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Prevention of preterm delivery
Give your child a good first step! Premature birth control that prospective parents must know
Baby and Mother September 2013 issue No.443
Interview author / Zhang Yuying Consulting / Taiwan Weekly Medical Association Chairman Cai Mingsong Photography / Zhang Mingwei Thanks for assisting in shooting / Tai Da Hospital Antai Ward, Chen Weijun couple
Definition of preterm birth
According to the definition of WHO, production occurring during the period of 20 to 37 weeks of pregnancy is called "premature birth" (called "abortion" 20 weeks ago). The fetus matures at about 34 weeks, and the full moon is more than 37 weeks. A birth weight of less than 2,500 grams is called "low birth weight" and a birth weight of less than 1500 grams is called "very low birth weight." Premature infants with lower birth weight usually have more problems. Currently, the minimum number of weeks a child can survive is 23 weeks.
Preterm birth rate
◎ Developed countries: about 5 to 10%, of which the United States and Taiwan are about 11%, and Europe is 5 to 7%.
◎ Developing countries: the incidence of premature babies is as high as 25%! Premature birth results in 60 to 80% of infants without congenital abnormalities (premature birth is the main cause of neonatal morbidity and mortality)!
The problem of premature babies should not be ignored!
In addition to the threat of death in premature infants, the acute and chronic problems associated with premature birth often make the entire family busy. According to some data, about half of the very low-weight premature infants (birth weight less than 1500 g) need to rely on the respirator to maintain breathing, other premature infant complications, from the most common respiratory distress, necrotic enteritis, arterial catheterization , to retinopathy, hearing impairment, white matter softening around the ventricles, and even more severe ventricular hemorrhage leading to brain injury. However, after treatment, 20 to 25% of very low birth weight premature infants will leave sequelae such as moderate or severe limb disorders and developmental delay.
Therefore, the sequelae derived from premature babies are not only the shadow of the child's life, but also a heavy burden on the family and society. Therefore, if pregnant women can protect themselves from premature birth, proper care can effectively prevent premature birth and reduce the hard work and huge medical expenses of premature infants in the future. However, Director Cai Mingsong said that the premature birth rate born before 22 weeks is very low; it will be much better after 23 weeks; the baby born after 28 weeks will have a significant decline in mortality. According to foreign statistics, premature babies born between 23 and 26 weeks, each day of successful fetus, can increase the survival rate of 3% of newborns! After 28 weeks, the survival rate increased significantly!
The most determined 3 major preterm birth indicators
1. Spontaneous premature delivery of the front tire.
2. Cervical length ≦ 25mm: The rate of premature birth is 7 or 8 times that of normal pregnant women!
3. "fetal fibronectin" positive: preterm birth rate is 14 times that of normal pregnant women!
Two ways to detect the risk of preterm birth
To prevent premature birth, Director Cai Mingsong said that there are two ways to make a clear assessment:
1. Detection of "fetal fibronectin":
Director Cai Mingsong said that "fetal fibronectin" is responsible for the adhesion of the uterus and placenta interface. When the uterus and placenta interface are damaged, it is released into the secretions of the cervix and vagina. When you are pregnant, you may be born soon. Because the interface will be loose, "fetal fibronectin" may also fall, and it is not an appropriate time to check. So the best time to detect is 22 to 35 weeks of pregnancy. If "fetal fibronectin" is positive, it is a high risk group of premature birth. If you are negative, don't worry about it!
2. Measuring "cervical length"
The length of the cervix for different weeks of pregnancy is recommended to be 11 to 13 weeks > 4 cm, 20 to 24 weeks > 2.5 cm. Ultrasonic measurement, if the length of the cervix is relatively short, it will be born earlier! According to empirical medicine, 2.5 cm is the critical value. If the length of the cervix is less than 2.5 cm and the "fetal fibronectin" is positive, then it should be noted that the premature birth rate is about 60%; if only the length of the cervix is short, "fetal fiber adhesion" Connexin is negative and the preterm birth rate is 1/4. If the cervix is larger than 2.5 cm, the "fetal fibronectin" is negative, there is no other combined disease, no bleeding, and the patient can be cured at home after clinical evaluation.
Professional physician's advice
Director Cai Mingsong finally stressed that there are dangerous signs of premature birth! After the break has not improved, you must go to the hospital! Accept fetal fibronectin and the length of the cervix. In order to reduce the chance of regret or regret for children in the future, prospective parents should be more careful, I believe that can reduce the chance of giving the baby a premature birth!
