Basic research. The main causes of preterm pregnancy Prevention of preterm pregnancy

1

1 State budgetary educational institution of higher professional education "South Ural State Medical University" of the Ministry of Health of the Russian Federation

Based on a retrospective analysis of medical records for 2000-2015. an assessment of socio-hygienic and clinical-anamnestic factors was carried out in women whose pregnancy ended premature birth. Group 1 included 89 women with perinatal losses, group 2 - 1039 women with premature birth and live birth, the control group (group 3) included 101 women whose pregnancy ended in timely delivery with a live birth. Among women with perinatal losses in this pregnancy, there were more often patients of early reproductive age, unemployed, unmarried, with a secondary education, who drank alcohol and smoked during pregnancy, more often had a personal history of preterm birth, menstrual irregularities, early start sexual life, chronic inflammatory diseases of the pelvic organs, urogenital infections, fetal loss syndrome, history of preterm birth, diseases of the gastrointestinal tract, initial underweight, overweight and obesity compared with the control group. Patients with preterm birth and live birth more often had such medical and social characteristics as early reproductive age, secondary education, unemployed, employees, early onset of sexual activity, first marriage, chronic inflammatory diseases of the pelvic organs, personal history of preterm birth, smoking during pregnancy, diseases of the cardiovascular system and gastrointestinal tract, eating disorders and metabolic disorders compared with the control group.

premature birth

perinatal losses

socio-hygienic factors

extragenital pathology

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Relevance. The prevalence of preterm birth in the world remains at a high level and averages from 5 to 11%. The level of perinatal mortality in preterm birth is 10 times higher than that in term birth and reaches 75% of all cases of perinatal death. Premature babies have a high frequency of respiratory dysfunction, the development of bronchopulmonary dysplasia, sepsis, intraventricular bleeding and, in the future, cerebral palsy, which ultimately leads to persistent health disorders with impaired behavioral and cognitive functions up to disability. The most significant factors on the part of the mother that determine the likelihood of preterm birth are age, level of education, socioeconomic factors, obstetric history, somatic diseases, bad habits, features of the course of this pregnancy. The contribution of various factors may also differ depending on the geographic region and ethnicity.

Target. Assess risk factors for preterm birth in women with preterm pregnancy.

Materials and methods. Study type: case-control with retrospective cohort. Study population: pregnant women who gave birth prematurely in the city center for premature births of the Regional Clinical Hospital No. 2 and the Regional Perinatal Center of Chelyabinsk for the period from 2000 to 2015.

Based on a retrospective analysis of medical records for the specified period, an assessment was made of socio-hygienic and clinical and anamnestic factors in women whose pregnancy ended in premature birth (22-36 weeks): group 1 included 89 women with perinatal losses, group 2 - 1039 women with a live birth, the control group (group 3) included 101 women whose pregnancy ended in timely delivery (≥ 37 weeks) with a live birth.

Statistical data analysis was carried out using the statistical software package Statistica for Windows 7.0 (StatSoftInc., USA). Student's t-test and Pearson's chi-square (χ 2) were used. The data in the text are presented as the arithmetic mean and its standard deviation (M±σ). For all types of analysis, p values ​​were considered statistically significant.<0,05.

Results and its discussion. The age of women varied from 16 to 42 years and was 26.5±4.8 years in group 1, 28.1±4.6 years in group 2, 30.5±5.7 years in group 3. age (less than 20 years) was higher in group 1 (19.1%, p 1-3 = 0.006) and in group 2 (14%, p 2-3 = 0.01) compared with the control group (5%) . At the same time, women of older reproductive age (over 35) in the groups met with approximately the same frequency (10.1%, 9.2% and 8.9%, respectively).

The level of education is one of the important factors influencing medical activity, which is manifested in the regularity of visits to the doctor, the implementation of recommendations and the observance of regime moments. Patients in group 1 more often had a secondary education (43.8% versus 31.3% in group 2 and 17.8% in controls, p 1-3<0,001), значительно реже - высшее образование (12,4% против 26,7% в группе 2 и 44,6% в группе 3, р 1-2,3 <0,001).

The social position of a woman reflects certain conditions, level and quality of life that are important for the normal course of pregnancy. The study of the social status of pregnant women in the compared groups showed that non-working women were more common in group 1 (62.5% versus 39.5% in group 2 and 22.8% in group 3, р 1-2.3<0,001). В группе 2 преобладали служащие (44,9% против 27% в группе 1 и 52,5% в группе 3, р 2-1 <0,001), а доля рабочих во всех группах была сопоставима (10,1% в группе 1, 12,5% в группе 2 и 13,9% в группе 3). Указаний на работу, связанную с профессиональными вредностями, среди исследуемых женщин не было.

When assessing marital status, half of the patients in group 1 were single (50.6% versus 25.3% in group 2 and 13.9% in the control group, p 1-2.3<0,001). В первом браке были зарегистрированы большая часть пациенток в группе 2 (66,2%, р 1-2 <0,001) и контрольной группе (76,2%, р 1-3 <0,001, р 2-3 =0,047). В повторном браке состояло 5,6% женщин в группе 1, 8,2% - в группе 2 и 9,9% - в группе 3.

A personal history of preterm birth was noted by 6.7% of women in group 1 (p 1-3 = 0.01) and 8.5% of women in group 2 (p 2-3 = 0.004) in the absence of such in the control group.

The frequency of bad habits that affect not only pregnancy outcomes, but also the health status of newborns is presented in Table 1.

Table 1

The frequency of bad habits in the studied patients

	Group 1 (n 89)		Group 2 (n 1039)		Group 3 (n 101)
Tobacco smoking
Alcohol consumption
Without harmful habits

Note: * - p 1- 3<0,05, ** - р 2-3 <0,05, *** - р 1- 2 <0,05.

