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MAP: The Threat of Premature Childbirth
The leading cause of hospitalization during pregnancy, the threat of premature childbirth is feared by future parents. The earlier it appears, the more severe the consequences can be for the unborn baby. But today it is possible to delay childbirth and reduce the risk of neonatal complications.
MAP: definition
Occurring between 22 and 36 weeks of complete amenorrhea, the threat of premature delivery is characterized by the association of cervical changes and regular and painful uterine contractions that will lead to premature delivery in the absence of medical intervention.
Medical examinations to detect PAD
The diagnosis of PAD is essentially clinical. The doctor confirms the existence of regular and painful uterine contractions with monitoring and modification of the cervix with ultrasound measurement of the cervix. Vaginal examination is less and less practiced. These examinations are supplemented by biological analyzes (blood test, cervico-vaginal sample, ECBU), in particular to look for a possible infection.
Causes of PAD
Infectious causes are frequently found. It could be a urinary or vaginal infection of the mother as well as an infection of the amniotic fluid following a crack in the membranes. Maternal age, under 18 or over 35, is also a risk factor, as is smoking, anemia, trauma to the belly, grueling professional activity, etc. May also be the cause of obstetric history. : history of premature childbirth, late abortion, uterine malformation … Finally, multiple pregnancy, hydramnios (excessive amount of amniotic fluid), placenta previa are also contributing factors. But six times out of ten, no explanation is found for the occurrence of PAD.
Possible treatments
Faced with a threat of premature delivery, the teams’ goal is to delay delivery as much as possible and reduce the risk of complications for the premature baby.
If PAD occurs within 32 weeks of amenorrhea or if the fetal weight is estimated to be less than 1500 grams, the expectant mother is hospitalized in a type III maternity hospital. Established in large hospitals, level III maternity units include a neonatal unit and a neonatal intensive care unit. If PAD occurs after 34 weeks of amenorrhea, hospitalization can most often take place in a “classic” type I maternity unit. neonatology) or in type III maternity (with neonatal unit and neonatal intensive care unit) is decided on a case-by-case basis.
The treatments implemented depend on the cause of the PAD, its importance, as well as the term of the pregnancy at which it occurs. Strict bed rest is systematic. If a triggering cause has been identified, such as an infection, it will be treated. Tocolytics will be given intravenously to try to stop uterine contractions. At the same time, corticosteroids will be administered to the fetus to accelerate the maturation of their pulmonary alveoli.
In the event of a favorable evolution, with in particular a stop of the contractions, and in the absence of cervical modifications and major risk factors, the return home can be considered, with strict rest and reinforced monitoring.
Premature childbirth
A full term pregnancy lasts 39 weeks, i.e. 41 weeks of amenorrhea (calculated from the 1st day of the last menstruation. A birth is premature when it occurs before 37 weeks of amenorrhea. But we must distinguish between average prematurity (birth between 33 WA and 36 WA + 6 days), very prematurity (birth between 28 WA and 32 WA + 6 days) and very great maturity (birth before 28 WA). situation to another.
Premature childbirth can be either spontaneous (in almost 2/3 of cases) or caused by a medical decision. Spontaneous premature delivery is frequently preceded by PAD.