Cai Mingsong
Education: Private Chinese Medicine University Doctor, Mayo Clinic, Minnesota, USA Current Director: Taiwan Weekly Medical Association Director, Cathay Pacific General Hospital Obstetrics and Gynecology Director, Cathay General Hospital Prenatal Genetic Diagnosis Center, Fu Jen University Faculty of Medicine Associate Professor And Associate Professor, Taipei Medical University
Present: Director of Taiwan Weekly Medical Association, Director of Obstetrics and Gynecology Department of Cathay General Hospital, Director of Prenatal Genetic Diagnosis Center of Cathay General Hospital, Associate Professor of Department of Medicine of Fu Jen University, and Associate Professor of Taipei Medical University *For more details, please refer to: [Baby With the mother] September 2013 issue. Https://www.mababy.com/
Taiwan Weekly Medical Association News, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Director Deng Senwen, New Trends in Arthropod Treatment
2013.12. Prevention of preterm birth, the current methods used are as follows:
1. cerclage: The experiment indicates that if a single child has a history of spontaneous preterm birth before 34 weeks of gestation, and the cervix is shorter than 25 mm before the 24th week of pregnancy, if cerclage is applied A 30% reduction in preterm birth chances in 35 weeks (28% vs 41%, RR 0.7), and a 36% reduction in pre- and post-natal mortality and morbidity (16% vs 25%, RR 0.64).
2.17α Hydroxy-Progesterone Caproate: If pregnant women have a history of preterm birth, we will prevent a second intrauterine injection of 17α Hydroxyprogesterone Caproate 250mg every week from 16-20 weeks to 36 weeks. However, the current evidence does not support its use on twins, and it does not inhibit active preterm labor.
3. Lutein: For pregnant women who do not have any symptoms of premature birth but have a short cervical length, the use of lutein helps to prolong the number of weeks of pregnancy, but the route and dosage form for optimal administration have not been determined. In one experiment, a group of pregnant women who had no history of spontaneous preterm birth had a cervix length of less than 20 mm measured by vaginal ultrasound before 24 weeks of gestation, and vaginal administration of lutein, whether it was a 90-mg gel Or 200-mg suppositories can reduce the incidence of spontaneous preterm birth and mortality and morbidity before and after birth.
Treatment of early contraction: 1. Inhibition of contraction. The use of anti-fetal drugs, the first line of drugs are still based on beta-adrenergic receptor agonists, calcium channel blockers or indomethacin (A) β-adrenergic Receptor Agonist (ritodrine) (B) MgSO4 (C) Indomethacin (D) Nitric Oxide Donors (nitroglycerin) (E) Nifedipine (F) Atosiban (Tractocile) 2 Corticosteroids 3. Antibiotics 4. Others:
Baby and Mother September 2013 issue No.443
Interview author / Zhang Yuying Consulting / Taiwan Weekly Medical Association Chairman Cai Mingsong Photography / Zhang Mingwei Thanks for assisting in shooting / Tai Da Hospital Antai Ward, Chen Weijun couple
Definition of preterm birth
According to the definition of WHO, production occurring during the period of 20 to 37 weeks of pregnancy is called "premature birth" (called "abortion" 20 weeks ago). The fetus matures at about 34 weeks, and the full moon is more than 37 weeks. A birth weight of less than 2,500 grams is called "low birth weight" and a birth weight of less than 1500 grams is called "very low birth weight." Premature infants with lower birth weight usually have more problems. Currently, the minimum number of weeks a child can survive is 23 weeks.
Preterm birth rate
◎ Developed countries: about 5 to 10%, of which the United States and Taiwan are about 11%, and Europe is 5 to 7%.
◎ Developing countries: the incidence of premature babies is as high as 25%! Premature birth results in 60 to 80% of infants without congenital abnormalities (premature birth is the main cause of neonatal morbidity and mortality)!
The problem of premature babies should not be ignored!
In addition to the threat of death in premature infants, the acute and chronic problems associated with premature birth often make the entire family busy. According to some data, about half of the very low-weight premature infants (birth weight less than 1500 g) need to rely on the respirator to maintain breathing, other premature infant complications, from the most common respiratory distress, necrotic enteritis, arterial catheterization , to retinopathy, hearing impairment, white matter softening around the ventricles, and even more severe ventricular hemorrhage leading to brain injury. However, after treatment, 20 to 25% of very low birth weight premature infants will leave sequelae such as moderate or severe limb disorders and developmental delay.
Therefore, the sequelae derived from premature babies are not only the shadow of the child's life, but also a heavy burden on the family and society. Therefore, if pregnant women can protect themselves from premature birth, proper care can effectively prevent premature birth and reduce the hard work and huge medical expenses of premature infants in the future. However, Director Cai Mingsong said that the premature birth rate born before 22 weeks is very low; it will be much better after 23 weeks; the baby born after 28 weeks will have a significant decline in mortality. According to foreign statistics, premature babies born between 23 and 26 weeks, each day of successful fetus, can increase the survival rate of 3% of newborns! After 28 weeks, the survival rate increased significantly!