Pregnant women in groups 1 and 2 were more likely to smoke tobacco and indicate the use of alcohol during pregnancy compared to those in the control group.

When studying the gynecological history, it was found that the average age of menarche was almost the same in the studied groups and amounted to 13.3 ± 1.3 years in group 1, 13.1 ± 1.4 years in group 2 and 12.7 ± 1, respectively. 0 years in group 3 (p>0.05). Patients in group 1 more often noted menstrual irregularities compared to groups 2 and 3 (24.5% versus 11.4% and 10%, respectively, p 1-2<0,001, p 1-3 =0,007).

Pregnant women in groups 1 and 2 more often began sexual activity before the age of 16 compared to those in group 3 (32.6%, 18.6% and 5.9%, respectively, p 1-2 = 0.013, p 1-3<0,001, р 2-3 <0,001). 22,5% пациенток 1-й группы имели трех и более половых партнеров, что значительно отличалось от группы 2 (12,7%, р=0,01) и группы контроля (8,9%, р=0,01).

Chronic inflammatory diseases of the pelvic organs (chronic endometritis, salpingo-oophoritis) were more common in women in group 1 (33.7%, p 1-3<0,001) и группе 2 (32,2%, р 2-3 <0,001) по сравнению с контрольной группой (7,9%). Указания на наличие урогенитальных инфекций - уреаплазменной (20,2, 22,2 и 5% соответственно) и микоплазменной (18, 18,3 и 4% соответственно) чаще отмечено у женщин в группах 1 и 2 по сравнению с контрольной группой. Различий по частоте бесплодия и гормональных нарушений в исследуемых группах не выявлено.

When assessing the obstetric history in the study groups, it was found that among women in group 1, primigravida was more common compared to the control group (43.8% vs. 30.7%, p 1-3<0,05). В то же время в группе 2 было больше первобеременных (41,1% против 30,7%, р 2-3 =0,04) и первородящих (24,9% против 14,9%, р 2-3 =0,024) по сравнению с контрольной группой. Среди пациенток группы 1 чаще выявлялся синдром потери плода по сравнению с таковыми в группах 2 и контрольной (5,6%, 1,4% и отсутствие в контрольной группе, р 1-2 =0,004, р 1-3 =0,02). Преждевременные роды в исходе предыдущей беременности чаще встречались в группах 1 и 2 по сравнению с контрольной (9, 11,8 и 1,8% соответственно, р 1-3 =0,004, р 2-3 =0,014). Значимых различий по частоте искусственных абортов, эктопической беременности, неразвивающейся беременности в анамнезе в исследуемых группах не выявлено.

A large contribution to the frequency of maternal and perinatal morbidity and mortality is made by the presence of extragenital pathology, the proportion of which is steadily growing. The frequency of extragenital pathology in the study groups is presented in Table 2.

table 2

The frequency of extragenital pathology in the studied groups

Diseases	Group 1 (n 89)		Group 2 (n 1039)		Group 3 (n 101)
Cardiovascular diseases
Diseases of the gastrointestinal tract
Diseases of the urinary dividing system
Overweight and obesity
Baseline underweight

Note: * - p 1-3<0,05, ** - р 2-3 <0,05, *** - р 1-2 <0,05.

In the structure of somatic pathology in group 1, the most common diseases of the gastrointestinal tract, eating disorders and metabolic disorders in the form of overweight and obesity, as well as initial underweight compared to the control group. Group 2 was dominated by diseases of the cardiovascular system in the form of varicose veins of the lower extremities and chronic arterial hypertension, diseases of the gastrointestinal tract and metabolic disorders.

Thus, the assessment of socio-hygienic and clinical-anamnestic factors can serve as an additional criterion for predicting the development of preterm labor in women both at the pregravid stage and from early pregnancy.

Conclusions. 1. The analysis of socio-hygienic factors showed that among women with perinatal losses in this pregnancy, there were more patients of early reproductive age, unemployed, unmarried, having a secondary education, drinking alcohol and smoking during pregnancy. 2. When studying clinical and anamnestic factors in women with perinatal losses in this pregnancy, a personal history of premature birth, menstrual irregularities, early onset of sexual activity, chronic inflammatory diseases of the pelvic organs, urogenital infections, fetal loss syndrome, premature birth in history, diseases of the gastrointestinal tract, initial underweight, overweight and obesity compared with the control group. 3. Patients with premature birth and live birth more often had such medical and social characteristics as early reproductive age, secondary education, unemployed, employees, early onset of sexual activity, first marriage, chronic inflammatory diseases of the pelvic organs, personal history of premature birth , smoking during pregnancy, diseases of the cardiovascular system and gastrointestinal tract, eating disorders and metabolic disorders compared with the control group.

Reviewers:

Uzlova T.V., Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology, South Ural State Medical University, Chelyabinsk;

Avilov O.V., Doctor of Medical Sciences, Professor of the Department of Public Health and Healthcare, SBEE HPE "South Ural State Medical University" of the Ministry of Health of Russia, Chelyabinsk.

Bibliographic link

Semenov Yu.A., Chulkov V.S., Sakharova V.V., Moskvicheva M.G. ASSESSMENT OF RISK FACTORS FOR THE DEVELOPMENT OF PRETERM BIRTH IN WOMEN WITH PRETERM PREGNANCY // Modern Problems of Science and Education. - 2015. - No. 4.;
URL: http://site/ru/article/view?id=21356 (date of access: 03.03.2020).

We bring to your attention the journals published by the publishing house "Academy of Natural History"

According to statistics, miscarriage is recorded in 10-25% of pregnant women.

