Premature birth - features of the course and management

Symptoms: how to determine that premature labor has begun

Symptoms of PR at different stages do not differ from each other. The difference can only be in the degree of their expression. Normally, with timely childbirth, the uterus “ripens” within a few days. With PR, this process occurs much more quickly. Typically, alarming symptoms occur several hours before the onset of labor itself.

What should you be wary of?

“A pregnancy of 38 weeks or more is considered full-term. If we are talking about planned surgical delivery (caesarean section), then this may be earlier. A woman should be alerted to the appearance of pain and copious watery discharge (leakage of amniotic fluid). A particularly dangerous symptom is the appearance of bloody discharge, in which case it is necessary to urgently call an ambulance.”

Kuranosova Irina Yurievna

expert

Clinical Hospital on Yauza Reproductologist, gynecologist, gynecologist-endocrinologist, head of the IVF department

The following changes in health should be a cause for concern:

• nagging/aching pain in the lower abdomen, reminiscent of pain during menstruation;
• uterine contractions, even if they do not cause pain and are irregular;
• pressing feeling in the perineum, vagina, rectum;
• frequent urination;
• discharge of clear or pinkish mucus from the vagina - most likely this is a mucus plug, which normally closes the entrance to the uterine cavity before childbirth.

In the future, if at least 4 contractions occur within 20 minutes, this indicates the beginning of the active stage of labor.

Can labor start suddenly?

Yes, in some cases the onset of PR can be sudden. Usually, the woman's amniotic fluid breaks. This can be understood by watery vaginal discharge. They can be abundant or weak.

Who's at risk

Any pregnant woman can give birth prematurely. Some expectant mothers have a higher chance of giving birth prematurely. Pregnant women at risk include:

• under 17 and over 35 years old;
• carry more than one fetus;
• have structural features of the uterus or its cervix;
• use harmful substances - drugs, alcohol, smoke;
• have heavy physical activity;
• have experience of premature birth;
• work in hazardous work;
• are subjected to sexual and emotional violence, stress, and mental stress.

Expectant mothers who did not register during pregnancy or ignore ultrasound, screenings, and laboratory tests are at risk.

The threat of early premature birth is more common with diagnoses: diabetes, anemia, hypertension, genitourinary infections, hypothyroidism, weight problems before conception (deficiency or obesity), thrombophilia, vaginal bleeding. There is also a risk when conceiving through IVF, with congenital malformations of the fetus.

If a woman has previously given birth to a child prematurely, the chances of premature birth remain in subsequent pregnancies. The same applies to the weight of the baby: if the first-born was born with a deficiency of body weight, then his brother or sister may also be underweight.

Risk factors

Doctors point to a number of factors that take place long before a child is conceived. These include:

1. Gynecological diseases suffered in childhood or adolescence;
2. Early onset of intimate life;
3. Hereditary factor;
4. Pathologies of previous pregnancy: gestosis, placental insufficiency, premature birth;
5. Excessive distension of the uterus during multiple pregnancy, polyhydramnios;
6. Threat of miscarriage in the early stages.

Another risk factor is surgery or trauma to the abdominal organs during pregnancy.

I suspect labor has begun. What to do?

Any of the above symptoms, even if it manifests itself slightly, is a reason to immediately go to the pregnancy pathology department. It is possible that pregnancy can still be maintained with medication.

If the water has already broken, you need to urgently call an ambulance for hospitalization. It is important to get to a maternity hospital with an intensive care unit for premature babies as soon as possible to avoid complications.

Video 1. Premature birth: symptoms, recommendations. What awaits a woman whose labor began prematurely, says obstetrician-gynecologist, Ph.D. Valentina Romanovskaya.

What to take with you?

It is better to prepare things that will be useful during childbirth in advance.
Photo: jolopes / Depositphotos It is better for the expectant mother to prepare things for the maternity hospital in advance, after the 22nd week of pregnancy. This can be an “alarm bag”, as well as a larger bag, which the woman’s relatives will give to the woman later, to the postpartum ward. Bags must be made of plastic - this is a requirement of sanitary standards. Optimally, transparent to make it easier to find the things you need. When going to bed or coming to give birth, you need to have with you:

• passport, policy, exchange card, birth certificate (it can be electronic);
• washable slippers;
• loose nightgown and robe;
• personal hygiene items;
• a 0.5 liter bottle of still water and cookies in case of a long labor;
• 1-2 packs of postpartum pads;
• 4-5 sanitary diapers;
• a pack of breast pads;
• compression stockings 1-2 degrees of compression;
• vasoconstrictor nasal spray and hygienic lipstick;
• socks;
• mobile phone and charger.

