the cervix for childbirth, vitamins, calcium supplements, and sometimes a caesarean section is used.

Pregnant women who have previously given birth to a child weighing more than 4 kg, as well as whose previous pregnancies were post-term, or who have suffered psycho-emotional shock, must undergo a comprehensive examination and go to the hospital no later than 40 weeks of pregnancy. Post-term pregnancy increases the risk of pathological birth and has an adverse effect on the unborn child.

Original article www.baby.com.ua Material prepared by E. Tolstykh

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Unfortunately, very, very much. These include various risk factors of a social, medical, physiological nature, as well as unforeseen life circumstances (for example, emergency caesarean section). The most important thing – no matter what the reason is for the child – is to do everything in the doctors and parents’ hands to care for him, so that in the future he is no different from his full-term peers. Premature (as defined by WHO) is a child who was born between the 22nd and 22nd term, weighing from 500 grams to 2500 grams.

Let's take a closer look at all the possible prerequisites for premature termination of pregnancy:

1.Socio-demographic reasons:

• low living (social) level of the family;
• too early or vice versa - late age for pregnancy (there is a tendency towards an increase in cases of prematurity depending on the age of the parents - the younger (less than 17-18 years) and the older (more than 35 years) the expectant mother, as well as the older the child’s father (more 50 years), the higher the probability of premature termination of pregnancy);
• problems in family life, frequent scandals, lack of mutual understanding;
• unwanted pregnancy (as a factor in psychological abortion);
• poor nutrition and bad habits pregnant woman.

2.Medical reasons:

• pregnancy that occurred earlier than one to three years after the previous birth;
• the woman has chronic diseases (endocrine system, gynecology, genetic), as well as family history on the part of either parent;
• acute and infectious diseases suffered by a woman during pregnancy;
• strong early toxicosis, burdened gestosis and other pathologies of pregnancy;
• undergone surgical interventions (operations) and physical injuries (especially the abdomen) while bearing a child;
• unstable mental and emotional state of a pregnant woman;
• hemolytic disease of the fetus, which developed against the background of incompatibility with the mother by blood type or Rh factor;
• previous surgical terminations of pregnancy (induced abortions), especially if complications arose during or after the operation;
• multiple pregnancy;
• various defects in the structure and development of the uterus and cervical canal (for example, bicornuate uterus, underdeveloped cervix);
• placenta previa or premature placental abruption;
• polyhydramnios or premature rupture of amniotic fluid;
• malformations in the development of the fetus or its intrauterine death.

3.Environmental and working conditions:

• aggressive environment in which the expectant mother lives (for example, proximity to the Chernobyl zone or other dangerous radiation sites, living next to a chemical plant, etc.);
• harmful conditions at work where either of the child’s parents works;
• heavy physical labor in which a pregnant woman is involved (for example, standing for long periods of time during the working day, work on an assembly line, work associated with carrying heavy loads).

Causes of premature pregnancy There are many more, and we simply do not have enough time or energy to list them all. In addition to the above reasons, there are also cases where the cause of premature labor remains unknown. Therefore, it is very important, at the first suspicion of a threat of premature labor, to immediately consult a doctor who will determine the cause. this phenomenon and will take all necessary measures aimed at continuing to bear the child.

Prevention of premature pregnancy

Prevention of this pathology of pregnancy should begin only when planning to conceive a baby.

To do this, a woman (and it wouldn’t hurt a man either) needs:

• be sure to treat all chronic and acute diseases she has (for which it is necessary to take responsibility for undergoing the necessary ones when planning a pregnancy!);
• follow the rules intimate hygiene, as well as lead a discriminating sex life;
• protect yourself from unwanted pregnancy (according to statistics, more than half of the cases of prematurity occur in women who had abortions shortly before pregnancy!);
• do not abuse alcoholic drinks, quit smoking;
• eat right, replenish the supply of vitamins in your body;
• avoid stress, anxiety, nervous tension.

