premature birth. Risk of preterm birth and causes of O24 Diabetes mellitus during pregnancy

Pregnancy is a special period for every woman. One of the common concerns of expectant mothers is preterm birth (according to ICD 10 code O60). Even though the pregnancy proceeds without complications, the threat of premature birth is not excluded.

preterm birth

Premature births (according to ICD 10 code O60) are considered births before the 38th week. In medical practice, for a long time, preterm birth was considered, starting from the 28th week. Childbirth at an earlier date was called a miscarriage. Modern equipment allows you to leave a child born after 22 weeks, whose weight is more than 1 kg. The frequency of preterm births in the world is not declining, but the survival rates of the child have increased. However, not every maternity hospital is equipped with such technologies. That is why you should choose in advance the maternity hospital in which you plan to have a baby.

Depending on the gestational age, preterm birth (according to ICD 10 code O60) is divided into:

• too early - childbirth that began between 22 and 27 weeks, the fetus during these periods reaches a weight of 0.5 kg to 1 kg
• early - childbirth that began between 28 and 33 weeks, the child in these terms reaches a weight of 1 kg to 2 kg
• premature birth - the process of childbirth begins from 34 to 37 weeks, the weight of the newborn reaches 2.5 kg

Treatment is different for each period. But the longer the fetus is in the mother's stomach, the higher the chance that the child will survive.

Causes of preterm birth

Factors that increase the risk of preterm birth:

1. Infectious diseases, inflammation - especially the risk increases in the early stages. During its development, the fetus increases in size, provoking uterine distension. The inflammatory process affects the muscle tissue, preventing their stretching. If there are obstacles to stretching, the uterus tries to throw off the fetus, causing childbirth. This is why doctors recommend testing for infections and treating them before conception. This will increase the chances of maintaining a pregnancy.
2. The presence of pathology in the cervix. A characteristic feature of the pathology is the weakness of the uterus. She cannot hold the developing fetus. Under the influence of the pressure of the child, the uterus opens, causing premature birth (according to ICD 10 code O60). Rarely, an anomaly of the cervix is ​​congenital. As a rule, it occurs as a result of an abortion or miscarriage, the presence of male hormones in the female body exceeding the norm.
3. Multiple pregnancy (at least twins). Strong stretching of the uterine cavity during pregnancy, at least with twins, can provoke premature birth.
4. Pathological development of the uterus.
5. Diabetes.
6. Thyroid dysfunction.
7. Premature birth (according to ICD 10 code O60) is not the first, but the second or more.
8. Difficult working conditions.
9. Stressful situations, bad habits.

Not only the probability of survival of the fetus, but also the health of the unborn baby depends on the duration of the child's stay in the mother's stomach. That is why it is important to provide the necessary assistance in a timely manner and do everything so that childbirth begins later. Therefore, it is important to know the symptoms.

Premature birth (according to ICD 10 code O60) are:

• threatening
• beginning
• started

Threatened preterm birth is manifested in pain in the lower abdominal cavity and lumbar region. The abdomen hardens, but the cervix does not dilate.

Symptoms of early preterm labor:

• increased tone of the uterus
• contractions begin
• pain in the lower abdomen
• amniotic fluid is poured out

The symptoms of the onset of preterm labor practically do not differ from the usual ones. But more often they are accompanied by complications, for example, bleeding. In time, such births pass faster.

Diagnosis of preterm birth

For diagnosis, an important criterion is the condition of the cervix, as well as the fetal bladder. Having gone to the maternity hospital, to confirm or refute the preliminary diagnosis, the doctor begins the examination:

1. The protocol of pregnancy is being studied, paying attention to the presence of risk factors.
2. The cervix is ​​examined, as well as the vagina in the mirrors.
3. The presence of amniotic fluid in the vagina is determined
4. Vaginal examination provides an assessment of the opening of the uterine os, the location of the fetus. The results obtained are recorded in the protocol. If there is a risk of premature discharge of water, a vaginal examination is not performed.
5. The condition of the fetus is assessed using ultrasound. The doctor carefully listens to the baby's heartbeat, assesses the amount of amniotic fluid, detects or eliminates intrauterine growth retardation.
6. To detect or exclude the presence of infection, it is recommended to do a urine and blood test.

Management of preterm birth

Birthing can be:

• expectant
• active

With a wait-and-see position, the doctor carefully monitors how the pregnancy proceeds. Often, during childbirth ahead of schedule, timely intervention of the doctor is necessary, to do a caesarean section.

Many factors influence the preterm birth protocol:

• stage of labor
• how dilated is the cervix
• infectious diseases

Statistical studies show that about 30 percent of preterm births occur with deviations (weak or too active labor activity). For this reason, preterm delivery is accompanied by the use of antispasmodic drugs. Caesarean section is done in case of severe pathology of the mother and child. Another factor according to which it is advisable to carry out a caesarean section is the presentation of the fetus. After the baby is born, resuscitation begins.

Adverse consequences are expected primarily not by the mother, but by the child. Depending on the condition of the newborn, the woman in labor may be delayed in the hospital.

Subsequent pregnancy will be monitored by a specialist. Especially in the period in which the first premature birth then began.

The consequences for the newborn depend on the period at which the pregnant woman was. If this happened before the 28th week, he will most likely be assigned to a specialized maternity hospital with modern equipment. If the baby was born between the 28th and 34th weeks, a specialized maternity hospital is not required. After all, the baby has more vitality. After the 34th week, the child can eat and breathe on his own. The only problem is the lack of body weight. In all three options, you will have to devote a lot of time to caring for a newborn ahead of time. But over time, the baby will not differ from his peers. If the birth canal is not ready due to toxicosis that threatens the health of the mother, a caesarean section is performed, regardless of the fact that the child has little chance of surviving.

Treatment

Finding the slightest symptoms of the onset of preterm labor, immediately call an ambulance. Do not travel from home to the hospital on your own. After all, excess physical stress and stress can only aggravate the situation. Especially in the early stages, it is important to get into a maternity hospital specializing in early childbirth. A maternity hospital equipped with equipment and qualified specialists will increase the likelihood of maintaining a pregnancy.

After contacting an ambulance, try to calm down, you can take a sedative of plant origin (for example, motherwort). After the examination, the doctor will decide whether this is actually a premature birth. The threat to give birth earlier than planned is reduced by the appointment of drugs that lower the tone of the uterus (for example, genipral). Despite the fact that the frequency of preterm births is not decreasing, competent treatment, following the recommendations of the doctor, and new equipment will help save the baby and pregnancy.

Further treatment depends on the factors that provoked the situation. If there is an infection, the doctor prescribes antibiotics. If the amniotic fluid has departed at the 34th week, it is not advisable to continue the pregnancy.

Prevention of preterm birth

To avoid early childbirth, especially if they are not the first, you need to follow these recommendations:

1. Undergo a medical examination in order to identify diseases of a chronic nature, to identify structural features of the uterus. Treat infections found during the examination.
2. Get registered with a local gynecologist in time. Tell the doctor in detail about all the factors that can provoke premature birth.
3. Avoid excessive physical activity at home and at work. Minimize stressful situations. On the recommendation of a doctor in stressful situations at home or at work, you can take sedative medications.
4. Take tests on time as advised by your doctor.

Following simple recommendations, you can minimize the possibility of premature birth. Some pregnant women try to delay hospitalization in the maternity hospital as long as possible. Motivating his decision by the fact that pregnancy is more comfortable at home. However, preterm birth should be taken seriously. After all, you are responsible not only for your life, but also for the life of your unborn child.

There is an effective remedy for stretch marks after childbirth. Follow the link and you will find out what effect Anastasia Volochkova achieved.

CLASS XV. PREGNANCY, BIRTH AND THE POSTPARTUM PERIOD (O00-O99)

Excludes: human immunodeficiency virus [HIV] disease ( B20-B24)
injury, poisoning and other consequences of external causes ( S00-T98)
mental and behavioral disorders associated with the postpartum period ( F53. -)
obstetric tetanus ( A34)
postpartum necrosis of the pituitary E23.0)
postpartum osteomalacia ( M83.0)
flow monitoring:
pregnancy in a woman at high risk ( Z35. -)
normal pregnancy ( Z34. -)

This class contains the following blocks:
O00-O08 Pregnancy with abortive outcome
O10-O16 Edema, proteinuria and hypertensive disorders
O20-O29 Other maternal illnesses predominantly related to pregnancy
O30-O48 Medical assistance to the mother in connection with the condition of the fetus, amniotic cavity and possible difficulties in delivery
O60-O75 Complications of childbirth and delivery
O38-O84 delivery
O85-O92 Complications associated mainly with the postpartum period
O95-O99 Other obstetric conditions not elsewhere classified

ABORTIVE PREGNANCY (O00-O08)

Excludes: ongoing pregnancy with multiple conception

after abortion of one or more fetuses ( O31.1)

O00 Ectopic [ectopic] pregnancy

Includes: ectopic pregnancy with rupture
O08. — .

O00.0 Abdominal [abdominal] pregnancy
Excludes: live birth in abdominal pregnancy ( O83.3)
maternal medical care in case of a viable fetus during abdominal pregnancy ( O36.7)
O00.1 tubal pregnancy. Pregnancy in the fallopian tube. Rupture (fallopian) tube due to pregnancy. tubal abortion
O00.2 Ovarian pregnancy
O00.8 Other forms of ectopic pregnancy
Pregnancy:
cervical
in the uterine horn
intraligamentary
wall
O00.9 Ectopic pregnancy, unspecified

O01 Blistering skid

Use an additional rubric code if necessary to identify any associated complication. O08. — .
Excludes: malignant hydatidiform mole ( D39.2)

O01.0 Bubble skid classic. Bubble skid full
O01.1 Bubble skid incomplete and partial
O01.9 Vesical skid, unspecified. Trophoblastic disease NOS. Vesical skid NOS

O02 Other abnormal products of conception

Use an additional rubric code if necessary to identify any associated complication. O08. — .
Excluded: paper fruit ( O31.0)

O02.0 Dead gestational sac and non-vesical mole
Skid:
fleshy
intrauterine NOS
pathological fertilized egg
O02.1 A failed miscarriage. Early fetal death with uterine retention
Excludes: miscarriage with:
dead egg ( O02.0)
skid:
vesicular ( O01. -)
non-bubbly ( O02.0)
O02.8 Other specified abnormal products of conception
Excluded: together with:
dead egg ( O02.0)

skid:

• vesicular ( O01. -)
• non-bubbly ( O02.0)

O02.9 Abnormal product of conception, unspecified

Note The term "incomplete abortion" includes the retention of products of conception after an abortion.

0 Incomplete abortion complicated by infection of the genital tract and pelvic organs
O08.0

1 Incomplete abortion complicated by prolonged or excessive bleeding
With conditions classified under subheading O08.1

2 Incomplete abortion complicated by embolism
With conditions classified under subheading O08.2

3 Incomplete abortion with other and unspecified complications
O08.3-O08.9

4 Incomplete abortion without complications

5 Complete or unspecified abortion complicated by infection of the genital tract and pelvic organs
With conditions classified under subheading O08.0

6 Complete or unspecified abortion complicated by prolonged or excessive bleeding
With conditions classified under subheading O08.1

7 Complete or unspecified abortion complicated by embolism
With conditions classified under subheading O08.2

8 Complete or unspecified abortion with other or unspecified complications
With conditions classified in subcategories O08.3-O08.9

9 Complete or unspecified abortion without complications

O03 Spontaneous abortion

O04 Medical abortion

O05 Other types of abortion

O06 Abortion, unspecified

O07 Failed abortion attempt

Includes: unsuccessful attempted induced abortion
Excluded: incomplete abortion ( O03-O06)

O07.0 Failed medical abortion complicated by infection of the genital tract and pelvic organs
With conditions classified under subheading O08.0
O07.1 Failed medical abortion complicated by prolonged or excessive bleeding
With conditions classified under subheading O08.1
O07.2 Failed medical abortion complicated by embolism
With conditions classified under subheading O08.2
O07.3 Failed medical abortion with other and unspecified complications
With conditions classified in subheadings
O08.3-O08.9
O07.4 Unsuccessful medical abortion without complications. Failed medical abortion NOS
O07.5 Other and unspecified failed abortion attempts complicated by infection of the genital tract and pelvic organs
With conditions classified under subheading O08.0
O07.6 Other and unspecified failed abortion attempts complicated by prolonged or excessive bleeding
With conditions classified under subheading O08.1
O07.7 Other and unspecified failed abortion attempts complicated by embolism
With conditions classified under subheading O08.2
O07.8 Other and unspecified failed abortion attempts with other and unspecified complications
With conditions classified in subheadings O08.3-O08.9
O07.9 Other and unspecified failed abortion attempts without complications. Failed abortion NOS

O08 Complications due to abortion, ectopic or molar pregnancy

Note This code is intended primarily for morbidity coding When using this rubric, the morbidity coding rules and guidelines given in v2 should be followed.