Different maternity hospitals may have certain restrictions regarding personal items that can be taken with you. It's better to find out about them in advance.

Premature birth in numbers and facts

• In Russia in 2017-2019, the number of children born prematurely amounted to 5.8% of the total number of births during this period⁵.
• Globally, about 10% of babies are born premature.
• Of those born at 22-23 weeks, 20% of premature newborns survive, at 26 weeks - 60%, at 27-28 - about 80%, at 32 - about 100%⁸.

Obstetrician's sequence of actions

When registering a patient with premature birth, the doctor gets acquainted with the exchange card, studies the general, gynecological and infectious history, and examination results. Clarifies complaints and assesses the condition of the woman in labor. He examines her, measures her pulse and respiration rate, temperature, pressure, abdominal circumference and height of the uterus.

It clarifies data about the fetus: movements, measures heart rate through auscultation - listening to the heart through the mother’s stomach through a device. To assess the condition of the baby, the doctor performs cardiotocography. The device records heart rate.

An ultrasound is performed to assess the condition of the baby and the mother’s organs.

A gynecological examination is carried out: if the membranes are intact - external, if they are ruptured - internal. This is necessary to determine the position and position of the child and assess the degree of dilation.

A laboratory examination is carried out. They take a smear from the vagina: culture for β-hemolytic streptococcus, bacterial culture, take blood and urine for a general analysis.

Based on the examination results, the obstetrician confirms or denies premature birth and its stage.

The expectant mother is informed about her condition and the prognosis for the child. At the slightest opportunity, they try to prolong the pregnancy. If the baby is ready to be born in the near future, the doctor determines the tactics of care and agrees with the woman in labor on the issue of pain relief.

In the absence of indications for caesarean section, the birth is performed naturally. This is the optimal method - it is less traumatic for the baby. A gentle approach is what a weak newborn needs.

Rules for assistance with premature birth

The mother in labor is provided with continuous psychological support. Describe the current obstetric situation.

With cephalic presentation, birth occurs naturally.

For pelvic cases, clinical indications are taken into account. Caesarean section is not the only effective method in this case. The operation does not improve the prognosis for a premature baby, but it puts an additional burden on the mother’s body: it increases infection, morbidity, and complications.

In case of breech presentation, only caesarean section is performed.

Anesthesia is carefully selected. Avoid opiates - they depress the respiratory center, which is dangerous for a premature baby.

When a baby is born before 34 weeks, vacuum aspiration is prohibited. It increases the risk of neonatal morbidity. Episiotomy, exit forceps to deliver the head, and epidural anesthesia are administered in doses.

The umbilical cord is clamped at least 1 minute after the baby is born. This tactic reduces the incidence of intraventricular hemorrhage in premature pregnancy up to 37 weeks of gestation.

Monitor the condition of the baby. CTG is done every hour for 40 minutes, auscultation is done periodically.

General recommendations for prevention

You need to think about it from the first trimester. If you want to carry your baby to term, follow the advice of gynecologists.

1. Take care of yourself. Rest, avoid nervous overload. Sleep at least 7 hours;
2. Eat well. Eat foods rich in vitamins, exclude fast food, fatty, fried, spicy and salty foods from your diet. Avoid coffee and strong tea;
3. Maintain drinking regime. Try not to feel thirsty - drink water every 2 hours. If you don’t want to, don’t force yourself;
4. Avoid physical activity. Active training, hard work, general cleaning alone are taboos for a pregnant woman. Try not to go outside in icy conditions - you may fall and strain your muscles - this can increase your tone and provoke premature birth;
5. Maintain personal hygiene. Wash yourself after bowel movement. Always wash and dry from front to back. This will prevent you from bringing bacteria from your gut into your vagina. Infections are provocateurs of premature birth;
6. Lead a healthy lifestyle. Alcohol and cigarettes are taboo. Pregnant women who smoke are prone to premature birth. If you take medications on an ongoing basis, tell your gynecologist about it. Take a walk in the fresh air. Cancel active workouts in favor of leisurely walks in the park;
7. Register with the antenatal clinic in the first trimester - at 6 - 8 weeks. Visit a gynecologist, listen to him, get tested, undergo ultrasounds, screenings;
8. Be careful with sex. In the first trimester, it is better to limit or abstain from it as much as possible - the embryo must gain a foothold. In case of placenta previa and other pathologies, the gynecologist may prohibit you from intimate contact - listen to him;
9. Learn to understand your body. In the 2nd trimester, start listening to the baby: his movements, activity. Record any changes, strange and unpleasant sensations - and tell your doctor about them. In case of acute pain, contractions, spasms, blood, urgently call an ambulance - this could be premature birth;
10. Maintain bed rest. The gynecologist can advise you to rest. For example, with increased uterine contractions, tone;
11. Rest every hour. Sit in a chair, raise your legs up. This will relax the muscles and eliminate swelling;
12. Remember the signs of preterm labor. If they threaten, do not miss the moment and consult a doctor. Perhaps the process can be stopped with the help of medications. Treatment minimizes complications in the premature baby.

