The management of very early preterm birth

Abstract

The objective: a determination of the management for very early preterm birth, depending on the gestational age, and an assessment of perinatal outcomes. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation. The patients were divided into two groups depending on the criteria of live birth: the 1st group – 79 women whose labor was as a late miscarriage (retrospective study); the 2nd group – 87 women with very early preterm birth (prospective study). Exclusion criteria: congenital malformations of the fetus. All women were examined using clinical, instrumental and laboratory research methods.Results. The main complications of gestation in pregnant women of both groups in the II trimester were the threat of pregnancy interruption and placental dysfunction (PD), which led to the development of fetal growth retardation in both groups (66% – in the 1st group, 63% – the 2nd group). The presence of PD by VEPB was confirmed histologically in 68% and 72% of cases in each group, respectively. 55 (69.6%) patients of the 1st group and in 26 (29.9%) women of the 2nd group had vaginal delivery. Indications for cesarean section (CR) in the 1st group were mainly from the mother (75%), in the 2d group 27.8% persons had indications from the mother, 4.9% (PD) – from the fetus, combined indications were determined in 65.6% (deep prematurity). The expansion of indications for CS by VEPD in 41% led to a 1.5-fold decrease in perinatal mortality (p<0.05). In the postpartum period, patients of both groups had a decrease frequency of purulent-septic complications after the preventive treatment from 13.9% (the 1st group) to 4.6% (the 2d group) (p<0.05). The analysis of perinatal mortality demonstrated a high rate at 22–24 weeks of gestation, while this indicator was in 1.5 times lower at 25 weeks and 3.5 times lower at 26–27 weeks. We found that the method of delivery did not affect perinatal results at 22–25 weeks, but at 26–27 weeks the survival rate of newborns born by CS is on 10% higher than by spontaneous delivery (p<0.05). The expansion of indications for the prevention of respiratory distress syndrome of the fetus from 22 weeks in the 2nd group (in the 1st group was not performed) by 10.7% led to an increase in the survival rate of children with extremely low body weight by 11% (p<0.05).Conclusions. In cases of threat of VTPB, the management is determined by the gestational age, the state of health of the mother and the fetus, the degree of readiness of the birth canal for delivery. Premature delivery is not an indication for CS, except for the presence of specific obstetric indications, but abdominal delivery is possible in early pregnancy (22–25 weeks). The questions about the operated vaginal delivery, the determination of the gestational age for the prevention of respiratory distress syndrome with glucocorticoids, the need to use tocolysis are controversial. The correct determination of the management of women with preterm birth will allow to apply timely measures to be taken to improve the results for the mother and the newborn and may have a prognostic character.