The cause of miscarriage can be various diseases that are difficult to cure or have become chronic. However, these diseases do not apply to the sexual sphere. An important feature of this kind of pathology is the unpredictability of the process, since for each specific pregnancy it is difficult to determine the true cause of abortion. Indeed, at the same time, the body of a pregnant woman is influenced by many different factors that can act covertly or explicitly. The outcome of pregnancy in case of habitual miscarriage is largely determined by the ongoing therapy. With three or more spontaneous miscarriages at gestational ages up to 20 weeks of gestation, an obstetrician-gynecologist diagnoses habitual miscarriage. This pathology occurs in 1% of all pregnant women.

After the fertilized ovum is “located” in the uterine cavity, the complex process of its engraftment there begins - implantation. The future baby first develops from a fetal egg, then becomes an embryo, then it is called a fetus that grows and develops during pregnancy. Unfortunately, at any stage of bearing a child, a woman may encounter such pathology of pregnancy as her miscarriage.

Miscarriage is the termination of pregnancy between the time of conception and the 37th week.

Risk of primary miscarriage

Doctors note a certain pattern: the risk of miscarriage after two failures increases by 24%, after three - 30%, after four - 40%.

In case of miscarriage, a complete or incomplete (the fetal egg exfoliated from the uterine wall, but remained in its cavity and did not come out) miscarriage occurs in the period up to 22 weeks. At a later date, in the period of 22-37 weeks, spontaneous abortion is called premature birth, and an immature but viable baby is born. Its mass ranges from 500 to 2500 g. Premature, prematurely born children are immature. Their death is often noted. In surviving children, malformations are often recorded. The concept of prematurity, in addition to the short term of pregnancy, includes low birth weight of the fetus, on average from 500 to 2500 g, as well as signs of physical immaturity in the fetus. Only by a combination of these three signs can a newborn be considered premature.

With the development of miscarriage, certain risk factors are indicated.

Modern advances in medicine and new technologies, the timeliness and quality of medical care make it possible to avoid serious complications and prevent premature termination of pregnancy.

A woman with a first trimester miscarriage should undergo a long-term examination before the expected pregnancy and during pregnancy to identify the true cause of the miscarriage. A very difficult situation develops with spontaneous miscarriage against the background of the normal course of pregnancy. In such cases, the woman and her doctor can do nothing to prevent such a course of events.

The most common factor in the development of premature termination of pregnancy are fetal chromosomal abnormalities. Chromosomes are microscopic elongated structures located in the internal structure of cells. Chromosomes contain genetic material that defines all the properties that are characteristic of each “person: eye color, hair, height, weight parameters, etc. There are 23 pairs of chromosomes in the structure of the human genetic code, 46 in total, with one part inherited from the mother organism, and the second - from the father. Two chromosomes in each set are called sex chromosomes and determine the sex of a person (XX chromosomes determine the female sex, XY chromosomes determine the male sex), while the other chromosomes carry the rest of the genetic information about the whole organism and are called somatic.

It has been established that about 70% of all miscarriages in early pregnancy are due to abnormalities of the somatic chromosomes in the fetus, while most of the chromosomal abnormalities of the developing fetus occurred due to the participation of a defective egg or sperm in the process of fertilization. This is due to the biological process of division, when the egg and sperm in the process of their preliminary maturation divide in order to form mature germ cells in which the set of chromosomes is 23. In other cases, eggs or spermatozoa are formed with an insufficient (22) or excessive (24) set chromosomes. In such cases, the formed embryo will develop with a chromosomal abnormality, leading to a miscarriage.

Trisomy can be considered the most common chromosomal defect, while the embryo is formed by the fusion of a germ cell with chromosome set 24, as a result of which the set of fetal chromosomes is not 46 (23 + 23), as it should be, but 47 (24 + 23) chromosomes . Most trisomies involving somatic chromosomes lead to the development of a fetus with malformations that are incompatible with life, which is why spontaneous miscarriage occurs in early pregnancy. In rare cases, a fetus with a similar developmental anomaly lives to a long time.

An example of the most well-known developmental anomaly caused by trisomy is Down's disease (represented by trisomy on chromosome 21).

A woman's age plays an important role in the occurrence of chromosomal disorders. And recent studies show that the age of the father plays an equally important role, the risk of genetic abnormalities increases with the age of the father over 40 years.
As a solution to this problem, couples where at least one partner is diagnosed with congenital genetic diseases are offered mandatory counseling by a geneticist. In certain cases, it is proposed to carry out IVF (in vitro fertilization - artificial insemination in vitro) with a donor egg or sperm, which directly depends on which of the partners revealed such chromosomal disorders.

Causes of primary miscarriage

There can be many reasons for such violations. The process of conceiving and carrying a baby is complex and fragile, it involves a large number of interrelated factors, one of which is endocrine (hormonal). The female body maintains a certain hormonal background so that the baby can develop correctly at each stage of its intrauterine development. If for some reason the body of the expectant mother begins to produce hormones incorrectly, then hormonal imbalances cause a threat of abortion.

Never take hormones on your own. Their intake can seriously disrupt the reproductive function.

The following congenital or life-acquired lesions of the uterus can threaten the course of pregnancy.

