ANALYSIS OF THE MANAGEMENT OF PRETERM LABOR THAT ENDS WITH THE BIRTH OF EXTREMELY LOW BIRTH WEIGHT BABIES: THE FIRST EXPERIENCE IN THE ERA OF NEW LIVE BIRTH CRITERIA

Objective. To estimate tactics for the management of very early preterm labor and the perinatal outcomes of extremely low birth weight (ELBW) babies. Subject and methods. The investigation included all infants born with an ELBW of less than 1000 g in 2012. In this period, a total of 64 ELBW babies were born. They were conventionally divided into 2 groups: 1) 44 survivors; 2) 20 dead infants. Maternal age, parity, duration of pregnancy at delivery, babies’ birthweight, causes of preterm labor, mode of delivery, fetal presentation, the number of fetuses, and type of chorionicity in multiple pregnancy were analyzed. Results. The investigation indicated that Group 2 mothers had a history of obstetric and gynecological diseases in 90% of cases. The babies weighing less than 500 g had the highest mortality rates (66.7%). The main cause of preterm labor was decompensated chronic fetoplacental insufficiency in Group 1 (38.6%) and premature amniorrhea and chorioamnionitis in Group 2 (55%). The critical period for survival of ELBW babies was 26 weeks’ gestational age. 85% of the ELBW babies with a gestational age of less than 26 weeks died; on the contrary, 86.4% of the neonates born more than 26 weeks gestation survived. In Group 1, the babies born from singleton pregnancy were prevalent (61.4%); in Group 2, there were no signif icant differences in the number of fetuses. Among the multiple births in Group 1, the proportion of bichorial and monochorial twins was approximately equal and, in Group 2, the monochorial twins were predominant (72.7%). Group 1 had high cesarean section rates (95.5%); in Group 2, only 45% of the women delivered abdominally. Conclusion. The best survival was observed in ELBW infants born at 26 weeks gestation or; moreover, abdominal delivery was preferred. At less than 26 weeks gestation, the mode of delivery and fetal presentation did not increase the likelihood of a favorable outcome.

extremely low birth weight, very early preterm labor, premature amniorrhea, chorioamnionitis, twins