O08.0 Infection of genital tract and pelvic organs due to abortion, ectopic and molar pregnancy

endometritis)
oophoritis)
parametrite)
Pelvic peritonitis) as a consequence of conditions,
Salpingitis ) classified in headings
Salpingoophoritis) O00-O07
sepsis)
septic shock)
septicemia)
Excludes: septic or septicopyemic embolism ( O08.2)
urinary tract infection ( O08.8)
O08.1 Prolonged or massive bleeding caused by abortion, ectopic and molar pregnancy
Afibrinogenemia) as a result of conditions,
Defibrination syndrome) classified
Intravascular coagulation ) in rubrics O00-O07
O08.2 Embolism caused by abortion, ectopic and molar pregnancy
Embolism:
NOS )
air)
amniotic fluid)
blood clot) as a result of conditions,
pulmonary) classified
pyemic) in rubrics O00-O07
septic or septic-)
pyemic)
from detergents)
O08.3 Shock caused by abortion, ectopic and molar pregnancy
Vascular collapse) as a result of conditions,
) classified
Shock (postoperative) ) ​​in rubrics O00-O07
Excludes: septic shock ( O08.0)
O08.4 Renal failure due to abortion, ectopic and molar pregnancy
Oliguria)
Renal(th)(th): )
insufficiency (acute) as a result of conditions,
cessation of function [anuria] ) classified
tubular necrosis ) under rubrics O00-O07
uremia)
O08.5 Metabolic disorders caused by abortion, ectopic and molar pregnancy
Violations of the water-salt balance as a consequence of the conditions classified in rubrics O00-O07
O08.6 Damage to the pelvic organs and tissues caused by abortion, ectopic and molar pregnancy
Rupture, perforation, tear or chemical damage:
Bladder )
intestines)
broad ligament of the uterus) as a result of conditions,
cervix) classified
periurethral tissue) under headings O00-O07
uterus)
O08.7 Other venous complications due to abortion, ectopic and molar pregnancy
O08.8 Other complications caused by abortion, ectopic and molar pregnancy
Cardiac arrest) as a result of conditions,
) classified
Urinary tract infection ) in rubrics O00-O07
O08.9 Complication due to abortion, ectopic and molar pregnancy, unspecified
Unspecified complication as a consequence of conditions classified under headings O00-O07

EDEMAS, PROTEINURIA AND HYPERTENSIVE DISORDERS DURING
PREGNANCY, CHILD AND POSTPARTUM (O10-O16)

O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium

Inclusions: listed conditions with prior proteinuria
Excludes: conditions with increasing or associated proteinuria ( O11)

O10.0 Pre-existing essential hypertension complicating pregnancy, childbirth, and the puerperium
I10, specified as reason for obstetric care
during pregnancy, childbirth and the postpartum period
O10.1 Pre-existing cardiovascular hypertension complicating pregnancy, childbirth, and the puerperium
Any condition classified under rubric I11
during pregnancy, childbirth and the postpartum period
O10.2 Pre-existing renal hypertension complicating pregnancy, childbirth, and the puerperium
Any condition classified under rubric I12— , specified as reason for obstetric care
during pregnancy, childbirth and the postpartum period
O10.3 Pre-existing cardiovascular and renal hypertension complicating pregnancy, childbirth, and the puerperium
period. Any condition classified under rubric I13— , specified as reason for obstetric care
during pregnancy, childbirth and the postpartum period
O10.4 Pre-existing secondary hypertension complicating pregnancy, childbirth, and the puerperium
Any condition classified under rubric I15— , specified as reason for obstetric care
during pregnancy, childbirth and the postpartum period
O10.9 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium, unspecified

O11 Preexisting hypertension with associated proteinuria

O10- complicated by increasing proteinuria
Associated preeclampsia

O12 Pregnancy-induced edema and proteinuria without hypertension

O12.0 swelling caused by pregnancy
O12.1 Pregnancy-induced proteinuria
O12.2 Pregnancy-induced edema with proteinuria

O13 Pregnancy-induced hypertension without significant proteinuria

Pregnancy-induced hypertension NOS
Mild preeclampsia [mild nephropathy]

O14 Pregnancy-induced hypertension with significant proteinuria

Excludes: associated preeclampsia ( O11)

O14.0 Preeclampsia [nephropathy] of moderate severity
O14.1 Severe preeclampsia
O14.9 Preeclampsia [nephropathy], unspecified

O15 Eclampsia

Includes: convulsions due to conditions classified under rubrics O10-O14 And O16

O15.0 Eclampsia during pregnancy
O15.1 Eclampsia in childbirth
O15.2 Eclampsia in the postpartum period
O15.9 Eclampsia, unspecified date. Eclampsia NOS

O16 Maternal hypertension, unspecified

Transient hypertension during pregnancy

OTHER MOTHERAL DISEASES ASSOCIATED PREFERENTIALLY WITH PREGNANCY (O20-O29)

Excludes: medical care of the mother in connection with the condition of the fetus, amniotic cavity and possible difficulties
delivery ( O30-O48)
maternal diseases classified elsewhere but complicating pregnancy, childbirth and the puerperium
period ( O98-O99)

O20 Bleeding in early pregnancy

Excludes: pregnancy with abortive outcome ( O00-O08)

O20.0 Threatened abortion. Bleeding specified as a manifestation of threatened abortion
O20.8 Other bleeding in early pregnancy
O20.9 Bleeding in early pregnancy, unspecified

O21 Excessive vomiting of pregnancy

O21.0 Mild or moderate vomiting during pregnancy
Vomiting of pregnancy, mild or unspecified, beginning before 22 completed weeks of gestation
O21.1 Excessive or severe vomiting of pregnant women with metabolic disorders
Excessive [severe] vomiting of pregnancy beginning before 22 completed weeks of pregnancy, with metabolic disorders such as:
depletion of carbohydrate stores
dehydration
violation of water-salt balance
O21.2 Late pregnancy vomiting. Excessive vomiting starting after 22 completed weeks of pregnancy
O21.8 Other forms of vomiting complicating pregnancy
Vomiting complicating pregnancy due to diseases classified elsewhere
Use an additional code if necessary to identify the cause.
O21.9 Vomiting of pregnancy, unspecified

O22 Venous complications during pregnancy

Excludes: obstetric pulmonary embolism ( O88. -)
the listed conditions as a complication:
O00 -O07 , O08.7 )
childbirth and the postpartum period O87. -)

O22.0 Varicose veins of the lower extremities during pregnancy
Varicose veins during pregnancy NOS
O22.1 Varicose veins of the genital organs during
pregnancy
perineum)
Vagina) varicose veins during pregnancy
vulva)
O22.2 Superficial thrombophlebitis during pregnancy. Thrombophlebitis of the lower extremities during pregnancy
O22.3 Deep phlebothrombosis during pregnancy. Deep vein thrombosis prenatal
O22.4 hemorrhoids during pregnancy
O22.5 Thrombosis of cerebral veins during pregnancy. Thrombosis of the cerebrovenous sinus during pregnancy
O22.8 Other venous complications during pregnancy
O22.9 Venous complication during pregnancy, unspecified
Gestational(s):
phlebitis NOS
phlebopathy NOS
thrombosis NOS

O23 Urinary tract infection in pregnancy

O23.0 kidney infection during pregnancy
O23.1 Bladder infection during pregnancy
O23.2 Urethral infection during pregnancy
O23.3 Infection of other parts of the urinary tract during pregnancy
O23.4 Urinary tract infection in pregnancy, unspecified
O23.5 Genital tract infection during pregnancy
O23.9 Other and unspecified urinary tract infection in pregnancy
Urinary tract infection during pregnancy NOS

O24 Diabetes mellitus in pregnancy

Included: during childbirth and in the postpartum period

O24.0 Pre-existing insulin-dependent diabetes mellitus
O24.1 Pre-existing non-insulin-dependent diabetes mellitus
O24.2 Pre-existing diabetes mellitus associated with malnutrition
O24.3 Pre-existing diabetes mellitus, unspecified
O24.4 Diabetes mellitus that developed during pregnancy. Gestational diabetes mellitus NOS
O24.9 Diabetes mellitus during pregnancy, unspecified

O25 Malnutrition in pregnancy

Malnutrition during delivery and postpartum
period

O26 Maternal care for other conditions predominantly related to pregnancy

O26.0 Excessive weight gain during pregnancy
Excludes: pregnancy-induced edema ( O12.0, O12.2)
O26.1 Insufficient weight gain during pregnancy
O26.2 Medical care for a woman with recurrent miscarriage
Excludes: habitual miscarriage:
with current abortion O03-O06)
no current pregnancy N96)
O26.3 Remaining intrauterine contraceptive during pregnancy
O26.4 Herpes pregnant
O26.5 Hypotensive syndrome in the mother. Hypotensive syndrome in the supine position
O26.6 Liver damage during pregnancy, childbirth and the postpartum period
Excludes: hepatic-renal syndrome due to childbirth ( O90.4)
O26.7 Subluxation of the pubic symphysis during pregnancy, childbirth and in the postpartum period
Excludes: traumatic separation of the pubic symphysis during delivery ( O71.6)
O26.8 Other specified conditions associated with pregnancy
exhaustion and fatigue)
Peripheral neuritis) associated with pregnancy
kidney disease)
O26.9 Pregnancy-related condition, unspecified

O28 Maternal antenatal examination abnormal

Excludes: results of diagnostic tests classified elsewhere

medical care for the mother in connection with the condition of the fetus, the amniotic cavity and possible difficulties in delivery ( O30-O48)

O28.0 Hematological abnormalities detected during antenatal examination of the mother
O28.1 Biochemical abnormalities detected during antenatal examination of the mother
O28.2 Cytological changes detected during antenatal examination of the mother
O28.3 Pathological changes revealed during ultrasound antenatal examination of the mother
O28.4 Pathological changes detected during antenatal X-ray examination of the mother
O28.5 Chromosomal or genetic abnormalities detected during antenatal examination of the mother
O28.8 Other abnormalities detected during antenatal examination of the mother
O28.9 Deviation from the norm, revealed during antenatal examination of the mother, unspecified

O29 Complications associated with anesthesia during pregnancy

Includes: maternal complications from general or local anesthesia, pain medication, or
sedatives during pregnancy
Excludes: anesthesia related complications during:
abortion, ectopic or molar pregnancy ( O00-O08)
labor and delivery ( O74. -)
postpartum period ( O89. -)

O29.0 Pulmonary complications of anesthesia during pregnancy
aspiration pneumonitis)
or gastric juice) due to anesthesia
Mendelssohn's syndrome) during pregnancy
pressor collapse of the lung)
O29.1 Cardiac complications of anesthesia during pregnancy
Heart failure) during pregnancy
O29.2 Complications from the central nervous system due to anesthesia during pregnancy
Cerebral anoxia due to anesthesia during pregnancy
O29.3 Toxic reaction to local anesthesia during pregnancy
O29.4 Headaches caused by the use of spinal or epidural anesthesia during pregnancy
O29.5 Other complications of spinal or epidural anesthesia during pregnancy
O29.6 Failure or difficulty in intubation during pregnancy
O29.8 Other complications of anesthesia during pregnancy
O29.9 Complication of anesthesia during pregnancy, unspecified

MEDICAL ASSISTANCE FOR THE MOTHER IN CONNECTION WITH THE STATE OF THE FETUS,
AMNIOTIC CAVITY AND POSSIBLE DELIVERY DIFFICULTIES (O30-O48)

O30 Multiple pregnancy

Excludes: complications specific to multiple pregnancy ( O31. -)

O30.0 twin pregnancy
O30.1 triplets pregnancy
O30.2 Pregnancy with four fetuses
O30.8 Other forms of multiple pregnancy
O30.9 Multiple pregnancy, unspecified. Multiple pregnancy NOS

O31 Complications specific to multiple pregnancy

Excludes: conjoined twins resulting in disproportionate size of the pelvis and fetus ( O33.7)
delay in the birth of a subsequent child from twins, triplets, etc. ( O63.2)
malpresentation of one or more than one fetus ( O32.5)
with difficult childbirth O64-O66)
O31.0 paper fruit. Fetus compressus
O31.1 Continuing pregnancy after abortion of one or more fetuses
O31.2 Continuing pregnancy after intrauterine death of one or more fetuses
O31.8 Other Complications Specific to Multiple Pregnancy

O32 Maternal care for known or suspected malpresentation

O64. -)

O32.0 Fetal instability requiring maternal medical attention
O32.1 Breech presentation of the fetus requiring maternal medical attention
O32.2 Transverse or oblique position of the fetus, requiring the provision of medical care to the mother
Presentation:
oblique
transverse
O32.3 Facial, frontal, or chin presentation of the fetus requiring maternal medical attention
O32.4 High standing of the head towards the end of pregnancy, requiring the provision of medical care to the mother
Not inserting the head
O32.5 Multiple pregnancy with malpresentation of one or more fetuses requiring medical attention of the mother
O32.6 Combined fetal presentation requiring maternal medical attention
O32.8 Other forms of malpresentation requiring maternal medical attention
O32.9 Malpresentation of fetus requiring maternal medical attention, unspecified

