Clinical and anamnestical aspects of very early preterm birth

Abstract

The objective: determine risk factors, causes and clinical features of patients with very early preterm birth. Materials and methods. The study analyzed the data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes of 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation. The fact of childbirth at these stages of pregnancy is 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 preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. During the management of pregnancy of patients of these groups, special attention was paid to the assessment of risk factors for the development of very early preterm labor, among which the main ones were urogenital infections (83,7% and 78,9% in groups 1 and 2, respectively), which caused perinatal mortality in both groups (p˂0,05). A combination of pathogens was found in almost half of the subjects (43% in group 1,44% in group 2). Patients of both groups had a serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. The main complications of gestation of pregnant women of both groups in the second trimester were the miscarriage risk (43% and 30%, respectively) and dysfunction of the fetoplacental complex (FPC) (22,7% and 21,8%, respectively), which caused the syndrome of delayed fetal development in both groups of subjects - in 66% and 63% of children, respectively. Conclusion. Analysis of general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a thorough examination for urogenital infections in women at the stage of pre-pregnancy and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as study of fetoplacental system function from early pregnancy. Preventive measures and timely treatment of fetoplacental disorders should promote prolonging pregnancy to longer gestations, which is the best way to improve perinatal outcomes.