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Preterm birth is labor between 22 and 37 weeks of pregnancy. Premature infants have higher morbidity and mortality rates than term infants. Therefore, prevention and treatment of preterm birth - threatened preterm birth is a matter of concern.1. Why do women give birth prematurely?
Most cases of preterm birth have no known cause. Some main causes can cause premature birth such as premature rupture of membranes, multiple pregnancy, polyhydramnios, fetal malformation; maternal diseases such as high blood pressure, pyelonephritis, appendicitis, uterine malformation, poor nutrition, smoking, drinking alcohol, overwork; Causes of placenta previa, placental abruption, placental insufficiency.Trắc nghiệm: Bạn có hiểu đúng về dấu hiệu mang thai sớm?
Các dấu hiệu mang thai sớm không phải chỉ mỗi trễ kinh mà còn có rất nhiều dấu hiệu khác như xuất huyết âm đạo, ngực căng tức,… Điểm xem bạn biết được bao nhiêu dấu hiệu mang thai sớm thông qua bài trắc nghiệm này nhé!
2. Threats of premature birth and premature birth?
2.1 Signs of threatened preterm birth Physical symptoms: Abdominal pain with episodic nature, heavy pressure in the lower abdomen, back pain; pink vaginal discharge or mucus. Physical symptoms: Uterine contractions with a frequency of 2 contractions / 10 minutes, duration of contractions less than 30 seconds; cervix closed or dilated less than 2cm 2.2 Signs of preterm birth Physical symptoms: Abdominal pain intermittently, regular and increasing nature; vaginal discharge, mucus, blood, and amniotic fluid. Physical symptoms: Uterine contractions are thicker in nature from 2-3 times/minute, and gradually increase over time; cervix dilated more than 2cm; Amniotic fluid formation and rupture of membranes.
Đau bụng từng cơn, tính chất đều đặn và tăng dần là dấu hiệu sinh non
3. Consequences of premature birth on babies
Children with low birth weight. Children's lungs are not yet mature, so they are prone to respiratory failure and death. If children live, they are also susceptible to respiratory diseases later on such as pneumonia, bronchitis... Children are prone to congenital defects such as congenital heart, blindness, deafness, mute... In addition, when they grow up Children often have obvious or potential neurological sequelae, thereby becoming a psychological and financial burden for the family.4. Treatment of threatened preterm birth - premature birth
4.1 Uterine pain relief or pain reliever Nifedipine: is the first choice in uterine contractions, if not in cases of contraindications.Contraindications: low blood pressure, cardiovascular diseases such as heart failure, pre-eclampsia, amniotic infection, fetal distress, antepartum hemorrhage, be careful when co-administering with Salbutamol and drugs containing MgSo4 .
Dosage:
Starting dose: 20mg Nifedipine orally (do not use delayed release) After 30 minutes, if uterine contractions are still present, give another 20mg dose. After another 30 minutes, if contractions continue, give add 1 additional oral dose of 20mg If blood pressure is stable, a maintenance dose of 20mg x 3 times/day for 48-72 hours can be given. Note: The maximum dose of Nifedipine is 120mg/day
Precautions: Combined monitoring electrolyte balance, urea, creatinine and liver function; monitor fetal heart continuously until the contraction stops, cardiopulmonary function every 8 hours; check vital signs every 30 minutes until contractions stop;
Undesirable effects: headache, nausea, dizziness, hot flushes, heart palpitations, drop in blood pressure, higher risk in people with heart failure, increased liver enzymes.
Salbutamol: As the 2nd choice, if it does not fall into contraindications
Contraindications: Do not use concomitantly with Nifedipine due to the "synergistic" effect; Do not use for women with heart failure, fetal heart failure, diabetes, thyroid disease.
Dosage:
Decrease uterine contractions: 5mg (5ml Ventolin tube for infusion in obstetrics) diluted with solvent to 100ml to obtain a solution concentration of 50mcg/ml It is recommended to use an electric syringe for intravenous infusion. Salbutamol, at an initial infusion rate of 12 mL/hr (10 mcg/min) and then increased every 30 min to 4 mL/hr (3.3 mcg/min) until uterine contractions, heart rate mother reached 120 times/min, the rate of infusion was 36ml/hour (30mcg/min). Caution:
Check electrolyte balance, urea and creatinine, before infusion; check blood sugar every 4 hours if there is abnormality; monitor cardiopulmonary function every 8 hours; check vital signs every 30 minutes; reduce the infusion rate if the pregnant woman's pulse reaches > 120 beats/min; if there are symptoms of chest pain, shortness of breath, respiratory rate > 30 times/minute, the infusion must be stopped immediately; Salbutamol treatment should not be prolonged for more than 48 hours, only in special cases will be infused for another 24 hours.
Undesirable effects: nausea, dizziness, hypotension, pulmonary edema, heart failure, hypokalemia, tremor, heart palpitations.
4.2 Corticosteroid therapy Effects: Increase production of surfactan, promote growth of connective tissue, reduce respiratory failure in preterm infants.
Indications: Pregnancy from 28 weeks to the end of 34 weeks.
Preferred drug:
Betamethasone 12mg, intramuscularly, the interval between doses is 24 hours. Dexamethasone 6mg/time, intramuscular dose, injected 4 times, each time 12 hours apart. 4.3 Treatment when labor inhibition is not successful Protect amniotic fluid until the cervix is fully dilated, limit oxytoxin use, wide episiotomy, cesarean section if indicated. Prevention of infections, leftover vegetables, postpartum bleeding Resuscitate mothers and take care of premature babies
5. How to prevent premature birth?
Cần tránh sự luyện tập quá sức trong lúc mang thai, nhất là ở những thai phụ có nguy cơ sinh non cao
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