If you notice the first signs that you are pregnant, do not put off visiting a gynecologist and registering. This is the only way you can avoid medical errors in calculating the true gestational age, which is one of the most common causes of premature pregnancy, especially if you gave birth at 36–37 weeks.

POSTMARGE PREGNANCY

Post-term pregnancy is a problem of great scientific and practical interest in obstetrics. Its relevance is explained by the large number of complications during childbirth and high perinatal mortality. The scientific approach to the problem of post-term pregnancy was determined by 1902, when Bellentine and then Runge (1948) first described signs of overmaturity in a newborn, and this syndrome was called Bellentine-Runge syndrome.

In modern obstetrics there are true (biological) post-maturity pregnancy and imaginary (chronological) or prolonged pregnancy.

Truly post-term Pregnancy should be considered if it continues more than 10-14 days after the expected due date (290-294 days). A child is born with signs of overmaturity and his life is in danger. Usually in these cases, petrificates, fatty degeneration, etc. are determined in the placenta.

Prolonged, or physiologically extended, should be considered a pregnancy that lasts more than 294 days and ends with the birth of a full-term, functionally mature child without signs of overmaturity and danger to his life.

ETIOLOGY AND PATHOGENESIS

Previous childhood infectious diseases, as well as extragenital diseases, which may be a premorbid background for post-term pregnancy.

Infantilism.

Endocrine diseases.

Mental trauma.

Gestosis (late).

Incorrect fetal position and head insertion.

Disorders of the pituitary-adrenal system of the fetus, and not just aging of the placenta. Fetal malformations are more common. Some authors believe that post-term pregnancy is associated with a violation of the mechanism of labor.

The leading role in the neurohumoral regulation of the functional state of the uterus, including labor, is played by the hypothalamus and the structures of the limbic complex, primarily the amygdaloid nuclei and cortical formations located in the temporal lobes of the cerebral hemispheres. In the onset of pregnancy, its course, development and nature of labor, a large role belongs to estrogens, gestagens, corticosteroids, human chorionic gonadotropin, some tissue hormones (acetylcholine, catecholamines, serotonin, kinins, histamines, prostaglandins), enzymes, electrolytes, trace elements and vitamins.

Based on research by many authors, it was found that when normal pregnancy an increase in estrogen levels is observed until the end of pregnancy. Estriol levels increase especially quickly after 32 weeks of pregnancy. It has been established that estrone and estriol play an important role in preparing the pregnant woman’s body for childbirth. The highest concentration of estrogen is during childbirth. Most authors believe that estrogen levels play an important role in the onset of labor, but are not the triggering factor for this process. The synthesis of estriol is carried out by the fetoplacental system. It begins with dehydroepianandrosterone (DHEA) in the fetal adrenal glands, which is hydrolyzed in the fetal liver to 16 DHEA and converted to estriol in the placenta. Only small amounts of DHEA and 16 DHEA are produced in the mother's body.

It has been established that abnormalities of fetal development, especially the central nervous system with severe damage to the adrenal glands, lead to post-term pregnancy. Thus, we can conclude that the cause of post-term pregnancy is often associated with the fetus and placenta, and not with the primary inertia of the uterus.

The changes observed in the placenta during post-term pregnancy appear to be secondary. However, in the future they can play an important role in steroidogenesis, the condition of the fetus and the onset of labor. Developing placental insufficiency leads to metabolic disorders in the fetus. Due to the existence of such a close connection between the fetus and the placenta, a decrease in fetal viability negatively affects the function of the placenta. This creates a circle of pathological processes inherent in post-term pregnancy.

CLINIC AND DIAGNOSTICS

The duration of pregnancy and childbirth is determined according to the following data:

By date of last menstruation (280 days).

By fertilization (268-275 days).

By ovulation (266 days).

Upon first appearance at the antenatal clinic.

At the first movement.

According to the formulas of Jordania, Skulsky, etc.