The most determined 3 major preterm birth indicators
1. Spontaneous premature delivery of the front tire.
2. Cervical length ≦ 25mm: The rate of premature birth is 7 or 8 times that of normal pregnant women!
3. "fetal fibronectin" positive: preterm birth rate is 14 times that of normal pregnant women!
Two ways to detect the risk of preterm birth
To prevent premature birth, Director Cai Mingsong said that there are two ways to make a clear assessment:
1. Detection of "fetal fibronectin":
Director Cai Mingsong said that "fetal fibronectin" is responsible for the adhesion of the uterus and placenta interface. When the uterus and placenta interface are damaged, it is released into the secretions of the cervix and vagina. When you are pregnant, you may be born soon. Because the interface will be loose, "fetal fibronectin" may also fall, and it is not an appropriate time to check. So the best time to detect is 22 to 35 weeks of pregnancy. If "fetal fibronectin" is positive, it is a high risk group of premature birth. If you are negative, don't worry about it!
2. Measuring "cervical length"
The length of the cervix for different weeks of pregnancy is recommended to be 11 to 13 weeks > 4 cm, 20 to 24 weeks > 2.5 cm. Ultrasonic measurement, if the length of the cervix is relatively short, it will be born earlier! According to empirical medicine, 2.5 cm is the critical value. If the length of the cervix is less than 2.5 cm and the "fetal fibronectin" is positive, then it should be noted that the premature birth rate is about 60%; if only the length of the cervix is short, "fetal fiber adhesion" Connexin is negative and the preterm birth rate is 1/4. If the cervix is larger than 2.5 cm, the "fetal fibronectin" is negative, there is no other combined disease, no bleeding, and the patient can be cured at home after clinical evaluation.
Professional physician's advice
Director Cai Mingsong finally stressed that there are dangerous signs of premature birth! After the break has not improved, you must go to the hospital! Accept fetal fibronectin and the length of the cervix. In order to reduce the chance of regret or regret for children in the future, prospective parents should be more careful, I believe that can reduce the chance of giving the baby a premature birth!
Cai Mingsong
Education: Private Chinese Medicine University Doctor, Mayo Clinic, Minnesota, USA Current Director: Taiwan Weekly Medical Association Director, Cathay Pacific General Hospital Obstetrics and Gynecology Director, Cathay General Hospital Prenatal Genetic Diagnosis Center, Fu Jen University Faculty of Medicine Associate Professor And Associate Professor, Taipei Medical University
Present: Director of Taiwan Weekly Medical Association, Director of Obstetrics and Gynecology Department of Cathay General Hospital, Director of Prenatal Genetic Diagnosis Center of Cathay General Hospital, Associate Professor of Department of Medicine of Fu Jen University, and Associate Professor of Taipei Medical University *For more details, please refer to: [Baby With the mother] September 2013 issue. Https://www.mababy.com/
Taiwan Weekly Medical Association News, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Director Deng Senwen, New Trends in Arthropod Treatment
2013.12. Prevention of preterm birth, the current methods used are as follows:
1. cerclage: The experiment indicates that if a single child has a history of spontaneous preterm birth before 34 weeks of gestation, and the cervix is shorter than 25 mm before the 24th week of pregnancy, if cerclage is applied A 30% reduction in preterm birth chances in 35 weeks (28% vs 41%, RR 0.7), and a 36% reduction in pre- and post-natal mortality and morbidity (16% vs 25%, RR 0.64).
2.17α Hydroxy-Progesterone Caproate: If pregnant women have a history of preterm birth, we will prevent a second intrauterine injection of 17α Hydroxyprogesterone Caproate 250mg every week from 16-20 weeks to 36 weeks. However, the current evidence does not support its use on twins, and it does not inhibit active preterm labor.
3. Lutein: For pregnant women who do not have any symptoms of premature birth but have a short cervical length, the use of lutein helps to prolong the number of weeks of pregnancy, but the route and dosage form for optimal administration have not been determined. In one experiment, a group of pregnant women who had no history of spontaneous preterm birth had a cervix length of less than 20 mm measured by vaginal ultrasound before 24 weeks of gestation, and vaginal administration of lutein, whether it was a 90-mg gel Or 200-mg suppositories can reduce the incidence of spontaneous preterm birth and mortality and morbidity before and after birth.
Treatment of early contraction: 1. Inhibition of contraction. The use of anti-fetal drugs, the first line of drugs are still based on beta-adrenergic receptor agonists, calcium channel blockers or indomethacin (A) β-adrenergic Receptor Agonist (ritodrine) (B) MgSO4 (C) Indomethacin (D) Nitric Oxide Donors (nitroglycerin) (E) Nifedipine (F) Atosiban (Tractocile) 2 Corticosteroids 3. Antibiotics 4. Others:
