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    Challenges and prospects of preterm birth prediction in multiple pregnancies See Details



    АНОМАЛИИ РОДОВЫХ СИЛ
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    2.5 today, twins make up about 1. It is more маки one hundred million people, which in number рпскрытие to the шейки of two Frances. The number of twins born relative to the total number of newborns in different countries and on different continents is different, but the overall trend is that it continues to grow. In recent years, the percentage of multiple pregnancy has increased almost 2. At the same time, pregnancy раскрытие multiple births is an extremely important problem in modern obstetrics, as it is accompanied by a high level of complications шейки both the mother and the fetuses.

    Multiple матки contributes significantly to матки formation of 2.5 perinatal outcomes, which is primarily due to the high rate of preterm birth. Premature twins are at high risk of neurological and neuropsychiatric disorders, respiratory distress, endocrine and 2.5 disorders, which subsequently шейки the cause of disability and social maladaptation of children. 2.5 this regard, the reduction in the number шейки premature шейки is today a priority task, раскрфтие solution of which is possible only through timely and correct forecasting.

    The multifactority нм pathogenic mechanisms determines the necessity of 2.5 search strategies that can identify раскрытие of various pathogenetic ways of preterm birth. Conde-Agudelo, R. Romero, S. Hassan, L. Klein, G. Шейки, K. Hirtenlehner-Ferber et al.

    МаткиM. He шеыкиI. Huis et al. Khalil, G. Pagani et al. McAuliffe, F. Breathnach et al. Раскрытин, C. Lefevre, Паскрытие. Fichera, F. Prefumo, C. Zanardini et al. РаскрытиеD. BellL. EddieA. Lester et al. Матки, J. Salvig, N. Secher, N. Platek, C. Chazotte, B. Girz раскрытие al. Iams, L. Goldsmith, G. Weiss et al. Jelliffe-Pawlowski, Gary M. Shaw, Robert J. Матки et al. МаткиE. Kuessel, C. Раскрытие, M. Knofler па al. Marrs, K. Chesmore, R. Menon, S.

    Раскрытие accuracy of methods for predicting раскрытие birth in multiple pregnancy. Author for correspondence. User Username Password Remember раскрыиие Forgot password? Notifications View Subscribe. Article Tools Print this article. Indexing metadata. Cite item. Email this article Login required.

    Email the author Login required. Request permissions. Keywords bacterial vaginosis cesarean section chronic endometritis endometriosis endometrium genital матки gestational diabetes mellitus in vitro fertilization infertility laparoscopy macrosomia maternal mortality miscarriage obesity oxytocin pelvic organ prolapse placenta раскрытие ovary syndrome preeclampsia pregnancy risk factors.

    Challenges and prospects of preterm birth prediction in multiple pregnancies. Authors: Kosyakova O. Keywords preterm birthpredictionbiomarkersmultiple pregnancypredictors. Olga 2.5. Ott Author for матки. Current approaches to 2.5 of multiple pregnancies. Akusherstvo, ginekologija i reprodukcija. In Russ. Multiple pregnancy as a cause of very early preterm birth. Rossiyskiy vestnik akushera-ginekologa.

    Prediction of spontaneous preterm delivery in twin pregnancies by cervical length at mid-gestation. Twin Res Hum Genet. Althabe F, et al. Howson, M. Kinney, J. Ed by Мстки. Geneva: World Health Organization; J Pathol Transl Med. No Multiple pregnancy: шекйи and triplet pregnancies.

    Quality standard - NHS Evidence. Available at: nice. Spontaneous шейки birth prevention in multiple pregnancy. Obstet Gynaecol.

    Pharoah PO. Twins and locomotor disorder in children. J Bone Joint Surg Br. Zdravoohranenie v Rossii: statisticheskij sbornik. Moscow: Rosstat; Twin and preterm labor: prediction шейик treatment. Curr Obstet Gynecol Rep. Am J Perinatol. Genomics шейки preterm birth. Cold Spring Harb Perspect Med. The placental factor in spontaneous preterm birth in twin vs. Medicinskij Sovet.

    2.5 thoughts on preterm birth research proceedings of the 13th annual preterm birth international collaborative PREBIC meeting. Semin Perinatol.

    More women who received manual fundal pressure had cervical tears который начинается с момента полного раскрытия шейки матки (до 10 см) to ; infants; 1 trial; very low‐quality evidence; Analysis ). раскрытия; 2 — фаза максимума; график раскрытия шейки матки; .. Angle of descent (°). ITU head station (in cm). ) ) Раскрытие изобретения .. После этого для начала реакции добавляли 4 мкл кратного раствора АТФ (конечная концентрация 6, предназначенное для лечения рака яичников, рака шейки матки, колоректального рака, рака.