Obstetric examination data:

1) decrease in abdominal volume by 5-10 cm, usually after 290 days (dehydration);

2) decreased turgor of pregnant skin;

3) a decrease in the pregnant woman’s body weight by 1 kg or more;

4) decrease in the pubo-xiphoid distance (for post-term pregnancy - 36 cm; prolonged - 35 cm; full-term - 34 cm);

5) an increase in the density of the uterus, which is due to a decrease in the amount of water and retraction of the uterine muscles;

6) oligohydramnios, limited fetal mobility, engulfment by the uterus, during vaginal examination - increased density of the skull bones, narrowness of the sutures and fontanelles;

7) changes in the nature of fetal heart sounds during auscultation (changes in sonority, rhythm frequency) are not specific for post-term pregnancy, but rather indicate fetal hypoxia caused by placental insufficiency;

8) secretion of milk from the mammary glands at the end of pregnancy, instead of colostrum;

9) frequent presence of an “immature” cervix.

The clinical symptoms of post-maturity detected after childbirth include signs of overmaturity (postmaturity) of the fetus and macroscopic changes in the placenta.

Signs of postmaturity include: dark green coloring of the skin, membranes, umbilical cord, maceration of the skin (in a living child), especially on the hands and feet (bath feet and palms); decrease in cheese-like lubrication, decrease in subcutaneous fatty tissue and formation of folds, decrease in skin turgor (senile appearance of a child); large size of the child (less often malnutrition), long nails fingers, poorly defined head configuration, dense skull bones, narrow sutures and fontanelles. A fruit can be considered post-term (overripe) if there is a combination of at least 2-3 of these signs.

Assessment of fetal overripeness according to Clifford (1965):

I degree. The newborn is dry but has normal skin color. The cheese-like lubricant is poorly expressed. The amniotic fluid is light, but its quantity is reduced. The general condition of the newborn is satisfactory.

II degree. The dryness of the skin is more pronounced, and there are signs of fetal malnutrition. The amniotic fluid, as well as the umbilical cord, and the skin of the newborn are stained with meconium green color. Perinatal mortality of children with II degree of overmaturity is high.

III degree. Amniotic fluid yellow color. The skin and nails of a newborn are yellow. These are signs of deeper hypoxia, but the mortality rate among these children is lower.

Data from laboratory and special research methods

Phono- and electrocardiography of the fetus

This method allows us to indirectly judge the condition of the post-term fetus (monotonicity, isorhythmia, is one of the main indicators of fetal hypoxia.). It was found that greatest number amniotic fluid is observed at 38 weeks of pregnancy, and then its amount quickly decreases (on average by 145 ml per week), reaching 244 ml by the 43rd week of pregnancy. A decrease in the amount of amniotic fluid is considered a sign of placental dysfunction and biological post-term pregnancy.

Amnioscopy

1) small amount of amniotic fluid;

2) detection of meconium;

3) small amount or absence of cheese-like lubricant;

4) determination of the degree of exfoliation of the membranes of the lower pole of the amniotic sac from the walls of the uterus, as an indicator of the readiness of the mother’s body for the onset of labor. With a detachment of 4 cm or more, labor occurs within 48 hours, and with a smaller area of ​​detachment of the membranes, much later.

Amniocentesis

Based on the physicochemical and biochemical indicators of the amniotic fluid, one can judge the condition of the fetus and its degree of maturity:

1) osmotic pressure during post-term pregnancy is reduced (normally 250 mol/kg);

2) the concentration of creatinine in the amniotic fluid increases;

3) the concentration of urea in the amniotic fluid is more than 3.8 mmol/l indicates postmaturity;

4) during postmaturity, the concentration of total protein in amniotic fluid is 5% higher than during full-term and prolonged pregnancy;

5) a ratio of lecithin to sphingomyelin of less than 1 is typical for an immature fetus; a ratio of more than 2 is observed from 33 to 40 weeks of pregnancy, and higher during postmaturity. This test is an important indicator of fetal lung maturity; (hp up to 40 weeks 2:1; with postmaturity - 4:1);

6) glucose concentration during post-term pregnancy (0.63 mmol/l), which is 40% lower than during full-term and prolonged pregnancy;

Excretion of estriol in the urine of a pregnant woman

The lower limit of acceptable estrioluria is 41.62 µmol/day. So, when the level of estriol in the urine is 41.62 µmol/day and higher, the condition of the fetus is good, the short-term prognosis is favorable. With estrioluria from 41.62 to 13.87 µmol/day, the prognosis is questionable; a level below 10.40 µmol/day is characteristic of intrauterine fetal death.

