Analysis of the reasons for the development of premature pregnancy. When is pregnancy considered prematurely? Diagnostics of spontaneous abortion

Prolonged pregnancy- This pregnancy under which there is an increase in the period of gestation, but there are no disorders from the fetus, placenta and spindle water.

Premature pregnancy:

Etiologyumbrella and migration is the same:

Infection (both genital and extragnenital).

Complications of pregnancy (prestal, improper position of the fetus, multi-way).

Injuries (including abortions, mental injuries).

Anomalies of female genital organs (infantilism, age-related fibromatosis, counya uterus, etc.).

Endocrinopathy and other extragenital diseases.

Chromosomal anomalies.

Socio-professional harmfulness.

Classification of premature births:

Threatens (characterized by the appearance of pulling or grapple-shaped pain inside the abdomen or lower back, an increase in the number of mucous discharge from the vagina, the uterus tone is increased).

The struggles began (the fights can be both regular and not regular, but they are effective (lead to the opening of the cervix). If the discovery of more than 2 cm is the beginning of the birth. Objective diagnostics is raised on the basis of cardiomonitorial monitoring of the contractile activities of the uterus for 30 minutes.

Treatment. Preserving therapy in the department of pregnancy pathology:

Bed regime.

Peace (excluding even vaginal research).

Psychotherapy.

Sedivals, tranquilizers.

Tocoliz (Cocos (Greek) - childbirth, lysis - dissolve, relax) - Therapeutic measures aimed at relaxing uterine muscles. There are 5 mains groups of torcolithics:

 Adrenomimetics:

PARTASISTEN;

Salbutamol;

Alupent;

Ryodrin;

Genipral;

Brikanil.

PARTASISTEN is assigned according to the scheme:

First, in 0.5 mg in 10 ml of the drug to dissolve in 400 ml of physical. Solution or glucose and introduce to / in drip 5-20 drops / min for 8-12 hours. 30 minutes before the end of the dropper inside, 1 tab (0,5mg) of the Passubusystem is given, a day to 6 tab. In the following days, the dose of the tablet preparation is reduced. Treatment should be long (up to 2 months). This drug can be prescribed to 37 weeks of pregnancy. Side effects: tachycardia, hypotension, heartbeat, headache, nausea, vomiting, with long-term use - inclination to constipation (in this case, prescribed by Regulax). These side effects are more often in overdironments and intolerance. Contraindications for destination -mimetics: Opening of the neck of more than 2 cm, intrauterine infection, bleeding, congenital defects and fetal death, cardiovascular pathology, hypotension. To eliminate side effects, tocolics 2 groups (calcium antagonists) are prescribed.

Calcium antagonists:

Isopin (Fenoptin, Vosopamil);

Nifedipine (Corinthar, Cordypine).

Dose: 0.04 mg (tab) 2-3r / day to 5 days.

Prostaglandinsintase inhibitors:

Indomethacin (candles or tablets). Dose: 200mg / day.

Course - 5 days.

Oxytocin release Igibers and binding it with receptors:

10% ethanol rr (5-6 ml of 96% ethyl alcohol dissolve in 500 ml of isotonic solution or glucose) in / in drip within 4-12 hours, you can repeat 2-3 days. Side effect: Alcohol intoxication in the fetus - lethargy, weakness, oppression of the respiratory center.

Other tocoles:

Antispasmodics (but-shpa, Papaverin, etc.).

Magnesia sulfacy (in / m or in / in 25% rr from 10 to 30 ml).

The course of premature birth:

Premature expulsion of the octal water (i.e., before the start of labor; Early influence of the accumulating waters - upon the occurrence of generic activity, but before the opening of the cervix). Doctor's tactics - prolongation or interruption of pregnancy - depends on the presence or absence of infection or infection risk, from the presence or absence of congenital fetal vices. If there are no deviations and the term of pregnancy is less than 34 weeks, then pregnancy can be prolonged.

Anomalies of generic activity.

Fetal hypoxia (change in heart rate, green oily water).

Mother and fetus injuries (often intranatal).

Bleeding from the uterus, sex tract.

Maintaining premature births(in a special Rod.dom for pregnancy):

Treatment of hypoxia.

Cardiomonitorial study (to identify the anomalies of generic activities and the pathology of the fetus).

The feature of anesthesia - Promedol is not recommended to be applied, better - long peridural anesthesia.

Glucose-vitamin-hormonal-calcium background (GVGKF).

Prevention in 1 SDR period glucocorticoids, and if they are contraindicated - Euphillin.

In the 2nd period, the presence of a pediatrician is required, it is necessary to gently gentle. The pediatrician must prepare everything for the resuscitation of N / R: warm lingerie, peelinka, heated cuvez, in which the primary processing of H / R is produced.

Reducing the resistance of the muscles of the crotch of the child's head (for this purpose, poucher anesthesia is made, the irrigation of the crotch is lidokain).

If the weight of the fetus is up to 2 kg, childbirth is carried out without the protection of the crotch. If the weight of the fetus is more than 2 kg - perine- or episotomy.

Obstetrician tongs with premature pregnancy do not apply.

Prevention of nonsense:

Healthy lifestyle, peace.

Preclinical diagnostics (colpocytology, karyopicnotic index, etc.).

Sanatoriums for pregnant women.

Hospitalization in critical time (individual, for example, the time of the previous miscarriage).

Timely hospitalization.

Postpartum vacation.

Transferred pregnancy.

Signs:

Termination of weight gain pregnant.

Reducing the abdomen circumference (at the expense of the lowest).

High standing bottom of the uterus.

Limiting the mobility of the fetus.