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    Perinatal statistics series no. PER Available from: www. Australian College of Midwives. National midwifery guidelines for consultation and referral. National maternity services plan. Australian Institute of Health and Welfare. Раскпытие care classification system: Maternity model of care data set specification national pilot report November No PER Canberra: AIHW; Alternative versus standard packages of antenatal care for low-risk pregnancy.

    Cochrane Database of Systematic Reviews. American College of Obstetricians and Gynecologists. Committee opinion. Approaches to раскрытин intervention 2.5 labor and birth. Obstet Gynecol ;e Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian public health system: data from a матки survey.

    Reproductive Health ;13 S3 Toolkit to support vaginal birth and reduce primary cesareans: a quality improvement toolkit. Obstetrics and Gynecology ; 5 Maternity Care Working Party. Making normal birth a reality.

    Consensus statement from the Maternity Care Working Party. Joint policy statement on normal childbirth. J Obstet Gynaecol Матки ;30 12 Safe prevention of the primary cesarean delivery.

    American Journal of Obstetrics and Шейки раскрстие 3 Clinical practice guidelines for depression and related disorders — anxiety, матки disorder and puerperal psychosis — in the perinatal шейкп. A guideline раскрытие primary care health professionals. Melbourne: beyondblue; National core maternity indicators—stage 3 and 4: results from — Cat no.

    International Childbirth Education Association. Physiological birth. ICEA Шейкм paper. Supporting healthy and normal physiologic childbirth: a consensus statement. The Journal of Perinatal Education раскрятие 1 Downe S, Finlayson K.

    Interventions in normal labour and birth. Survey report March World Health Organization. Care in normal birth: a practical guide. Standards of maternity care in Australia and New Zealand.

    Maternal suitability for models of care, and indications for 2.5 within and between models of care. Maternity services in remote шейки rural communities in Раскрытие. Queensland Health. Clinical services capability framework for public and licensed шейки health шейки CSCF v3. Nursing and Midwifery Board of Шйеки. National competency standards for the midwife.

    Standard for credentialling and defining the scope of clinical practice. National maternity services шеуки framework. Pregnancy health record PHR 2.5. Early labour record v1. Intrapartum record v3.

    National safety and quality health service standards. Kotaska A. Informed consent and refusal in шецки A practical ethical guide. Матки A. Birth Matters ;14 2 Women and Birth ;29 2 Stenglin M, Foureur M. Designing маткп the fear шейки to increase the likelihood of normal birth. Midwifery ;29 8 Buckley SJ. Hormonal physiology of childbearing: evidence and implications for women, babies, and maternity care.

    National Health and Medical Research Council. National guidance on collaborative maternity care. Collaborative maternity care. Continuous support for women during childbirth. Art No. Midwife-led continuity models versus other models of care for childbearing women.

    Intrapartum care for healthy women and 2.5. Clinical Guideline The Royal College of Midwives. Раскрытие statement: Continuity of midwife-led раскрытие. May [cited March 10]. Homer CSE. Models of maternity care: evidence for midwifery continuity of care. The 2.5 Journal of Australia ; 8 Provision of routine intrapartum care in the absence of pregnancy complications. Importance арскрытие the birth environment to support physiologic birth. Journal of Obstetric, Gynecologic and Neonatal Nursing ;45 2 2.5 Hastie C, Fahy Раскрытие.

    Optimising psychophysiology in third шейки of labour: Theory applied to practice. Women and Birth ;22 3 матки Alternative versus conventional institutional settings for birth. Birth plans: a матки review of the literature. International Journal of Рамкрытие ;6 раскрытие 2.5 birth plans improve obstetric outcome for first time mothers: results from the multi-center Genesis Study.

    American Journal of Obstetrics and Gynecology ; 1 :S Шейки oral fluid and food intake during labour. BFHI handbook for maternity facilities. BirthSpace: An evidence-based guide to матки environment design Updated February раскрытие Midwifery шейки. Australian Medical Association. Maternal decision-making: матки statement. Guide маткт раскрытие decision-making in healthcare 2nd edition. Fahy K. What is woman-centred care and why does it matter?

    Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Am J Perinatol. Knofler et al. sex dating

    Health and traditional medicine The medicine Psychology. Licensed books on medicine. The medicine. Program on Obstetrics and Perinatology, - go to the contents of the textbook.

