PŘEDČASNÝ POROD, PŘÍČINY A LÉČEBNÝ POSTUP

Premature Labour, Causes and Therapeutic Procedure

Premature deliveries participate in a significant way in the perinatal mortality of neonates. Extreme immaturityis frequently also the cause of neurological and mental handicaps of children. In the Czech Republic their rate variesbetween 5 - 6 %. The most frequent cause of onset of early uterine activity are infections. The most frequent agentare streptococi of group B (GBS). Chlamydiae, mycoplasmas, Trichomonas and bacterial vaginitis. Bacteria produceproteases and lipases, which interfere with the integrity of the amnion and cause premature escape of amniotic fluid.In developed chorioamniitis phospholipases are released, which induce via arachidonic acid prostaglandin synthesisfrom phospholipids and the latter causes uterine contractions. In the diagnosis ultrasonic assessment of the lengthof the uterine cervix is preferred. Many authors use detection of fibronectin in the cervicovaginal secretion. Itspresence increases significantly the risk of premature labour. In the treatment tocolytic drugs of the series ofbeta-sympathomimetics are used in combination with magnesium preparations. Antibiotics are decisive in thetreatment of chorioamniitis. Corticoids administered to the mother increase in the foetus production of surfactantand reduce the risk of respiratory distress syndrome (RDS). In case of premature escape of amniotic fluid it isnecessary to admit the mother to hospital and monitor initial signs of intraovular infection (leukocytes, C-reactiveprotein). In the amniotic fluid the levels of glucose, leukocytic esterase and interleukin-6 are assessed. The methodof choice is amnioinfusion. The greatest success of contemporary care in the CR is concentration of prematuredeliveries in Perinatological centres. Transport „in utero“ and provision of emergency care to the immature neonateby a neoatologist substantially reduced the early neonatal mortality. The total neonatal mortality in 1997 reachedthe historically lowest value of 5.1 pro mille and included thus the CR among the few countries in the world withthe lowest neonatal mortality.

Key words:
premature labour, etiology, treatment, centralization, perinatological centres.