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Preterm birth: symptoms, definition and how to act

Preterm birth: symptoms, definition and how to act

In life everything has a certain time to happen. One of the moments in which this maxim most manifests itself is the birth of a human being. For a baby to develop its limbs, tissues and organs properly it is necessary that the gestation period, which goes from conception to birth, lasts on average from 38 to 42 weeks.

However, it may happen that the baby be born before 37 weeks. This arrival before the regulatory period is known as premature birth, according to the World Health Organization. Thus, it can be understood as premature birth a birth that occurs between 22 and 37 weeks. [3]

Preterm pregnancy is defined as one whose gestational age is between 22 (or 154 days) and 37 (or 259 days) weeks. In this period, labor is characterized by the presence of frequent contractions (one every 5 to 8 minutes) accompanied by cervical changes characterized by dilation greater than 2.0 cm and / or greater than 50%. The timing of the awakening of labor continues to be a mystery to medicine, but a thesis is clear and true: the spontaneous moment for the onset of labor is where the fetus no longer feels well inside the womb and the mother no longer feels comfortable with another being dividing the same body. That is, "the time has come to break the shell of the egg". [1]

According to the Ministry of Health, Brazil is the tenth country with the highest rate of preterm birth. This is the leading cause of infant death in the first month of life. [7]

Threat of premature birth

In some cases it may happen that the pregnant woman begins to have signs that she is going into labor, manifesting some contractions. However, as the name itself says it is only a threat and labor does not actually happen.

Some signs may indicate a threat of preterm birth:

Irregular contractions

  • Decreased contractions over time
  • Absence of cervical dilation
  • Abdominal pain
  • It is important to note that if the pregnant woman experiences contractions before 37 weeks, it is imperative that she go to the hospital as soon as possible so that she and the baby examined. Only the doctor can tell whether or not the pregnant woman is in labor or is a threat of preterm labor. [3] [4]

Types of prematurity

When a baby is born before the 38th week, it is considered premature. However, there are different levels of prematurity that vary according to the period of gestation that the baby was born:

Extreme premature

The premature baby is born with less than 30 weeks of gestation. When this type of delivery happens, this baby will need a lot of care. You will need to spend some time in the neonatal ICU and in the incubator. You will need to take a shower to improve jaundice (yellowing of the skin). It may also be necessary to feed this baby through a tube.

Moderate premature

The moderate premature baby was born between 31 and 35 weeks. This baby will also need a lot of care as well as the extreme premature did not develop his immune and respiratory system completely. In addition, these babies lose a lot of heat by the head, so they need to stay in incubators that are warm and in contact with light. Depending on the baby's history in the mother's belly, he may have a little more mature lungs. But this condition varies from case to case.

Premature infants

The premature infants are born between 36 and 37 weeks. This baby will also need specific care. However, in some cases, this baby may have greater contact with the mother, stay out of the incubator longer, and be breastfed.

It is important to say that the needs and possible consequences that the baby may have throughout life may vary from one case to another. Therefore, only doctors can tell you what procedures and how long the premature baby will need intensive care. [3]

Causes of premature labor

Experts explain that there is no cause in medicine that causes premature labor. However, there are some factors related to gestation and the health of the mother that can increase the chances of a preterm birth.

Urinary infection: the culture of bacteria present in the pregnant woman's urine can cause uterine contractions, leading to premature delivery . In order to avoid it, it is important to perform prenatal follow-up in a disciplined manner, performing the necessary exams and attending the appointments.