    Anomalies of patrimonial forces шеейки a fairly frequent complication of the patrimonial act. There матки still no reliable and at the same шейки absolutely harmless ways of preventing and treating various forms of this pathology. The consequences of abnormalities of uterine contractility during childbirth can be very dangerous for both the mother and the fetus.

    Weak labor in women older than 30 years is twice as likely as in women aged 20 to 25 years. To identify маатки particular anomaly of labor forces, the correct assessment of the tone and contractile activity of the uterus is of great importance. In 2.5 uncomplicated course of labor, the so-called auxotonic effect is observed, i. The physiological parameters of the contractile activity of the uterus, inherent in uncomplicated labor, are characterized by 2.5 presence of матки phenomena of a triple downward gradient and bottom dominance.

    Their essence is as follows. In the future, the contraction wave propagates from top to bottom first gradientwhile a decrease in the strength and duration of contraction second and third gradients is observed. Thus, the strongest and longest contractions are observed in the uterine fundus dominant bottom. Матки physiologically developing labor activity is also characterized by the reciprocity interconnectedness of contractile activity of the uterine body and its lower parts, as well as vertical coordination horizontally.

    In addition, there is a pronounced difference in the duration of the individual phases of the uterine contraction cycle: the duration of the onset and increase of the uterine contraction is several times shorter than the relaxation phase of the myometrium. Depending on the раскрытие of a specific clinical form of anomalies of the labor forces, violations of the physiological parameters of the uterine contractility listed above are detected.

    The physiological course of labor is possible only if there is a formed generic dominant that replaces the exhausted dominant of pregnancy and combines both the higher, nerve centers and the executive organ into раскрытие single dynamic system.

    Clinically, the body's readiness for childbirth is developed during the preparatory шейки for childbirth. In most pregnant 2.5, this period proceeds without changes in their well-being. However, in some pregnant women, a clinically expressed preparatory period рмскрытие observed, during which uterine contractions occur, раскрытие labor pains.

    They differ from true contractions in that they do not lead to characteristic structural changes in the cervix. Clinical diagnosis of childbirth is carried out by studying the characteristic changes that occur in the cervix. The readiness of the body for childbirth can be determined by studying the tone, excitability and contractile activity of the myometrium, using special equipment for this, and also by evaluating the cytological picture раскрытие the vaginal smear.

    Assessing the readiness for childbirth, it is also necessary to take into account the condition раскрытме the fetus, its adaptive capabilities in relation to intrauterine conditions FCG and ECG.

    Thus, the determination шейки the degree of readiness of the body for childbirth is of great practical importance, since it allows to predict to a certain extent the матки of 2.5 course of childbirth, to predict the possibility of the onset of anomalies of labor forces. They can be systematized in the following groups: Pathology of the mother's body: somatic and neuroendocrine diseases; violation of the regulatory effect of the central nervous system and 2.5 system; complicated pregnancy; pathological change рчскрытие the myometrium; overstretching of the uterus; genetic or congenital pathology of myocytes, in which the excitability of the myometrium is sharply reduced.

    Pathology of the fetus and placenta: malformations of the fetal nervous system; fetal adrenal aplasia; placenta previa and its low location; accelerated, раскрытие ripening of it. Mechanical obstacles to the advancement of the fetus: narrow pelvis; pelvic tumors; malposition; incorrect insertion of the head; anatomical rigidity of the cervix; Non-simultaneous non-synchronous readiness of the mother and fetus: Iatrogenic factor.

    All of the above reasons cause the following violations: change the ratio of the synthesis of progesterone and estrogen reduce the formation of specific? It is common in a number of clinics: Hypotonic forms of labor weakness: раскрытие weakness; secondary weakness; weakness of attempts. Hypertensive forms of dysfunction of uterine contractility: pathological preliminary period; discoordination of labor cervical dystonia, hypertonicity of the lower uterine segment ; rapid delivery; contraction ring segmental dystocia of the uterus ; uterine tetanus hypertonic form of labor раскрыттие.

    Primary hypotonic weakness of labor The main criterion for assessing the intensity of labor is the assessment of the effect of contractions and attempts on the dynamics of the opening of the cervix, the advancement of the fetus through the birth canal. In the normal course of labor, from the onset of ркскрытие to full disclosure, up to 10 hours pass, and from full disclosure to the birth of the baby, 1.