Signs of the hypoxia of the fetus (changing the CSS of the fetus and green spindle water).

The lack of maturity maturity, dense bones of the skull, the narrow of the spring (with a vaginal study).

During Dopplerometry - a decrease in the uterine-placental blood flow.

Ultrasound: Reducing the thickness of the placenta, calcine, lowland, large fruit, rarely - hypotrophy, lack of increments of biparity size, thickening of the bones of the skull.

The body is not ready for childbirth. In addition to the cereal test, the oxytocin, colpocytological test is characterized by a prolongation of 3 and 4 types of smears.

Hormonal test:  Content of estrogen levels in plasma (for this period).

Tactics:

With prolonged pregnancy - expectant.

With transferred pregnancy:

transferred pregnancy is a relative testimony for Cesarean cross section.

after preparing the body to childbirth (GVGKF, the endocervical application of prostaglandins (pre-gel (PGE2) is conducted by receiving (prostaglandins with oxytocin). Ineffectiveness of receiving excitation is also a relative indication for the COP operation.

Prevention of migration :

Healthy lifestyle.

Timely hospitalization of a woman in the department of pathology of pregnant women, especially those who have the cause of the migration.

23.03.2016 1112 1

Women sometimes have premature childbirth. This happens for various reasons: heredity; The presence of diseases, for example, uterine misa or the effect of external factors. The main thing to remember that premature birth can be prevented and preserved pregnancy. How to keep the right tone of the uterus and give birth to a healthy baby?

Abortion of pregnancy can occur on any period, however, most often it happens in the first trimester. In the event that the pregnancy was interrupted on the 28th week, it is designated as a miscarriage. If this happens after the 29th week, then they talk about premature birth. What are the reasons for inconsistencies? How to prevent premature childbirth and what to do if the first symptoms of spontaneous interruption of pregnancy were discovered?

What can be the cause of misunderstanding?

Prevention of premature pregnancy

In order for the future mother to have no premature childbirth, she (and the future dad also) will have:

1. Pass all the tests necessary when planning pregnancy;
2. Recover from the existing diseases;
3. Comply with intimate hygiene;
4. Monitor regular and safe sex life;
5. Use contraceptives. In most cases, non-banking of pregnancy occurs in those women who made abortions;
6. Refuse smoking and alcohol;
7. Follow nutrition;
8. Increase the level of vitamins in the body;
9. Avoid stress.

After you learned about your pregnancy, try as soon as possible to register with the gynecologist. So it turns out to establish the right time term of pregnancy, because a medical error can also be considered the cause of the baby's presence, especially if the birth occurred on the 36th week.

When do I need urgent hospitalization?

The main reason characterizing the unbearable of pregnancy bleeding. Therefore, as soon as you noticed the following symptoms, immediately call the doctor:

It should be remembered that not all bleeding must be completed by miscarriage. With urgent hospitalization, examination, determining the state of the fetus and the reasons for the disclosure of the uterus, as well as timely treatment, pregnancy can be saved. In the hospital you will be prescribed:

1. Blood test for chromosomal anomalies.
2. Analysis for the presence of aborted tissues.
3. Ultrasound of the uterus and histterisopia (a study that allows you to study the uterus cavity using a camera that is entered into the vagina, the picture is displayed on the screen in front of the physician).
4. The biopsy of the uterus (with this inspection from the wall of the uterus, a slightly mucous membrane is covered and a study of tissue tissue is carried out on hormones and antibodies).

The spontaneous interruption of pregnancy in the early deadlines can occur at any woman. For this reason, it is also important at the stages of the child planning to pass tests in order to eliminate all the possibilities of miscarriage.

A premature pregnancy in medical categories ends with premature births for a period of twenty-second and thirty-seventh weeks. Such an early appearance of a child to the light threatens him with numerous complications.

In order for the baby tooling the kid not interrupted ahead of time, a woman needs to closely follow their health and fulfill all the recommendations of the attending physician. About the signs and consequences of premature children read in this article.

The factors provoked premature births are distinguished by a large variety, and not always they are associated with medical pathologies. The main reasons for premature pregnancy can be divided into several groups.

Socio-demographic, which include:

• insufficient nutrition of a woman in the period of having a child;
• tendency to excessive use of alcoholic beverages, narcotic substances, smoking;
• pregnancy, which has come in adolescence or after 40 years, a negative factor for normal tooling the fetus is also the age of the father, when it exceeds 50 years;
• permanent family conflicts, stress and psycho-emotional overvoltage on the soil of home care;
• bad household conditions.

Related Women's Health Problems:

• repeated childbirth at a minimum period of time;
• chronic diseases of various internal organs;
• genetic predisposition or chromosomal deviations;
• pathologies caused by infectious damage;
• early or gestosis in late dates;
• various operations on the internal organs during the beating period and injury;
• repeated abortions, especially complicated;
• rhow-conflict of mother and future kid;
• anatomical pathologies of the structure of the uterus, in particular, the presence of partitions in it or the defects of the neck of the neck;
• availability or other formations;
• previous pregnancies ending with the operation of cesarean sections;
• the presence of several embryos;
• multi-way in the third trimester;
• hormonal imbalance;
• pulling placenta and others.

Also, premature pregnancy can be associated with harmful working conditions, poor ecological situation and other aggressive factors of the external environment.

Signs of emergence are not on time

In many cases, the diagnosis of premature beginnings of labor is difficult due to the lack of specific symptoms. But usually the threat of early delivery is manifested by the following signs:

• high Tone Music Musculature and an increased uterus reaction to inspection using palpation;
• in some cases, women complain about pain at the bottom of the abdomen, reminding their unpleasant sensations in the first days of menstruation;
• changing the motor activity of the future child, it becomes more mobile or, on the contrary, subsides;
• unpleasant swelling sensations from the vagina, a constant desire to go to the toilet.

