Dr. Long Chelsea98.com Wisdom Week Million Dragon Health Education
November 17th is "World Premature Birth Day". According to the World Health Organization, more than 15 million premature babies are born every year, and 1 million of them die from complications of premature birth. Nowadays, premature birth has become the leading cause of neonatal death. Even if these premature babies are lucky enough to survive, they also need to face life-long health problems such as learning disabilities, vision and hearing. The incidence of preterm birth accounts for about 5%-10% of all pregnancies, but it accounts for 80% of all neonatal deaths.
What is a premature baby?
The uterus is a luxurious suite for fetuses, and there is a breeding ground for them. Usually the fetus stays in for 37 weeks and above, and can leave the womb and go alone. This is a full-term fetus. The World Health Organization refers to newborns who are 20 weeks pregnant, gestational age less than 37 weeks, and birth weight less than 2500 grams as premature babies. The younger the gestational age, the less mature the fetus, the more complications, and the more difficult it is to treat and care. Generally, the larger the number of weeks of pregnancy at birth, the higher the survival rate. Premature babies born before 28 weeks of pregnancy and weighing less than 1kg are very dangerous and most of them are accompanied by complications.
Significance of gestational age assessment and fetal weight prediction
After 12 weeks of pregnancy, the head of the fetus can be clearly seen. Therefore, from the 12th week of pregnancy, B-ultrasound can be used to measure various indicators of the fetal head and use this to assess the size of the gestational age. The fetal head measurement indicators include biparietal diameter (BPD), head circumference (HC), occipital frontal diameter (OFD). The most commonly used is BPD, and fetal abdominal circumference (AC) and femoral long diameter (FL) can also be measured by B ultrasound to assess gestational age. In addition to predicting the expected date of delivery, the gestational age assessment can also infer the development of the fetus in the uterus, such as whether there is intrauterine growth retardation. However, it should be noted that there are certain individual differences between each fetus, and factors such as heredity, race, nutrition, disease, etc., have a certain impact on the development of the fetus. For example, compared to a pregnant woman with a tall body and a pregnant woman with a short body, various predictors of the fetus may be different. Therefore, when analyzing the prediction results, it is necessary to consider the normal range of changes, the changes in the menstrual cycle of expectant mothers, and the accuracy of doctors' operations. If the predicted result is larger or smaller than the actual gestational age, it does not all mean abnormal fetal development. Specific analysis should be done, or recheck after a certain interval.
For expectant mothers in special circumstances, sometimes the doctor will predict the weight of the fetus to find out any potential dangers. If the expectant mother suffers from gestational diabetes, it is necessary to use the fetal weight prediction to detect whether there is a giant baby; if the placenta function is not good or the umbilical cord development is problematic, the growth and development of the fetus may be affected, and it may appear Intrauterine growth retardation also needs to be judged by fetal weight prediction.
What is fetal movement?
Fetal movement refers to the movement of the fetus in the uterine cavity impacting the uterine wall. The fetus stretches its hands, kicks its legs, and impacts the uterine wall in the womb. This is fetal movement. After 4 months of pregnancy, the activity of the fetus can be clearly felt. Fetal movement is one of the important contents of clinical prenatal fetal monitoring technology. Fetal movement is the voluntary movement of the fetus. As early as 8 weeks of pregnancy, through ultrasound scans, we can observe that the fetus’s limbs have gradually matured, and they have begun to move hands and feet, and body rotation. However, because the fetus is too small at this time, the pregnant woman cannot feel the fetal movement at that time.
Overall, the average number of activities will change according to the pregnancy cycle:
1. In the 8th week, the fetal movement is 60 times every 12 hours, but pregnant women cannot feel it;
2. At the 20th week, the fetal movement is up to 200 times every 12 hours;
3. At the 32nd week, the fetal movement increased to 575 times every 12 hours;
4. At the 40th week, the fetal movement decreased to 282 times every 12 hours. This is because the late fetus enlarges, the amniotic fluid is relatively reduced, and the fetal movement space is reduced.
On average, menstrual women (for the second time or more) will start to feel fetal movement at 18 weeks of pregnancy. A pregnant woman who is pregnant for the first time will not feel her fetal movement until the 20th week of her pregnancy. With the passage of pregnancy, in addition to the frequency becoming frequent, fetal movement will gradually become very obvious. This is related to the size of the fetus, the extent of extension, the strength of the limbs and the conscious sensitivity of the pregnant woman.