Cytological examination of vaginal smears

This diagnostic method is successfully used not only to recognize post-term pregnancy, but also to assess the functional state of the fetus and placenta. A cytological sign of postterm pregnancy should be considered prolongation of the III-IV cytotype of the vaginal smear (CPI >40%).

Ultrasonography

This is the most objective research method. Characteristic ultrasound signs of post-term pregnancy include: a decrease in the thickness of the placenta, its calcification, sharp lobulation, fatty degeneration and increase in size, oligohydramnios, lack of growth biparietal size fetal heads, thickening of the skull bones, larger fetal sizes. To establish a post-term pregnancy, biochemical, hormonal and instrumental studies should be carried out over time with an interval of 24-48 hours.

Scheme of examination of pregnant women:

1) determination of the gestational age according to the anamnesis and the formulas of Negele, Skulsky, Jordania and the pregnancy calendar, etc.;

2) external examination (height of the uterine fundus, abdominal circumference, etc.) and internal ("maturity of the cervix, density of parts of the skull, condition of the sutures and fontanelles of the fetus) obstetric examination;

3) phono- and electrocardiography of the fetus;

4) amnioscopy;

5)ultrasound scanning;

6) colpocytology;

7) determination of the level of estrogens, especially estriol and progesterone (pregnanediol) in urine and amniotic fluid;

8) determination of the concentration of placental lactogen, human chorionic gonadotropin, corticosteroids and α-feto-proteins;

9) amniocentesis followed by examination of amniotic fluid (lactic acid, glucose, creatinine, total protein, lecithin/sphingomyelin, LDH and TAL activity, cytology, etc.);

10) functional tests (oxytocin test, atropine test, non-stress test, cardiotocography, etc.).

Delayed birth with a post-term fetus usually has the following complications:

premature and early rupture of water;

anomalies of labor;

prolonged labor;

chronic fetal hypoxia, asphyxia and trauma of the newborn;

clinically narrow pelvis (due to poor head configuration);

labor is induced artificially;

postpartum infectious diseases.

Emergence fetal hypoxia The following factors contribute to childbirth during postterm pregnancy:

Impaired uteroplacental circulation due to functional and morphological changes in the placenta.

Previous chronic intrauterine hypoxia, reducing the reserve capacity of the post-term fetus.

Decreased fetal adrenocortical function.

Greater sensitivity of the post-term fetus to oxygen deficiency during labor due to increased maturity of the central nervous system.

Reduced ability of the fetal head to shape due to the pronounced density of the bones of the skull and the narrowness of the sutures and fontanelle.

Large fruit size.

Premature rupture of water with subsequent retraction of the uterus.

Frequent disturbances in uterine contractility.

Excitation or stimulation of labor in the uterus, leading to disruption of the uteroplacental circulation.

Frequent surgical interventions during childbirth.

In the postpartum period, there were often bleedings as a result of hypotension or atony of the uterus and traumatic injuries to the soft birth canal, and infectious diseases.