Diagnostics

At the clinic, an obstetrician-gynecologist examines the vagina using a speculum. Transvaginal ultrasound allows you to measure the length of the cervix and determine the degree of its dilatation. Special rapid tests of vaginal discharge are used. A blood test is performed, the mother's blood pressure and pulse are measured, and the fetus is auscultated (listening to the heartbeat with a stethoscope)³.

When to save and when not to?

The decision to carry out manipulations to maintain pregnancy is made by the attending physician based on diagnostic data and indications after studying the anamnesis. If the health of the fetus and mother is not in danger, the doctor chooses a wait-and-see approach. However, in some cases, premature delivery is an objective necessity. For example, the condition of the fetus worsens, an infection actively develops, which can significantly affect the health of the child.

False contractions

False contractions begin in the third trimester. They can feel like a general tension in your uterus, like it's being squeezed into a ball, or like your baby is rolling over inside your belly. Usually false contractions are painless and almost always last no more than 1 hour. Although all women experience false contractions, not all women experience them, especially during their first pregnancy. So you don't have to worry if you don't feel them.

Treatment

Therapeutic manipulations are aimed at maintaining pregnancy. Patients may be prescribed the following medications³:

• Antenatal corticosteroid therapy (ACT). It is used for faster maturation of the fetal lungs. Betamethasone and dexamethasone are prescribed.
• Tocolytics. Medicines based on the active ingredients fenoterol, hexoprenaline sulfate, atosiban, nifedipine. They relax the muscles of the uterus and reduce the frequency of its contractions. However, they can only prolong pregnancy by 2-7 days. This time is usually used for the maturation of the fetal lungs.
• Magnesium therapy. Magnesium sulfate can reduce the frequency of myometrial contractile activity.
• Antibacterial therapy. If the patient is diagnosed with an infectious disease, drugs that act against the pathogen are prescribed - ampicillin, penicillin, cephalosporins, etc.
• Antihypertension medications. They are prescribed for rising blood pressure and the threat of preeclampsia.

In the absence of severe complications, patients at risk of PR at 22-36 weeks are hospitalized in a hospital and remain under medical supervision.

Surgery

The goal of the manipulations is the same - to delay childbirth and, if possible, bring the gestation period as close as possible to the 36th week. To do this, an operation called cerclage is performed. If the uterus is shortened, stitches are placed on its cervix under anesthesia. The procedure is used for periods up to the 26th week inclusive³.

In the II-III trimester, it is possible to apply an unloading obstetric pessary - a flexible silicone ring - to the cervix.

The pessary is designed to prolong the gestational age in order to reduce risks to the health of the unborn child. Source: Murray SR, Stock SJ, Cowan S, Cooper ES, Norman JE. The Obstetrician & Gynecologist / ResearchGate (CC BY 4.0)

How does premature birth occur?

The procedure is significantly different from normal childbirth. The patient’s free movement around the delivery room is excluded, since doctors immediately connect her to the equipment using cardiotocography sensors to monitor the work of the child’s heart. A woman can only take the most comfortable position for her.

Unlike normal labor, epidural analgesia is often used during birth control.

