Premature birth. Successes and failures

Abstract

5–18% of pregnancies end in premature birth, defined as birth before 37 weeks of gestation. Every year, 15,000,000 babies are born prematurely worldwide, of which more than 1,000,000 die due to complications associated with prematurity. Their contribution to neonatal and infant mortality is significant (70 and 36%, respectively). Premature birth is a syndrome characterized by many etiological factors, such as intra- and extrauterine infections, decreased excretion and decreased reception of progesterone, uterine overdistension, cervical factor, stress and a number of other, sometimes unknown, reasons. Over the past decade, some progress has been made in predicting and preventing spontaneous preterm birth. The main method for predicting and diagnosing the threat of premature birth is transvaginal ultrasound cervicometry in the second trimester of pregnancy (14–24 weeks). The length of the sonographically measured cervix is the most accurate prognostic criterion for assessing the risk of preterm birth, especially in pregnant women at risk (history of preterm birth). Vaginal administration of micronized progesterone reduces the risk of preterm birth in women with a short cervix. Diagnosis is based on taking into account clinical symptoms, cervical length and biochemical tests that determine placental proteins. Hospitalization in a perinatal center or level III institutions, which include intensive care units and the second stage of nursing newborns, serves as the basis for the effective organization of medical care for premature birth. When indications for surgical delivery are indicated, preference should be given to a cesarean section with the extraction of a low-weight fetus in the entire amniotic sac. The article also reflects the contribution of the staff of the Department of Obstetrics and Gynecology named after prof. V.S. Gruzdev of Kazan State Medical University in solving the problem of premature birth.

Keywords

premature birth / prevention / diagnosis / delivery / cesarean section / extraction of the fetus in the whole amniotic sac

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