• Anatomical malformations of the uterus - duplication of the uterus, saddle uterus, bicornuate uterus, unicornuate uterus, partial or complete uterine septum in the cavity - are congenital. Most often, they prevent the fetal egg from successfully implanting (for example, the egg "sits" on the septum, which is not able to perform the functions of the inner layer of the uterus), which is why a miscarriage occurs.
• Chronic endometritis - inflammation of the mucous layer of the uterus - the endometrium. As you remember from the section that provides information on the anatomy and physiology of a woman, the endometrium has an important reproductive function, but only as long as it is “healthy”. Prolonged inflammation changes the nature of the mucous layer and disrupts its functionality. It will not be easy for a fetal egg to attach and grow and develop normally on such an endometrium, which can lead to pregnancy loss.
• Polyps and hyperplasia of the endometrium - the growth of the mucous membrane of the uterine cavity - the endometrium. This pathology can also prevent the implantation of the embryo.
• Intrauterine synechia - adhesions between the walls in the uterine cavity, which do not allow the fertilized egg to move, implant and develop. Synechia most often occurs as a result of mechanical trauma to the uterine cavity or inflammatory diseases.
• Uterine fibroids are benign tumor processes that occur in the muscular layer of the uterus - myometrium. Fibroids can cause miscarriage if the fetal egg is implanted next to the myoma node, which has broken the tissue of the internal cavity of the uterus, “takes over” the blood flow and can grow towards the fetal egg.
• Isthmic-cervical insufficiency. It is considered the most common cause of perinatal losses in the second trimester of pregnancy (13-20%). The cervix shortens with subsequent dilatation, which leads to pregnancy loss. Typically, isthmic-cervical insufficiency occurs in women whose cervix has been damaged earlier (abortion, rupture in childbirth, etc.), has a congenital malformation or cannot cope with increased stress during pregnancy (large fetus, polyhydramnios, multiple pregnancy, etc.). P.).

Some women have a congenital predisposition to thrombosis (blood clotting, the formation of blood clots in the vessels), which makes it difficult for the implantation of the fetal egg and prevents normal blood flow between the placenta, baby and mother.

The expectant mother often does not know at all about her pathology before pregnancy, since her hemostasis system coped well with its functions before pregnancy, that is, without the “double” load that appears with the task of bearing a baby.

There are other causes of miscarriage that need to be diagnosed for timely prevention and treatment. Methods of correction will depend on the identified cause.

The cause of habitual miscarriage can also be normal chromosomes, which do not give problems in the development of both partners, but carry a hidden carriage of chromosomal disorders, which affect the developmental anomalies of the fetus. In such a situation, both parents should have their blood tested for a karyotype in order to identify such chromosomal abnormalities (carriage of non-manifesting chromosomal abnormalities). During this examination, based on the results of karyotyping, a probable assessment of the course of a subsequent pregnancy is determined, and the examination cannot give a 100% guarantee of possible anomalies.

Chromosomal abnormalities are diverse, they can also be the cause of non-developing pregnancy. In this case, only fetal membranes are formed, while the fetus itself may not be. It is noted that the fetal egg is either formed initially, or it stopped its further development in the early stages. For this, in the early stages, the cessation of the characteristic symptoms of pregnancy is characteristic, at the same time, dark brown discharge from the vagina often appears. Ultrasound can reliably determine the absence of a fetal egg.

Miscarriage in the second trimester of pregnancy is mainly due to abnormalities in the structure of the uterus (such as an irregular shape of the uterus, an additional uterine horn, its saddle shape, the presence of a septum, or weakening of the cervix's retentive capacity, the opening of which leads to preterm labor). In this case, possible causes of miscarriage in the later stages may be infection of the mother (inflammatory diseases of the appendages and uterus) or chromosomal abnormalities of the fetus. According to statistics, chromosomal abnormalities are the cause of miscarriage in the second trimester of pregnancy in 20% of cases.

Symptoms and signs of primary miscarriage

A characteristic symptom of miscarriage is bleeding. Bloody discharge from the vagina with spontaneous miscarriage usually begins suddenly. In some cases, miscarriage is preceded by pulling pain in the lower abdomen, which resembles pain before menstruation. Together with the release of blood from the genital tract, with the onset of spontaneous miscarriage, the following symptoms are often observed: general weakness, malaise, fever, a decrease in nausea that was present before, emotional tension.

But not all cases of spotting in early pregnancy end in spontaneous miscarriage. In case of bleeding from the vagina, a woman should consult a doctor. Only a doctor will be able to conduct a proper examination, determine the condition of the fetus, find out if the cervix is ​​dilated and choose the right treatment aimed at maintaining pregnancy.

If bloody discharge from the genital tract is detected in the hospital, a vaginal examination is performed first. If the miscarriage is the first and occurred in the first trimester of pregnancy, then the study is carried out shallowly. In the event of a miscarriage in the second trimester or two or more spontaneous abortions in the first trimester of pregnancy, a complete examination becomes necessary.

In this case, the course of a complete examination includes a certain set of examinations:

1. blood tests for chromosomal abnormalities in both parents (clarification of the karyotype) and the determination of hormonal and immunological changes in the blood of the mother;
2. testing for chromosomal abnormalities of aborted tissues (it is possible to determine if these tissues are available - either the woman herself saved them, or they were removed after curettage of the uterus in a hospital);
3. ultrasound examination of the uterus and hysteroscopy (examination of the uterine cavity using a video camera that is inserted through the cervix and displays a picture on the screen);
4. hysterosalpingography (X-ray examination of the uterus;
5. biopsy of the endometrium (inner layer) of the uterus. This manipulation involves taking a small piece of the uterine mucosa, after which a hormonal examination of the tissue is performed.

Treatment and prevention of primary miscarriage

If pregnancy is threatened by endocrine disorders in a woman, then after laboratory tests, the doctor prescribes hormone therapy. In order to prevent unwanted surges in hormones, medications can be prescribed even before pregnancy, with subsequent adjustment of the dosage and drugs already during pregnancy. In the case of hormone therapy, the condition of the expectant mother is always monitored and appropriate laboratory tests (analyzes) are performed.

If miscarriage is due to uterine factors, then appropriate treatment is carried out a few months before the conception of the baby, as it requires surgical intervention. During the operation, synechiae are dissected, polyps of the uterine cavity are removed, fibroids that interfere with the course of pregnancy are removed. Medications before pregnancy treat infections that contribute to the development of endometritis. Isthmic-cervical insufficiency during pregnancy is corrected surgically. Most often, the doctor prescribes suturing the cervix (for a period of 13-27 weeks) in the event of its insufficiency - the cervix begins to shorten, become softer, the internal or external pharynx opens. The stitches are removed at 37 weeks of gestation. A woman with a sutured cervix is ​​shown a sparing physical regimen, the absence of psychological stress, since even on a sutured cervix, amniotic fluid may leak.

