From Big Medical Encyclopedia

PREMATURE BURSTING OF WATERS (synonym premature izlity waters) — izlity amniotic waters at a rupture of fetal membranes prior to childbirth. If fetal membranes are broken off in the presence of pains, but before full disclosure of a uterine pharynx, tell about early izlitiya of waters. The premature bursting of waters is noted in 12 — 15% of childbirth.

The item of the lake of century depends on a number of factors, in particular it is observed at a high arrangement of the prelying part of a fruit. At a narrow basin, pelvic presentations, a large fruit, extension of a head (frontal, front), and also in cases of cross and slanting provision of a fruit, when there is no a belt of contact of the prelying part of a fruit with a basin, all force of intrauterine pressure is directed to the lower pole of a bag of waters, and fetal membranes (see) are broken off prematurely. The item of the lake of century can be also promoted by the inferiority of a neck and the lower segment of a uterus caused by morphological or functional changes — istmiko-cervical insufficiency (see). Also inflammatory or dystrophic changes in fetal membranes, their insufficient elasticity as a result of disturbance of biosynthesis of collagen can be the cause of a gap. P. is frequent the lake of century is observed at women with the burdened obstetric anamnesis and the complicated course of pregnancy (threat of interruption, toxicosis, the general diseases, local inflammatory processes).

The rupture of fetal membranes occurs over an internal uterine pharynx or above (a high side gap). After P. of the lake of century fetal membranes disperse or densely cover a head of a fruit, and at a side gap the bag of waters can be defined, but it loses the elasticity.

At the full-term pregnancy and existence of readiness for childbirth after P. of the lake of century excitability of a uterus increases, its tone raises that leads to development of spontaneous patrimonial activity; childbirth comes to an end safely, their duration same, as at timely izlitiya of waters. In the absence of readiness for childbirth the functional uterine activity does not accrue, there can be a weakness or the disco shouting the dination of patrimonial activity. The item of the lake of century at premature pregnancy at first leads to increase in a tone of a uterus, but further patrimonial, activity can not develop. At the same time fetal membranes produce waters, uteroplacental blood circulation and satisfactory condition of a fruit remains. Prolongation of pregnancy within several weeks (is possible especially at a high side gap), sometimes to a mature condition of a fruit; pregnancy comes to an end with normal childbirth.

P.'s danger of the lake of century consists first of all in development of an infection. Contagiums from a vagina easily extend in the ascending way, striking a decidua (see), amnion, chorion (see. Germ , Fetal membranes ), placenta (see). The fruit is infected through amniotic waters or a placenta. As a result of development of a horio-amnionitis (see. Cesarean section ) and a metroendometritis (see) uteroplacental blood circulation is broken, the fruit suffers from intoxication, a hypoxia, on this background further at the newborn disturbance of cerebral circulation can develop.

At P. of the lake of century the pregnant woman notes the expiration from a vagina of a significant amount of liquid or its slow dribble. At the wrong provisions, adverse insertions and discrepancy of a head of a fruit to a basin of mother loss of small parts of a fruit and loops of an umbilical cord is possible. During the opening of a neck of uterus lack of a bag of waters is defined palpatorno at vaginal examonation. At a safe neck of uterus carry usually in addition out an amnio-skopiya (see). Besides, conduct microscopic examination of allocations from a vagina for detection of elements of amniotic waters (hair of a fruit, syrovidny lubricant and so forth).

The item of the lake of century is the indication to hospitalization. Tactics of the doctor is defined by duration of gestation, and at a mature fruit depends on existence of readiness for childbirth. With readiness for childbirth and a mature fruit resort to a rodovozbuzhdeniye. Covers move apart, exempting from them a head of a fruit. If there is no readiness for childbirth, enter estrogen, glucose, calcium, vitamins, ATP, trying to obtain «maturing» of a neck of uterus. At inefficiency of these actions and existence of the burdening factors (the still birth in the anamnesis, pelvic presentation, the cross provision of a fruit, etc.) needs to be made timely Cesarean section (see).

If amniotic waters (see) stream at a crude fruit, carry out the therapy directed to preservation of pregnancy. For maturing of lungs of a fruit to the woman appoint glucocorticoids. Considering risk of infection, to all women later 6 hours later from lithium of amniotic waters if fast delivery is not expected, enter antibiotics, preferably semi-synthetic penicillin (ampicillin) or cephalosporins. At emergence of symptoms of an infection delivery in natural patrimonial ways is necessary.

P.'s outcomes of the lake of century depend on duration of gestation, the accompanying complications, a functional condition of a uterus, adaptation opportunities of a fruit.

For P.'s prevention by the lake of century carry out treatment of inflammatory diseases to and during pregnancy, toxicoses of pregnant women, try to improve the wrong situation of a fruit, to prevent Criminal Investigation Department -< the storage of premature births.

Bibliography: Abramchenko V. V., Morozov V. V. and Varfolomeyev D. I. Features of a current of a childbed and sokratitelny activity of a uterus at women in labor at premature izlitiya of amniotic waters, Vopr. okhr. mat. also it is put., t. 23, No. 5, page 60, 1978; And N to and rs to and I am A. S. Bacterial infection of a fruit, Akush. and ginek., No. 9, page 3, 1979; L y z and to about in N. F. Premature bursting of waters, Minsk, 1971, bibliogr.; Nemeadze N. O. Influence untimely an izlitiya of amniotic waters on a functional condition of a fruit in labor, Akush. and ginek., No. 7, page 44, 1978; Persianinov JI. Page, e-leznov B. I. and Bogoyavlensky N. V. Fiziologiya and pathology of sokratitelny activity of a uterus, M., 1975, bibliogr.; Cederqvist L. L. and. lake of The relationship between prematurely ruptured membranes and fetal immunoglobulin production, Amer. J. Obstet. Gynec., V. 134, p. 784, 1979; Clinical perinatology, ed. by S. Aladj'em a. o., St Louis, 1980; Fetal physiology and medicine, The basis of perinatology, ed. by R. W. Beard a. P. W. Nathanielsz, L. a. o., 1976; Ruck-häberle K. E. u. a. Art der Geburtsbeendigung, Zustandsdiagnostik und kindlicher Ausgang bei Frühgeburt, Zbl. Gynäk., Bd 101, S. 532, 1979; Th 1165a (Partusisten) bei der Behandlung in der Geburtshilfe und Perinatologie, hrsg. v. H. Jung u. F. K. Klöck, Stuttgart, 1975.

M. M. Melnikova.