Download Невынашивание и перенашивание беременности

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 birthweight 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 22-27 weeks- fetal
weight at this time is generally from 500 to
1000 gr
 Early prematurity - 28-33 weeks- in fetal
weight at this time is typically from 1000 to
2000 gr
 Prematurity - 34-37 weeks- in fetal weight at
this time is typically from 2000 to 2500 gr
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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
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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)
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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 :
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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
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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%.
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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
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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.
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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
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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
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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
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