Premature birth and caesarean section

Among many women, there is an opinion that birth control is only possible by caesarean section.
In fact, it is recommended in a number of cases - mainly if there are initial signs of fetal impairment and in case of breech presentation. In other cases, at any stage, preference is given to the natural birth of a child, since it carries fewer risks for the mother. After the baby is born, he is immediately placed in a special box in the intensive care unit. For example, with early birth defects, the child cannot yet breathe independently due to the fact that the lungs have not matured. Therefore, it is urgent to provide conditions for the functioning and maturation of the respiratory system. The same applies to measures to support the functioning of the cardiovascular system. Nutrition is organized, because children born at an early stage cannot yet fully absorb mother's milk. If necessary, the child at the second stage of nursing is sent to the perinatal center, where he will remain until he gains optimal body weight or until he is treated for identified diseases (developmental defects).

A premature baby in an incubator - a special incubator in which the temperature and humidity are optimal for the baby. Photo: bzyxx/Depositphotos

When is a baby considered premature?

A baby born at the beginning of the 37th week is already considered full-term, and artificial continuation of pregnancy in the period from 37 to 40 weeks is rarely carried out. It is not believed to significantly affect the health of the newborn. The body weight of a premature fetus can be:

• extremely low - 500-1000 g;
• very low - up to 1500 g;
• medium low - up to 2000 g;
• low - up to 2500 g.

When you can't wait to be born

The life of a pregnant woman follows a clear schedule, starting with her diet and ending with visits to the gynecologist. The expectant mother expects such commitment to the intended plan from her baby in the womb - it’s not for nothing that his birthday is already marked in red on the calendar. However, the nine-month wait can sometimes be shortened.

Please tell us which births are considered premature?

Anastasia Vladimirovna: In general, a woman’s pregnancy duration is 280 days, starting from the first day of her last menstruation. But this does not mean at all that the norm prescribes delivery strictly on the same day as the initially established date of birth of the baby. A term birth (i.e., occurring on time) is considered to be a birth that occurred in the period from 37 weeks 0 days to 41 weeks 6 days. But if the child was born after 22 weeks 0 days and before 36 weeks 6 days of pregnancy, then we are talking about premature birth. By the way, in Russia for a long time the calculation of premature births began at 28 weeks. Only since 2012, newborns in Russia began to be registered from 22 weeks, as is customary throughout the world. And now children born after this period and weighing more than 500 g have a real chance of salvation. Now doctors are simply obliged to make every effort to deliver such babies, although, of course, their survival and health status are very difficult to predict - and this is bad news. The good news is that, according to statistics, the highest percentage of premature births occurs in the period from 34 to 37 weeks of pregnancy, when the prognosis for a premature baby is most favorable. From 34 weeks, children are quite viable, and now at some international medical congresses there is a proposal to consider urgent birth from 34 weeks. Although neonatologists are unlikely to agree with this decision...

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Margarita Borisovna: Yes, from the point of view of neonatology, such innovations are not justified. We have a common saying: for a child, a day in the womb is minus a week in the intensive care unit. Of course, at 34 weeks, the baby is already mature enough to live outside of his mother, and is able to recover quickly. However, such babies still require special labor management tactics and subsequent careful care. The last 6 weeks of pregnancy are very important for the development of the baby's brain. We advocate for prolonging the baby's stay in the womb as long as possible.

What ways can you prolong pregnancy if there is a threat of premature birth?

Anastasia Vladimirovna: Alas, it is not always possible to stop premature labor that has begun. Moreover, in some cases, when there is a serious threat to the health of the mother or fetus, it is necessary, on the contrary, to even induce labor artificially. Such extremes can be avoided if a pregnant woman visits her doctor in a timely manner and undergoes all the necessary examinations. The sooner the factors that provoke premature birth are identified, the higher the chances of the expectant mother to give birth on time. Preconditions such as infections or hormonal disorders that can affect the course of pregnancy are best neutralized long before pregnancy or at an early stage. Childbirth can begin ahead of schedule also with isthmic-cervical insufficiency - this is a dysfunction of the cervix in which, due to its incompetence, it can no longer hold the fetus in the womb and opens, thereby leading to premature rupture of water and triggering the mechanism of labor. If diagnostics have shown that the length of the cervix does not correspond to the norm for a given stage of pregnancy, the process of its dilatation can be restrained by suturing (in exceptional cases, if the patient has a history of two or more premature births) or introducing a special support ring - an obstetric pessary. The use of micronized progesterone is also quite effective, which can significantly improve pregnancy outcomes in women with a short cervix.