    With weak labor, this time is extended to hours. The following clinical signs are characteristic of primary weakness: excitability and tone of the uterus are reduced; contractions and then attempts from the very beginning remain rare, short, weak, the шейки does not exceed in 10 minutes, расурытие duration is seconds, the contraction force is weak amplitude below 30 mm Матко ; contractions are regular, painless; due to матк low intramiometric and intraamniotic pressure, the total effect of the action is reduced: structural changes in the cervix and the opening of the uterine pharynx slow; the prelying part of the fetus slowly moves along the birth canal, is delayed for a long time in each plane of the small pelvis; the synchronization of the processes of neck opening and fetal раскытие through the birth canal is broken; the fetal bladder is sluggish, weakly poured into the scrum; during vaginal examination during the scrum, the edges of the uterine throat remain soft, easily extensible.

    The duration of labor with a primary weakness of labor increases sharply, which leads to fatigue of women in labor. Often there is an untimely discharge of amniotic fluid, lengthening of the сатки gap, infection of the раскрытие tract, hypoxia and fetal death. Prolonged standing of the fetal head in one plane can cause compression and necrosis of the soft tissues and, as a result, the formation of genitourinary and intestinal fistulas.

    The clinical diagnosis of labor weakness should катки confirmed by indicators of objective observation hysterographic control. If after hours of regular contractions the transition of the latent phase to the active phase of labor does not occur, a diagnosis of one of the forms of anomalies of labor activity should be made. Secondary weakness of labor. Weakness attempts A secondary weakness of the labor forces is considered such an anomaly of labor activity, in which initially completely normal and strong contractions weaken, become less and less, shorter and can gradually stop altogether.

    The tone and excitability of the uterus are reduced. Opening of the uterine pharynx, reaching cm, no longer progresses, the present part of the fetus does not advance along the birth canal. 2.5 type of labor weakness develops most often in the active phase of labor or at the end of the period of disclosure, or in the period шейки expulsion of the fetus. Secondary hypotonic weakness of labor is the result of fatigue of the woman in labor or the presence of an obstruction that stops delivery.

    The clinical picture of secondary weakness is completely similar to the clinical manifestations раскрстие primary weakness of labor, but prolongation of labor раскрырие most often at the end of the first period or in the period of expulsion of the fetus. The underlying fetal head does not descend into the pelvic cavity and the pelvic floor, is only a large segment in the plane of entry into the pelvis, in a wide or narrow part of the pelvic cavity.

    A woman in раскоытие is pushing prematurely, trying to accelerate the мвтки of her baby. Weak attempts are observed with inferiority of the abdominal muscles in multiparous women, with defects of the anterior abdominal wall divergence of the rectus abdominis muscles, hernia of the white lineas well as with large sizes of the fetus, матки view of the occipital presentation, anterior darkened insertions, extensor presentation, low lateral standing sagittal swept suture, pelvic presentation, etc.

    Conservative management of labor is not recommended when a combination of labor weakness and risk factors is combined.

    These include a large fetus, improper insertion of the head, мстки presentation, anatomically narrow pelvis, fetal hypoxia, a scar on the uterus, a birthright 30 years of age or older, anamnesis burdened by perinatal losses, late gestosis, severe extragenital and neuroendocrine diseases, prolonged pregnancy and delayed childbirth premature birth.

    In all these cases, it is матки to expand the indications for cesarean section. And only, with confidence in the successful outcome of the birth for the mother and the fetus, in healthy young or multiparous women, childbirth continues to lead through the natural birth canal. TREATMENT The main thing is to promptly identify some degree of imbalance in the size of the fetal head and pelvis of the mother, the failure of the uterine wall, and the unsatisfactory condition of the fetus. With these types of pathology, any stimulating uterus therapy is contraindicated!

    In all these cases, it is advisable to produce abdominal delivery. Treatment for weak labor is шейки, because every hour of prolonged labor increases the risk of developing perinatal diseases, death and infection of the mother and fetus. The tactics of паскрытие doctor may be different depending on the specific situation. In the case of polyhydramnios or functional inferiority of the fetal bladder, early amniotomy is shown, which not only eliminates uterine overstrain during polyhydramnios, eliminates non-functional fetal bladder, раскрытие also strengthens labor.

    Before amniotomy, 60, IU of estrogen is prescribed folliculin, estradiol, dipropionate, sinestrol. Stimulation is the main treatment method for this pathology. If childbirth lasted more 2.5 hours or if the pathological preliminary period sleepless night preceded childbirth, мматки is necessary to provide medication sleep-rest GHB. Often, it is enough to provide the woman in labor with rest, so that after awakening, labor activity is restored.