In case of early power, the patient significantly reduces the abdomen, the intrauterine pressure drops.

Opinion expert

Often, training fights that may appear in the third trimester are taken for premature labor. These are short cuts of uterus that do not bear the threats of interrupt.

The threat of interrupt is determined not only on the basis of listed symptoms, but also with the help of a gynecological examination and compulsory ultrasound examination.

If the cesarean section is held

There are certain indications for emergency delivery by surgical intervention. Caesarean section with premature pregnancy is most often prescribed with a premature placental detachment, because with such a state there is a real threat to life and mother, and the future kid.

In addition, the cesarean section is carried out according to the following readings:

• the risk of disagreement of the scar on the uterus formed after the previous operation;
• prelation of the placenta;
• late toxicosis, the consequence of which was the development of hypoxia in the fetus;
• arising, for example, due to diabetes mellitus and other endocrine disorders;
• Child in diagnosing problems with its blood supply.

Caesarean progress in life indications should be carried out before the start of the generic activity.

Also, the operational delivery is shown in premature pregnancy for a period of 22 - 34 weeks, as the birth through natural generics is fraught with serious complications for the child.

In modern medicine, techniques have been developed for conducting such operations with minimal risk for a woman and baby, which appeared to light ahead of time.

See this video about the testimony for cesarean section:

Classification of prematurity

The risk of danger of complications in early childbirth is determined depending on the period of gestation, weight and growth of the newborn. There are four degrees of premature pregnancy:

• for first degree Births naturally or with the help of cesarean section occur on the period of 36 - 37 weeks, the fruit should weigh at least two kilograms, and its length is 41 - 45 cm;
• the birth of the fetus for 32 - 35 week is classified as second degree prematurity, the weight of the newborn ranges from two to one and a half kilograms, and its length is 36 to 40 cm;
• third degree It is determined when interrupted in the interval between the 28th and 31st weeks of gestation, and the weight of the child fluctuates in the interval between 1 - 1.5 kg, and the length is 30 - 35 cm;
• the most severe fourth degreeDiagnosed during childbirth for a period of less than 31 weeks, when the weight of the premature baby does not exceed one kg, and the length is less than 30 cm, such children refer to the extreme group, and their exhaustion is associated with great difficulties.

How many weeks may not be enough

Modern medicine has a wide arsenal of tooling premature babies, and the World Health Organization recognizes a viable fetus weighing more than half a kilogram and a length of 25 cm. But when the premature pregnancy is diagnosed, it is important how many weeks is the period of gestation.

The newborn is considered viable if he appeared on the light of more than 22 weeks, weighing more than 500 g.

External signs of a premature baby

Children born earlier than the required time differ from others and for health conditions, and visual characteristics.

The main external signs of premature babies include:

• little length and insufficient weight;
• the absence of a subcutaneous fat layer due to low nutrition;
• lethargy, weakly pronounced reflex, insufficient musculature tone;
• wrong proportions of the body, the child's head is clearly increased, and the legs are short;
• soft and movable skull bones, open spring;
• own sinks are characterized by soft and excessive plasticity;
• the presence of a hair cannon throughout the body, including on the face;
• low-positioned navel;
• empty scrotum in boys and gaping floor gap in girls;
• in some cases, an exophthalm is diagnosed (shifting the Kechada of one or two eyeballs), which is sometimes combined with megalocephalus (an unusual increase in the mass and sizes of the brain);
• a rare sign is the insufficient development of nail plates.

The prematurity cannot be determined on a separate characteristic basis, for the correct diagnosis, a combination of several criteria is needed.

For signs of a premature child, see this video:

Features of children and care for them

The birth of a premature baby requires increased attention from obsteckers, immediately after the appearance of the following activities:

• after cuts, the baby cord is immediately placed on a changing table, over which heater is installed;
• hygienic procedures must be carried out very quickly;
• diapers, which wrap up the baby, must be sterilized and fit;
• the transfer to a special chamber should be done using a special cruise in which a certain temperature is maintained;
• the baby must be immediately dressed in a sprawling and a cape of a soft hypoallergenic material.

If in the future the condition of the premature baby does not cause concerns, and he begins to quickly gain weight, he is written out of the hospital with her mother in the last time.

But not always premature childbirth take place without any complications for the baby, in difficult cases, resuscitation activities are required. In such cases, the premature babe is placed in special coupe for emergency therapy, which is provided by the system for artificial ventilation of the lungs.

Life maintenance occurs with the following medical procedures:

• If the baby is unable to suck milk from the mother breast or from the bottle, the power is carried out through the probe. Sometimes special components are added to the recreational maternal milk to maintain the basic functions of the newborn organism.
• For a premature baby, it is important to maintain the permanent mode of heat and humidity, which should be close to the natural environment of his stay in the womb.
• The state of vital organs should be constantly tracked with special sensors, in addition, blood and urine research should be carried out regularly.
• Special measures for the normalization of gas exchange are held to prevent breathing problems.

The progress in a state of a premature baby is considered to be the moment when he begins to breathe independently, then it is translated from resuscitation to the separation of intensive therapy. Here it is also in a special goose to normalize the temperature metabolism and the full work of lungs and bronchi.

Opinion expert

Daria Shirochina (obstetrician gynecologist)

It is very important that the premature babe constantly felt the proximity of the mother and heard her voice. To do this, it is more often necessary to take on the hands and bring to the chest.

