PRETERM BIRTH

Preterm delivery is the birth between 24 weeks and 37 weeks according to the last menstrual date. Preterm births between the 34th and 37th weeks make up 70% of all preterm births and are called late preterm labor.
Births between 37 weeks and 41 weeks are considered to be normal time deliveries. The onset of labor pains is called the threat of premature birth.
Approximately 10% of all births are in the form of preterm birth. Preterm births are responsible for 75% of neonatal deaths (neonatal deaths), except for congenital anomalies. Pregnancies resulting in preterm labor are more likely to be seen in the baby with vision and hearing problems, chronic lung disease, school failure, and cerebral palsy (spastic child).
In early births, the chance of life of the baby increases gradually as the week of birth increases. For example, very few babies can live at births at 24 weeks of gestation, while babies have a 50% chance to live at births at 26 weeks. Mortality rate is about 25% at births in the 28th week, while it is around 10% in the 30th week. Those born after 34 weeks have a high chance of living.
What is preterm labor?
The threat of premature birth, that is, the risk of preterm birth, refers to the onset of pains only in a pregnancy before 37 weeks. If these pains increase, preterm birth may occur. If there is an opening in the cervix, the baby has begun to advance in the birth canal, now birth is taking place, this is called preterm labor. In the threat of preterm labor, there is no action, no opening, no progress or very little, only pain.
Risk factors for preterm labor, causes:
- Those who gave birth earlier
- A stillbirth story before
- Those who had surgery on the cervix
- Uterine anomalies, deformities
- Smoking
- Drug addiction
- Anemia in the mother
- Chronic diseases of the mother
- Stress and depression in the mother
- Urinary tract infection during pregnancy
- Opening the membranes early and getting water (EMR)
- Bleeding during pregnancy
- Low socioeconomic level
- In black race, preterm birth is 2-4 times more common.
- High blood pressure during pregnancy
- Multiple pregnancies
- Excessive physical activity
- Short time between births
- Maternal age is under 18 or over.
- As the weight of the mother decreases, the risk of preterm birth increases. (There are other risks associated with excess weight.)
- Oligohydramnios, polyhydramnios (Amnion water is low or high)
- IVF, ICSI (IVF)
Increased problems in premature babies:
- Respiratuate distress syndrome (Respiratory distress)
- Bronchopulmonary dysplasia
- Intraventricular bleeding
- Necrositan enterocolitis
- Sepsis, Group B streptococcal infection
- Hyperbilirubinemia
- Premature retinopathy
- Patent ductus arteriosus
- Premature anemia
- Hypoglycaemia
- Long-term vision and hearing problems, myopia, strabismus, asthma, hypertension, impaired glucose tolerance
Treatment:
The process of stopping the pain for treatment at preterm delivery is called tocolysis. For this, drugs such as ritodrin, magnesium sulfate, nifedipine, indomethacin, oxytocin antagonists (atosiban), nitric oxide can be used. In addition to drug therapy, it is important for the mother to rest, calm down and meet the need for fluids. In addition, beta-metasone-type steroid drugs are given to the mother to help babies who are thought to have not completed lung development before birth. These drugs are made in pregnancies between 24-34 weeks.
Tocolysis is not performed to stop preterm labor if:
- In the presence of a dead fetus
- In the presence of a fatal anomaly in the fetus
- Fetal well-being tests give poor results (fetal distress)
- Severe intrauterine growth retardation
- Chorioamnionitis, that is, inflammation of the gestational membranes
- Mother's excessive vaginal bleeding
- Severe high blood pressure, severe preeclampsia
When does the risk of preterm labor begin? How to understand?
It is impossible to say that there is no risk of preterm birth in a pregnancy by examining it from the first months. So it is true that this could potentially happen in every pregnancy. But it happens in some pregnancies, but not in others. It can be understood that in pregnancies with a risk of preterm labor, such as opening in the cervix and pregnancies, preterm labor may occur in the coming weeks, but the opposite is not possible. In other words, it is not possible to say that there will never be preterm birth in this pregnancy. Pregnancy losses before 20 weeks are called miscarriage. Births between 20-37 weeks are called preterm birth. Therefore, the risk of preterm birth begins theoretically at 20 weeks and ends at 37 weeks. No pregnancy can be said to be at risk of preterm birth, there is no such danger at all. However, some are less dangerous and others more dangerous. For example, if she had a premature birth in the old years or now has twin pregnancy, the risk of preterm delivery is higher than the average. However, this does not mean that preterm delivery will be precise, such a pregnancy may not be preterm.
How to prevent the risk of preterm birth?
Pregnant women whose preterm birth rates are determined are hospitalized and bed rest, hydration (serum delivery) and, if necessary, pain relief medication are started. With the NST device, the baby's heartbeat and the mother's pain are monitored. If the pains stop completely and the mother is sent home, it is recommended not to get too tired, to exercise and exercise, to stay hydrated to prevent preterm labor. Sometimes medications are given for home use.
What should those who risk preterm labor pay attention to? What to do?
Although exercise is free during a normal pregnancy, exercise, sports may be prohibited in those at risk of preterm labor, for example, in a patient who has given birth too early. Walking can be done at a slight pace, but excessive fatigue and excessive sweating should be avoided. In addition, mothers who are at risk of preterm labor should not be dehydrated, drink plenty of water, avoid excessive sweating, do not work in very tiring jobs, and stay away from stress. If smokers drink even 1-2 a day, the risk of preterm birth increases, so every pregnant woman should stay away. It is also important that the expectant mother uses anti-anemia medications, paying attention to blood tests and controls. Because anemia is one of the factors that increase the risk of preterm birth. Those with a risk of preterm birth should lie like normal pregnant women, so if it does not cause discomfort, it is recommended that they lie on the left side. Sexual intercourse is not prohibited in cases of mild risk without cervical opening. However, in patients with an opening in the cervix or bleeding occasionally, sexuality can be prohibited. Although there is no method, medication or surgery that will definitely guarantee not giving birth again, paying attention to such points will reduce the risks.
What should pretermists pay attention to after birth?
Care of the mother after preterm birth is the same as in a normal birth and a delivery that takes place just in time during cesarean section. It is recommended that mothers who have preterm labor should consult a gynecologist and obstetrician before their next pregnancy, when they intend to become pregnant. Necessary tests are performed before delivery and if there is a disorder that increases the risk of preterm birth, such as anemia, it is corrected early. Inspection and ultrasound are done. The fact that mothers who have preterm labor become pregnant again early increases the risk of preterm birth a little more. Therefore, it is recommended to take a break of about 2 years. Being pregnant again soon will cause some increase in risks such as preterm birth and low birth weight.
ADDITIONAL INFORMATION:
- Some of the infections associated with preterm labor: Bacterial vaginosis, trichomasas vaginalis, mycoplasma hominis, uroplasma uroliticum, fusobacterium, gonorrhea, chlamydia, asymptomatic bacteriuria, pyelonephritis, appendicitis, pneumonia
- Excessive weakness (low weight) is a risk factor for preterm delivery, and obesity is a risk factor for sunbathing.
- Pregnancies obtained by assisted reproductive methods (IVF) such as IVF and ICSI are more risky than spontaneous pregnancies, even if they are single pregnancies.



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