In addition to suturing the cervix, a less traumatic intervention is used - putting on the neck of the Meyer ring (obstetric pessary), which also protects the cervix from further disclosure.

The doctor will suggest the most suitable method for each specific situation.

Do not forget that not only ultrasound data is important, but also information obtained during a vaginal examination, since the neck can be not only shortened, but also softened.

For the prevention and treatment of problems associated with the hemostasis system of the expectant mother, the doctor will prescribe laboratory blood tests (mutations of the hemostasis system, coagulogram, D-dimer, etc.). Based on the results of the examination, drug treatment (tablets, injections) can be applied to improve blood flow. Expectant mothers with impaired venous blood flow are recommended to wear therapeutic compression stockings.

There can be many reasons for miscarriage. We did not mention severe extragenital pathologies (diseases that are not related to the genital area), in which it is difficult to bear a child. It is possible that for a particular woman, not one reason “works” for her condition, but several factors at once, which, overlapping each other, give such a pathology.

It is very important that a woman with a miscarriage (three or more losses in history) be examined and undergo medical preparation BEFORE the upcoming pregnancy in order to avoid this complication.

Treatment of such a pathology is extremely difficult and requires a strictly individual approach.

Most women do not need treatment as such immediately after a spontaneous miscarriage in the early stages. The uterus is gradually and completely self-cleansing, as it happens during menstruation. However, in some cases of incomplete miscarriage (partially the remains of the fetal egg remain in the uterine cavity) and when the cervix is ​​bent, it becomes necessary to scrape the uterine cavity. Such manipulation is also required in case of intense and non-stop bleeding, as well as in cases of a threat of the development of an infectious process, or if, according to ultrasound, remnants of the membranes are found in the uterus.

Anomalies in the structure of the uterus is one of the main causes of habitual miscarriage (the cause is in 10-15% of cases of repeated miscarriage in both the first and second trimesters of pregnancy). Such anomalies of the structure include: the irregular shape of the uterus, the presence of a septum in the uterine cavity, benign neoplasms that deform the uterine cavity (myomas, fibromas, fibromyomas) or scars from previous surgical interventions (caesarean section, removal of fibromatous nodes). As a result of such violations, problems arise for the growth and development of the fetus. The solution in such cases is the elimination of possible structural disorders and very close monitoring during pregnancy.

A certain weakness of the muscular ring of the cervix plays an equally important role in habitual miscarriage, while the most typical term for termination of pregnancy for this reason is 16-18 weeks of pregnancy. Initially, the weakness of the muscular ring of the cervix can be congenital, and can also be the result of medical interventions - traumatic injuries of the muscular ring of the cervix (as a result of abortions, purges, ruptures of the cervix during childbirth) or a certain kind of hormonal disorders (in particular, an increase in the level of male sex hormones). The problem can be solved by applying a special suture around the cervix at the beginning of a subsequent pregnancy. The procedure is called "cervical seclage".

A significant cause of recurrent miscarriage is hormonal imbalance. Thus, ongoing studies have revealed that low progesterone levels are extremely important in maintaining pregnancy in the early stages. It is the deficiency of this hormone that is the cause of early termination of pregnancy in 40% of cases. The modern pharmaceutical market has been significantly replenished with drugs similar to the hormone progesterone. They are called progestins. The molecules of such synthetic substances are very similar to progesterone, but they also have a number of differences due to modification. Such drugs are used in hormone replacement therapy in cases of corpus luteum insufficiency, although each of them has a certain range of disadvantages and side effects. Currently, there is only one drug that is completely identical to natural progesterone - utrogestan. The drug is very convenient to use - it can be taken orally and injected into the vagina. Moreover, the vaginal route of administration has a large number of advantages, since, being absorbed into the vagina, progesterone immediately enters the uterine bloodstream, therefore, the secretion of progesterone by the corpus luteum is simulated. To maintain the luteal phase, micronized progesterone is prescribed at a dose of 2-3 capsules per day. If, against the background of the use of utrozhestan, pregnancy develops safely, then it is continued, and the dose is increased to 10 capsules (which is determined by the gynecologist). With the course of pregnancy, the dosage of the drug is gradually reduced. The drug is reasonably used until the 20th week of pregnancy.

A pronounced hormonal disorder may be the result of polycystic altered ovaries, resulting in multiple cystic formations in the body of the ovaries. The reasons for recurrent non-violence in such cases are not well understood. Habitual miscarriage is often the result of immune disorders in the body of the mother and fetus. This is due to the specific feature of the body to produce antibodies to fight penetrating infections. However, the body can also produce antibodies against the body's own cells (autoantibodies), which can attack the body's own tissues, causing health problems and premature termination of pregnancy. These autoimmune disorders are responsible for 3-15% of cases of recurrent miscarriage. In such a situation, it is first necessary to measure the existing level of antibodies with the help of special blood tests. Treatment involves the use of small doses of aspirin and drugs that thin the blood (heparin), which leads to the possibility of carrying a healthy baby.

Modern medicine draws attention to a new genetic anomaly - a Leiden mutation of factor V, which affects blood clotting. This genetic trait may also play an important role in recurrent miscarriage. Treatment of this kind of disorders is currently not fully developed.

