EFFICIENCY OF PREVENTION OF PREMATURE BIRTH

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow Objective. To reduce premature birth rates, by optimizing the management tactics for pregnant women at high risk, and to subsequently assess maternal and fetal outcomes. Subject and methods. A retrospective group included 137 women with premature birth, who had been followed up in the Kaliningrad women’s health clinics in 2004 to 2009. A prospective group consisted of 143 women at high risk for premature birth, who had been followed up since early pregnancy at Maternity Home One, Kaliningrad Region. Results. The causes of premature birth were retrospectively analyzed; their outcomes in the period 2004-2009 were assessed. By using the findings, the authors formed a prospective group of pregnant women at high risk for premature birth. They developed a pregnancy management plan in terms of the diagnostic criteria: the efficiency of vaginal pH-metry, actim partus and actim prom test systems in diagnosing premature labor premature rupture of membranes, respectively. Detection rates for hereditary thrombophilias -hemostatic system gene mutations -were estimated; efferent (plasmapheresis), disaggregant, and anticoagulant therapies were used. The efficiency of different tocolytic therapy options in preventing threatened preterm labor was evaluated, by taking into account the period of pregnancy and the necessity of preventing neonatal respiratory distress syndrome. Based on the findings, the authors elaborated a package of medical and diagnostic measures to prevent premature birth at Maternity Home One, Kaliningrad Region. Conclusion. The intensive follow-up of pregnant women since the early periods, the timely recovery of vaginal normocenosis, the use of preventive antithrombotic therapy in cases of diagnosed hereditary thrombophilia, the prevention of fetal distress syndrome, and the prescription ofmicronized natural progesterone in the early stages of pregnancy in high-risk group women allow pregnancy management tactics to be optimized. The timely application of a package of the elaborated medical measures makes it possible to reduce preterm birth rates and to have a higher percentage of live full-term babies.

premature birth, micronized natural progesterone, vaginal pH-metry, phosphorylated insulinlike growth factor binding protein-1, hereditary thrombophilia, plasmapheresis, disaggregants, anticoagulants, tocolytic therapy, prevention of fetal respiratory distress syndrome