Features management of very early preterm birth

Abstract

The objective: to determine features of tactics of very early preterm birth depending on the gestational age with the assessment of perinatal consequences. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation (the main criterion of inclusion). The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early premature (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups had serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. All women have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. The main complications of gestation in pregnant women of both groups in the second trimester were the threat of abortion and insufficiency of the fetoplacental (IFP), which caused fetal growth retardation syndrome (FGRS) in both groups – 66% and 63% of children, respectively. IFP in VEPB was confirmed histologically in 68% and 72% of cases in each group of mothers. Vaginal delivery occurred with 55 patients of group 1 and 26 women of group 2 (69,6% and 29,9%), among them in the period of 22–24 weeks – 100% and 57,1%, 25 weeks – 83,3% and 26,7%, 26–27 weeks – 57,7% and 24,1%, respectively, in each group. Indications for cesarean section (CS) in group 1 were mainly from the mother (75%), in group 2 – 27,8% from the mother, from the fetus – 4,9% (IFP), according to the combined indications – 65,6% (deep prematurity). Expansion of indications for CS in VEPB by 41% led to a decrease in perinatal mortality by 1,5 times (p<0,05). In the postpartum period, patients in both groups showed a decrease in purulent-septic complications on the background of preventive treatment from 13,9% (group 1) to 4,6% (group 2) (p<0,05). In the analysis of perinatal mortality, the highest rates were observed at 22–24 weeks of gestation, while they are 1,5 times lower at 25 weeks and 3,5 times lower at 26–27 weeks. The study found that the method of delivery did not affect perinatal outcomes at 22–25 weeks, but at 26–27 weeks, the survival of children born by CS surgery is higher than in spontaneous births, by 10% (p<0,05). Expansion of indications for the prevention of respiratory distress syndrome (RDS) of the fetus from 22 weeks in group 2 (in group 1 was not performed) by 10,7% led to an increase in survival of children with extremely low body weight (ELBW) by 11% (p<0,05). Conclusions. Under threat of VEPB the choice of delivery tactics is determined by the gestation period, the state of health of the mother and fetus, the degree of readiness of the birth canal for delivery. Premature pregnancy is not an indication for CS, except the specific obstetric indications, but abdominal delivery is possible for children in early pregnancy (22–25 weeks). The questions concerning the usage of instrumental care at birth, determination of gestational dates for the beginning of RDS prophylaxis with glucocorticoids, the necessity of using tocolysis remains ambiguous. Proper definition of management of women who give birth prematurely will allow timely implementation of measures aimed at improving the results for mother and newborn, and can be prognostic.