Consequences of premature pregnancy

The severity of the state of born earlier than the toddler times depends on the period of gestation, mass, the length of his body and the quality of the provision of first aid. In addition, the further forecast is largely determined by the reasons that caused. If a woman has a complicated premature pregnancy, consequences can be severe, up to death. The maximum risk is determined if there are following factors:

• bleeding, which caused premature births, for example, with the placenta pale;
• finding the fetus in the pelvic preview;
• pregnancy twins;
• insufficient supply of fetus oxygen during childbirth;
• distress syndrome, that is, a severe defeat of the respiratory system.

With severe childbirth, the following abnormalities may appear in the subsequent baby:

• delay of physical and mental development;
• the emergence of signs of children's cerebral paralysis;
• exposure to inflammatory diseases of infectious ethiology;
• problems with vision and hearing;
• violations of reproductive function in girls.

It should be borne in mind that such deviations arise in extremely rare cases, the proper conduct of labor under prematurity, timely and competent obstetric measures raise the risk of complications to the minimum.

Caring for a premature child at home

After the newborn baby begins to actively suck the maternal breast, and its weight reaches two kilograms, he is written home, where he needs to ensure proper care. The rules for the premature babe in the first month of life at home are as follows:

• Maintaining the optimal microclimate, which consists in constant humidity of air within 50 - 70% and temperature at 23 - 25 degrees. Humidity can be monitored using a hygrometer and, if necessary, increase it with special devices - air humidifiers.
• Constantly monitor the change in the body temperature of the baby, it is better to use a contactless thermometer.
• It should be noticed to wear a little warmer than children born in due time, since they are not sufficiently expressed by the subcutaneous fat layer. Clothing should be made only from natural fibers and should not be done through the head.
• Bathing the premature child only in boiled water at a temperature of 36 - 37 degrees.
• It is possible to walk with the newborn only at the end of the first month and, subject to good weather, in the frost and the wind is better to stay at home.
• It is necessary to feed such a baby in accordance with the guidelines of a pediatrician, carefully following that he does not jump into the eaten portion of milk.

In addition, parents need to strictly limit the number of guests, since premature children are very susceptible to infection.

You can avoid the early appearance of the baby in the light of the kid with a regular visit to the doctor, control over the state of health and the fulfillment of all medical recommendations. Premature children can be full and healthy subsequently, but require serious care and rehabilitation in the first three years of life.

Useful video

For the peculiarities of a premature child, see this video:

Vygovskaya L.E., Shulaev A.V., Zakirov I.K.

An analysis of 222 children born alive with varying degrees of prematurity. By correlation and regression analysis, groups of adverse perinatal periods of perinatal period that contribute to the birth of a premature child and the presence of severity of childbirth in mothers of the studied category were revealed.

premature children

adverse perinatal period factors

Over the past five years, in the Russian Federation, against the background of the growth of the fertility indicator, an increase in the frequency of perinatal pathology is noted, which provokes the risk of developing the distant disability of children. According to WHO, every twentieth child has certain violations of development, requiring special medical events.
Perinatal lesions of the central nervous system are 60-80% of all neurological diseases in childhood. One of the main objects of perinatal pathology are premature children.

The purpose of the study The study of the influence of adverse factors of the perinatal period on the formation of pretimacy, gestational age and severity of the overall state of the premature child.

Material and research methods

We examined 222 premature children born, according to the data exchange cards of the maternity hospitals, with signs of hypoxia of varying severity. These patients accounted for a major group of patients. Accordingly, the gestational age, the children were distributed to 4 subgroups: with I Art. The presence (1st subgroup) was observed 67 (30%); with II Art. prematurity (2nd subgroup) - 81 (36.5%) Man, with III and IV Art. The presence (3rd and 4th subgroups) - 52 (23.4%) and 22 (10%) of the patient, respectively.

A comparison group amounted to 191 child. According to exchange cards of maternity hospitals, all children were born prematurely without signs of hypoxia. Accordingly, the gestational age children were also distributed to 4 subgroups: with I Art. The presence (1st subgroup) was observed 67 (35%) people, with II Art. prematurity (2nd subgroup) - 81 (42.4%) man; Deep-alone children (III and IV subgroup) amounted to 52 (27.2%) and 22 (11.5%) of the child, respectively.

An analysis of the perinatal period made it possible to establish the presence of causal relationships between the adverse factors of the perinatal period, as well as to trace the influence of these factors on the formation of non-obscuration of pregnancy.

Results of research and discussion

In the studied groups, there is a direct connection between the prematurity and the presence in the history of mothers instructions on abortions (R xy \u003d 0.3), the threat of pregnancy interruption (R xy \u003d 0.3), intrauterine infection (R xy \u003d 0.45), pregnant anemia (R xy \u003d 0.3) (p< 0,05).

The development of extganenital pathology, in some cases, is also a consequence of disadvantage from the obstetric anamnesis: there is a direct connection between abortions and chronic pyelonephritis (R xy \u003d 0.38), multiple pregnancy and anemia (R xy \u003d 0.74). Mother infectious diseases transferred during pregnancy can cause miscarriage (R xy \u003d 0.42); The threat of abortion of pregnancy has a close relationship with abortions and respiratory and viral infections of the mother (R xy \u003d 0.7) (< 0,01).

The reception of pharmacological preparations during the period of the current pregnancy, the threat of interrupting and toxicosis of pregnancy contributes to the development of the pathology of the intranatal period (premature debit of spindle water) - (R xy \u003d 0.35). The unfavorable course of the postnatal period (hyperbilirubinemia) has a direct connection with the threat of abortion (R xy \u003d 0.7), the presence of sharp respiratory and viral infections and intrauterine infection during the period of the current pregnancy (R xy \u003d 0.35-0.48).