A special place among the causes of habitual miscarriage is occupied by asymptomatic infectious processes in the genitals. It is possible to prevent premature termination of pregnancy by routine testing of partners for infections, including women, before a planned pregnancy. The main pathogens that cause habitual miscarriage are mycoplasmas and ureaplasmas. Antibiotics are used to treat such infections: ofloxin, vibromycin, doxycycline. The treatment provided must be performed by both partners. A control examination for the presence of these pathogens is performed one month after the end of antibiotic therapy. In this case, a combination of local and general treatment is extremely necessary. Locally, it is better to use broad-spectrum drugs that act on several pathogens at the same time.

In the event that the causes of repeated miscarriage cannot be detected even after a comprehensive examination, the spouses should not lose hope. It has been statistically established that in 65% of cases after miscarriage, spouses have a successful subsequent pregnancy. To do this, it is important to strictly follow the prescriptions of doctors, namely, to take a proper break between pregnancies. For a complete physiological recovery after a spontaneous miscarriage, it takes from several weeks to a month, depending on how long the pregnancy was terminated. For example, certain pregnancy hormones remain in the blood for one or two months after a miscarriage, and menstruation in most cases begins 4-6 weeks after the termination of pregnancy. But psycho-emotional recovery often takes much longer.

It should be remembered that the observation of a pregnant woman with habitual miscarriage should be carried out weekly, and if necessary, more often, for which hospitalization is carried out. After establishing the fact of pregnancy, an ultrasound examination should be performed to confirm the uterine form, and then every two weeks until the period at which the previous pregnancy was terminated. If, according to ultrasound data, fetal cardiac activity is not recorded, it is recommended to take fetal tissues for karyotyping.

Once fetal heart activity is detected, additional blood tests are no longer needed. However, in later pregnancy, an assessment of the level of α-fetoprotein is desirable in addition to ultrasound. An increase in its level may indicate malformations of the neural tube, and low values ​​- chromosomal disorders. An increase in the concentration of α-fetoprotein without obvious reasons at a period of 16-18 weeks of pregnancy may indicate the risk of spontaneous abortion in the second and third trimesters.

Of great importance is the assessment of the fetal karyotype. This study should be carried out not only for all pregnant women over 35 years old, but also for women with recurrent miscarriage, which is associated with an increased likelihood of fetal malformations in subsequent pregnancies.

When treating recurrent miscarriage of an unclear cause, one of the alternatives can be considered the IVF technique. This method allows you to perform a study of germ cells for the presence of chromosomal abnormalities even before artificial insemination in vitro. The combination of the application of this technique with the use of a donor egg gives positive results in the onset of the desired full-fledged pregnancy. According to statistics, a full-fledged pregnancy in women with recurrent miscarriage after this procedure occurred in 86% of cases, and the frequency of miscarriages is reduced to 11%.

In addition to the various methods described for the treatment of recurrent miscarriage, it should be noted that non-specific, background therapy, the purpose of which is to relieve the increased tone of the muscular wall of the uterus. It is the increased tone of the uterus of a different nature that is the main cause of premature miscarriages. Treatment involves the use of no-shpa, suppositories with papaverine or belladonna (introduced into the rectum), intravenous drip of magnesia.

Currently, a serious problem from a social point of view is preterm pregnancy, which occurs with a frequency of 10-25%. Premature is considered a pregnancy that ends either in premature birth or miscarriage (abortion).

There are many factors that cause preterm pregnancy. Usually they are divided into two groups, namely, diseases of the pregnant woman and anomalies of a medical nature.

Speaking about the diseases of a pregnant woman, experts mean infectious diseases, among which influenza, herpes, and toxoplasmosis stand out. Also, diseases of the pelvic organs, gastrointestinal diseases, kidney failure, blood diseases and toxicosis affect the course of pregnancy. To avoid the impact of these factors on the course of pregnancy and on the health of the mother and unborn child, a woman should be observed by a doctor and follow his recommendations. At the slightest indisposition, pregnant women are advised to contact specialists, because only timely intervention will help eliminate the threat of miscarriage and save the pregnancy.

Among obstetric anomalies, one can single out the incorrect position of the fetus by the time of the onset of labor, hemolytic disease of the fetus. In addition, pregnancy itself, when a woman expects the birth of two or more children, can become a decisive factor. According to doctors, the cause of premature pregnancy can be a deficiency of nutrients and vitamins, as well as the profession of a future mother. According to statistics, preterm pregnancy is more common in working women than in housewives.

Among the signs that may indicate that pregnancy is threatened by a sudden interruption, there are pains in the abdomen and lumbar spine, bloody vaginal discharge. If a woman observes one of these signs, she should immediately consult a doctor. Most likely, she will be hospitalized until her condition stabilizes.

For a baby, every day that he spends in the womb, where he develops, is very important. If a child is born prematurely, this indicates that some period of intrauterine development was missed, which affects the further physical and even mental development of the baby.

Premature pregnancy does not have the best effect on newborns, they have very weak immunity, the likelihood of infectious diseases is very high. There is a risk that the child will not adapt well to his environment, and there may also be a developmental delay. For this reason, women whose previous pregnancy was premature are advised to pay more attention to their health and listen to the body. Only attention and care can keep the health of the mother, which is the key to a successful birth resolution in due time.

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

Diagnosis of spontaneous abortion

Diagnosis of abortion itself is not difficult.
The most common symptom of a threatening condition is pain in the lower abdomen and in the lumbar region, or an indefinite feeling of heaviness, discomfort in the pelvic region. If the pain, although mild, is felt periodically, then it can be attributed to uterine contractions. Explicit cramping pains indicate the onset of termination of pregnancy.
The second symptom of threatening miscarriage is bleeding from the uterus. With early abortions, in contrast to late ones, occurring in the second half of pregnancy, the main signs are bleeding and pain. The presence of pain indicates contraction of the uterus and disclosure of the cervix. The intensity of bleeding is directly dependent on the degree of detachment of the villi from the uterine wall and the fork of myometrial contraction. Of decisive importance for the recognition of a breakthrough pregnancy are data from a study of the state of the uterus. This condition is characterized by a high excitability of the uterus, and even with the usual internal examination, its contraction occurs.
With a threatening termination of pregnancy, the opening of the cervix even by one finger diameter, in the absence of smoothing it, makes it possible to assess the changes that have occurred as reversible. In such cases, an attempt should be made to prevent abortion.