O33 Maternal care for reported or suspected mismatch between pelvis and fetus

Includes: conditions warranting observation, hospitalization or other obstetric care for the mother,
as well as for caesarean section before the onset of labor
Excludes: listed conditions with obstructed labor ( O65-O66)

O33.0 Deformation of the pelvic bones, leading to an imbalance that requires the provision of medical care to the mother
Pelvic deformity causing disproportion, NOS
O33.1 Uniformly constricted pelvis leading to disproportion requiring maternal medical attention
Constricted pelvis causing disproportion, NOS
O33.2 Constriction of the pelvic inlet leading to an imbalance requiring medical attention to the mother
Narrowing of the inlet (pelvis), causing disproportion
O33.3 Narrowing of the pelvic outlet leading to an imbalance requiring medical attention for the mother
Tapering in the average diameter) causing the discrepancy
Narrowing of the outlet - the size of the pelvis and fetus
O33.4 Disproportion of mixed maternal and fetal origin, requiring the provision of medical care to the mother
O33.5 Large fetal size leading to disproportion requiring medical care for the mother
Disproportion of fetal origin with a normally formed fetus. Fetal imbalance NOS
O33.6 Fetal hydrocephalus leading to disproportion requiring maternal medical attention
O33.7 Other fetal anomalies resulting in disproportion requiring maternal care
conjoined twins)
fruit:)
ascites)
dropsy) leading to disproportion
myelomeningocele)
sacral teratoma)
tumor)
O33.8 Disproportion due to other causes, requiring the provision of medical care to the mother
O33.9 Disproportion requiring maternal care, unspecified
Cephalopelviodisproportion NOS. Fetopelviodisproportion NOS

O34 Maternal care for known or suspected pelvic malformation

Includes: conditions warranting observation, hospitalization or other obstetric care for the mother,
as well as for caesarean section before the onset of labor
Excludes: listed conditions with obstructed labor ( O65.5)

O34.0 Congenital uterine anomalies requiring maternal medical attention
double uterus
bicornuate uterus
O34.1 Tumor of the body of the uterus, requiring the provision of medical care to the mother
Maternal care for:
uterine body polyp
uterine fibroid
Excludes: maternal care for cervical tumor ( O34.4)
O34.2 Postoperative uterine scar requiring maternal medical care
Medical care of the mother with a scar from a previous caesarean section
Excludes: vaginal delivery after previous caesarean section NOS ( O75.7)
O34.3 Isthmic-cervical insufficiency requiring maternal medical care
Closure of the neck with a circular suture (with mention of cervical insufficiency)
Seam on Shirodkar) or without it
O34.4 Other cervical anomalies requiring maternal medical attention
Maternal care for:
cervical polyp
previous cervical surgery
stricture and stenosis of the cervix
cervical tumors
O34.5 Other abnormalities of the pregnant uterus requiring maternal medical attention
Providing medical care to the mother in case of:
infringement)
prolapse) of the pregnant uterus
retroversion)
O34.6 Vaginal anomalies requiring maternal medical attention
Maternal care for:
prior vaginal surgery
dense hymen
vaginal septum
vaginal stenosis (acquired) (congenital)
vaginal stricture
vaginal tumors
Excludes: maternal care for vaginal varicose veins during pregnancy ( O22.1)
O34.7 Anomalies of the vulva and perineum requiring maternal medical attention
Maternal care for:
perineal fibrosis
previous surgery on the perineum and vulva
rigid perineum
vulvar tumors
Excludes: maternal care for perineal and vulvar varicose veins during pregnancy O22.1)

O34.8 Other specified pelvic malformations requiring maternal medical care
Maternal care for:
cystocele
pelvic floor plasty (and history)
saggy belly
rectocele
rigid pelvic floor
O34.9 Pelvic organ anomaly requiring maternal medical attention, unspecified

O35 Maternal care for known or suspected fetal abnormalities and injuries

Inclusions: conditions leading to observation, hospitalization and other obstetric care of the mother or
to terminate a pregnancy
Excludes: medical assistance to the mother in case of established or suspected discrepancy between the size of the pelvis and
fetus ( O33. -)

O35.0 Malformations of the central nervous system in the fetus, requiring the provision of medical care to the mother
Maternal care for:
anencephaly
spina bifida
O35.1)
O35.1 Chromosomal abnormalities in the fetus (suspected) requiring maternal medical attention
O35.2 Hereditary diseases in the fetus (suspected), requiring the provision of medical care to the mother
Excludes: fetal chromosomal abnormalities ( O35.1)
O35.3 Damage to the fetus (suspected) as a result of a viral illness of the mother, requiring the provision of medical care to the mother. Maternal care for (suspected) injury
fetus in connection with the transferred by her:
cytomegalovirus infection
rubella
O35.4 Fetal injury (suspected) due to alcohol exposure requiring maternal medical attention
O35.5 Injury to the fetus (suspected) as a result of the use of drugs, requiring the provision of medical care to the mother. Maternal care for (suspected) fetal injury due to maternal drug abuse
Excludes: drug-related fetal distress at delivery ( O68. -)
O35.6 Injury to the fetus (suspected) due to radiation requiring maternal medical attention
O35.7 Damage to the fetus (suspected) as a result of other medical procedures, requiring the provision of medical care to the mother. Maternal care for (suspected) injury
fetus as a result:
amniocentesis
biopsy
hematological research
use of an intrauterine contraceptive
intrauterine operation
O35.8 Other fetal anomalies and lesions (suspected) requiring maternal medical attention
Maternal care for (suspected) injury
fetus in connection with the transferred by her:
listeriosis
toxoplasmosis
O35.9 Anomaly and impairment of the fetus requiring maternal medical attention, unspecified

O36 Maternal care for other known or suspected fetal conditions

Includes: fetal conditions warranting observation, hospitalization and other obstetric care of the mother or termination of pregnancy
Excludes: childbirth and delivery complicated by fetal stress (distress) ( O68. -)
placental transfusion syndrome O43.0)

O36.0 Rh immunization requiring maternal medical care
Anti-D antibodies. Rh incompatibility (with fetal dropsy)
O36.1 Other forms of isoimmunization requiring maternal care
AB0-isoimmunization. Isoimmunization NOS (with fetal hydrops)
O36.2 Hydrops fetalis requiring maternal medical attention
Dropsy fetus:
NOS
not related to isoimmunization
O36.3 Signs of intrauterine fetal hypoxia requiring medical care for the mother
O36.4 Intrauterine fetal death requiring maternal medical care
Excluded: missed miscarriage ( O02.1)
O36.5 Insufficient fetal growth requiring maternal medical attention
Maternal care for known or suspected conditions:
« small for the time"
placental insufficiency
« undersized for term"
O36.6 Excessive fetal growth requiring maternal medical attention
Maternal care for known or suspected condition: "major for term"
O36.7 Viable fetus in abdominal pregnancy requiring maternal medical care
O36.8 Other specified abnormalities in the condition of the fetus, requiring the provision of medical care to the mother
O36.9 Deviation in fetal condition requiring maternal medical attention, unspecified

O40 Polyhydramnios

hydramnios

O41 Other disorders of amniotic fluid and membranes

Excludes: premature rupture of membranes ( O42. -)

O41.0 Oligohydramnios. Oligohydramnios without mention of ruptured membranes
O41.1 Infection of the amniotic cavity and fetal membranes. Amnionitis. Chorioamnionitis. Membranit. Placentitis
O41.8 Other specified disorders of amniotic fluid and membranes
O41.9 Disturbance of amniotic fluid and membranes, unspecified

O42 Premature rupture of membranes

O42.0 Premature rupture of membranes, onset of labor within the next 24 hours
O42.1 Premature rupture of membranes, onset of labor after a 24-hour anhydrous period
Excludes: with therapy-related delayed labor ( O42.2)
O42.2 Premature rupture of membranes, delayed labor associated with ongoing therapy
O42.9 Premature rupture of membranes, unspecified

O43 Placental disorders

Excludes: maternal care for poor fetal growth due to placental insufficiency ( O36.5)
placenta previa ( O44. -)
O45. -)

O43.0 Syndromes of placental transfusion
Transfusion:
fetal-maternal
maternal-fetal
twin
O43.1 Anomaly of the placenta. Pathology of the placenta NOS. Rolled placenta
O43.8 Other placental disorders
Placenta:
dysfunction
heart attack
O43.9 Placental disorder, unspecified

O44 Placenta previa

O44.0 Placenta previa, specified as without bleeding
Low implantation of the placenta, specified as no bleeding
O44.1 Placenta previa with bleeding. Low insertion of placenta NOS or with bleeding
Placenta previa:
edge)
partial) NOS or with bleeding
complete)
Excludes: childbirth and delivery complicated by bleeding from presenting vessels ( O69.4)

O45 Premature placental abruption [abruptio placentae]

O45.0 Premature placental abruption with bleeding disorders
Separation of the placenta with (heavy) bleeding due to:
afibrinogenemia

hyperfibrinolysis
hypofibrinogenemia
O45.8 Other placental abruption
O45.9 Placental abruption, unspecified Separation of placenta NOS

O46 Antenatal haemorrhage, not elsewhere classified

Excludes: bleeding in early pregnancy ( O20. -)
bleeding during childbirth NKDF ( O67. -)
placenta previa ( O44. -)
premature detachment of the placenta [abruptio placentae] ( O45. -)

O46.0 Prenatal hemorrhage with clotting disorder
Prenatal (heavy) bleeding associated with:
afibrinogenemia
disseminated intravascular coagulation
hyperfibrinolysis
hypofibrinogenemia
O46.8 Other prenatal bleeding
O46.9 Prenatal haemorrhage, unspecified

O47 False contractions

O47.0 False contractions before 37 completed weeks of pregnancy
O47.1 False contractions from 37 completed weeks of pregnancy
O47.9 False contractions, unspecified

O48 ​​Postterm pregnancy

Continuing after the calculated (estimated) due date
Continuing beyond normal pregnancy

COMPLICATIONS OF LABOR AND DELIVERY (O60-O75)

O60 Premature birth

Onset of labor (spontaneous) before 37 completed weeks of pregnancy

O61 Failed attempt to induce labor

O61.0 Unsuccessful attempt to induce labor with medication
means:
oxytocin
prostaglandins
O61.1 Unsuccessful attempt to stimulate labor with instrumental
methods:
mechanical
surgical
O61.8 Other types of unsuccessful attempt to induce labor
O61.9 Failed attempt to induce labor, unspecified

O62 Violations of labor activity [patrimonial forces]

O62.0 Primary weakness of labor activity. No progressive dilatation of the cervix
Primary hypotonic uterine dysfunction
O62.1 Secondary weakness of labor activity. Termination of contractions in the active phase of labor
Secondary hypotonic uterine dysfunction
O62.2 Other types of weakness of labor activity. Uterine atony. Random fights. Hypotonic uterine dysfunction NOS. Irregular contractions. Weak contractions. Weakness of labor NOS
O62.3 Rapid delivery
O62.4 Hypertensive, uncoordinated and prolonged uterine contractions
Contraction ring, dystocia. Discoordinated labor activity. Contraction of the uterus in the form of an hourglass
Hypertonic dysfunction of the uterus. Uncoordinated activity of the uterus. Tetanic contractions
Uterine dystocia NOS
Excludes: dystocia [difficult labor] (of fetal origin), (maternal origin) NOS ( O66.9)
O62.8 Other violations of labor activity
O62.9 Violation of labor activity, unspecified

O63 Prolonged labor

O63.0 Protracted first stage of labor
O63.1 Prolonged second stage of labor
O63.2 Delayed birth of the second fetus from twins, triplets, etc.
O63.9 Prolonged labor, unspecified. Prolonged labor NOS

O64 Difficulty in labor due to fetal position or presentation

O64.0 Difficulty in labor due to incomplete rotation of the fetal head
Deep [low] lateral position of the head
Difficulty in labor due to stable (position):
occipitoiliac
occipitoposterior
occipitosacral
occipitotransverse
O64.1 Difficulty in labor due to breech presentation
O64.2 Difficulty giving birth due to facial presentation. Difficulty in labor due to chin presentation
O64.3 Difficulty in labor due to frontal presentation
O64.4 Difficult delivery due to shoulder presentation. Handle falling out
Excludes: driven shoulder ( O66.0)
dystocia due to shoulder presentation O66.0)
O64.5 Difficulty in labor due to combined presentation
O64.8 Difficulty in labor due to other abnormal position and presentation of the fetus
O64.9 Difficulty in labor due to malposition and presentation of unspecified fetus

O65 Obstructed labor due to maternal pelvic abnormality

O65.0 Difficulty in childbirth due to pelvic deformity
O65.1 Difficulty in childbirth due to evenly narrowed pelvis
O65.2 Difficulty in childbirth due to narrowing of the pelvic inlet
O65.3 Difficulty in childbirth due to narrowing of the outlet and the average diameter of the pelvis
O65.4 Obstructed labor due to size mismatch between pelvis and fetus, unspecified
Excludes: dystocia due to fetal abnormality ( O66.2-O66.3)
O65.5 Difficulty in childbirth due to abnormalities of the pelvic organs in the mother
Obstructed labor due to the conditions listed in the rubric O34. O65.8 Difficulty in labor due to other maternal pelvic abnormalities
O65.9 Obstructed labor due to maternal pelvic anomaly, unspecified