  • Placenta detachment: The placenta is a round, flattened organ that forms during pregnancy, with the function of nourish and provide oxygen to the baby. Placental abruption is a pregnancy problem in which the placenta separates too early from the wall of the uterus. In a normal pregnancy, the placenta keeps firmly attached to the inner wall of the uterus until after the baby is born. If there is premature detachment of the placenta, it ruptures from the wall of the uterus very early, thus causing premature delivery
  • Pre-eclampsia: this condition occurs when a pregnant woman has high blood pressure (above 140/90 mmHg) at any moment after your 20th week of pregnancy. Pre-eclampsia can cause premature labor as it can cause the placenta to detach from the uterine wall ahead of time. Medical follow-up during pregnancy as well as control of ingested foods may help reduce the risk of preeclampsia
  • Premature placental abruption: The placenta is a round, flattened organ that forms during pregnancy, with the function to nourish and provide oxygen to the baby. Placental abruption is a pregnancy problem in which the placenta separates too early from the wall of the uterus. Placental abruption can be very harmful. In rare cases, it can be deadly. The baby may be born very early (precocious) or underweight. The mother can lose a lot of blood
  • Gestational diabetes: a condition characterized by hyperglycemia (increased blood glucose levels) that is recognized for the first time during pregnancy. The condition occurs in approximately 4% of all pregnancies
  • Thyroid disorders: Uncompensated hypothyroidism is responsible for preterm deliveries. When you become pregnant, you need to have triplicate attention with the thyroid because it decompensates during pregnancy without warning. Obstetric attention is directed to the thyroid. Likewise, hyperthyroidism during pregnancy can result in several problems for both mother and fetus, such as causing placental abruption.
  • Congenital infections: Health conditions such as syphilis, AIDS, toxoplasmosis and cytomegalovirus can cause premature detachment of placenta. Therefore, medical monitoring during pregnancy and attention to the immunity of pregnant women is of great importance.
  • Smoking: Smoking affects the uteroplacental circulation that causes less fetal oxygenation, "says Roberto Eduardo Bittar. baby makes her growth become more restricted, which generates a premature termination of pregnancy, ie, the woman goes into labor before the time
  • Alcoholism and illicit drugs: The specific mechanism of how alcohol and other drugs illicit causes of preterm labor are unknown, but in addition to increasing the risk of infection, it causes placenta detachment prematurely
  • Uterine pathologies: There are malformations of the uterine cavity that are incompatible with the evolution of a pregnancy.Parties such as fibroids, Polyps and inflammatory processes may also act in this way. The examination for assessment of the uterine cavity is hysteroscopy, where it is possible to have direct vision of the uterine cavity. In general, late abortions are related to malformations, such as the didelphic uterus (two uteri formed by two uterine horns and two tails), the bicornuate uterus (two uterine bodies in one colon), the septate uterus (with a uterine cavity) and cervical incompetence. [3] [4] [5] [6]
  • However, some conditions of the baby can also lead to the birth of a premature baby. Some of them:

Fetal malformations

  • Presence of genetic syndrome
  • Twin pregnancy
  • Symptoms of preterm birth

When the pregnant woman goes into preterm labor the body manifests some symptoms. If you experience these symptoms before the 37th week of gestation, it is imperative that you go to the hospital.

Back pain: usually women who go into preterm labor show lower back pain. These pains can be constant or come and go but will not stop

  • Contractions every 10 minutes or in shorter periods
  • Lower abdomen pain
  • Leakage of fluid from your vagina
  • Similar symptoms flu, such as nausea, vomiting or diarrhea
  • Increased pressure in your pelvis or vagina
  • Vaginal bleeding, including light bleeding [2] [4]
  • Table comparing premature delivery with a threat of

How is the contraction sensation

As the muscles of the uterus contract with the pregnant woman, she may feel the abdomen harden. When the contraction disappears the uterus relaxes. During pregnancy the layers of the uterus will contract irregularly, causing what doctors call Braxton-Hicks contractions or training contractions, these contractions do not hurt and also do not open the cervix

However, if contractions become regular or more frequent, one every 10 or 12 minutes for one hour may be contractions of preterm labor and may cause cervical opening. How to check for contractions

Knowing how to check for contractions can help identify preterm labor:

Place your fingertips in the abdomen

If you feel your uterus contracting and relaxing, you can be a sign of contraction

  • Time your contractions. It is important to note the time between one contraction and another. When you feel the contraction ask someone to keep an eye on the clock and see how long it takes for the next contraction to appear. Call your doctor and go to the hospital if the contractions manifest every 10 minutes or if the other symptoms of preterm birth When a pregnant woman arrives at the hospital suspected of having a preterm birth she will soon need to be seen to see how she and her baby are.
  • First the medical staff will ask questions about the pregnancy history, exams performed and medications that may have been ingested during pregnancy.
  • Next, the pregnant woman's pulse, blood pressure and temperature will be checked.

check the baby's contractions and heart rate

Verify the cervix for signs of swelling.

  • It may happen that the mother has a threat premature birth. In this case, your doctor may recommend that you go home and remain at rest.
  • If you are diagnosed that you are in preterm labor, you will need to take some steps to delay the process. See below
  • Magnesium sulphate medication with a dose given at the start of treatment and a smaller dose 12 or 24 hours later
  • Corticosteroid medication: this drug aims to mature the baby's lungs

Other medicines to decrease the frequency of contractions

Cerclageing of the cervix as a way to contain the fetus inside the uterus

  • If doctors can not stop contractions, it is likely that labor will continue and physicians will do the procedure for the baby to come to the world. The type of birth of a preterm, normal or cesarean baby will depend on how well the mother and baby are at that time. [3] [4].

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