At the onset of labor, doctors adhere to conservative expectant tactics, trying to prolong the pregnancy for as long as possible.
For this purpose, therapy is carried out to help reduce the tone of the uterus and suppress its contractile activity: the patient is prescribed tocolytics - substances that cause relaxation of the uterus. Thanks to such drugs, it is possible to delay childbirth by at least 48-72 hours. Anastasia Vladimirovna Novikova, obstetrician-gynecologist, head of the maternity department of the Scandinavia clinic

Margarita Borisovna: It would seem that these few days of respite can give us? In fact, this time is priceless - it is necessary to urgently prepare the baby for birth. With premature birth in the early stages, the biggest danger for such babies is breathing problems. This manifests itself in the so-called respiratory distress syndrome: the lungs of prematurely born children are poorly developed due to tissue immaturity and a deficiency of surfactant, which prevents the alveoli from collapsing during exhalation (through which oxygen enters the lungs). And just these 48-72 hours make it possible for the patient to undergo a course of administration of the drug Dexamethasone, which stimulates the maturation of the fetal lungs. Thanks to this therapy, the newborn better adapts to life outside the mother, and it is much easier to restore his respiratory system. At the same time, we focus on non-invasive ventilation of the baby’s lungs: after all, an artificial respiration apparatus can lead to damage to the baby’s lung tissue, so in modern neonatology it is used only in the most extreme cases.

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How does premature birth occur? What consequences do they have for mother and child?

Anastasia Vladimirovna: We advise women planning to give birth in our clinic to immediately report sudden and suspicious changes in their condition (pain in the lower abdomen, discharge, contractions) to the department. In anticipation of the patient's arrival, our specialists prepare the operating room or delivery room (depending on preliminary indications) and assemble a team of doctors who must be present at the birth. And if it is not possible to prolong the pregnancy, we can quickly take action. If delivery is not required, our doctors can offer you observation at the antenatal department. The birth itself is carried out as carefully as possible - with pain relief, at a moderate pace, sometimes even with the use of drugs that reduce the excessive activity of labor. Carrying out a cesarean section also has its own nuances: the fact is that as a result of such operations, performed in the early stages of pregnancy, the scar is formed not in the lower segment of the uterus, but almost in its center. And, as a rule, such operations are indications for special attention during subsequent pregnancies. When delivering the baby, the obstetrician tries to preserve the integrity of the amniotic sac for as long as possible - it is opened only at the last moment, before transferring the newborn to a neonatologist.

Margarita Borisovna: A neonatologist receives the baby in a special sterile bag to carefully transfer it to the children's table, protecting it from temperature changes. The smaller the baby, the more important such thermal protection is for him. In general, even before the onset of labor, the neonatologists of our department, thanks to close interaction with obstetricians, have all the necessary information regarding the condition of the fetus and prepare incubators (special incubators) with full monitoring and climate control, means for artificial ventilation of the lungs and other equipment necessary for delivery and nursing premature babies.

Of course, too early premature birth results in very negative consequences for babies: 50% of babies born before 26 weeks experience very significant health problems - neurological problems, impaired vision and hearing, intragastric hemorrhages.
Margarita Borisovna Fedotova, neonatologist, head of the neonatology department at the Scandinavia clinic

Even judging by the Apgar score - the simplest assessment system with which neonatologists characterize the condition of a child in the first minutes of his life - premature babies are significantly behind children born at term and, accordingly, require special care and observation in the intensive care unit. There, the necessary conditions are maintained for the baby to gain the required weight and for the final formation of all organs and systems to occur.

Anastasia Vladimirovna: All this time, the mother remains in the maternity hospital, because she also needs a recovery period after premature birth. In the maternity ward of the Scandinavia clinic, patients are placed in separate rooms equipped with everything necessary for a comfortable stay.

Margarita Borisovna: And, of course, mothers can and even need to visit their child, even if he is still weak and in an incubator. It is important for a child to feel not only the care of the staff, but also the love of a loved one. Thanks to such emotional contact, the child recovers much faster - this is akin to a miracle, but it is true.

Date of publication: 02/14/16

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Classification of premature birth

The classification of birth defects by stage of pregnancy was developed by WHO and is recognized throughout the world:

• Very early PR - from the beginning of the 22nd week to 27 weeks and 6 days (about 5% of clinical cases of PR);
• early PR - from the beginning of the 28th week until 30 weeks and 6 days (about 15% of all PR);
• premature birth - from the beginning of the 31st week to 33 weeks and 6 days (about 20% of cases);
• late PR - from the beginning of the 34th week until 36 weeks and 6 days, average weight - 2500-2600 g.