O66 Other types of obstructed labor

O66.0 Difficult labor [dystocia] due to shoulder presentation. Impacted shoulder
O66.1 Difficulty in childbirth due to coupling [collision] of twins
O66.2 Difficulty in labor due to an unusually large fetus
O66.3 Difficulty in labor due to other fetal abnormalities
Dystocia due to:
fusion of twins
presence in the fetus:
ascites
dropsy
meningomyelocele
sacral teratoma
tumors
fetal hydrocephalus
O66.4 Unsuccessful attempt to induce labor, unspecified. Failed attempt to induce labor followed by caesarean section
O66.5 Unsuccessful attempt with vacuum extractor and forceps, unspecified
Failed vacuum or forceps delivery followed by forceps delivery or caesarean section, respectively
O66.8 Other specified types of obstructed labor
O66.9 Obstructed labor, unspecified
Dystocia:
NOS
fetal origin NOS
maternal origin NOS

O67 Labor and delivery complicated by bleeding during labor, not elsewhere classified

Excludes: antenatal hemorrhage NKDF ( O46. -)
placenta previa ( O44. -)
postpartum hemorrhage O72. -)
premature detachment of the placenta [abruptio placentae] ( O45. -)

O67.0 Bleeding during childbirth with a bleeding disorder
Bleeding (heavy) during childbirth caused by:
afibrinogenemia
disseminated intravascular coagulation
hyperfibrinolysis
hypofibrinogenemia
O67.8 Other bleeding during childbirth. Severe bleeding during childbirth
O67.9 Bleeding during childbirth, unspecified

O68 Labor and delivery complicated by fetal stress [distress]

Includes: fetal distress during labor or delivery due to drug administration

O68.0 Childbirth complicated by changes in fetal heart rate
bradycardia)
Rhythm disturbance) in the fetus
tachycardia)
Excludes: with the release of meconium into the amniotic fluid ( O68.2)
O68.1 Childbirth complicated by the release of meconium into the amniotic fluid
Excludes: in combination with changes in fetal heart rate ( O68.2)
O68.2 Childbirth complicated by changes in the fetal heart rate with the release of meconium into the amniotic
liquid
O68.3 Childbirth complicated by the appearance of biochemical signs of fetal stress
acidemia)
Violation of acid-base balance) in the fetus
O68.8 Childbirth complicated by the appearance of other signs of fetal stress
Signs of fetal distress:
electrocardiographic
ultrasonic
O68.9 Childbirth complicated by fetal stress, unspecified

O69 Childbirth and delivery complicated by pathological condition of the umbilical cord

O69.0 Childbirth complicated by prolapse of the umbilical cord
O69.1 Childbirth complicated by entanglement of the umbilical cord around the neck with compression
O69.2 Childbirth, complicated by entanglement of the umbilical cord. Entanglement of the umbilical cord of twins in one amniotic sac
umbilical cord knot
O69.3 Childbirth complicated by a short umbilical cord
O69.4 Childbirth, complicated by the presentation of the vessel. Bleeding from a presenting vessel
O69.5 Childbirth, complicated by damage to the vessels of the umbilical cord. Umbilical cord injury. Umbilical cord hematoma
Thrombosis of the vessels of the umbilical cord
O69.8 Childbirth complicated by other pathological conditions of the umbilical cord
O69.9 Childbirth complicated by pathological condition of the umbilical cord, unspecified

O70 Tearing of the perineum during delivery

Includes: episiotomy continued by rupture
Excludes: obstetric rupture of upper vagina only ( O71.4)

O70.0 First-degree perineal tear during delivery
Perineal rupture (involving):
posterior commissure of the labia)
labia)
skin)
superficial) during delivery
vagina)
vulva)
O70.1 Second-degree perineal tear during delivery
O70.0 but exciting also:
pelvic floor)
perineal muscles) during delivery
vaginal muscles)
Excludes: with anal sphincter involvement ( O70.2)
O70.2 Third-degree perineal tear during delivery
Perineal tear similar to that classified in subheading O70.1 but exciting also:
anal sphincter)
rectovaginal septum) in the process
sphincter NOS) delivery
Excludes: involving the mucous membrane of the anus or rectum ( O70.3)
O70.3 Fourth degree perineal tear during delivery
Perineal tear similar to that classified in subheading O70.2 but exciting also:
mucous membrane of the anus) in the process
mucous membrane of the rectum) delivery
O70.3 Perineal tear during delivery, unspecified

O71 Other obstetric injuries

Inclusions: tool damage

O71.0 Uterine rupture prior to labor
O71.1 Rupture of the uterus during childbirth. Uterine rupture not listed as having developed prior to labor
O71.2 Postpartum uterine inversion
O71.3 Obstetric rupture of the cervix. Circular dissection of the cervix
O71.4 Obstetric rupture of only the upper part of the vagina. Rupture of the vaginal wall without mention of a rupture
perineum
Excluded: with crotch rupture ( O70. -)
O71.5 Other obstetric pelvic injuries
Obstetric trauma:
Bladder
urethra
O71.6 Obstetric injuries of the pelvic joints and ligaments
Avulsion of the internal cartilage of the symphysis)
coccyx injury)
Traumatic discrepancy obstetric
pubic joint)
O71.7 Obstetric pelvic hematoma
Obstetric hematoma:
perineum
vagina
vulva
O71.8 Other specified obstetric injuries
O71.9 Obstetric trauma, unspecified

O72 Postpartum haemorrhage

Inclusions: haemorrhage after delivery of a fetus or child

O72.0 Bleeding in the third stage of labor. Bleeding associated with retention, accretion, or strangulation of the placenta
Retained placenta NOS
O72.1 Other bleeding in the early postpartum period
Bleeding after delivery of the placenta. Postpartum haemorrhage (atonic) NOS
O72.2 Late or secondary postpartum hemorrhage
Bleeding associated with retained parts of the placenta or membranes
Retention of parts of gestational sac [products of conception] NOS after delivery
O72.3 Postpartum(oh):
afibrinogenemia
fibrinolysis

O73 Retained placenta and membranes without bleeding

O73.0 Retention of the placenta without bleeding. Placenta accreta without bleeding
O73.1 Retention of parts of the placenta or membranes without bleeding
Retention of parts of the fetal egg after delivery without bleeding

O74 Complications associated with anesthesia during labor and delivery

Includes: maternal complications due to the use of general or local anesthetics, painkillers or
other sedatives during labor and delivery

O74.0 Aspiration pneumonitis due to anesthesia during labor and delivery
Aspiration of stomach contents) due to anesthesia
or gastric juice NOS) during childbirth and
Mendelssohn's syndrome) delivery
O74.1 Other pulmonary complications due to anesthesia during labor and delivery
Pressor collapse of the lung due to anesthesia during labor and delivery
O74.2 Cardiac complications due to anesthesia during labor and delivery
Cardiac arrest) due to anesthesia during
Heart failure) childbirth and delivery
O74.3 Complications from the side of the central nervous system due to anesthesia during labor and delivery
Cerebral anoxia due to anesthesia during childbirth
O74.4 Toxic reaction to local anesthesia during labor and delivery
O74.5 Headaches associated with spinal and epidural anesthesia during labor and delivery
O74.6 Other complications of spinal and epidural anesthesia during labor and delivery
O74.7 Failed attempt or difficulty with intubation during labor and delivery
O74.8 Other complications of anesthesia during labor and delivery
O74.9 Complication of anesthesia during labor and delivery, unspecified

O75 Other complications of labor and delivery, not elsewhere classified

Excludes: postpartum(s):
infection ( O86. -)
sepsis ( O85)

O75.0 Maternal distress during labor and delivery
O75.1 Maternal shock during or after labor and delivery. obstetric shock
O75.2 Hyperthermia during childbirth, not elsewhere classified
O75.3 Other infections during childbirth. Septicemia during childbirth
O75.4 Other complications caused by obstetric surgery and other procedures
cardiac arrest) after a caesarean section or
Heart failure) other obstetric surgeries
Cerebral anoxia) and procedures, including rodo resolution NOS
Excludes: complications of anesthesia during childbirth ( O74. -)
obstetric (surgical) wound:
divergence of seams ( O90.0-O90.1)
hematoma ( O90.2)
infection ( O86.0)
O75.5 Delayed labor after artificial rupture of membranes
O75.6 Delayed labor after spontaneous or unspecified rupture of membranes
Excludes: spontaneous premature rupture of membranes ( O42. -)
O75.7 Vaginal delivery after previous caesarean section
O75.8 Other specified complications of labor and delivery
O75.9 Complication of childbirth, unspecified

DELIVERY (O80-O84)

Note Codes O80-O84 intended for morbidity coding Codes in this block should be used for primary morbidity coding only if there are no records of other conditions classified in class XV. The use of these rubrics should be guided by the recommendations and rules for coding the incidence set out in v2.

O80 Singleton birth, spontaneous delivery

Includes: cases with minimal or no assistance, with or without episiotomy, normal delivery

O80.0 Spontaneous delivery in the occipital presentation
O80.1 Spontaneous delivery in breech presentation
O80.8 Other spontaneous singleton births
O80.9 Singleton spontaneous delivery, unspecified. Spontaneous delivery NOS

O81 Singleton delivery, delivery with forceps or vacuum extractor

Excludes: unsuccessful attempt to use a vacuum extractor or forceps ( O66.5)

O81.0 Application of low [exit] tongs
O81.1 Application of medium [cavitary] forceps
O81.2 Application of medium [cavitary] forceps with rotation
O81.3 Application of other and unspecified forceps
O81.4 Application of vacuum extractor
O81.5 Delivery with combined use of forceps and vacuum extractor

O82 Singleton delivery, delivery by caesarean section

O82.0 Conducting an elective caesarean section. Repeat caesarean section NOS
O82.1 Performing an emergency caesarean section
O82.2 Cesarean section with hysterectomy
O82.8 Other singleton births by caesarean section
O82.9 Birth by caesarean section, unspecified

O83 Singleton birth, delivery using another obstetric aid

O83.0 Extraction of the fetus by the pelvic end
O83.1 Another obstetric benefit for breech delivery. Birth in breech presentation NOS
O83.2 Childbirth with other obstetric manipulations [manual techniques]. Fruit rotation with extraction
O83.3 Live delivery during abdominal pregnancy
O83.4 Destructive operation during delivery
Cleidotomy)
craniotomy) for relief
Embryotomy) delivery
O83.8 Other specified types of obstetric benefits for singleton births
O83.9 Obstetric allowance for singleton births, unspecified. Childbirth with obstetric assistance NOS

O84 Multiple births

If necessary, to identify the method of delivery by each fetus or child, use an additional code ( O80-O83).

O84.0 Multiple births, completely spontaneous
O84.1 Multiple births, fully using forceps and a vacuum extractor
O84.2 Multiple births, completely by caesarean section
O84.8 Another delivery in multiple births. Combined delivery methods for multiple births
childbirth
O84.9 Multiple births, unspecified

COMPLICATIONS MOSTLY ASSOCIATED WITH THE POSTPARTUM PERIOD (O85-O92)

NoteIn headings O88. — , O91. - And O92. — the conditions listed below are included, even if they occur during pregnancy and childbirth.
Excludes: mental and behavioral disorders,
associated with the postpartum period F53. -)
obstetric tetanus ( A34)
postpartum osteomalacia ( M83.0)

O85 postpartum sepsis
Postpartum(s):
endometritis
fever
peritonitis
septicemia
If it is necessary to identify the infectious agent, use an additional code ( B95-B97).
Excludes: obstetric pyemic and septic embolism ( O88.3)
septicemia during childbirth ( O75.3)

O86 Other puerperal infections

Excludes: infection during childbirth ( O75.3)

O86.0 Surgical obstetric wound infection
Infected:
caesarean section wound)
perineal suture) after childbirth
O86.1 Other genital tract infections after childbirth
cervicitis)
Vaginitis) after childbirth
O86.2 urinary tract infection after childbirth
N10-N12, N15. — ,N30. — , N34. — , N39.0 developed after childbirth
O86.3 Other urinary tract infections after childbirth. Postpartum urinary tract infection NOS
O86.4 Hyperthermia of unknown origin after childbirth
Postpartum:
infection NOS
pyrexia NOS
Excludes: puerperal fever ( O85)
hyperthermia during childbirth ( O75.2)
O86.8 Other specified postpartum infections

O87 Venous complications in the puerperium

Includes: during childbirth, delivery and postpartum
Excludes: obstetric embolism ( O88. -)
venous complications during pregnancy ( O22. -)

O87.0 Superficial thrombophlebitis in the postpartum period
O87.1 Deep phlebothrombosis in the postpartum period. Deep vein thrombosis postpartum
Pelvic thrombophlebitis postpartum
O87.2 Hemorrhoids in the postpartum period
O87.3 Thrombosis of cerebral veins in the postpartum period. Thrombosis of the cerebrovenous sinus in the postpartum period
O87.8 Other venous complications in the postpartum period
Varicose veins of the genital organs in the postpartum period
O87.9 Venous complications in the puerperium, unspecified
Postpartum(s):
phlebitis NOS
phlebopathy NOS
thrombosis NOS

