Невынашивание и перенашивание беременности
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Transcript 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
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
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)
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 :
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
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%.
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
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.
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
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
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