Obstetrics and Gynecology - A. M. Gromova 2000

Miscarriage and Post-Term Pregnancy
Miscarriage
Prevention of Respiratory Distress Syndrome in Newborns

Respiratory distress syndrome in preterm infants develops due to surfactant deficiency in immature Lungs. RDS Prevention involves administering antenatal therapy to accelerate lung maturation and stimulate surfactant synthesis. Indications for RDS prevention include:

- threatened preterm labor with the risk of uterine activity onset (from 28 weeks of gestation, 3 courses);

- Premature Rupture of membranes in preterm Pregnancy (before 35 weeks) in the absence of labor activity;

- onset of The First stage of labor when uterine contractions have been successfully halted;

- Placenta Previa or low-lying placenta with a risk of recurrent bleeding (from 28 weeks of gestation, 3 courses);

- pregnancy complicated by Rh-sensitization requiring early delivery (from 28 weeks of gestation, 3 courses).

In the presence of active labor, RDS prevention is carried out through a comprehensive set of measures for intranatal fetal protection.

The administration of corticosteroids promotes the acceleration of fetal pulmonary tissue maturation.

Dexamethasone is administered intramuscularly at a dose of 8-12 mg (4 mg 2-3 times daily for 2-3 days). Oral tablets (0.5 mg): 2 mg on the first day, 2 mg 3 times daily on the second day, and 2 mg 3 times daily on the third day. Administering dexamethasone to accelerate fetal lung maturation is advisable when tocolytic therapy is insufficiently effective and There is a high risk of preterm birth. Because the success of tocolysis in threatened preterm labor cannot always be predicted, corticosteroids should be administered to all pregnant women undergoing tocolysis. In addition to dexamethasone, other agents used for distress syndrome prophylaxis include: prednisolone at 60 mg daily for 2 days, and dexasone at 4 mg intramuscularly twice daily for 2 days.

Besides corticosteroids, other drugs may be used to stimulate surfactant maturation. If the pregnant woman presents with hypertensive syndrome, a 2.4% aminophylline solution at a dose of 10 ml in 10 ml of a 20% glucose solution daily for 3 days is prescribed for this purpose. Despite the modest efficacy of this method, it remains virtually the only option when Hypertension coincides with the threat of preterm labor.

Acceleration of fetal lung maturation is promoted by small doses (2.5-5 thousand IU) of folliculin daily for 5-7 days, Methionine (1 tablet 3 times daily), Essentiale (2 capsules 3 times daily), intravenous ethanol infusion, and partusisten. Ambroxol (lasolvan) is comparable in efficacy to corticosteroids regarding its effect on fetal lungs and has virtually no contraindications. It is administered via intravenous drip at a dose of 800-1000 mg daily for 5 days.

Lactin (whose MECHANISM OF ACTION is based on stimulating prolactin, which in turn promotes pulmonary surfactant production) is administered at 100 IU intramuscularly twice daily for 3 days.

Nicotinic acid is prescribed at a daily dose of 0.1 g for 10 days, no later than a month before expected premature delivery. No contraindications for this method of fetal RDS prevention have been identified. Nicotinic acid may be combined with corticosteroids, which contributes to the mutual potentiation of their effects.

Fetal RDS prevention is indicated at a gestational age of 28-34 weeks. Treatment is repeated after 7 days for a total of 2-3 courses. In cases where prolongation of pregnancy is impossible, Alveofact is used as replacement therapy after birth. Alveofact is a purified natural surfactant derived from bovine lungs. The drug improves gas exchange and lung compliance, shortens the duration of intensive care with mechanical ventilation (IVF), and reduces the incidence of bronchopulmonary Dysplasia. Alveofact treatment is administered immediately after birth via intratracheal instillation. During the first hour after birth, the drug is administered at a rate of 1.2 ml per 1 kg of body weight. The total administered dose should not exceed 4 doses over 5 days. There are no contraindications to The Use of Alveofact.

When amniotic membranes rupture before 35 weeks of gestation, a conservative- expectant management approach is acceptable only in the absence of infection, late toxicosis, polyhydramnios, Fetal Hypoxia, suspected fetal malformations, or severe maternal somatic diseases. This approach includes Antibiotics, agents for preventing fetal RDS and hypoxia, and medications to reduce uterine contractile activity. The woman's pads must be sterile. Daily Blood tests and vaginal discharge analyses must be performed to timely detect potential Amniotic Fluid infection, alongside monitoring fetal Heart rate and condition. For the prevention of intrauterine fetal infection, we have developed a technique of intra-amniotic drip infusion of ampicillin solution (0.5 g in 400 ml of saline), which helped reduce infectious complications in the early neonatal period. If there is a history of chronic genital diseases, elevated leukocyte counts in blood or vaginal smears, or deterioration in maternal or fetal condition, management shifts to an active approach (induction of labor).

When amniotic membranes rupture at a gestational age greater than 35 weeks, following the establishment of an estrogen-vitamin-glucose-calcium Background, labor induction is indicated via intravenous drip infusion of Enzaprost 5 mg in 500 ml of a 5% glucose solution. Occasionally, simultaneous intravenous drip infusion of Enzaprost 2.5 mg and oxytocin 0.5 ml in 400 ml of a 5% glucose solution may be used.

Preterm labor should be managed cautiously, monitoring the dynamics of cervical dilation, labor activity, descent of the presenting fetal part, and the condition of both mother and fetus. In case of uterine inertia, a labor-stimulating mixture of Enzaprost 2.5 mg, oxytocin 0.5 ml, and 500 ml of a 5% glucose solution is carefully administered via intravenous drip at a rate of 8-10-15 drops per minute, closely monitoring uterine contractility. In cases of rapid or precipitous preterm labor, agents that inhibit uterine contractility—such as ß-mimetics and magnesium sulfate—should be prescribed.

Mandatory measures during the first stage of preterm labor include the prevention or treatment of fetal hypoxia: 40% glucose solution 20 ml with 5 ml of 5% ascorbic acid solution, 1% sigetin solution 2-4 ml every 4-5 hours, and administration of curantyl 10-20 mg in 200 ml of a 10% glucose solution or 200 ml of rheopolyglucine.

Management of the Second Stage of preterm labor is conducted without perineal protection or traction, using pudendal anesthesia with 120-160 ml of 0.5% novocaine solution. In primigravidae and women with a rigid Perineum, Episiotomy or Perineotomy (incision of the perineum toward the ischial tuberosity or anus) is performed. A neonatologist must be present at the delivery. The newborn is received in warm blankets. Signs of prematurity include: body weight less than 2500 g, height not exceeding 45 cm, underdevelopment of subcutaneous adipose tissue, soft ear and nasal Cartilage, undescended Testes in male infants, Labia Majora not covering the Labia minora in females, wide cranial sutures and fontanelles, an Abundance of vernix caseosa, etc.

Provision of care to premature infants is carried out in accordance with Order No. 4 of the Ministry of Health of Ukraine dated January 5, 1996. Prevention of Miscarriage involves maintaining a healthy lifestyle, preventing abortions and Inflammatory Diseases of the FEMALE REPRODUCTIVE Organs, timely treatment of Menstrual disorders, creating favorable working and resting conditions, high-quality antenatal care in women's consultation clinics, and timely administration of necessary therapy. In cases of recurrent miscarriage, the woman is monitored by a geneticist, obstetrician-gynecologist, and general practitioner both before and during pregnancy.