Monitor fetal movement
When the fetus is in distress (such as hypoxia due to the umbilical cord wrapped around the neck), the number of fetal movements will first increase and then decrease. Therefore, measuring the number of fetal movements is the easiest and most commonly used method for pregnant women to self-monitor the health of the fetus. This method is especially suitable for use in the middle and late stages of pregnancy when fetal movement is easier to perceive. At present, there is no exact and uniform value to define whether the number of fetal movements is normal or abnormal. This is because the number of fetal movements varies from person to person, and each mother's subjective feelings are also different. However, according to clinical studies, between 28-43 weeks of pregnancy, the mother's feeling of abnormal fetal movement is often closely related to the abnormal ultrasound test results.
Because pregnant women have very different sensitivity to fetal movements, they report the number of fetal movements that they can feel within 12 hours, ranging from 50 to 950. The drop is mainly due to subtle fetal movements, which most pregnant women cannot detect. However, if the fetal movement can last for more than 10 seconds or there are large movements, or when the pregnant woman's attention is relatively concentrated, these fetal movements should be felt. For this reason, pregnant mothers often say that fetal movements will generally be more obvious when they rest after eating. It is believed that this is due to increased blood sugar and more concentrated thoughts during rest. In addition, the most frequent time for pregnant women to report fetal movement is between 9 pm and 1 am. It is unknown whether this is related to the fetal sleep cycle, or whether the pregnant woman will feel even weaker fetal movements at rest at night. So if you want to calculate fetal momentum, pregnant women need to be able to compare them at the same work and rest time. According to the guidelines of The Amercian Congress of Obstetricians and Gynaecologists, when calculating fetal movements, pregnant women need to lie on their sides and count all fetal movements that can be felt. Pregnant women should feel at least 10 fetal movements within 2 hours before they are "rest assured".
Fetal movement decreased
There is often no special reason for the reduction of fetal movement. But the most important thing is to determine whether there is fetal distress (fetal distress), and the following are the possible reasons for fetal distress:
1. Umbilical cord compression: Because the fetus can move freely in the amniotic fluid, it is not uncommon for the fetal umbilical cord to wrap around the neck. It occurs at term and 30% of fetuses have this condition. However, the degree of winding has elasticity. Even two or three circles, as long as it is loose, will rarely cause fetal distress; however, even if there is only one circle, if the entanglement is too tight or a knot is tied, the fetus will be hypoxic and even die.
2. Early placental detachment: If placental detachment occurs during labor, the blood of the fetus will be hypoxic. Can cause immediate life-threatening (stillbirth). The common symptoms are severe abdominal pain in pregnant women, combined with massive vaginal bleeding and decelerated fetal heartbeat. This situation is an emergency of pregnancy.
3. Pregnant women have fever: If the body temperature of the pregnant woman exceeds 38℃ and the fever is being reduced, the blood flow around the pregnant woman's body will increase in order to reduce the body temperature, but on the contrary the blood flow of the uterus and placenta will decrease, and the fetus will naturally become less active.
4. Pregnant women take tranquilizers: the drug will be passed to the fetus through the placenta, which will reduce the fetal activity.
5. Poor function of the placenta: This will cause the placenta to supply insufficient oxygen to the fetus, which will slow down the fetal movement. Examples include smoking, pregnancy toxemia, etc.
Generally speaking, fetal movement at the end of pregnancy (about 36 to 40 weeks) will reduce fetal movement due to the reduction of fetal space. Although it is a normal condition, it should not be ignored. If the fetal movement is still significantly reduced as the aforementioned method, you must go to the hospital as soon as possible to further confirm whether there is fetal distress. Although in clinical studies so far, calculating fetal movement cannot completely prevent stillbirth or cerebral palsy caused by hypoxia, this is the only warning sign that mothers-to-be can feel through non-instrumental methods. The closer to the expected date of delivery, the greater the chance of the above-mentioned complications, so you need to pay more attention to fetal movement!
What are the hazards of preterm birth?