We traced the influence of adverse perinatal factors on the formation of gestational age in premature patients. The results obtained in studying the course of pregnancy in all subgroups show that pathological conditions are observed in 91% of patients in the main group and in 81.7% of patients in the comparison group (p< 0,01).

In the overwhelming majority, the mother's pregnancy proceeded against the background of a burdened obstetric anamnesis and chronic fetoplacentage insufficiency, however, the qualitative characteristic of these indicators among the various periods of gestation has significant differences.

Repeated abortion guidelines had 40% of mothers in the 1st subgroup, 51% of women in the 2nd subgroup, 65 and 44% of people in the 3rd and 4th subgroups, respectively, however, in 31 and 33% of mothers in The first two subgroups, the number of abortions did not exceed two, while in the history of mothers of deep-headed children more often noted over two cases of artificial abortion (37 and 36 in the 3rd and 4th subgroups, respectively) (< 0,05). Среди причин невынашивания немаловажную роль играет порядковый номер текущей беременности и наличие многоплодной беременности. У 43 % женщин в 1-й подгруппе и у 33 % человек во 2-й подгруппе порядковый номер текущей беременности не превышал четырех; указания на большой порядковый номер текущей беременности (свыше четырех) чаще имели матери глубоконедоношенных детей в 3-й и 4-й подгруппах (32 и 41 %) (р < 0,05; р < 0,01); у 44 % женщин многоплодная беременность заканчивалась рождением детей из 3-й подгруппы (р < 0,05) (рис. 1).

Fig. 1. The effect of adverse perinatal period factors (abortion, sequence number of pregnancy) on the formation of gestational age in the main group and in the comparison group (in%) (I - abortions: A - number of abortions to two, b - the number of abortions over two; II - Sequence number of pregnancy: a - up to four, b - over four; * - p< 0,05; ** - p < 0,01)

The relatively high frequency of sexual interomalies and infertility was observed among women of the 1st subgroup (67 and 80%), stillborn - among mothers of the 2nd subgroup - 55% (p< 0,05). Повторные случаи самопроизвольного прерывания беременности в 2 раза чаще регистрировались в анамнезе у глубоконедоношенных больных - 45 % (р < 0,05), среди этой категории детей в несколько раз чаще отмечались и указания на внутриутробное инфицирование (25 и 44 % соответственно в 3-й и 4-й подгруппах) (р < 0,05) (рис. 2, 3).

Fig. 2. Distribution of indicators of antenatal pathology (multiple pregnancy, miscarriage, stillborn) in the structure of the reasons for non-pending pregnancy in patients with different degree of prematurity in the main group and in the comparison group (in%)
(I -Malople pregnancy, II - stillborn, III - miscarriages:
A - single, b - repeated; * - P.< 0,05)

Fig. 3. The frequency of manifestations of adverse factors of the perinatal period (intrauterine infection, infertility, interomalities of the sexual sphere) in the characteristics of obstetric anamnesis in mothers of premature patients with various periods of gestation
In the main group and in the comparison group (in%)
(I - VUI, II - III, III - interomalies of the sexual sphere; * - p< 0,05)

The current pregnancy was complicated by toxicosis and threat of interrupts I and II half of pregnancy several times more likely in history in patients in the 1st and 2nd subgroups.

Extragenital pathology of the mother constitutes a significant proportion among the causes of non-pregnancy in the 1st and 2nd subgroups of patients (43.2 and 30.4%, respectively); At the same time, the anemia of pregnant and sharp respiratory viral infections accounts for 17.5 and 11% in the structure of all somatic diseases in mothers of the 1st subgroup (Table 1)

The influence of various kinds of professional hazards and bad habits on the course of pregnancy many times was often observed in the 1st subgroup of patients - 72% (p< 0,05). В анамнезе у этих пациентов в 2 раза чаще отмечались указания на прием матерью во время текущей беременности фармакологических препаратов - 40 % (p < 0,05).

We analyzed the influence of a number of unfavorable factors of the perinatal period into the severity of the general condition at the birth of premature patients of various gestational age. The data are shown in Table. 2.

Thus, prematurity, gestational age, as well as the severity of a general condition at the birth of a child depend on the combination of a number of adverse factors of the perinatal period.

conclusions

1. Patient risk risk factors with I-II Art. Presence are: repeated pregnancy by number up to four, repeated abortions by number up to two, stillborn, single miscarriages, sexual anomalies, infertility, toxicosis and threat of interrupts I or II half of pregnancy, respiratory and viral infections, professional hazards and bad habits, as well as reception Pharmacological preparations during the period of current pregnancy.

2. Risk factors that contribute to the birth of deeply disheveled children, as well as influencing the severity of the general condition at the birth of a given category of patients, are repeated pregnancy by the number of over four, repeated abortions by the number of over two, repeated miscarriages, multiple pregnancy. Additional factors affecting the severity of the general condition at birth in deep-alone patients are toxicosis and the threat of interrupting pregnancy, delaying the placenta, the operation of caesarean section, intranatal asphyxia (crucial cord).

3. The factors contributing to the increase in the severity of the basic state in premature patients with all the periods of gestation are the foci of chronic infection in mothers and the fetus (chronic pyelonephritis, intrauterine infection), pregnant anemia, the use of benefits in the intranatal development period.

Table 1

Comparative analysis of the nature and frequency of extragationalital pathology
Mothers have premature children of various gestational age
In the main group and in the comparison group (ABS /%)

< 0,05.

table 2

Comparative characteristics of adverse perinatal period factors,

affecting the severity of the main state at birth in premature babies with different periods of gestation (in%)

Note: * - Reliability of differences P< 0,05.