O88 Obstetric embolism

Includes: pulmonary embolism during pregnancy, childbirth or the puerperium
Excludes: embolism complicating abortion, ectopic or molar pregnancy ( O00-O07, O08.2)

O88.0 obstetric air embolism
O88.1 Amniotic fluid embolism
O88.2 Obstetric embolism with blood clots. Obstetric (pulmonary) embolism NOS. Postpartum (pulmonary) embolism NOS
O88.3 Obstetric pyemic and septic embolism
O88.8 Other obstetric embolism. obstetric fat embolism

O89 Complications associated with the use of anesthesia in the postpartum period

Includes: complications in the mother due to the use of general or local anesthesia, painkillers or other sedatives in the postpartum period

O89.0 Pulmonary complications due to the use of anesthesia in the postpartum period
aspiration pneumonitis)
aspiration of stomach contents)
or gastric juice NOS) due to anesthesia
Mendelssohn's syndrome) in the postpartum period
pressor collapse of the lung)
O89.1 Cardiac complications due to the use of anesthesia in the postpartum period
Cardiac arrest) due to anesthesia
Heart failure) in the postpartum period
O89.2 Complications from the central nervous system due to the use of anesthesia in the postpartum period
Cerebral anoxia due to anesthesia in the postpartum period
O89.3 Toxic reaction to local anesthesia in the postpartum period
O89.4 Headaches associated with spinal and epidural anesthesia in the postpartum period
O89.5 Other complications of spinal and epidural anesthesia in the postpartum period
O89.6 Failed attempt or difficulty with intubation in the postpartum period
O89.8 Other complications of anesthesia in the postpartum period
O89.9 Complication of anesthesia in the postpartum period, unspecified

O90 Complications in the puerperium, not elsewhere classified

O90.0 Divergence of seams after caesarean section
O90.1 Divergence of the sutures of the perineum
Seam separation after:
episiotomy
perineal rupture suturing
Secondary perineal tear
O90.2 Hematoma of an obstetric surgical wound
O90.3 Cardiomyopathy in the postpartum period
Conditions classified under rubric I42. - complicating the postpartum period
O90.4 Postpartum acute renal failure. Hepatorenal syndrome accompanying childbirth
O90.5 Postpartum thyroiditis
O90.8 Other complications of the puerperium, not elsewhere classified. placental polyp
O90.9 Complication of the postpartum period, unspecified

O91 Breast infections associated with childbearing

Includes: listed conditions during pregnancy, puerperium, or lactation

O91.0 Nipple infections associated with childbearing
Nipple abscess:
during pregnancy
in the postpartum period
O91.1 Breast abscess associated with childbearing
breast abscess)
Purulent mastitis) gestational or
Subareolar abscess) postpartum
O91.2 Non-suppurative mastitis associated with childbearing
Lymphangitis of the mammary gland
Mastitis:
NOS )
interstitial) gestational or
parenchymal) postpartum

O92 Other breast changes and lactation disorders associated with childbearing

Includes: listed conditions during pregnancy, puerperium or lactation

O92.0 inverted nipple
O92.1 Fissure of the nipple associated with childbearing. Nipple fissure during pregnancy or postpartum
O92.2 Other and unspecified breast changes associated with childbearing
O92.3 Agalactia. Primary agalactia
O92.4 Hypogalactia
O92.5 Weak [suppressed] lactation
Agalactia:
optional
secondary
for medical reasons
O92.6 Galactorrhea
Excludes: galactorrhea not associated with childbearing ( N64.3)
O92.7 Other and unspecified lactation disorders. Galactocele in the postpartum period

OTHER OBSTETRIC CONDITIONS NOT OTHERWISE CLASSIFIED (O95-O99)

NoteWhen using rubrics O95-O97 the rules for mortality coding and the recommendations in Part 2 should be followed.

O95 Obstetric death of unspecified cause

Maternal death from unspecified cause during pregnancy,
childbirth or postpartum

O96 Maternal death from any obstetric cause more than 42 days but less than one year after delivery

If necessary, an additional code is used to identify the obstetric cause of death.

O97 Maternal death from consequences of direct obstetric causes

Death from any direct obstetric cause one year or more after delivery

Includes: listed conditions that complicate pregnancy, are aggravated by pregnancy, or are an indication for obstetric care
If necessary, to identify a specific condition, use an additional code (class I).
Excludes: asymptomatic human immunodeficiency virus [HIV] infection status ( Z21)
human immunodeficiency virus [HIV] disease ( B20-B24)
laboratory confirmation of human immunodeficiency virus [HIV] carriage ( R75)
obstetric tetanus ( A34)
postpartum:
infection ( O86. -)
sepsis ( O85)
cases where the mother's medical care is provided in connection with her illness, which obviously or presumably affects the fetus ( O35-O36)

O99.0 Anemia complicating pregnancy, childbirth, and the postpartum period
Conditions classified in rubrics D50-D64
O99.1 Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism that complicate pregnancy, childbirth and the postpartum period. Conditions classified in rubrics D65-D89
Excludes: bleeding with coagulation disorders ( O46.0,O67.0, O72.3)
O99.2 Diseases of the endocrine system, eating disorders and metabolic disorders that complicate pregnancy,
childbirth and the postpartum period. Conditions classified in rubrics E00-E90
Excludes: diabetes mellitus ( O24. -)
malnutrition ( O25)
postpartum thyroiditis ( O90.5)
O99.3 Mental disorders and diseases of the nervous system complicating pregnancy, childbirth and postpartum
period. Conditions classified in rubrics F00-F99 And G00-G99
Excludes: postnatal depression ( F53.0)
Pregnancy-related peripheral nerve damage ( O26.8)
postpartum psychosis ( F53.1)
O99.4 Diseases of the circulatory system that complicate pregnancy, childbirth and the postpartum period
Conditions classified in rubrics I00-I99
Excludes: postpartum cardiomyopathy ( O90.3)
hypertensive disorders ( O10-O16)
obstetric embolism ( O88. -)
venous complications and thrombosis of the cerebrovenous sinus during:
childbirth and in the postpartum period O87. -)
pregnancy ( O22. -)
O99.5 Respiratory diseases complicating pregnancy, childbirth and the postpartum period
Conditions classified in rubrics J00-J99
O99.6 Diseases of the digestive system that complicate pregnancy, childbirth and the postpartum period
Conditions classified in rubrics K00-K93
Excludes: liver injury during pregnancy, childbirth and the puerperium ( O26.6)
O99.7 Diseases of the skin and subcutaneous tissue complicating pregnancy, childbirth and the postpartum period
Conditions classified in rubrics L00-L99
Excludes: herpes of pregnancy ( O26.4)
O99.8 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
Combination of conditions classified under headings O99.0-O99.7
Conditions classified in rubrics C00-D48,H00-H95, M00-M99, N00-N99, And Q00-Q99
Excludes: urinary tract infections during pregnancy O23. -)
urinary tract infections after delivery ( O86.0-O86.3)
medical assistance to the mother in connection with an established or suspected anomaly of the pelvic organs ( O34. -)
postpartum acute renal failure ( O90.4)

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Premature birth (O60)

general information

Short description

preterm birth- partial or complete separation of a normally located placenta from the uterine wall, which occurred before the birth of the fetus, during pregnancy or in childbirth.

Preterm births are those that occurred at 28-37 weeks of gestation, and the weight of the fetus in this case ranges from 500 to 2500 g.

According to the definition of the World Health Organization (WHO), if the pregnancy is terminated at a period of 22 weeks or more, and the fetal weight is 500 g or more, then the birth is considered premature.

Protocol code: H-O-020 "Preterm delivery"
For obstetric and gynecological hospitals

Code (codes) according to ICD-10: O60 Premature birth

Classification

There are stages of preterm birth:

threatening;

Beginners;

Started.

Factors and risk groups

1. Low socio-economic status.

2. The age of the pregnant woman is younger than 18 or older than 40 years.

3. Low body weight before pregnancy.

4. Repeated termination of pregnancy at a later date.

5. Multiple pregnancy or polyhydramnios.

6. Premature birth in history.

7. Malformations of the uterus.

8. Trauma during pregnancy.

9. Infections during pregnancy.

10. Smoking.

11. Drug addiction.

12. Alcoholism.

13. Severe somatic diseases.

Diagnostics

Diagnostic criteria

The onset of labor is evidenced by regular contractions, leading to the opening of the cervix. Regular contractions in the absence of cervical dilatation are not a sign of the onset of labor. Diagnosis is especially difficult in the phase of slow opening of the cervix, when the premature onset of labor is differentiated from gastroenteritis, preparatory contractions and other conditions that manifest as pain and discomfort in the abdomen.

Preterm birth is characterized by: untimely discharge of amniotic fluid; weakness of labor activity, discoordination or excessively strong labor activity; fast or rapid childbirth, or vice versa, an increase in the duration of labor; bleeding due to placental abruption; bleeding in the afterbirth and early postpartum periods due to retention of parts of the placenta; inflammatory complications, both during childbirth and in the postpartum period; fetal hypoxia.

During the examination, it is necessary to determine the possible cause of the threat of termination of pregnancy, the gestational age and the estimated weight of the fetus, its position, presentation, features of the heartbeat, the nature of the discharge from the woman's genital tract (amniotic fluid, blood), the condition of the cervix and fetal bladder (whole, opened), the presence or absence of signs of infection, assess labor activity, determine the stage of preterm labor.

Complaints and anamnesis

Preterm labor is characterized by: cramping pain, discomfort or a feeling of fullness in the lower abdomen, which occurs approximately every 15 minutes. In most cases, the pregnant woman notes a gradual increase and intensification of seizures.

Carefully study the history of the pregnant woman, paying attention to risk factors for preterm birth, exclude diseases with a similar clinical picture.

Physical examination

Clinical symptoms:

Bleeding from the genital tract in 80%;

Pain syndrome of varying severity;

Local pain and tension on palpation of the uterus;

Blood staining of amniotic fluid;

Symptoms of shock (painful or hypovolemic);

Signs of intrauterine fetal hypoxia (auscultation, if possible CTG).

Survey scope:

1. The nature of hemodynamic parameters - blood pressure, pulse, skin color.

2. Assessment of uterine tone and the condition of the fetus.

3. Examination of the cervix and vagina in the mirrors. Pay attention to the presence of amniotic fluid in the vagina.

4. After exclusion of premature rupture of amniotic fluid and placenta previa, a vaginal examination is performed. The degree of opening of the internal os, the length and consistency of the cervix, the position of the fetus and the degree of insertion of the presenting part into the small pelvis are assessed. The results of the study are recorded in the medical history. If within 4-6 hours there is a dilatation of the cervix, a diagnosis of premature birth is made. If premature rupture of amniotic fluid is suspected, vaginal examination is refrained. If placenta previa is suspected, a vaginal examination is performed only after ultrasound.

5. A preliminary diagnosis of premature onset of labor can sometimes be made at the first vaginal examination - when it is detected against the background of regular contractions that the cervix is ​​dilated by more than 2 cm or its shortening by more than 80%.

Laboratory research:

1. Determination of the level of hemoglobin and hematocrit.

2. The study of indicators of the coagulation system, the number of platelets, the time of blood clotting.

3. Determination of blood group and Rh factor.

4. General analysis of urine.

Cervical discharge is cultured to detect Streptococcus agalactiae, Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae to exclude urogenital infection.

Instrumental Research

Ultrasound of the uterus helps to confirm the diagnosis of premature abruption of a normally located placenta (PONRP) (confirms the diagnosis in 15% of cases):

Localization and condition of the placenta;

Fetal condition (heart rate, fetal activity), exclusion of placenta previa.

Indications for consultation of specialists: according to indications.

Differential diagnosis: no.

List of main diagnostic measures:

1. Thermometry (every 3 hours).

2. Fetal heart rate (every 30 minutes).

3. Determination of the number of leukocytes in the blood and ESR (2 times a day).

4. Clinical blood test (on admission, later according to indications).

5. Bacteriological examination of discharge from the genital tract.

List of additional diagnostic measures:

1. Immunological studies (determination of the total number of T-lymphocytes, detection of C-reactive protein, etc.) according to indications.

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Treatment tactics:

1. Delivery with monitoring of vital functions.

2. Careful monitoring of the state of the pregnant woman - heart rate, blood pressure, hemoglobin, indicators of the coagulation system, control of diuresis through the urinary catheter.

3. Monitoring the condition of the fetus CTG, ultrasound.

4. Antishock therapy.

5. Treatment of DIC.

6. Oxygen inhalation.

Depending on the obstetric situation, conservative expectant or active management of preterm labor is chosen. Conservative-expectant tactics are indicated for the whole fetal bladder, gestational age up to 36 weeks, good condition of the mother and fetus, dilatation of the cervix by no more than 2-4 cm, and no signs of infection.