MANAGEMENT OF PREGNANCY AND CHILDREN IN POST TERM PREGNANCY

Although there are still supporters of conservative tactics for managing labor during post-term pregnancy, the majority of obstetricians and gynecologists adhere to active tactics for managing labor, in which perinatal mortality has been reduced by 2-3 times. Particular attention during observation in the antenatal clinic should be paid to pregnant women at risk of post-term pregnancy. If the pregnancy is more than 40 weeks, hospitalization in a hospital is recommended to clarify the gestational age and condition of the fetus. The issue of delivery is decided depending on many factors: the “maturity” of the cervix, the condition of the fetus, concomitant pathology, etc. Conservative methods of labor induction include non-medicinal (electroanalgesia, physiotherapeutic method, acupuncture, etc.) and medicinal (non-hormonal preparation of the cervix in within 5 days and accelerated during childbirth). To induce and stimulate labor, oxytocin or prostaglandins are administered. Surgical methods of inducing labor include amniotomy. Currently, a combined method of labor induction is more often used. In obstetric practice, they usually combine the medicinal method of induction of labor with the surgical one or the surgical one with the medicinal one. If the combined method of labor induction is unsuccessful, the birth must be completed by abdominal caesarean section. C-section are performed routinely in conjunction with other relative indications (immaturity of the cervix, extragenital and obstetric pathology, ineffective non-hormonal preparation of the cervix, age of the first-time mother, etc.).

PREMATURE BIRTH (MARCH OF PREGNANCY)

Prematurity pregnancy is considered to be its spontaneous termination in the period from 22 to 37 weeks. Termination of pregnancy before 16 weeks is early spontaneous miscarriages, from 16 weeks to 28 weeks - late spontaneous miscarriages, from 28 weeks to 37 weeks - premature birth.

ETIOLOGY

The etiological factors of preterm pregnancy are complex and diverse. This creates significant difficulties in diagnosis, choice of treatment methods and prevention of preterm pregnancy. Under the term "habitual miscarriage" Many obstetricians and gynecologists understand termination of pregnancy 2 or more times.

The main reasons for termination of pregnancy:

1.Genetic.

2. Neuro-endocrine (hyperandrogenism of adrenal origin, hyperandrogenism of ovarian origin, dysfunction of the thyroid gland, etc.).

3. Infectious diseases of the female genital organs, general infectious diseases.

4. Anomalies in the development of female genital organs.

5.Genital infantilism.

6.Uterine fibroids.

7. Extragenital non-infectious diseases of the uterus.

8.Complicated pregnancy.

9.Isthmic-cervical insufficiency.

Genetic diseases. An important role in the etiology of spontaneous miscarriages in early pregnancy is played by chromosomal abnormalities that lead to the death of the embryo. So, up to 6 weeks of pregnancy, the frequency of chromosomal abnormalities is 70%, at 6 - 10 weeks - 45% and up to 20 weeks - 20%. Cytological examination reveals various options chromosomal aberrations (trisomy, monosomy, translocation, etc.). Most chromosomal disorders are not hereditary and occur during gametogenesis of the parents or in the early stages of zygote division.

Neuroendocrine diseases. In the case of hyperplasia of the reticular zone of the adrenal cortex or the formation of a tumor in it, which leads to atrophy of other layers of the adrenal glands, adrenogenital syndrome can be combined with Addison's disease. With hyperplasia of the zona reticularis and zona fasciculata of the adrenal cortex, adrenogenital syndrome and Cushing's syndrome develop. Such severe lesions of the adrenal cortex are not typical for prematurity.

Erased forms of Cushing's syndrome can cause miscarriage. Cushing's syndrome develops as a consequence of hyperplasia of the zona fasciculata of the adrenal cortex and, like adrenogenital syndrome, can be caused by hyperplasia or a tumor. With adrenal insufficiency (Addison's disease), a high frequency of early and late miscarriages is also noted.

Of all the diseases that are accompanied by ovarian hyperandrogenism, the most important in the problem of prematurity is Stein-Leventhal syndrome, which has several forms. Thanks to the success of therapy, women suffering from this disease can have a pregnancy, which often occurs with the threat of miscarriage. In this case, there is a high frequency of spontaneous miscarriage. Stein-Leventhal syndrome is based on a violation of steroidogenesis in the ovaries.

With severe hypofunction of the thyroid gland, infertility usually occurs, and in mild forms, miscarriage. With hyperfunction of the thyroid gland, miscarriage is no more common than in the population. In severe hyperthyroidism, pregnancy is contraindicated.

Infectious diseases of the female genital organs, general infectious diseases. One of the common causes of preterm pregnancy is latent infectious diseases, such as chronic tonsillitis, mycoplasma infection, chronic inflammatory diseases of the female genital organs, chlamydia, and viral diseases.