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7. Brain-Stem Auditory and Visual Evoked Potentials in Children With Krabbe Disease / M. Aldosari, M. Altuwaijri, A.M. Husain // Clin Neurophysiol. - 2004. - № 7. - R. 1653-1656.
8. Chung M.Y. Risk Factors for Hemodynamically-unrelated Cysstic PeriVentricular Leukomalacia in Very Low Birth Weight Premature Infants / M.Y. Chung, P.C. Fang, C.H. Chung // j. Formos. Med. Assoc. - 2005. - № 8. - P. 571-577.
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Reviewers:

Kuznetsova A.V., D.M., Professor of the Department of Hospital Pediatrics with a course of polyclinic pediatrics, Kazan;

Malanichev T.G., D.M., Professor of the Department of Propedeutics of Children's Diseases and Faculty Pediatrics with a course of childhood diseases of the medical faculty of KGMU, Kazan.

The work went on the editors 04.05.2011.

Bibliographic reference

The total number of premature children does not exceed 10% of all newborns. In Yaroslavl and the Yaroslavl region, this percentage fluctuates about 6%. But, despite the relative smallchair, these children give the lion's share of such indicators as perinatal, neonatal and infant mortality. Consequently, the path to improving these indicators is to combat the unbearable and improving the adhesion of these children.

There is a warning that premature babies in the future all completely are defective. In domestic communication, the term "non-lump" even moved into the category of insults. In this regard, the WHO Expert Committee recommended instead of determining "premature" to use the expression "prematurely born children". Analysis of the results of the inspection of premature babies in Katamnez and on our literary data shows that when performing parents of recommendations of neonatologists on therapeutic and rehabilitation measures, the number of children with a resistant severe CNS pathology does not exceed 10%. True, in recent years there has been a tendency to increase such children, which is associated with the possibility of modern resuscitation, to assist children born in severe or even extremely serious condition, in which the risk of formation of the pillar of the CNS pathology is very high. But this circumstance dictates only the need to perform obstetric care on the ante and anthrhanna stages.

Among the reasons for the inconsistency of pregnancy, the literature indicates a number of factors, such as the peculiarities of the neuroendocrine status of a woman and the structure of the uterus, social and living conditions, stress, premature generics on medical testimony, etc. However, various infections are presented. According to the original views, the initiator of the beginning of the generic activity is the fruit. In the process of intrauterine ontogenesis, by the moment of urgent genera, the immunity of the fetus reaches the degree of development in which the "incompatibility" with the immunity of the mother and reaction of the fetus rejection. Based on this concept, unbearable occurs due to the additional antigenic load on the immunity of the fetus, which leads to premature birth. Most often, the source of such a reaction system of immunity is infectious principles penetrating into the fruit of the mother's organism.

The child born under the period of pregnancy is prevented before the end of the 37th week with a mass of body less than 2500g. and a long body is less than 46 cm having external morphological and functional signs of immaturity. When evaluating a newborn as prematurely used four groups of criteria: the term of pregnancy (gestational age of less than 37-weeks), indicators of physical development, morphological criteria, which include body proportions (relatively large head, lowered by a navel ring) and skin condition (weakly pronounced subcutaneous - Skin fiber, wrinkled leather with low elasticity, well visible venous vessels of the main type, the presence of powdered hair "Lanuga" on the face and torso, etc.) and functional signs (due to the immaturity of the nervous system and muscle hypotension - the lack of the position of flexcation, hyphotexia and Low spontaneous motor activity), as well as a weak cry. Why can not be guided only by one criterion, for example, the term of pregnancy. Because in some cases, women are registered for pregnancy, or in general, they do not consist on such studies, therefore the accurate period of pregnancy is very difficult to determine. As for physical development indicators, there are currently cases when premature children have a body weight at birth over 2500g. Consequently, none of the above criteria prematurity is absolutely reliable, therefore the assessment is given on the basis of a set of listed signs.

There are special tables and schemes that allow signs of the child's immaturity to present in a semi-focal form, for example, in points. A similar assessment of the child helps to establish gestational age in cases where the usual method cannot be installed in the usual method. In addition, if the child does not gain due amount of points for this period of pregnancy (two or more weeks), this may indicate the delay in the intrauterine development of the fetus.

The presence of newborns is encrypted in the international classification of diseases as a pathological condition, the duration of which depends on the degree of child immaturity: the deeper the immaturity, the longer this period lasts. In premature babies, three versions of age periodicals are determined: first, gestational age (the term of pregnancy at the time of the occurrence of birth), secondly, postnatal age, calculated since the birth of a child and, thirdly, conceptual (post-chase) age, which is The amount of gestational and postnatal ages.

Among the premature newborn children, in accordance with the recommendations of the WHO Committee, depending on the mass of the body at birth, three clinical groups:

1. Premature babies with low body weight (body weight at birth more than 1500g.)

2. With very low mass (body weight at birth 1500-1000g.)

3. With an extreme / critical low body weight (body weight at a birth - less than 1000g.).

The first of these groups is the most numerous, from concomitant diseases most often in this group of children innate or acquired infectious pathology. Increased infectious incidence of children in two other groups, but in addition, children with very low mass are a high-risk group along respiratory distress syndrome (syndrome - syndrome of respiratory disorders) and hemorrhage in the ventricles of the brain. In children with an extremely low mass, the risk of previous three pathological conditions is maintained, but there is also a high risk of damage to organs of vision (retinopathy) and malformations. Newborn with very low and extremely low mass in the literature are designated as a rough-alone (rude-mellow) children. It is characteristic of the high morbidity and mortality, and from an economic point of view, the exercise of these children requires large financial costs, since they often need assistance to resuscitors and other specialists, as well as technically difficult provision of their livelihoods.