In case of premature rupture of amniotic fluid and the absence of labor activity at a gestational age of 22-34 weeks, good condition of the mother and fetus, absence of severe extragenital and obstetric pathology and signs of infection, conservative-expectant tactics should also be followed due to the unpreparedness of the uterus, especially its cervix , to childbirth and the difficulties in labor induction caused by this. In the first 3-5 days after the outflow of amniotic fluid, vasospasm may occur in the uteroplacental circulation system and, as a result, fetal hypoxia, the risk of infection increases. In this regard, careful monitoring of the condition of the woman and the fetus is necessary.

Active management of childbirth is used in case of an open fetal bladder, regular labor, signs of infection, impaired fetal life, severe extragenital diseases of a woman, pregnancy complications (toxicosis of pregnant women, polyhydramnios, etc.), not amenable to therapy, with suspected malformations of the fetus. Childbirth, as a rule, is carried out through the natural birth canal, with the exception of those cases when there are urgent indications from the mother or fetus for a caesarean section.

Treatment Goals

In case of threatening and incipient childbirth, complex treatment is carried out aimed at reducing the excitability and suppressing the contractile activity of the uterus, increasing the vital activity of the fetus and its “maturation”, as well as eliminating the pathological conditions that caused premature birth.

At the beginning of childbirth, the goal is to reduce the risk of pathological conditions and infectious complications in the mother and fetus.

Non-drug treatment

For the treatment of pregnant women who have threatening preterm birth, it is necessary to prescribe bed rest. You can use physiotherapy such as electrorelaxation of the uterus by exposing it to an alternating sinusoidal current with a frequency in the range from 50 to 500 Hz and a current of up to 10 mA, electroanalgesia, electrorelaxation, acupuncture.

Medical treatment

1. In case of threatening and beginning childbirth, the following is prescribed:

Sedatives (preparations of valerian, motherwort);

Agents that reduce uterine contractility (magnesium sulfate, terbutaline, indomethacin) (A) .

Mandatory prevention of respiratory distress syndrome in newborns, to accelerate the maturation of the lungs of the fetus, a pregnant woman is prescribed dexamethasone 12 mg per day, for 2 days; if delivery has not occurred and the gestational age does not exceed 32 weeks, it is recommended to repeat the course of treatment with dexamethasone at the same dose after 7 days (A) .

2. With the onset of childbirth:

To stimulate labor activity, oxytocin and (or) prostaglandins are used in the same mode as in timely delivery. Means that stimulate uterine contractions should be administered carefully, strictly controlling the nature of the contractile activity of the uterus.

3. With fast and rapid premature birth:

Use means that inhibit labor activity (tocolytics) (until the opening of the cervix up to 2 cm).

4. Premature labor can be induced artificially (induced preterm labor) due to severe pathology of the pregnant woman and even death of the fetus. For their excitation, oxytocin, prostaglandins are used (prostaglandins can be administered intravenously, intra- and extraamnially).

Further management

After a premature birth, the observation of a woman occurs in the same way as after a normal birth. If a woman wants to have children in the future, she needs to undergo a thorough examination in order to eliminate the causes of premature birth.

Particular attention after premature birth is given to the child, as he has signs of immaturity. Premature newborns do not tolerate various stressful situations that arise in connection with the onset of extrauterine life. Their lungs are not yet mature enough to carry out adequate breathing, the digestive tract cannot yet fully assimilate some of the necessary substances contained in milk. The resistance of premature newborns to infection is also weak; thermoregulation is disturbed due to an increase in the rate of heat loss. Increased fragility of blood vessels is a prerequisite for the occurrence of hemorrhages, especially in the ventricle of the brain and the cervical spinal cord.

The most common and severe complications for preterm infants are respiratory distress syndrome, intracranial hemorrhage, infections, and asphyxia. In children born to mothers with various extragenital diseases, preeclampsia or fetoplacental insufficiency, there may be signs of intrauterine growth retardation.

The WHO defines preterm birth as occurring between 22 and 37 weeks of gestation (154–259 days of gestation, counting from the first day of the last menstrual period).

In the Russian Federation, according to the order of the Ministry of Health of the Russian Federation No. 318 of 1992, preterm birth is a birth that occurred between 28 and 37 weeks of gestation (196–259 days of pregnancy, counting from the first day of the last menstruation). All newborns born alive or dead with a body weight of 1000 g or more are subject to registration in the registry office (in case of unknown body weight at birth, newborns with a body length of 35 cm or more are subject to registration), including newborns weighing less than 1000 g in case of multiple births.

Spontaneous termination of pregnancy at a period of 22 to 27 weeks of gestation in the Russian Federation is singled out as a separate category that is not related to preterm birth. All newborns born with a body weight of 500 to 999 g are subject to registration in the registry office in cases where they have lived more than 168 hours after birth (7 days).

This causes differences in the statistical data of Russian and foreign authors.

From the point of view of perinatology, it is advisable to classify newborns depending on body weight with
birth:

newborns born weighing less than 2500 g are considered low birth weight fetuses; up to 1500 g - very low; up to 1000 g - with extremely low. This division is associated with differences in perinatal prognosis in different groups of newborns. Children born with extremely low body weight are significantly more likely to develop persistent CNS disorders, neurological disorders, visual and hearing impairments, dysfunctional disorders of the respiratory, digestive and genitourinary systems.

ICD-10 CODE

O60 Premature birth.
O42 PRPO.

EPIDEMIOLOGY

The frequency of preterm birth is 6-10% of all births, varies depending on the duration of pregnancy: in the period from 22 to 28 weeks of gestation (5-7% of all cases of preterm birth), in the period from 29 to 34 weeks of gestation (33- 42%), in the period from 34 to 37 weeks of pregnancy (50-60%).

In 25–38% of cases, preterm birth is preceded by PPROM.

The high incidence of perinatal morbidity and PS (from 30 to 70%) in preterm birth is due to the low body weight of the newborn, its immaturity and concomitant intrauterine infection of the fetus.

CLASSIFICATION OF PRETERM BIRTH

There is no single generally accepted classification of preterm birth.

It is advisable to allocate the following intervals:

preterm birth at 22–27 weeks of gestation;
preterm birth at 28–33 weeks of gestation;
preterm birth at 34–37 weeks of gestation.

According to the mechanism of occurrence, preterm birth is divided into:

spontaneous;
induced (caused artificially):
- for medical reasons, both on the part of the mother and the fetus;
- according to social indications.

For medical reasons, termination of pregnancy is carried out regardless of its duration in the event that pregnancy and childbirth can worsen the health of a woman and threaten her life, or if abnormalities in the development of the fetus are detected. The indications are established by the attending obstetrician-gynecologist together with specialists of the relevant profile (therapist, surgeon, oncologist, psychiatrist, etc.) and the head of the medical institution after examining the patient in a hospital. At the same time, the woman writes a statement that is considered by the medical commission.

According to social indications, abortion is carried out for up to 22 weeks. Decree

The Government of the Russian Federation of August 11, 2003 compiled a list of social indications for induced abortion: a court decision to deprive or restrict parental rights; pregnancy as a result of rape; stay of a woman in places of deprivation of liberty; disability of the I-II group in the husband or the death of the husband during pregnancy.

The issue of termination of pregnancy for the listed indications is decided by the commission after the conclusion of the obstetrician-gynecologist of the antenatal clinic on the gestational age and upon presentation of the relevant legal documents. If there are other grounds for terminating a pregnancy of a non-medical nature, the issue of this termination is decided by the commission on an individual basis. The commission includes the chief physician or his deputy for medical work, the head of the department, the attending physician, as well as specialists: a lawyer, a psychiatrist, etc.

Regardless of the gestational age, it is customary to distinguish the following clinical stages of the course of preterm labor:

threatening premature birth;
incipient preterm labor
initiation of preterm labor.

It should be remembered that it is difficult or impossible to differentiate the transition from one stage to another. In this case, one should focus on the dynamics of the opening of the uterine os or be guided by the data of cardiotocographic monitoring of the contractile activity of the uterus.

ETIOLOGY (CAUSES) OF PRETERM BIRTH

Hormonal disorders, genital tract infection and their combination are the main etiological factors of preterm birth. Violations in the hemostasis system are another mechanism for abortion.

Premature birth at 22–27 weeks of gestation is more often caused by infectious etiology and congenital hereditary pathology of the fetus. At this time, the lungs of the fetus are immature, it is not possible to accelerate their maturation by prescribing medications to the mother in a short period of time. Due to such physiological characteristics during this period, the outcome for the fetus in this group is the most unfavorable, mortality and morbidity are extremely high. At 28–33 weeks, infectious etiology prevails only in 50% of cases; from 34 weeks, preterm birth is due to many other causes not associated with infection.

Risk factors for preterm birth:

low socio-economic status of women;
extragenital diseases (AH, BA, hyperthyroidism, heart disease, anemia with Hb £90 g/l);
drug addiction and smoking;
professional hazards;
· heredity;
transferred viral infection;
history of premature birth
ICN;
Malformations of the uterus
Overstretching of the uterus (polyhydramnios, multiple pregnancy, macrosomia in diabetes);
Surgical operations during pregnancy, especially on the abdominal organs or trauma.

PATHOGENESIS

The pathogenesis of preterm birth is associated with:
Increased release of cytokines in infectious lesions;
· coagulopathic processes leading to microthrombosis of the placenta with subsequent detachment;
An increase in the number and activation of oxytocin receptors in the myometrium, which contributes to the opening of calcium channels in myocytes and the initiation of contractile activity of the uterus.

The pathogenetic mechanism of PROM is infection of the lower pole of the fetal bladder, which is facilitated by ICI.

CLINICAL PICTURE (SYMPTOMS) OF PRETERM LABOR

The clinical picture of the onset of preterm labor does not differ from the clinic of timely delivery.
Clinical picture of the threat of premature birth:
increase in uterine tone. The pregnant woman complains of pulling or cramping pains in the lower abdomen and in the lower back;
feeling of pressure and fullness in the vaginal area;
Frequent urination is a symptom of a low location of the presenting part.

With PRPO, a pregnant woman complains of liquid discharge from the genital tract. With abundant leakage of OM, the volume of the pregnant woman's abdomen decreases, and VDM decreases. In the case of the development of chorionamnionitis, symptoms of intoxication appear: a feeling of chills, an increase in body temperature, water.

DIAGNOSTICS

Diagnosis of preterm labor is not difficult and is based on the complaints of the pregnant woman, general examination data and vaginal examination. If PROM is suspected, clarification of the diagnosis requires the involvement of paraclinical services.

ANAMNESIS

When collecting an anamnesis, it is necessary to pay attention to the presence of the above risk factors for preterm birth, the course and outcome of previous pregnancies, if any. In multiparous women, clarify the period of previous births, fetal weight, features of the course of labor and the postpartum period. To develop the correct therapeutic and diagnostic tactics, it is necessary to accurately determine the gestational age. In cases of gynecological surgical interventions, especially laparoscopically, the extent of the intervention should be as detailed as possible. In the case of surgical interventions on the uterus (removal of myomatous nodes, coagulation of endometriosis foci), the presence of a scar on the uterus should be reflected in the diagnosis.

PHYSICAL EXAMINATION

During a general examination, body temperature, blood pressure, the frequency and nature of the pulse of the pregnant woman are measured. A decrease in blood pressure, tachycardia with a reduced filling of the pulse indicates concomitant placental abruption. An increase in temperature, tachycardia and other signs of a systemic inflammatory response syndrome are noted with symptoms of chorionamnionitis. When examining a pregnant woman, increased excitability or uterine tone is noted with threatening preterm labor and regular contractions during labor that begins or has begun. In the latent phase, the contractions are irregular, with an interval of 5-10 minutes.

If concomitant placental abruption is suspected, examination of the cervix in the mirrors is carried out only with warm mirrors, always with an expanded operating room. According to indications, ultrasound is performed.

During a vaginal examination in case of threatened preterm birth, a formed cervix more than 1.5–2 cm long is determined, the external os is either closed, or in multiparous women it passes the tip of the finger, in some cases the lower uterine segment is stretched by the presenting part of the fetus, which is palpated in the upper or middle third of the vagina. When implementing dynamic control, due to the individual characteristics of the cervix in each patient, it is advisable to conduct studies by one specialist. In the presence of dynamics in the form of softening, shortening of the cervix, opening of the cervical canal, we are talking about beginning premature birth.

For the diagnosis of PROM, attention should be paid to the nature of the vaginal discharge, with an open cervical canal, determine the presence or absence of the fetal bladder and membranes. When viewed in the mirrors, a “cough push test” is carried out - the cervix is ​​exposed in the mirrors and the pregnant woman is asked to make coughing movements. Leakage of fluid from the cervical canal indicates PROM.

LABORATORY RESEARCH

Laboratory diagnostics is carried out in order to determine the etiology of the threat of preterm birth. If an infectious etiology is suspected, a culture is performed from the cervical canal with a mandatory determination of sensitivity to antibiotics; if a viral infection is suspected, a high-quality PCR is performed. In cases of habitual miscarriage, recurrent placental abruption, a blood hemostasis study is performed to determine APS markers.