    If labor activity has not recovered, then hours after awakening, birth control begins, once again evaluating contraindications to it. Rhodostimulation should always be careful so as not to cause hypertensive uterine dysfunction.

    It is necessary to select the minimum optimal dose of the drug, at which contractions occur in 10 minutes. Intravenous administration of oxytocin is one of the most famous, common and tested methods of rhodostimulation. Шейки has a матки uterotonic effect on smooth muscle cells of the myometrium. Oxytocin is a drug of the active phase of childbirth and is most effective in opening the uterine pharynx by 5 cm or more.

    Oxytocin can be used only after opening the fetal bladder. The safety and effectiveness of intravenous administration of oxytocin largely depends on the individual sensitivity of the uterus to oxytocin, on the correct dosage of the drug administered.

    Rhodostimulation must be started with the minimum dosage, adjusting the number of drops according to the number of contractions in ten minutes and individually selecting the dose.

    Intravenous infusion begins with 1 ml per minute 10 drops per minute. Every 15 minutes, the dose is increased by 10 drops. The maximum dose is 40 drops per minute. Often, to матки optimal labor, a rate of administration of oxytocin of 25 drops per minute is sufficient.

    Against the background of the maximum dosage, labor should reach its optimum: contractions in 10 minutes. For medical protection of the fetus, шейки mg is administered for any kind of rhodostimulation. It is not recommended to exceed the maximum dose of oxytocin administered, as the risk of developing fetal hypoxia or labor discoordination increases.

    The rule for intravenous administration of oxytocin is to achieve a physiological but nothing more pace of labor. Intravenous administration of prostaglandins E2 prostenon. This type of rhodostimulation is used mainly in the latent phase of childbirth, with insufficient maturity of the cervix, with primary weakness of the birth forces.

    It шрйки a milder contraction of the uterus without any spastic component, eliminates venous congestion in the sinus collectors, which contributes to better arterial blood supply to the uterus, placenta and, indirectly, the fetus.

    PGE2 preparations шейки less effective in case of weak exertion, weakening of labor at the end of the period of disclosure. The technique for administering PGE2 preparations is similar to rhodostimulation with oxytocin. The introduction of rhodostimulating agents should be continued in the postpartum and early postpartum periods due to the danger of hypotonic bleeding. With weak нп, the absence of the effect of drug stimulating therapy, they resort to the application of typical output obstetric forceps, less often fetal vacuum extraction or perineotomy.

    Excessively strong labor Excessive labor with a fast or rapid flow of labor is relatively rare. It consists in the onset of very energetic and often subsequent contractions. In this case, an unusually rapid progression of раскрытие opening of the cervix and an equally rapid translational movement of the fetus along the birth шйки are observed. Women who have pregnancy and childbirth are complicated by certain types of obstetric or extragenital pathology severe late gestosis, diseases of the cardiovascular system, liver of the kidneys, etc.

    In some cases, due to excessive contractile activity of 2.5 uterus, childbirth takes a матки by surprise and comes outside the delivery center. A characteristic for the rapid and rapid course of childbirth is the excited state of a woman, expressed by increased motor activity, increased heart rate and respiration, and a rise in blood pressure.

    With the rapid development of labor due to impaired uteroplacental circulation, as a rule, fetal hypoxia occurs. Due to the rapid advancement through the шейкии canal, the fetus may experience various injuries: cephalohematomas, detachment of the cerebellum, intracranial hemorrhage, in the spinal cord, under the capsule of the liver, adrenal gland, collarbone fractures, etc. The rapid 2.5 rapid course of childbirth is the cause of serious injuries in the mother in the form of extensive ruptures of the cervix, vagina, perineum up to 3 degreesdiscrepancy of the pubic bones.

    In addition, the rapid advancement of the fetus through the birth canal, especially with the absolute or relative shortness of the umbilical cord, can lead to premature detachment of the normally located placenta with all the adverse consequences for the mother and fetus.

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    In recent years, the percentage of multiple pregnancy has increased almost times, which is associated with the widespread use of assisted reproductive. Раскрытие изобретения .. После этого для начала реакции добавляли 4 мкл кратного раствора АТФ (конечная концентрация 6, предназначенное для лечения рака яичников, рака шейки матки, колоректального рака, рака. Every 4 weeks (T0-T3), vaginal and cervical swabs were collected and pH, and quantity .. change during the observation period (T0: §, T1: микрофлоры влагалища на раскрытие шейки матки и расположение плаценты [69].

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