Prevention and treatment of spontaneous abortion

In the prevention and treatment of premature termination of pregnancy, the complex treatment of pathological conditions, which resulted in spontaneous miscarriages, is of great importance.
In cases where the pregnancy is still violated, it is necessary to stop the further development of a threatening abortion. First of all, it is necessary to create complete physical and mental peace. The patient must comply with strict bed rest.
To address the issue of the need for complex hormonal therapy, especially in the presence of a history of miscarriages in very early pregnancy, the determination of the excretion of sex hormones is of great importance. The low content of pregnandiol and estriol is the basis for the appointment of hormones.
Given the important role of the corpus luteum for the nidation of a fertilized egg and the normal development of pregnancy, it is advisable to use progesterone in the form of intramuscular injections of at least 15 mg per day for 8-10 days. At the same time, estrogens are administered at a dosage of 0.5-1 mg per day. The course of treatment is 8-10 days. Estrogens enhance uteroplacental circulation, increase the secretory activity of the trophoblast, normalize the excretion of pregnandiol (N. S. Baksheev and E. T. Mikhailenko, 1964; Schmidt and Poliwoda, 1965, and others).
The use of estrogens and progesterone in certain ratios up to 14-15 weeks of pregnancy is justified, since these hormones potentiate each other's action, which leads to the activation of a number of complex chemical and morphological processes that ensure the preservation of pregnancy (II. S. Baksheev, 1965; I. S. Rozovsky, 1971; Martin, 1964; Zander, 1967, etc.). In the later stages of pregnancy, estrogens introduced from the outside help to increase the metabolism of the corpus luteum hormone and remove it from the body, resulting in increased excitability of the uterine muscles (L. T. Volkova, 1966). In this regard, estrogen therapy with the threat of prematurity is indicated only in the early stages of pregnancy.
Some authors (V. Shulovich et al., 1961; I. S. Rozovsky, 1966; Froewis, 1961, etc.) recommend the combined use of progesterone, estrogens and HG. As a result of such treatment, implantation processes are normalized and uteroplacental circulation is improved. Hormone therapy is usually combined with the appointment of drugs that reduce neuropsychic excitability (Pavlov's mixture, caffeine, trioxazine, antihistamines - pipolfen or suprastin), as well as vitamins.
Of the vitamins, vitamin E (tocopherol) deserves special attention. Our observations, as well as literature data, indicate a high therapeutic efficacy of vitamin E in the treatment of prematurity. Lack of vitamin E in the body leads to fetal death and termination of pregnancy. Vitamin E introduced from the outside enhances the production of the corpus luteum hormone or potentiates its activity. There is also evidence that vitamin E activates the processes of cell division. This contributes to the proper development of the embryo, and also affects the trophism of the placenta, increasing the functional ability of this organ, which is necessary to maintain pregnancy and its full term (L. V. Knysh, 1966). Vitamin E is prescribed at 30-50 mg daily as a concentrate per os or 30% oil solution intramuscularly. The total dose ranges from 210 to 3000 mg, depending on the severity of the symptoms.
Treatment is continued even after the elimination of the symptoms of a threatening abortion to prevent possible relapses. Simultaneously with vitamin E, intramuscular injections of progesterone 10 mg 1 time per day are prescribed for 8-10 days. With habitual prematurity, vitamin E is combined with progesterone even before the onset of signs of termination of pregnancy. For the treatment of this pathology, it is also recommended to use nicotinic acid in an amount of 100 mg per day (V. F. Gorvat, 1966).
It is also advisable to prescribe vitamins C and PP. It has been established that the concentration of vitamins C and PP in the blood and urine of women suffering from prematurity is lowered and the supply of these vitamins to the fetus depends on their content in the mother's body (VF Gorvat, 1966). The role of hypovitaminosis C in the etiology of prematurity can be confirmed by data on the effect of seasonality on the frequency of preterm birth. In the winter-spring months, there is a tendency to some increase in the frequency of premature births (L. I. Shinkarenko, 1966): in January - 7%, in September - 3.8%. Vitamin C is prescribed in the form of ascorbic acid 3 times a day, 0.2 g each, or in the form of products that contain this vitamin (rosehip paste), especially in the autumn-winter period. The use of nicotinic acid in the amount of 100 mg per day with the threat of termination of pregnancy has a positive therapeutic effect: the excitability of the uterus decreases and the pain stops.
As mentioned above, one of the causes of preterm pregnancy is isthmicocervical insufficiency associated with anatomical disorders in the isthmus and upper cervical region or with the functional features of these departments.
Currently, in our country, the surgical method of treating insufficiency of the obturator function of the uterus is widely used (A. I. Lyubimova, 1966; S. M. Soskipa, 1966, 1969; N. S. Baksheev, 1972, etc.). It consists in narrowing the lumen of the cervical canal closer to the internal call by applying a circular suture. Shirodkar (1951) was the first to perform such an operation. There are several options for the elimination of isthmicocervical insufficiency. The operation is performed under local infiltration anesthesia. All pregnant women after surgery are shown to prescribe progesterone at a dose of 10 mg daily for 5-7 days. With the preservation of pregnancy and its normal course, the ligature is removed 1-2 weeks before delivery. In case of premature discharge of water and the onset of labor, the suture must be removed.
It is extremely important to maintain a strict medical and protective regimen. The doctor should inspire the patient with confidence in the successful outcome of the pregnancy. M. Ya. Miloslavsky recommends resorting to psychotherapy without the use of any therapeutic measures. The patient is explained the groundlessness of her fears and fears, they give advice on the way of life most acceptable to her, they note the effectiveness of those therapeutic agents that are prescribed to her. Observing pregnant women with signs of a threatening abortion, the author showed that such women have functional paralysis in the higher parts of the central nervous system, which are expressed in a decrease in the excitability of the brain. Under the influence of treatment by the method of verbal influence, these violations are removed.