In the conditions of a specialized clinic, it is possible to identify markers of early manifestations of intrauterine infection: plasma fibronectin, IL-6 in the mucus of the cervical canal. Predicting the onset of preterm birth using immune tests of monoclonal antibodies has a low predictive value compared to the data of an objective study, and due to the high cost is applicable only in the field of commercial medicine.

In pregnant women with an uncomplicated history, with rapid relief of the symptoms of the threat of preterm labor and with a satisfactory condition of the fetus, it is not recommended to conduct additional diagnostics.

Laboratory diagnosis is of the greatest importance in case of suspected PPROM. A smear for the determination of OB elements and an amniotest based on the determination of placental a1-microglobulin in vaginal discharge are common laboratory tests. There is a test based on the determination of protein-1, which binds insulin-like growth factor, in the discharge from the cervical canal.

INSTRUMENTAL RESEARCH METHODS

The main task of ultrasound examination (ultrasound) is to accurately determine the gestational age and weight of the fetus, the identification of IGR is necessary for the correct development of obstetric tactics. Ultrasound allows you to determine the dynamics of changes in the cervix (especially the internal os), which allows you to reduce the number of vaginal examinations, respectively, reduce the infectious risk for a pregnant woman.

In PROM, an ultrasound control of the AF index is carried out to resolve the issue of the possibility and expediency of further prolongation of pregnancy. In the case of a pronounced uterine tone, it is necessary to conduct an ultrasound scan in order to exclude placental abruption. With a long-term threat of preterm labor, it is advisable to perform CTG or Doppler to monitor the condition of the fetus.

DIFFERENTIAL DIAGNOSIS

It is not difficult for an obstetrician to make a diagnosis of threatening or incipient preterm birth. However, the obstetrician should remember that the threat of preterm labor may be secondary, caused, for example, by pain.

Differential diagnosis is carried out with acute pyelonephritis or renal colic, caused by a violation of the outflow of urine mainly from the right kidney.

A symptom of the latent phase of preterm labor - nausea - can be caused by food poisoning, a manifestation of biliary dyskinesia, subacute pancreatitis.

Drawing pains in the abdomen due to uterine tone may mask the pain caused by acute appendicitis (AA).

With concomitant uterine fibroids, pain can be caused by malnutrition in the node.

If there is a scar on the uterus, the threat of premature birth may be caused by its failure.

The greatest difficulty in the differential diagnosis of scar failure is caused by scars on the uterus after electrocoagulation during laparoscopic operations. When the scar is located on the back wall, it is difficult to visualize it with ultrasound. Uterine ruptures at this location of the scar may have an erased clinic and show signs of intra-abdominal bleeding.

If a surgical or other extragenital pathology is suspected, it is necessary to consult a pregnant woman with an appropriate specialist. If suspicion appears at the pre-hospital stage, the pregnant woman is hospitalized in a maternity hospital at a general hospital.

Indications for consulting other specialists

The help of doctors of other specialties is required for concomitant pathology or for differential diagnosis. It is necessary to involve a neonatologist-resuscitator to resolve the issue of the tactics of childbirth.

Diagnosis example

Pregnancy 22 weeks. Pelvic presentation. The threat of late spontaneous abortion.
Pregnancy 28 weeks. PRPO. Long dry period. Chorioamnionitis.

TREATMENT

GOALS OF TREATMENT

Prolongation of pregnancy to the terms at which all signs of the morphofunctional maturity of the fetus are achieved.

INDICATIONS FOR HOSPITALIZATION

Hospitalization of pregnant women with the threat of miscarriage, with the onset of preterm labor, PROM from the 22nd week of pregnancy is carried out in the pregnancy pathology department of the maternity hospital, and not in the gynecological hospital.

Hospitalization in the antenatal ward or a separate box of the maternity ward for the time of acute tocolysis is indicated:
With a pronounced threat of premature birth;
with a shortened to 1 cm or smoothed cervix;
with regular contractions
with a history of preterm births that have taken place.

After stopping the threat phenomena, the pregnant woman is transferred to the pathology department for further treatment. If there are signs of chorionamnionitis, hospitalization is carried out in the obstetric observational department of the maternity hospital.

NON-DRUG TREATMENT

With the threat of premature birth, bed rest, physical, emotional and sexual rest are indicated.

Physiotherapeutic methods - magnesium electrophoresis with a sinusoidal modulated current, acupuncture, electroanalgesia.

MEDICAL TREATMENT

Drug treatment of the threat of preterm labor is complex, includes:
Tocolytic therapy;
prevention of fetal RDS (if necessary);
sedative and symptomatic therapy.

Tocolytic therapy. When preterm labor begins or has begun, in order to suppress the contractile activity of the uterus, massive (acute) tocolysis is first performed, characterized by a high rate of administration of the drug, then the administration is continued at a lower rate to maintain the tocolytic effect (maintenance tocolysis). For the treatment of acute tocolysis, selective b2-agonists and magnesium sulfate are used.

Of the selective b2-agonists, fenoterol, hexoprenaline and salbutamol are used. It is advisable to combine the intake of b2-adrenergic agonists with the preliminary intake of calcium channel blockers (verapamil 40 mg, nifedipine 10 mg).

Route of administration and doses:

Hexoprenaline (ginipral ©) is used for acute tocolysis. Dose with intravenous drip - 100 mcg per 400 ml of 0.9% sodium chloride solution or 5% glucose solution. The introduction of the drug begins with 0.3 mcg / min (20–25 drops per minute), if necessary, treatment can be started with a slow intravenous jet injection of 10 mcg. For maintenance tocolysis, the rate is 0.075 µg/min (10–15 drops per minute) for 4–12 hours. The daily dose is up to 430 mcg (exceeding is possible only in exceptional cases). Calculation of the rate of administration (dose): to ensure the rate of administration of 0.3 mcg / min, the following ratios of the amount of the drug and the rate of administration can be used: 25 mcg - 30 drops / min; 50 mcg - 60 drops / min; 75 mcg - 90 drops / min; 100 mcg - 120 drops / min;

Fenoterol is used for acute tocolysis, injected into / in drip. The solution is diluted in 5% glucose solution, 0.9% sodium chloride solution. The introduction of the drug begins with 5-8 drops per minute, gradually increasing the dose until the contractile activity of the uterus stops. The average rate of administration of the solution is 15-20 drops per minute for 4-12 hours (according to the manufacturer, for a short period (2-3 minutes), the maximum administration of the drug is allowed - 0.5-3 μg / min). After the suppression of the contractile activity of the uterus, they switch to a maintenance rate of administration - 1–2 μg / min;

Salbutamol is used for acute tocolysis: 10 mg (4 ampoules) per 400 ml of 0.9% sodium chloride solution or 5% glucose solution. As a maintenance tocolysis - in / in drip, 2.5–5 mg is dissolved in 500 ml of solution. The rate of intravenous drip (20-40 drops / min) depends on the intensity of the contractile activity of the uterus and on the tolerability of the drug.

In the case of a positive effect, 15–20 minutes before the end of the drug administration, oral administration of the drug is started. After 2–3 days, in the case of removal of the contractile activity of the uterus, the dose of tocolytics is gradually reduced over 8–10 days. If necessary, oral administration of b2-adrenergic agonists in combination with calcium channel blockers is prescribed.

Side effects when using b2-agonists:

· hypotension;
heartbeat;
· sweating;
tremor
· anxiety;
· dizziness;
· headache;
· nausea;
· vomit;
hyperglycemia;
· arrhythmia;
myocardial ischemia;
· pulmonary edema.

The appearance of pronounced side effects is an indication for the abolition of therapy with b2-agonists.

Contraindications for treatment with b2-agonists:

hypersensitivity;
thyrotoxicosis;
pheochromocytoma;
Atrial tachyarrhythmia
myocarditis;
· cardiac ischemia;
· Wolf-Parkinson-White syndrome;
arterial or pulmonary hypertension;
· hypokalemia;
hepatic or renal insufficiency;
Angle-closure glaucoma
· PONRP;
Uncorrected disorders of carbohydrate metabolism.

In order to suppress the contractile activity of the uterus in combination with b2-adrenergic agonists, calcium channel blockers - verapamil (a first-generation calcium channel blocker, a derivative of diphenylalkylamine) are used. In terms of effectiveness, calcium antagonists are practically not inferior to b2-adrenergic agonists. For a tocolytic effect, take 40-80 mg 4-6 times a day, 20-30 minutes before taking b2-agonists.

Side effects: bradycardia, pronounced decrease in blood pressure, collapse, dizziness, headache, fainting, anxiety, lethargy, fatigue, asthenia, drowsiness, depression, tremor of the hands and fingers hands, difficulty swallowing, nausea, constipation, swelling, increased appetite, increased activity of "liver" transaminases.

Contraindications for the use of calcium antagonists: hypersensitivity, arterial hypotension, Wolff-Parkinson-White syndrome or Lown-Ganong-Levin syndrome.

Magnesium sulfate 25% solution for intravenous administration through an infusion pump (preferably) or dissolved in 400 ml or 500 ml of 5% glucose solution. For acute tocolysis, the rate of administration is 5–6 g/h, i.e. at least 20 mg of a 25% solution, maintaining a rate of 3 g / hour. The maximum daily dose is 40 g / day. During the administration of the drug, control of reflexes and diuresis is necessary. Inhibition of reflexes and a decrease in diuresis to 30 ml per hour is an indication for discontinuation of the drug.

Magnesia therapy is carried out in cases where there are contraindications to therapy with b2-agonists, if it is impossible to exclude placental abruption.

Contraindications to magnesium therapy:

hypersensitivity;
arterial hypotension;
depression of the respiratory center;
severe bradycardia;
AV blockade;
Severe CKD.

Preventive therapy for RDS in the newborn. All pregnant women in the presence of threatening and incipient preterm labor, in the case of PROM in the gestation period from 25 to 34 weeks, are required to prevent RDS in the newborn with glucocorticoids, which contributes to the maturation of the fetal lung surfactant.

Surfactant - a heterogeneous mixture of lipids and proteins synthesized in large alveoli, coats them, promotes opening and prevents them from collapsing during inspiration.

Under the influence of glucocorticoids administered to a pregnant woman or directly to the fetus, more rapid maturation of the lungs is observed, since there is an accelerated surfactant synthesis. At a gestational age of more than 34 weeks, the prevention of RDS is not indicated.

Dexamethasone IM 4 mg 5 injections, with an interval of 6 hours, course dose - 20 mg or IM 6 mg 4 injections with an interval of 12 hours, course dose - 24 mg. Oral administration of dexamethasone 2 mg (4 tablets) 4 doses on the first day (daily dose 8 mg), 2 mg 3 doses on the second day (daily dose 6 mg), 2 mg 2 doses on the third day (daily dose 4 mg ). Currently, in countries with a highly developed neonatal service, the prevention of RDS with glucocorticoids is not carried out.

Betamethasone intramuscularly 12 mg, 2 times a day, with an interval of 24 hours, course dose - 24 mg. In European countries, a single administration of 12 mg of the drug is used.

The optimal duration of exposure to glucocorticoids is 48 hours. The prophylactic effect of glucocorticoids lasts 7 days. A single repeated (after 7 days) administration of glucocorticoids is acceptable with a gestational age of less than 34 weeks and no signs of fetal lung maturity.

Contraindications to the use of glucocorticoids:

peptic ulcer of the stomach and duodenum;
· insufficiency of blood circulation of the III stage;
· endocarditis;
Renal failure
active form of tuberculosis;
severe forms of diabetes;
· osteoporosis;
severe form of nephropathy;
acute infection or exacerbation of chronic;
· Cushing's syndrome;
porphyria.

sedative therapy. As sedatives are used:

oxazepam 0.01 2-3 times a day;
diazepam 0.015 1-2 times a day.

Symptomatic therapy with antispasmodics as monotherapy is currently practically not used.

In complex therapy, a solution of drotaverine 2.0 ml / m, a solution of papaverine hydrochloride 2% 2.0 / m is used.

To inhibit the synthesis of prostaglandin synthetase, non-steroidal anti-inflammatory drugs (NSAIDs) are used as an ambulance - indomethacin in suppositories of 50-100 mg, 1-2 times, from 14 to 32 weeks of pregnancy. Long-term use is hampered by the described side effects - hemorrhages in the adrenal glands of the fetus.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

In the case of concomitant extragenital pathology, a consultation of the relevant specialists is carried out.

TERMS AND METHODS OF DELIVERY

Close connection and continuity in the work of obstetrician-gynecologists and neonatologists is the main principle of organizing medical care for preterm birth.

The responsible obstetrician-gynecologist is obliged to notify in advance of the birth of a very premature child a neonatologist with resuscitation skills, whose duties include preparing and turning on the incubator, supplying oxygen, warming linen, serviceability and readiness of diagnostic and medical equipment, completeness of medicines for resuscitation and intensive care .

The neonatologist is obliged to be present at the birth, provide the necessary resuscitation assistance and ensure the transportation of the child from the delivery room to the intensive care unit.

