Classification and features of early-term labor
Preterm labor is classified by gestational age (extremely early, early, and late), by mechanism (spontaneous and induced), and by stage (threatened, in progress). Labor abnormalities occurring before 34 weeks and the onset of labor with an unripe cervix are important factors in choosing the method of delivery.
The impact of cesarean section on fetal outcomes lies in reducing perinatal mortality and decreasing the incidence of severe intraventricular hemorrhage. However, surgical intervention cannot eliminate pathologies caused by deep morphofunctional immaturity of the newborn.
Premature rupture of membranes and infectious risks
Preterm premature rupture of membranes is recorded in 30–40% of preterm birth cases. This condition significantly increases neonatal morbidity and mortality due to intrauterine infection.
- Pathogenesis: Infection affects the lower pole of the amniotic sac, disrupting membrane integrity and causing chorioamnionitis.
- Clinical presentation: Appearance of fluid discharge from the genital tract, and upon inflammation onset — fever and chills.
- Diagnostic limitations: Vaginal examination is strictly contraindicated; only speculum examination is performed.
- Laboratory markers: Tests for placental alpha-1 microglobulin and insulin-like growth factor-binding protein-1 possess high accuracy.
Expectant management and patient care
Management tactics depend on gestational age and the presence of complications:
- Before 26 weeks: decisions are made jointly with the parents after informing them about potential outcomes; cesarean section is performed strictly for emergent maternal indications.
- From 26 weeks: in the absence of severe oligohydramnios and signs of infection, expectant management is indicated.
- Components of management: antibiotic therapy, vaginal cleansing, tocolytics in case of threatened preterm labor, and prevention of respiratory distress syndrome.
Pregnancy continuation is strictly contraindicated in severe oligohydramnios (amniotic fluid index less than 5 cm) and chorioamnionitis, which is confirmed by leukocytosis, tachycardia, and positive CRP tests.
Characteristics of premature newborns
Children born prematurely have characteristic morphofunctional features: soft cartilage, underdeveloped subcutaneous fat, undescended testes in boys, and a weak cry.
The most frequent severe complication in newborns weighing less than 2,000 grams is respiratory distress syndrome (RDS) due to surfactant system immaturity. To assess the severity of respiratory failure, the Silverman score is used, which takes into account the character of respiratory movements, intercostal retractions, and expiratory grunt.
Briefly: answers to topical questions
What is the difference between threatened abortion and inevitable abortion (abortus incipiens)?
Threatened and inevitable abortion (abortus incipiens) differ in the degree of ovum detachment and clinical manifestations.
| Sign | Threatened abortion | Inevitable abortion |
|---|---|---|
| Pathogenesis | Connection between the ovum and the uterine wall is preserved | Detachment of the ovum from the wall |
| Bloody discharge | Absent | (No data in source) |
| Internal os | Closed | (No data in source) |
What clinical symptoms are characteristic of incomplete abortion (abortus incompletus)?
In incomplete abortion, remnants of the ovum are retained in the uterine cavity, which may be accompanied by uterine bleeding. If infection is present, signs of septic abortion are possible: fever, chills, and purulent vaginal discharge.
What is the surgical approach for diagnosed incomplete abortion with heavy bleeding?
In incomplete abortion with heavy bleeding, immediate instrumental revision and prompt uterine evacuation are indicated.
- Instrumental revision is performed to remove the remnants of the ovum and achieve hemostasis.
- Uterine evacuation is accompanied by intravenous administration of oxytocin.
- Surgical hemostasis — in case of ongoing bleeding, laparotomy and ligation of the hypogastric arteries or uterine artery embolization is used.
Which ultrasound signs confirm the presence of ovum remnants in incomplete abortion?
An ultrasound sign of incomplete abortion is the visualization of ovum remnants in the uterine cavity. M-echo greater than 15 mm and echogenic or echolucent inclusions may be detected; however, endometrial thickening and heterogeneous structure alone do not confirm the presence of remnants and are not grounds for surgical intervention without clinical signs.
What five clinical signs are evaluated using the Silverman score in premature newborns?
The Silverman score is used to assess respiratory function in premature newborns and includes five clinical signs.
- Respiratory movements — the character of upper chest movements is evaluated.
- Intercostal retraction — analyzes the retraction of the intercostal spaces and lower lateral chest wall.
- Sternal retraction — determines the presence of retraction in the xiphoid process area.
- Nasal flaring — evaluates the participation of the nose in the act of breathing.
- Expiratory grunt — determines the presence of a sound during expiration.
The rule of three "I"s in premature rupture of membranes: Infection (monitoring for chorioamnionitis), Induction/Interdiction of exams (avoidance of vaginal examination), and Injections (RDS prevention with glucocorticoids).
Class and exam questions
Why is digital vaginal examination contraindicated in premature rupture of membranes?
Vaginal examination is not performed to avoid introducing infection from the lower genital tract into the uterine cavity and to prevent the development of severe chorioamnionitis.
What are the main clinical signs indicating the development of chorioamnionitis?
Signs of infection include fetal tachycardia, maternal fever and tachycardia, leukocytosis, abnormal vaginal discharge, and elevated C-reactive protein levels.
What is the core concept of the Silverman score?
The Silverman score evaluates the severity of respiratory failure in premature newborns based on five clinical signs (sternal and intercostal retractions, nasal flaring, etc.) from 0 to 2 points each.
What else to study on this topic
- Spontaneous abortion: clinical presentation and treatment principles
- Causes of recurrent pregnancy loss
- Classification of preterm labor by gestational age and mechanism
- Cervical incompetence and methods of its correction
- Pregravid preparation and prevention of preterm birth
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