Abnormalities of the uterus in recent years, they have been detected somewhat more often due to the improvement of research methods (hysterosalpingography, ultrasound scanning). Among women suffering from preterm pregnancy, uterine malformations were noted in 10.8% -14.3% of cases. Reasons for violation reproductive function Most researchers see the anatomical and physiological inferiority of the uterus, the accompanying isthmic-cervical insufficiency and ovarian hypofunction.

Malformations of the female genital organs are often combined with developmental anomalies of the urinary system, since these systems are characterized by common ontogenesis. In case of miscarriage, the most common types of uterine anomalies are the following: intrauterine septum (usually incomplete), bicornuate, saddle-shaped, unicornuate and very rarely double uterus.

The mechanism of abortion in some uterine malformations is associated not only with ovarian hypofunction, but also with a violation of the implantation process ovum, insufficient development of the endometrium, due to inadequate vascularization of the organ, close spatial relationships, functional characteristics of the myometrium.

Genital infantilism characterize the underdevelopment of the female genital organs and various disorders in the hypothalamus-pituitary-ovary-uterus system. Determining the level of reception in the endometrium made it possible to confirm the assumption that a woman’s body has an inadequate tissue response to ovarian hormones.

Uterine fibroids- one of the reasons for termination of pregnancy. According to E.M. Vikhlyaeva and L.N. Vasilevskaya (1981), in every 4-5th patient with uterine fibroids, pregnancy is complicated by the threat of miscarriage, and spontaneous miscarriages were observed in 5-6% of patients. Premature termination of pregnancy with uterine fibroids may be due to the high bioelectrical activity of the myometrium and increased enzymatic activity of the contractile complex of the uterus. Sometimes the threat of termination of pregnancy is caused by malnutrition in the nodes or their necrosis.

Extragenital diseases of the mother are one of the common causes of abortion (cardiovascular diseases, hypertonic disease, chronic diseases lungs, kidneys, liver, etc.).

Complicated pregnancy. Among the factors of termination of pregnancy, its complicated course is of great importance. Toxicoses, especially severe forms, both early and late, lead to termination of pregnancy. This also includes abnormal positions of the fetus, abnormal placental attachment, abruption of a normally located placenta, multiple births, polyhydramnios, and oligohydramnios.

Isthmic-cervical insufficiency occurs in 20% to 34% of cases and can be traumatic (anatomical) and hormonal. In the first case, cervical insufficiency is caused by trauma to the cervix in the area of ​​the internal os, in the second - by hormonal insufficiency (insufficient progesterone production).

EXAMINATION OF WOMEN SUFFERING WITH PRETERM PREGNANCY

It is advisable to begin examining women suffering from miscarriage when the patient is not pregnant. During this period, they have significantly more opportunities for diagnosing isthmic-cervical insufficiency, malformations of the genital organs, intrauterine adhesions, genital infantilism, as well as for studying the characteristics of the endocrine organs. With such an examination, the background against which miscarriage or premature birth occurs is determined, and the prerequisites are created for the use of appropriate therapy to prevent miscarriage.

At the Helsinki Convention, Russia signed agreements in which, among others, there were recommendations to consider premature birth from 22 weeks to 37 weeks of pregnancy, when a child is born weighing from 500 g to 2500 g, length 35-45-47 cm, with signs of immaturity, prematurity .

According to the clinic, it is necessary to distinguish between: threatening premature labor, beginning and beginning.

Threatening premature birth characterized by pain in the lumbar region and lower abdomen. The excitability and tone of the uterus are increased, which can be confirmed by hyperography and tonusometry data. During vaginal examination, the cervix was preserved, the external os of the cervix was closed. In multiparous women, it may miss the tip of the finger. Increased fetal activity. The presenting part of the fetus is pressed against the entrance to the pelvis.

At beginning premature birth- severe cramping pain in the lower abdomen or regular contractions, as confirmed by hysterography data. During vaginal examination, unfolding of the lower segment of the uterus, shortening of the cervix, and often its smoothing are noted.