In the case of a normal course of childbirth, they are carried out expectantly, adequate anesthesia of childbirth is carried out.

Due to its adverse effect on the respiratory center of the fetus, it is not advisable to use Promedol during preterm birth. The optimal method of pain relief in preterm labor is epidural analgesia, which allows:

reduce the risk of abnormal contractile activity of the uterus;
reduce hyperactive labor activity;
· to achieve stable relaxation of the pelvic floor muscles, which leads to a reduction in traumatism in childbirth.

The main task of conducting the first stage of labor is the prevention of their rapid course. Adequate anesthesia and prevention of violent labor activity are the main measures to prevent traumatization of premature babies.

In case of development of anomalies of labor activity, they are treated. Correction of violations of the contractile activity of the uterus during rapid preterm labor is carried out by intravenous drip administration of tocolytics. Tocolysis lasts at least 2-3 hours, as discoordinated contractions or hyperactivity of the uterus reappear after rapid discontinuation of the drug. Tocolysis should be stopped when the cervix is ​​8–9 cm dilated, i.e. 30-40 minutes before the expected birth. The drug of choice is hexoprenaline (ginipral©). At the beginning of treatment, 10 μg of ginipral © (1 ampoule - 2 ml) is diluted in 10 ml of sodium chloride solution, administered intravenously slowly, then the infusion is continued at a rate of 0.3 μg / min. It is possible to do infusions without prior bolus administration of the drug. Also use ginipral © concentrate for infusion 25 mcg (1 ampoule - 5 ml). The concentrate for infusion is dissolved in 500 ml of sodium chloride solution or 5% glucose solution.

Concentrate for infusion is convenient to use in automatic dosing infusion pumps. When using infusion pumps, 75 µg (3 ampoules of concentrate for infusion 25 µg) is diluted with isotonic sodium chloride solution or 5% glucose solution to 50 ml; infusion rate - 0.3 mcg / min (Table 25-1).

Table 25-1. Calculation of the dose of hexoprenaline for intravenous administration at a rate of 0.3 μg / min

With the weakness of labor activity, it is stimulated. The introduction of stimulants in preterm labor should be carried out carefully, monitoring the nature of labor and the condition of the fetus. The most effective method of labor stimulation is the combined use of oxytocin 2.5 U and PG-F2a at a dose of 2.5 mg in 500 ml of 0.9% sodium chloride solution. The introduction should be carried out, starting with 5-8 drops per minute. In the future, the dose is increased every 10–20 minutes by 4–5 drops until regular contractions appear with a frequency of 3–4 in 10 minutes. A better effect is given by the introduction of uterotonic agents, such as oxytocin, through an infusomat: 0.075 µg/min IV drip.

In case of premature birth, careful administration of uterotonic agents is indicated only until the contractility of the uterus normalizes under the control of a monitor for 1–2 hours, then the administration of sodium chloride solution without uterotonic agents continues. If regular labor activity continues in the future, then uterotonic agents are used to prevent bleeding in the afterbirth and early postpartum periods.

If weakness of labor occurs in the second stage of labor, oxytocin can also be administered. The use of the so-called Christeller method, a vacuum extractor in a premature fetus is especially contraindicated.

The use of obstetric forceps is possible with gestation periods of 34-37 weeks.

Delivery in preterm birth should be as careful as possible, especially when this pathology is combined with IGR. It should be especially noted that the place of delivery of women with premature birth is determined by the capabilities of the perinatal service. In the absence of effective resuscitation (IVL, the introduction of artificial surfactant), the woman in labor is shown to be transferred to a higher-level medical institution.

Pudendal anesthesia is mandatory even for epidural analgesia in childbirth. For it, at least 120 ml of a 0.5% solution of novocaine or 10 ml of a 2% solution of lidocaine are used. The issue of dissection of the perineum should be decided depending on its condition, compliance, "height", parity and gestational age - the shorter the period, the more perineotomy is indicated.

In case of breech presentation of a premature fetus, CS should be considered preferable, however, if the woman in labor refuses or there are contraindications, childbirth can be carried out through the natural birth canal carefully in compliance with all the rules for providing assistance in this situation (pudendal anesthesia, perineotomy), with the provision of Tsovyanov's allowance for purely gluteal presentation and a very careful classic manual aid with mixed and foot.

The child should not be lifted or lowered below the level of the uterus, so as not to create hyper or hypovolemia in the newborn. It is necessary to take the child in warm diapers. It is advisable to separate it from the mother after the end of the pulsation of the umbilical cord, and before that it is necessary to suck out the mucus from the respiratory tract, assess the condition of the child on the Apgar and Silverman scale to determine the volume and stages of therapeutic measures.

Prevention of bleeding in the afterbirth and early postpartum periods is carried out according to the usual method (intravenous administration of mainly oxytocin).

The issue of early delivery by CS operation is decided individually.

In the interests of the fetus in these terms of pregnancy, the question of the operation may be raised:

at perinatal risk;
breech presentation;
with a transverse, oblique position of the fetus;
in the presence of a burdened obstetric history (infertility, miscarriage);
a combination of different indications.

Expansion of indications for abdominal delivery on the part of the fetus with a gestational age of less than 34 weeks is advisable only if there is an intensive care neonatal service. During the operation with a non-deployed lower segment of the uterus, a longitudinal incision (not a “blunt” dilution of the wound edges) on the uterus is more appropriate, since removal of the fetus during a transverse incision can be difficult.

It should be noted that the most sparing is the extraction of the fetus in the whole fetal bladder.

In the case of PROM, the question of the timing and mode of delivery depends on the gestational age and the capacity of the neonatal service of the obstetric institution.

Currently, in preterm pregnancy and PROM adhere to expectant management with control over the possible development of infection. Expectant management is more preferable than the shorter gestational age, since with the course of the anhydrous period, accelerated maturation of the fetal lung surfactant and a decrease in the incidence of hyaline membrane disease occur. Favorable outcomes are described even in the case of a super-long (up to 4-5 weeks) outpouring of water.

Obstetric tactics in PRPO includes:

hospitalization in a specialized ward equipped with bactericidal lamps;
Processing of the ward, which is carried out according to the principle of current cleaning of the maternity ward - change of sterile linen diapers 3-4 times a day and daily change of linen;
bed rest;
daily measurement of abdominal circumference and VDM;
control of the quantity and nature of leaking water;
three-hour monitoring of body temperature and fetal heart rate;
control of the level of blood leukocytes with an interval of 12 hours, with its increase, the assessment of the leukocyte formula;
smears for microflora every five days.

In the presence of an equipped laboratory base, culture from the cervical canal with the determination of sensitivity to antibiotics, in the presence of an immunological laboratory - the determination of C-reactive protein.

Within 48-72 hours, tocolytic therapy is carried out.

In pregnant women with a high risk of infectious complications, prophylactic antibiotic therapy is advisable. Treatment with antibiotics begins with an increase in leukocytosis and other manifestations of chorionamnionitis.

Only with the participation of the pregnant woman it is necessary to decide whether to prolong the pregnancy or to refuse it.

A woman should receive all reliable information about the proposed obstetric tactics, possible complications and the risk of an adverse outcome. To develop tactics, it is advisable to involve a neonatologist who is obliged to provide the pregnant woman with information about the prospects of the newborn, the immediate and long-term consequences of a particular decision.

Approximate periods of incapacity for work

The duration of disability depends on the severity of the threat of premature birth.

After a preterm birth, a postpartum leave of 86 days is issued.

Evaluation of the effectiveness of treatment

Prolongation of pregnancy indicates the effectiveness of the treatment.

In PRPO, the effectiveness criteria are:

Progression of pregnancy
absence of symptoms of chorionamnionitis;
No signs of fetal distress.

PREVENTION

Observation of a pregnant woman, timely diagnosis and treatment of emerging disorders (infections, CCI, concomitant extragenital pathology).

Preventive measures include:

rational pregravid preparation;
Identification of risk groups for preterm birth;
Prevention of placental insufficiency from early pregnancy.

INFORMATION FOR THE PATIENT

Premature birth is not good for the baby. If you experience pain in the lower abdomen, tension of the uterus, suspected outpouring of water, you should immediately consult a doctor. Recommendations for hospitalization should be strictly followed.

FORECAST

Survival of premature newborns is determined by a number of factors:
gestational age;
body weight at birth
gender - boys have the worst ability to adapt;
Presentation (mortality in breech presentation is 5–7 times higher than in head presentation in the case of vaginal delivery);
method of delivery
The nature of labor activity (risk factor - rapid delivery);
The presence of PONRP;
the presence of chorionamnionitis;
The severity of intrauterine infection of the fetus.

Pregnancy can be threatened by a very large number of pathological conditions. A woman should be aware of such conditions and the possible measures that she can take. Of course, it is hardly possible to do without the participation of doctors in such situations if a woman wants to keep her pregnancy.

Threat of abortion: ICD-10 code

What does the international classification of diseases say about such a problematic situation? This code is O20.0, which in this classification is called threatened abortion. ICD-10: threatened miscarriage (terms) - what can be said about them? In this case, there is a danger of detachment of the fetus from the uterine wall. The most dangerous in this regard can be considered the eighth - tenth week.

Ultrasound: threatened miscarriage (ICD) is a reminder that with appropriate ultrasound diagnostics after a woman has become pregnant, such a problem can be prevented if violations are suspected in time.

Signs of a threatened abortion in the early stages

The first symptom that should alert a woman is the appearance of painful sensations. In the lower abdomen, you can feel sipping pain, which can also be localized in the lumbar region. In the presence of an injury or a stressful situation, severe pain can be observed, which quickly turn into cramping. In this case, you can also face intense bleeding. If bleeding begins, you need to urgently call an ambulance, as in this case you can lose your own pregnancy.

If there is a threat of interrupting the bearing of a baby, you can also see the presence of spotting. Sometimes there may not be such secretions in case of a threat. If you do not take action after the appearance of small spotting, they can intensify and acquire a scarlet bloody color. Why do such discharges appear when there is a threat of miscarriage? The fact is that the fetal egg gradually begins to exfoliate from the uterine wall, as a result of which the blood vessels are damaged.

Among other symptoms, one can distinguish such as a decrease in basal temperature, a drop in the level of chorionic gonadotropin. A woman should monitor the basal temperature regularly and when a verdict is issued on the presence of a threat. If a woman has had problems getting pregnant for a long time or she has persistent hormonal imbalances, she will be familiar with the basal temperature monitoring schedule.

The threat of abortion in the early stages: treatment

Russian doctors prefer to carry out an integrated approach in the treatment of women with threatened miscarriage. The sooner treatment is carried out, the higher the likelihood that the pregnancy will be saved. The therapy used should be both medical and other. It is also necessary to observe the daily routine and proper nutrition.

The first thing to mention is the use of basic therapy. This concept includes adherence to the regimen and proper dietary nutrition. Pregnant women should exclude intense physical activity, sometimes it is shown to observe bed rest. It is important to sleep enough hours a day and observe sexual rest. Moreover, it is important that a woman's diet contains adequate amounts of proteins, carbohydrates and fats. Sometimes, if a woman is in a nervous state, psychotherapy and auto-training sessions will be required for her.

As a sedative, valerian or motherwort tincture is indicated.

Treating threatened miscarriage with medication

When you know about the threat of termination of pregnancy and the symptoms, you can start talking about methods of treatment with drugs.

Threat of termination of pregnancy: forum - what is this request? Very often, if a woman has been diagnosed with such a diagnosis, she seeks to find support somewhere, both morally and in the form of advice. And very often various kinds of forums serve as a source of such support.

The threat of abortion: what to do in this case? Often doctors decide to prescribe antispasmodics to a woman. They are represented by drotaverine, noshpa, which lead to relaxation of the uterine muscles. However, as a rule, such drugs are administered intramuscularly. An excellent remedy is Magne B6, which contains the vitamin of the same name and magnesium. Rectal suppositories with papaverine are also used. Papaverine is able to quickly cope with pain.

Often, with the threat of termination of pregnancy, hormonal agents are used, namely progesterone. In the early stages, Duphaston is prescribed at a dosage of 40 mg, and four tablets at once. After that, every eight hours you need to take one tablet. If it is not possible to stop the threat of miscarriage, then the dosage has to be increased. Another commonly prescribed remedy is Utrozhestan.

Pregnancy after threatened miscarriage

If a woman does have a miscarriage, she is worried about what to do next and after what time you can try to conceive a child again. Of course, this is a great tragedy not only for the woman herself, but for her entire family. That is why the first step towards recovery can be considered the normalization of one's own psycho-emotional state. If a woman is not able to cope with this on her own, then it is necessary to seek help from a psychologist or psychotherapist. Of course, a woman wants to try to conceive a baby again as soon as possible. But this should not be rushed.

Doctors recommend that women wait at least six months before their next attempt at conceiving a child. During this period, you need to take care of reliable contraception. The fact is that if a subsequent pregnancy occurs immediately after a miscarriage, the likelihood of a recurrence of the situation increases several times. This must be taken into account when planning a subsequent pregnancy, if a woman wants to endure it.