Tashkent Medical Academy Department of Obstetrics and Gynecology for 4-5 courses Seminar №6. Premature birth. Use of tocolytics. Use of corticosteroids in antenatal period. Carry a pregnancy. Induction of labor at term pregnancy. Emergency conditions and problems of the fetus..

Premature birth Considered premature births at term between 22 and 37 weeks of pregnancy, child birth- weight of 500 to 2500g., A length of 25 to 45 cm, with signs of immaturity

Risk factors for preterm birth 1. Socio-biological causes Age Occupation Bad habits living conditions 2. Obstetric and gynecological history The nature of the menstrual cycle Outcomes of previous pregnancies and births Gynecological diseases Malformations of the uterus 3. Extragenital diseases Acute infections during pregnancy Heart defects Hypertonic disease Kidney disease Diabetes mellitus 4. The complications of this pregnancy Gipertezivnye state of pregnancy Rhesus sensibilazatsiya Antiphospholipid syndrome Polyhydramnios Twins Placenta previa

Types of preterm birth Very early prematurity - a weeks- fetal weight at this time is generally from 500 to 1000 gr Early prematurity weeks- in fetal weight at this time is typically from 1000 to 2000 gr Prematurity weeks- in fetal weight at this time is typically from 2000 to 2500 gr

Clinical classification of premature birth Threatening preterm labor - complaints of abdominal pain and back pain, irritability and increased uterine tone, vaginal examination the cervix is not changed. Beginning prematurity - complaints cramping in the lower abdomen and lower back, or regular contractions, vaginal examination marked changes in the cervix (shortening or flattening), cervical dilatation below 4 cm Went into premature labor - complaints on regular contractions, vaginal examination marked changes in the cervix (shortening or flattening), cervical dilatation after 4 cm

When you receive a pregnant about preterm birth MUST: Find out the possible cause of the threat or occurrence of preterm birth Set the duration of pregnancy and the estimated weight of the fetus, its position, the presentation, the nature of the fetal heart, the nature of vaginal discharge (amniotic fluid, bleeding), the state of the cervix and membranes, the presence or absence of signs of infection, the availability of labor and its intensity Determine the stage of development of preterm delivery (threatening, beginners, start)

Clinical management of preterm labor When starting or threatening birth: Acute tocolysis (magnesium, beta-mimetics, prostaglandin inhibitor - indomethacin) Bed rest Prevention of distress in the newborn (dexamethasone)

Contraindications for inhibiting preterm labor : Inconclusive fetal (FPI 2-3 items, a single zero blood flow) Fetal death Fetal anomalies Wasting severe degree Fetal damage Severe pre-eclampsia or eclampsia Mother's illness: severe course of diabetes, heart, kidney disease decompensated Placenta previa with bleeding The presence of infection (horionamnionit)

Symptoms of premature infants Weight less than 2500g, height less than 45 cm skin syrovidnaya plentiful greasing subcutaneous tissue is underdeveloped the whole body is covered with fuzz Otic and nasal cartilage, soft nails do not extend beyond the fingertips umbilical ring is closer to the pubis In boys, the testicles are not omitted in the scrotum In girls, the clitoris and the labia are not covered by large Weak cry baby (squeaky)

Carry a pregnancy Pregnancy is called post-term if its duration is 42 or more weeks' gestation, and the child born with such a pregnancy has signs of "ripeness" Frequency postterm averages about 11.5%.

Reasons of postterm Experienced in childhood infectious diseases Extragenital diseases, endocrine diseases infantilism mental trauma Malposition and insertion head Violation of the mechanism of labor

What are the dangers postterm 1. Complications of the mother: large fetus, clinically narrow pelvis surgical delivery hypotonic hemorrhage puerperal septic diseases genital tract injuries (fractures, fistulas) 2. Neonatal complications Increased risk of morbidity and mortality in newborn development of asphyxia aspiration of amniotic fluid birth injury when large masses

Signs postterm for mothers: Lack of biological preparedness cervix at term (38-40 weeks); Reducing abdominal circumference after 40 weeks of pregnancy (indirect evidence of reducing the amount of amniotic fluid); Increasing the height of the bottom of the uterus due to the larger size of the fetus and hypertonicity of the lower segment, the high location of the fetal presenting part; Reduced estrogen saturation of the body: a decrease in the blood levels of estradiol, placental lactogen, corticosteroids, trophoblastic globulin.

Signs of over-ripeness of the fetus: The dark green color of the skin Weak expression of the layer of subcutaneous fat scanty syrovidnaya lubrication maceration of the skin "Bath" hands and feet reduction in skin turgor, senile appearance of the child The large size of the child long finger nails poorly expressed head configuration dense bone of the skull narrow seams and fontanelles

Signs of over-ripeness in the placenta: fatty degeneration calcifications Yellow-green staining of membranes

Diagnosis of postterm The correct calculation of the pregnancy Ultrasonography in early stage Ultrasound signs postterm

Tactics of the physician in postterm The use of prostaglandins for the "maturation" of the cervix When mature the cervix - the use of prostaglandins and oxytocin With large fetus timely resolve the question of operative delivery