1. Death of premature babies: The organs and tissues of premature babies are not fully developed. Most premature babies have weak hearts and other organs that cannot support their future growth and development. Premature birth is the number one cause of neonatal death.
2. The lungs are immature: the lungs of premature infants may be immature. Due to the lack of a lipid on the surface of the alveoli, the alveoli cannot be kept in an inflated state, which further leads to breathing difficulties, hypoxia, and seriousness. Sometimes suffocation may even occur. If the symptoms are mild, use an oxygen mask first. If the symptoms are severe, artificial respiration must be taken. Exacerbation of respiratory disorders can easily increase neonatal mortality.
3. The central system is underdeveloped and the body temperature regulation function is weak: the body temperature regulation center of premature babies is underdeveloped, has less energy stored, and cannot maintain normal body temperature with changes in external temperature, so premature babies are prone to symptoms of hypothermia . This low body temperature must not be underestimated. It can easily cause hard skin, pulmonary hemorrhage, and even death in premature babies.
4. Imperfect liver development and poor coagulation mechanism: Due to the immature development of the enzyme system in the liver of premature infants, and the intestinal flora that can synthesize vitamin K in the body is very small. Therefore, premature babies have a higher chance of bleeding. Common bleeding manifestations are: skin bleeding, blood in the stool, lung bleeding and so on.
5. Weak resistance: premature infants have poor antiviral and antibacterial abilities, are greatly affected by the surrounding environment, and are prone to symptoms such as lung infection; the incidence of sepsis or meningitis in preterm infants is almost 4 times that of term infants. Intravenous indwelling cannula, endotracheal cannula and skin breakage, and premature infants have significantly lower serum immunoglobulin levels, leading to an increased possibility of infection. Premature babies are the only ones susceptible to necrotizing enterocolitis.
6. Jaundice is easy to cause: premature babies are more prone to jaundice than full-term babies, mainly caused by weakened immunity and liver insufficiency. If the jaundice is severe, the serum bilirubin level will increase and it will damage the brain cells, thus leading to cerebral palsy or dementia. In this case, there is no cure.
7. Poor sucking ability: Due to poor sucking ability, it is difficult to feed premature infants, which can cause symptoms such as hypoglycemia. In severe cases, nasal feeding is required. Premature infants can’t suck milk normally, which can cause neonatal hypoglycemia. In severe cases, nasal feeding is required. Even if it is necessary to substitute formula milk, it is best to adopt a small amount of gradual feeding method. In addition, a very small part of premature babies will develop necrotizing enteritis, which requires special treatment.
8. Retinopathy: Premature delivery may hinder the normal development of retinal neovascularization, resulting in stunted eye development, and more likely to have problems such as myopia. You should go to the children's eye department for follow-up examination.
9. Periventricular and intraventricular hemorrhage: Because the ventricle structure of premature infants is immature and the vascular structure is quite fragile, it is easy to rupture and hemorrhage due to increased cerebral pressure. Generally, it can be divided into four levels. If it is light bleeding and does not cause ventricle enlargement, it will mostly be absorbed by the brain. However, if a large amount of bleeding causes the ventricle to expand or expand to the brain tissue, it may affect the nerve function, resulting in delayed motor development or behavioral disorders. Brain ultrasound should be done after birth. If there are problems, follow-up examinations are required regularly.
10. Inducing other diseases: premature babies often suffer from a series of health problems such as asphyxia, respiratory distress, pulmonary hypoplasia, growth retardation, neurological abnormalities, neonatal sepsis, and congenital heart disease.
What are the signs of preterm birth?
1. Uterine contractions: At 28-36 weeks of pregnancy, if there are regular and frequent contractions, accompanied by backache and back pain, this may be a sign of premature birth.
2. Vaginal bleeding: In the third trimester (28-36 weeks), if the expectant mother has regular contractions of the uterus, accompanied by vaginal bleeding or bloody secretions, and the amount of bleeding is large, this is also one of the signs of preterm labor.
3. Amniotic fluid outflow: In the third trimester, if the mother-to-be has warm water and natural-smelling fluid in the vagina, it flows out slowly and uncontrollably. This may be a sign of premature birth and requires immediate medical attention. Note: Many mothers will have false contractions in the third trimester. If the mother cannot tell the difference between the two, you can seek medical advice in time.