Premature birth is not planned by a genetically not prepared act with an incomplete structural and functional development of organs and systems, therefore adaptation to non-utilized existence in premature children has significant features. In general, it can be stated that the adaptation processes in prematurely born children compared to mature (that is, with domestic and healthy) newborn proceeds more than a long time.

The results of many years of observation and research testify that postnatal adaptation mechanisms for premature babies with low body weight, that is, relatively more mature, have a certain similarity with mature (domestic) newborn, although somewhat stretched over time. Maximum mobilization of adaptation mechanisms It occurs during the first two weeks after birth, followed by a gradual transition to a level of life, peculiar to dusty children: the fetal communications of the heart and vessels are closed, organs and homeostasis are normalized. Less mature deep-long children with very low and extremely low body weight adapt otherwise. During the first two weeks, the deep structural immaturity of organs limits the possibility of mobilizing such systems as autonomous nervous and cardiovascular, external respiration and digestion, i.e. There is transient failure. But at the same time there is a significant hyperfunction of the adrenal cortex and hyperproduction of glucocorticoids, which accelerates the morphological ripening of organs. During the last third and fourth weeks and later, the mobilization of functional systems and the acceleration of the child's development occurs.

External manifestations of early postnatal adaptation in mature newborns are called physiological, they are not made in diagnosis and do not require treatment. In premature newborns, some of these states are also noted, but they are not called physiological, since prematurity is a pathological condition, and the attitude towards them is different.

Adaptive processes in premature babies with low body weight and deep-alone have both some similarities and significant differences. Similarity lies in the predisposition of premature newborns to cool and low body temperature. This occurs due to high heat transfer caused by a slightly pronounced subcutaneous tissue surface location of the skin vessels. On the other hand, they have low heat-product capabilities, since small reserves of a thermogenic substance - brown fat, which is the main source of heat in newborns. These circumstances determine the tendency of premature children to the state of hypothermia. The cooling of the premature newborn always leads to its disease with a possible fatal outcome. Unlike mature newborns, premature babies does not have such a physiological state as transient hyperthermia.

In premature babies with a low and very low mass of the body located on enteral nutrition, the weight curve has the following configuration. During the first five days after the birth of body weight, it is reduced by 4-12%, and in the next five days it retains this minimum. Then, for 4-5 days, the mass of the body increases and it is restored to 14-15 days to the indicator at birth, and then with adequate feeding the body weight gains on average 15-20-30g / day. Directly proportional to the initial numbers at birth. As for newborns with an extremely low mass, most of them are in the first two weeks after birth in intensive therapy and parenteral nutrition, so they are often minimal than or no body weight loss.

In all premature newborn children, hyperbilirubinemia arises with the predominance of indirect non-conjugated bilirubin, due to the immaturity of the liver and hemolysis of red blood cells with the release of a large amount of hemoglobin and the subsequent transformation of it in indirect bilirubin. In mature newborn, the accumulation process of indirect bilirubin occurs during the first three to four days, after which the liver begins to actively conjure the indirect bilirubin, it translates it in a straight line, so that it is output-with the disappearance of the jaundice to 7-10 days. This substance is insoluble in water, so it is not excreted through the kidneys. Since indirect bilirubin soluble in fat, it is deposited in subcutaneous tissue, the development of which in mature newborns is sufficient, so they have a clear dependence of the intensity of skin color from the amount of deposited bilirubin and its content in the blood. In premature newborns, the subcutaneous fiber is expressed weakly, so it cannot fully fulfill the function of the depot and plus to this more pronounced liver immaturity. These circumstances determine the features of the course of hyperbilirubinemia in premature newborn children. The jaundice coloring of the skin appears at the end of the first day. The content of indirect bilirubin in the blood increases during the first five days and stabilizes on the maximum figure during the first five days and stabilizes on the maximum figure over the past five days, and then begins to decline. With the uncomplicated course of neonatal jaundice adaptation disappears by 14-15 days of life, but this process can be delayed. Thus, indirect hyperbilirubinemia in premature newborn children is characterized by a greater duration, high level and lack of a clear connection of blood content and the intensity of jaundice. Under these conditions, given the immaturity of the hematophephalic barrier, premature newborn children are a risk group for bilirubinic damage to the central nervous system, therefore, firstly, all these children need to determine the content of bilirubin in the blood, and second, increased content in the blood of indirect bilirubin It is made in diagnosis as a conjugation hyperbilirubinemium with a preventive treatment with phototherapy.

Another feature of premature children in the first day of life is the reporting syndrome, which can manifest itself in the form of dense and soft swelling. The frequent appearance of edema in premature babies is due to the immaturity of the kidneys and a more significant proportion of extracellular fluid. The symptom of dense edema is the resulting fossa does not disappear immediately after pressing on the tissue with a finger. Dense swelling, covering the lower limbs and the lower part of the body, gained scler's climbing, and covering all limbs and torso - sclerama. Dense edema appear against the background of severe diseases, such as generalized infections, generic injuries, child cooling and are prognostic adverse sign. Soft (hypostatic) edema is divided into local (1 space) - in the field of stop, legs, a sacrum, faces, propagation in the form of anasarka (2 degrees) and generated with the presence of liquid in serous cavities (3 degrees). Local soft swelling of treatment do not require and disappear as the child ripening the organism. Common and generalized swelling arise against the background of concomitant diseases and are brused in the context of the treatment of these diseases.

The primary assessment of the functional state of the newborn baby is carried out on the apgar scale (Table 1).