PRs are also classified according to clinical characteristics - as spontaneous and induced. Spontaneous (70-80% of cases) include birth defects, in which regular labor occurs, amniotic fluid leaves, but there are no fetal pathologies or membranes. Induced birth defects include those in which complications develop that threaten the life of the fetus and/or mother. In such cases, labor is artificially induced.

Video 2. Premature birth: management tactics. Obstetrician-gynecologist Anna Tyagunova tells.

Review

Premature births are those born alive before 37 completed weeks of pregnancy. Prematurely born children are divided into categories depending on the stage of pregnancy:

• babies born extremely prematurely (less than 28 weeks);
• babies born significantly premature (from 28 to 32 weeks);
• babies born moderately and slightly prematurely (32 to 37 weeks).

Unless medically indicated, labor should not be induced or a caesarean section performed before 39 completed weeks of pregnancy.

Causes of premature birth

It is reliably known that 30-40% of clinical cases of PR are associated with infectious lesions of the urogenital tract⁸. During pregnancy, the immune system is weakened, so harmful bacteria actively develop in the vagina². Unfortunately, infection is often associated with a significant risk of purulent-septic complications and active uterine contractions. The most common infectious diseases that provoke PR are bacterial vaginitis, chorioamnionitis and endometritis.

Among the causes of a non-inflammatory nature, scientists name an increase in the hormone corticoliberin in a woman’s blood. It, in turn, increases the production of another hormone - oxytocin. This is a powerful activator of uterine contractility.

Anatomical reasons include insufficient maturation of the lower part of the amniotic sac - it may be too thin. Isthmic-cervical insufficiency is also common, when the too short cervix is ​​unable to hold the fetus.

Sometimes labor begins unexpectedly, ahead of schedule. Pain in the lower abdomen and clear discharge may be signs that the baby has decided to be born. Photo: Milkos/Depositphotos

Risk factors

There are dozens of factors that can trigger the birth of a premature baby. The clinical recommendations of the Ministry of Health of the Russian Federation indicate the main ones. The risk of pregnancy loss increases if a woman⁵:

• age under 18 and over 34 years old;
• high levels of stress;
• during pregnancy there was an acute respiratory viral infection or herpetic infection;
• there have already been birth defects, miscarriages, artificial terminations of pregnancy (abortions);
• surgical intervention was performed during this pregnancy;
• there were 4 or more normal births;
• cervix amputated;
• congenital uterine defects;
• multiple pregnancy;
• addiction to smoking, drugs, alcohol.

Also, doctors and scientists identify diseases in which pregnant women are automatically included in the risk group for pregnancy loss. Such pathologies include⁵:

• infectious diseases of the urinary tract;
• hormonal disorders;
• severe stages of diabetes;
• placenta previa;
• vaginal infectious diseases;
• premature detachment of a normally located placenta;
• intrauterine bleeding;
• hyperthermia (constantly elevated temperature);
• premature cervical ripening.

Important!

89% of women with PR had extragenital pathologies, Omsk scientists found this out in 2021 during a study. Chronic anemia, kidney disease and arterial hypertension were more common ⁵. Therefore, patients with these diseases should especially monitor their condition during pregnancy.

Causes of the condition

Early delivery can occur for various reasons, and even a healthy woman is not immune from such a pathology. Gynecologists note the following reasons that most often provoke the risk of premature birth:

• bad habits (drinking alcohol and drugs, smoking);
• consequences of severe toxicosis;
• infectious diseases;
• antiphospholipid syndrome;
• short period between two pregnancies;
• abortions leading to disruption of the reproductive system;
• age of women over 40 years old;
• inflammatory processes in the body.

An unhealthy lifestyle and early abortions can lead to early labor. Also, do not forget about the various social factors that influence early delivery.

Complications and consequences

The lists of possible risks for premature newborns include various neurological disorders, problems with hearing/vision, digestion, and breathing. Unfortunately, they occur in almost half of children born in the early and very early stages. In women giving birth, injuries to the tissues of the genital organs most often occur; infectious diseases are possible - endometritis, peritonitis.

Is it possible to get pregnant after premature birth?

Pregnancy is not a contraindication after PR. However, as we noted above, even a history of ADRs carries a high risk of recurrence. Therefore, such patients are prescribed drug therapy (in particular, micronized progesterone) to prolong pregnancy, and sutures may be placed on the cervix. If the birth took place by cesarean section, doctors may recommend that the couple take birth control for 6-18 months.