4. Abdominal pain: If the birth arrives early, the expectant mother will have abdominal pain similar to dysmenorrhea. In severe cases, increased lower body secretions and vaginal bleeding may also be found. The above situations need to seek medical examination in time to avoid premature birth.
5. Vomiting: Severe vomiting can cause pregnant women to become dehydrated and even worry about their lives, so they need to seek medical attention in time.
What are the factors that cause preterm birth?
1. Smoking, alcoholism, and use of addictive drugs;
2. Poor personal hygiene habits cause frequent infections of the urinary tract or reproductive system;
3. Excessive workload and pressure;
4. Malnutrition (imbalance), weight less than 45kg;
5. The pregnancy age is less than 18 years old or more than 40 years old;
6. The interval between two pregnancies is less than one year;
7. Those who have undergone artificial abortion or cervical cone surgery;
8. Those who have had premature birth experience.
When do expectant mothers need to see a doctor?
Pregnant women can compare the symptoms listed below. If two or more conditions occur at the same time, they should seek medical attention in time.
1. Abnormal contractions, frequent regular contractions (>5 times/h, lasting>2h);
2. Lower abdominal pain;
3. A dull pain in the lower back;
4. Increased pressure on lower abdomen and thighs indicates that the pelvic cavity is heavy;
5. Compared with usual, the speed of bowel movement is accelerated;
6. The lower body secretions are increased, watery, or bloodshot;
7. The mother-to-be feels physically abnormal.
Prevent premature birth12Measures
1. Pre-pregnancy health care should be done: before pregnancy, consider age, try not to give birth at a young or old age (less than 17, greater than 35 years old); considering weight, BMI is best to be 20.0-24.9 kg/m2; bad habits, smoking , Alcoholism, drug abuse, etc.; improve pre-pregnancy check-ups and actively treat existing diseases.
2. Indispensable for pregnancy check-ups: regular check-ups in accordance with the prescribed time, perfect screening of fetal related abnormalities. Pay attention to prevent infections such as viruses and bacteria, prevent premature rupture of membranes, chorioamnionitis and other diseases. In addition, it is necessary to actively prevent the deterioration and complications of various pregnancy complications. Especially for some pregnant women who suffer from pregnancy-induced hypertension, heart disease, twins and other multiple pregnancies, placental previa, and polyhydramnios, each check-up must be on time, and several fetal movements must be maintained every day. If abnormalities are found, they must Go to the hospital the first time. If the situation is serious, you will have to be hospitalized for fetal protection during the second trimester.
3. Health management and daily life: ensure that you have enough sleep and do not stay up late; pay attention to work intensity, rest in time, and avoid fatigue; do not stand for a long time, do not take heavy objects; pay attention to the frequency of sexual life, try to avoid having sex in the third trimester; Walk carefully, do not go shopping for a long time, and do not walk on the floor that has just been wiped; try to avoid unnecessary long-distance travel; once the expectant mother is hit by a severe external force, it will cause violent fetal movement, and even cause miscarriage and premature delivery.
4. Appropriate ambient temperature: In the home care of pregnant women or parturients, the indoor temperature should be maintained at 26-28 degrees Celsius, the relative humidity should be between 55-65%, and the air should be kept fresh. Premature delivery is prone to occur in summer, and more attention should be paid to the environmental temperature; in winter, it is easy to catch cold and cause fetal movement.
5. Always pay attention to uterine contractions: uterine contractions are the most obvious sign of premature birth. The uterus is usually loose during pregnancy. In the second trimester of pregnancy, the uterus may contract 3-5 times a day. At this time, the pregnant mother will feel that the belly is hard, but if the number of contractions is too frequent, and may even reach more than 3 times per hour, be very careful . In addition, if you have lower abdomen, lower back pain, obvious feeling of falling, genital pressure or bleeding, broken water, etc., you should consider the possibility of premature delivery and seek immediate medical attention. If the cervix changes in less than 24 weeks of pregnancy, but there are no contractions, your doctor may recommend cervical cerclage. During the operation, the doctor uses a strong suture around your cervix to strengthen the strength of the cervix and help the cervix stay closed. For women who have had 3 or more unexplained miscarriages or preterm births in the second trimester, cervical cerclage may be beneficial.