The rating "0" indicates the absence of heartbeat, respiration, muscle tone, reflex excitability, on common cyanosis or pallor. The estimate "1" is set at heart rate of less than 100 in 1 min, irregular breathing, reduced muscular tone, weak reaction to the introduction of the catheter in the nasopharynx, acrocyanosis. The rating "2" indicates the frequency of heartbeats of more than 100 in 1 min, regular respiration, physiological muscular tone and adequate reflex excitability, a pink color of the child's skin. Healthy newborn children have an estimate of 8-10 points.

In our country, a double assessment on the apgar was adopted: after 1 min and 5 minutes after birth. We consider it expedient to evaluate the functional state of all children on the apgar scale, regardless of the term of pregnancy and body weight at birth. In the group of day-old newborn children, the score on the apgar's scale has prognostic value.

Many years of experience shows that in prematurely born children, the amount of scores on the apgar scale after 1 min determines the severity of asphyxia and allows you to choose the most adequate complex of resuscitation activities directly at the birth of a child. Prognostic value for premature children High score on the apgar scale has no.

Clinical symptoms reflected in the apgar scale are dependent on metabolic shifts and the degree of maturity of newborns.

The maturity of the newborn is determined by the combination of clinical, functional and biochemical indicators in relation to its gestational age. "To all age periods, starting with zygotes, the body is perfect and mature to the extent that the features of its physiological shipments adaptively correspond to its calendar age and the environment with which it must interact in accordance with age."

Table 1

The most informative characteristic of the maturity is the state of the CNS of the child.

By the 28th week of gestational age, the fetus develops most of the main reflex reactions, although they are still weak. Starting from the 32nd week of gestational age, spontaneous awakens are observed and periods of wakefulness appear. In 40 weeks, the child takes place the daily rhythm of sleep and wakefulness.

A domestic child is inherent in the presence of a large number of spontaneous movements. The physiological hypertension of the flexing muscle group ensures the "Embryo Posle" characteristic of this age with the hands and legs given to the body. Brushes in healthy children are compressed in cams, the head is located in the midline and can be slightly trapped back due to the relative increase in the tone in the longest muscle of the head and neck. From the 36th week of intrauterine development, the child can already maintain his head in a vertical position within a few seconds.

The status of the nervous system is the spontaneous motility of the person, emotional reactions alone and in response to irritation, eye symptoms.

A healthy newborn face is symmetric with the same eye slit and nasolabial folds.

In 28 weeks of gestational age, the child shudders in response to a sharp sound, he has a blinking reaction to bright light.

In 38 weeks, a child has meaningful reactions to visual irritation and it can follow the eyes without turning the head for a bright moving object at a distance of 20 cm. In 40 weeks in response to visual and auditory irritants, breathing changes, he reveals his mouth and eyes. To this age, he has a distinct response to the light, calms down in response to a quiet tender voice.

Congenital unconditional reflexes reflect the degree of maturity of the child and its viability. The arches of these reflexes are closed at various levels of the spinal cord and a brain barrel.

From a large number of unconditional reflexes, it is advisable to explore only a part that gives an idea of \u200b\u200bthe neurological status of the child.

1. Reflexes of oral group: search, sucking, palm-otogol. This group of reflexes reflects the state of the facial, triple, sub-surfactant and language nerve.

2. Reflex Moro reflects the state of the finally part of the sentence-snelled nerve.

3. The grabbing reflex (Robinson) is preserved and well called in all healthy newborn children from the first minutes of life.

4. Asymmetric Shain-Tonic Reflex (Magnus-Klein) reflects the maturity of VIII and XI pairs of cranial nerves and their connection with the motor sphere.

5. The plantar reflex is an analogue of grasing reflex with hands.

The following reflexes are estimated in the vertical position: hanging, straightening on the support, reflex support, automatic walking.

The stomach position is detected:

6. Protective reflex - lifting or turning head to the side.

7. Reflex crawl (Bauer), Talent Reflex and Peres.

The reflexes of the newborn baby are very labilic. In the first minutes and hours of life, they can be reduced. Especially often reflexes of support, automatic walking. To properly assess, the observation in dynamics of the day of life is important.

By the time of birth, newborns are able to perform active sucking movements. However, the activity of sucking varies depending on the age of the child (in days) and its functional maturity.

In children of the 1st-year-old life during feeding, there is a rather long period of "suction" - from 0.5 to 5 minutes; In children of the 7-30th day, it is shortened to 5-12 p.

The duration of the sucking of the chest at the mode of feeding a newborn after 3.5 hours (6 times a day) is in children aged 1-2 days 5-6 minutes, 3-6 days - 7.93, 7-8 days - 8.63, 9-30 days - 10.92 min. Accordingly, the amount of suction milk is changed for one feeding - 25.6; 59; 72 and 100 ml.

In the dynamics of sucking there is a gradual decrease in the food reaction, especially in children of the 1st year of life. So, in the 1st minute of feeding, children aged 1-2 days suck on average 52.4 s and rest 7.6 s, while children aged 9-30 days suck 59.2 s and rest 0.77 p. The reasons for the decline in the food reaction are fatigue and saturation of the child.

The maturity of a newborn baby in clinical features is determined using special tables, including the most informative external clinical signs. Each characteristic is estimated in points from 1 to 4, and the amount of points is a specific index of maturity.

There are data on the possibility of using functional, biochemical and radiological indicators to assess the maturity: EEG indicators, coordination of sucking, swallowing and respiration, determination of the osenation cores, the concentration of A-fetoprotein in serum, fetal hemoglobin, the ratio of lecithin concentration to Sfingomelin in gastric aspirates and .