Recovery

Most often, the rehabilitation process is no different from normal childbirth. After consultation with a gynecologist, women perform a set of exercises to prevent prolapse of the genital organs and the development of urinary incontinence. The body recovers in 5-10 weeks. Some women may additionally need counseling from a psychologist, as the effects of post-traumatic stress may take a long time to manifest.

Recovery from premature birth can take anywhere from several weeks to several months. Photo: Photo by Aditya Romansa on Unsplash

Complications

Due to the immaturity of all internal organs, premature babies may experience:

• birth injuries (damage to the cervical segment of the spine, hemorrhages into the cranial cavity);
• hypoxia;
• functional immaturity of the lungs.

For a woman in labor, such an end to pregnancy can lead to rupture and injury to the reproductive organs, postpartum blood loss and infections (suppuration of sutures, inflammation of the peritoneum, internal mucous and muscular layer of the uterus, blood poisoning).

Prevention of PR

Preventive measures are divided into general and medicinal. Common ones include:

• rules of intimate hygiene;
• maintaining a healthy diet;
• giving up any bad habits;
• avoiding stress;
• strict adherence to observation periods in the antenatal clinic;
• you need to carefully monitor the possible symptoms of PR, which we talked about at the beginning of the article.

Drug prevention of PR is provided with the help of glucocorticosteroids - 1-2 courses are carried out at a period of 24-33 weeks⁸. To prevent fetal respiratory distress syndrome, betamethasone or dexamethasone is prescribed intramuscularly. The clinical guidelines of the Ministry of Health also recommend prophylactic administration of progesterone drugs³. If preeclampsia is at risk, doctors may prescribe aspirin starting at 12-14 weeks of pregnancy.

Sources

1. Garmaeva E.D., Botoeva E.A. and others. Premature birth // Bulletin of the Buryat State University. - 2010. - No. 12. - P. 143-147.
2. Devyatova E.A. Premature birth // Obstetrics and gynecology. - 2015. - No. 3. - P. 60-69.
3. Clinical recommendations. Premature birth. - M.: 2021. - p. 66.
4. Kuzibaeva R.K. Causes and results of premature birth // Bulletin of new medical technologies. - 2015 - T. 22, No. 2. - P. 67-71.
5. Kuklina L.V., Kravchenko E.N. and others. Risk factors, course of pregnancy and gestational outcomes at different stages of pregnancy during premature birth //Mother and Child in Kuzbass. — 2021. — No. 2 (85). — P. 103-108.
6. Martynenko P.G., Volkov V.G., Granatovich N.N. Epidemiology of premature birth // Bulletin of new medical technologies. - 2009. - T. XVI, No. 2. - P. 104-106.
7. Nechunaeva A. N. et al. Premature birth // Bulletin of the Buryat State University. Medicine and pharmacy. — 2018. — Issue. 2. - pp. 52-57.
8. Serov V.N., Sukhorukova O.I. Prevention of premature birth // Russian Medical Journal. - 2014. - No. 1. - P. 3-6.

What happens to the baby after premature birth?4

Currently, it is possible to nurse children whose body weight at birth is more than 1 kilogram, but, unfortunately, such low birth weight babies survive only in 50% of cases. Sometimes children with a body weight of 500 to 1000 grams are nursed, but this happens extremely rarely, in addition, it is a very, very expensive process. Children born weighing more than 1500 grams are easier for pediatricians to care for, since all their organs are more “mature.”

At the second stage of nursing, premature babies are often sent to children's hospitals.

1

Preterm birth is usually diagnosed after 28 weeks of pregnancy.
Spontaneous termination of pregnancy between conception and 28 weeks is called spontaneous abortion (miscarriage). For more information about the threat of termination of pregnancy, see: A. Koroleva, “Threat of termination of pregnancy” / No. 1 -2001. 2
For more information about infectious diseases, see: Zh. Mirzoyan “You need to know the enemy by sight.
TORCH infections - what is it?”/No. 4-2001; S. Gonchar “Treatment is light, and non-treatment is darkness. Diseases that threaten intrauterine infected fetuses”/No. 5-2001. 30
during the postpartum period, see N. Brovkina’s article “The Fourth Trimester” in this issue of the magazine.
4
The subject of this article is premature birth, so literally a few lines are devoted to nursing premature babies. Detailed material on methods of caring for premature and low birth weight babies will be published in one of the upcoming issues of our magazine.