6. Pay attention to personal hygiene during pregnancy: During pregnancy, the vaginal environment will change, the immunity of expectant mothers will decrease, vaginal secretions will increase, and the chance of suffering from bacterial infection will increase. Therefore, pay attention to personal hygiene and do not give bacteria a chance. Once you find vulvar itching, leucorrhea or abnormal odor, you must go to the hospital for examination in time.
7. Pay attention to oral health: Periodontal disease is a common oral disease in women of childbearing age. Periodontal disease caused by oral anaerobic bacteria is one of the risk factors for miscarriage and premature delivery. Therefore, oral disease should be treated before pregnancy; brush teeth normally. .
8. If you have a fever, you must see a doctor immediately: Fever is a symptom of infection, and the increase in body temperature may cause uterine contractions, so you must go to the hospital as soon as possible to lower the body temperature. If necessary, the doctor will allow pregnant women to take special antipyretics or antibiotics. If the fetus is suffocated in the womb, or the pregnant woman is in danger, the doctor may decide to let the baby be born early.
9. Keep your mind and body happy and avoid excessive mental stimulation. If you are always in a state of tension and fatigue, the mood of the fetus will also be affected. For example: singing, music, reading, painting, walking, and doing what you like to do, etc.
10. Don’t take drugs or supplements randomly during pregnancy, and stay away from drugs that may cause teratogenicity; consult a professional, understand your physique, choose healthy nutritional preparations to supplement nutritional deficiency; once you have sub-health symptoms (including morning sickness, constipation) , Urinary tract infections, etc.), try to choose effective nutritional preparations, do not use drugs indiscriminately.
11. Try to avoid X-ray or other radiation exposure during pregnancy; reduce the use time of electronic products such as mobile phones, computers, and televisions; try to stay away from high-voltage lines or communication stations.
12, Six principles of nutrition management:
(1) Ingest more high-quality protein: eggs, meat, milk, fish and shrimp, seafood, fungi, etc. must be ingested to ensure a balanced diet and adequate nutrition. Pay attention to food hygiene to avoid premature delivery due to diarrhea and abdominal pain caused by unclean food.
(2) Eat more spinach, the best fetus-preserving vegetable. During the first two months of pregnancy, you should eat more spinach or take folic acid capsules. But spinach also contains a lot of oxalic acid, which can interfere with the body's absorption of trace elements such as iron and zinc. If spinach is blanched in boiling water, most of the oxalic acid will be destroyed.
(3) Eat the best anti-premature food-fish. The survey found that if you eat fish once a week during pregnancy, the probability of preterm delivery is only 1.9%, while the probability of preterm delivery for pregnant women who never eat fish is 7.1%.
(4) Avoid using spicy seasonings, such as fennel, pepper, pepper, cinnamon, chili, garlic, etc. Hawthorn should be eaten sparingly. Hawthorn can accelerate the contraction of the uterus and can lead to premature delivery. It is best to "keep away."
(5) Do not take too much vitamin A, so as not to cause premature delivery and unsound fetal development; pig liver is very rich in vitamin A, avoid excessive eating; avoid eating black fungus, which has the effect of promoting blood circulation and removing blood stasis, which is not conducive to embryos Stable and grow; avoid eating apricots and almonds, apricots are acidic and hot, and have a fetal effect, which is a taboo for pregnant women.
(6) Avoid eating greasy products, such as columbine and purslane. Myriad has an excitatory effect on the uterine muscle, which can promote uterine contraction, which may induce premature delivery; Portulaca is cold and slippery in nature, and has obvious excitatory effect on the uterus, which is easy to cause premature delivery.
Last and most important:
Consult a professional and caring health manager to make a full-cycle health management plan for yourself, from pregnancy, pregnancy, to childbirth, confinement, lactation, and even infant health management. This is the wisest choice!
If you have any questions, please consult the Canadian Boshilong Health Management Center to provide meticulous and professional heart-warming services for your healthy production or the full cycle of life and health!
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Chelsea98.com--Wise Week Million Dragon's Great Health Project Dr. Kyle Long, registered dietitian, registered health manager, from Smart Week Smart Financial Education Group-Sincere, clear and efficient personalized FAH financial quotient and health quotient education