preterm birth

It is customary to call preterm birth abortion in terms of 28 to 37 weeks; while the fetus is premature, but viable.
According to the definitions adopted in our country, a newborn born after 28 weeks of gestation and having a weight of at least 1000 g and a height of at least 35 cm is considered viable. are classified as late miscarriages, but if he is alive by the end of the perinatal period, he is considered prematurely born.
Dappy literature and clinical observations indicate a high perinatal mortality of premature babies. The stillbirth rate in preterm birth is more than 5 times higher than in normal birth (N. F. Lyzikov, 1971, etc.). High mortality and premature babies.
The frequency of preterm birth varies greatly. In recent years, there has been a trend towards a more frequent complication of pregnancy by premature birth. The reasons for the onset of preterm birth are varied: infantilism, extragenital diseases, pregnancy complications (toxicosis, polyhydramnios, multiple pregnancies, premature detachment of the placenta, etc.). Often there is not one, but several reasons. According to L. V. Timoshenko, B. K. Kvashenko and others (1972), preterm birth occurred in 10.1% of pregnant women with uterine fibroids.
There are also conflicting data regarding the comparative frequency of preterm birth in certain months of pregnancy. So, according to Yu. F. Krasnopols, Coy (1954), premature birth occurs mainly in the VII-VIII lunar month, according to the observations of E. Ch. Novikova (1971), in the last 2 months of pregnancy.

Preterm birth clinic

The clinical course of preterm labor is characterized by a number of features. V. I. Konstantinov (1962) believes that premature births, as a rule, are shorter than urgent ones. At the same time, A. I. Petchenko notes the long duration of preterm labor and explains this phenomenon by the insufficiency of neurohumoral factors, the unpreparedness of the cervix and the ineffective labor activity as a result.
Primary and secondary weakness of labor activity during prematurity are observed, according to L. V. Timoshenko et al. (1966), in 5.57o, V.I. Konstantinov (1962), in 10.2% of women. The development of the weakness of labor activity is largely associated with the disorder of complex neurohumoral factors that regulate the act of labor. And, finally, infantilism, which is one of the causes of prematurity, also adversely affects the course of childbirth.
Despite the low birth weight of children, there is a significant traumatism of mothers in childbirth. So, according to V. I. Konstantinov (1962), ruptures of the perineum during premature birth occur in 9.7-14.6% of women. This can be explained by the fact that the tissues of the perineum are not sufficiently prepared for stretching. In the postpartum period, more often than after urgent delivery, there is an increase in temperature, subinvolution of the uterus, endometritis, and retention of membranes.
In preterm birth, early and premature discharge of amniotic fluid is especially often noted (according to I. M. Lyandres, 1961; N. F. Lyzikov, 1963, and others, within 12-34%). Many authors consider premature discharge of amniotic fluid as a manifestation of the functional failure of the woman's body. According to 3. A. Simonenko (1959) and others, this pathology often occurs in pregnant women with infantilism. K. A. Kirsanova (1966) and others associate premature discharge of water with the morphological and biophysical features of the membranes, their strength and extensibility.
Many researchers point to the role of infection in the etiology of this complication, as well as gynecological diseases, past abortions, mechanical factors, malposition of the fetus, etc.
It is known that the frequency of death of children increases as their weight and degree of maturity decrease. Therefore, prolongation of pregnancy with the threat of its interruption in recent months, at least for a short time, increases the viability of the fetus. That is why, in the fight against perinatal mortality, the issue of managing preterm pregnancy with premature discharge of amniotic fluid is of particular importance.

Prevention and tactics of a doctor in preterm birth

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

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

Termination of pregnancy can occur at any time, however, most often this happens in the first trimester. In the event that the pregnancy was interrupted at the 28th week, then it is referred to as a miscarriage. If this occurs after the 29th week, then they speak of premature birth. What are the reasons for miscarriage? How to prevent premature birth and what to do if the first symptoms of spontaneous abortion were found?

What can cause miscarriage?

Prevention of preterm pregnancy

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

1. Pass all the tests necessary when planning a pregnancy;
2. Get cured of existing diseases;
3. Observe intimate hygiene;
4. Follow a regular and safe sexual life;
5. Use contraceptives. In most cases, miscarriage occurs in those women who have had abortions;
6. Quit smoking and alcohol;
7. Monitor nutrition;
8. Increase the level of vitamins in the body;
9. Avoid stress.

Once you find out about your pregnancy, try to register with a gynecologist as soon as possible. This way it will be possible to establish the correct gestational age, because a medical error can also be considered the cause of the baby's prematurity, especially if the birth occurred at the 36th week.

When is urgent hospitalization needed?

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

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

1. Blood test for chromosomal abnormalities.
2. Analysis for the presence of aborted tissues.
3. Ultrasound of the uterus and hysteroscopy (a study that allows you to examine the uterine cavity using a camera that is inserted into the vagina, while the picture is displayed on the screen in front of the doctor).
4. A biopsy of the uterus (with such an examination, a little mucous membrane is removed from the wall of the uterus and a study of the tissue taken for hormones and antibodies is carried out).

Spontaneous abortion in the early stages can occur in any woman. For this reason, it is important to take tests at the planning stages of the child in order to exclude all possibilities of miscarriage.