For the onset of premature labor characterized by regular labor and dynamics of cervical dilatation (more than 3-4 cm), which indicates advanced pathological process and its irreversibility.

The course of premature birth has a number of features. These include frequent premature effusion amniotic fluid (40%), anomalies of labor (weakness, incoordination), rapid or rapid labor due to isthmic-cervical insufficiency or prolonged labor due to an immature cervix, unpreparedness of the systems of neurohumoral and neuroendocrine regulatory mechanisms, fetal hypoxia. Bleeding is possible in the afterbirth and early postpartum periods, due to disruption of the mechanisms of placental abruption and retention of parts of the placenta, infectious complications during childbirth (chorioamnionitis) and the postpartum period (endometritis, phlebitis, etc.).

DIAGNOSTICS

Diagnosis of impending and beginning premature labor often presents certain difficulties. When examining a pregnant woman, it is necessary to find out: the cause of premature birth; determine the duration of pregnancy and the expected weight of the fetus, its position, presentation, heartbeat, the nature of vaginal discharge (water, bloody discharge), the condition of the cervix and amniotic sac, the presence or absence of signs of infection, the stage of development of premature labor (threatening, beginning, beginning) , because therapy must be strictly differentiated.

In order to more objectively assess the obstetric situation during premature birth, you can use the tocolysis index proposed by K. Baumgarten in 1974 (Table 1). The total score gives an idea of ​​the tocolysis index: the lower it is, the more successful the therapy can be. The higher it is, the more likely it is that labor has entered the active phase and pregnancy preservation therapy will be unsuccessful.

OBSTETRIC TACTICS

Depending on the situation, adhere to conservative-expectant(pregnancy prolongation) or active management tactics for premature pregnancy.

23.03.2016 1112 1

Women sometimes experience premature birth. This happens for various reasons: heredity; the presence of diseases, for example, uterine fibroids or the influence external factors. The main thing to remember is that premature birth can be prevented and the pregnancy can be maintained. How to maintain proper uterine tone and give birth to a healthy baby?

Termination of pregnancy can occur at any stage, however, most often it happens in the first trimester. If the pregnancy is terminated at the 28th week, it is designated as a miscarriage. If this happens after the 29th week, then they speak of premature birth. What are the causes of miscarriage? How to prevent premature birth and what to do if the first symptoms of spontaneous abortion are detected?

What can cause prematurity?

Prevention of premature pregnancy

In order to expectant mother If premature birth does not occur, she (and the future dad too) will have to:

1. Go through all the tests necessary when planning a pregnancy;
2. Cure from existing diseases;
3. Maintain intimate hygiene;
4. Maintain regular and safe sex life;
5. Use contraceptives. In most cases, miscarriage occurs in women who have had abortions;
6. Quit smoking and alcohol;
7. Monitor your diet;
8. Increase the level of vitamins in the body;
9. Avoid stress.

After you find out about your pregnancy, try to register with a gynecologist as soon as possible. This is how you can install it correct term pregnancy, because medical error can also be considered the cause of prematurity, especially if the birth occurred at the 36th week.

When is urgent hospitalization needed?

The main reason characterizing miscarriage bleeding. Therefore, as soon as you notice the following symptoms, call a doctor immediately:

It should be remembered that not all bleeding necessarily ends in miscarriage. With urgent hospitalization, examination, determination of the condition of the fetus and the cause of uterine dilatation, as well as timely treatment, pregnancy can be saved. At the hospital you will be prescribed:

1. Blood test for chromosomal abnormalities.
2. Analysis for the presence of aborted tissue.
3. Ultrasound of the uterus and hysteriscopy (a study that allows you to examine the uterine cavity using a camera that is inserted into the vagina, the image is displayed on the screen in front of the doctor).
4. Uterine biopsy (during this examination, a little mucous membrane is removed from the wall of the uterus and the tissue taken is examined for hormones and antibodies).

Spontaneous termination of pregnancy in the early stages can occur in any woman. For this reason, it is important to get tested even at the planning stages of a child in order to exclude all possibilities of miscarriage.