Μία φυσιολογική εγκυμοσύνη διαρκεί 37 έως 42 εβδομάδες, αρχής γενομένης από την πρώτη ημέρα της τελευταίας περιόδου. Μια εγκυμοσύνη που συνεχίζει μετά από τις 37 εβδομάδες ονομάζεται «τελειόμηνη».
Ο πρόωρος τοκετός ορίζεται ως ο τοκετός που ξεκινά πριν από τις 37 εβδομάδες της κύησης. Πρόκειται για την πιο σημαντική αιτία νεογνικής θνητότητας και νοσηρότητας. Με το σωστό προγεννητικό έλεγχο μπορούμε να προσδιορίσουμε ορισμένες, αλλά όχι όλες, τις γυναίκες σε κίνδυνο για πρόωρο τοκετό. Σε περίπτωση αυξημένης πιθανότητας πρόωρου τοκετού, μπορούν να ληφθούν μέτρα για να καθυστερήσουμε τον τοκετό και να μειώσουμε τον κίνδυνο νεογνικών επιπλοκών.
Συχνότητα
Περίπου το 12 % των βρεφών γεννιούνται πρόωρα. Στο 80 % από αυτά οφείλεται σε πρόωρο τοκετό που εμφανίζεται αυτόματα ή μετά από πρόωρη ρήξη των εμβρυϊκών υμένων. Το υπόλοιπο 20% πρόκειται για προγραμματισμένους τοκετούς που γίνονται λόγω μητρικών ή εμβρυϊκών προβλημάτων, που εμποδίζουν τη γυναίκα από το να είναι σε θέση να συνεχίσει με ασφάλεια την εγκυμοσύνη της .
Δεν είναι απαραίτητο ότι όλες οι γυναίκες που είναι σε αυξημένο κίνδυνο για πρόωρο τοκετό ότι θα γεννήσουν το μωρό τους νωρίς. Εκτιμάται ότι μεταξύ 30 και 50% των γυναικών υψηλού κινδύνου θα γεννήσουν τελειόμηνα μωρά.
Προβλήματα που σχετίζονται με τον πρόωρο τοκετό
Σε περίπτωση πρόωρου τοκετού τα νεογέννητα είναι σε αυξημένο κίνδυνο να αναπτύξουν προβλήματα που σχετίζονται με την ατελή ανάπτυξη των οργάνων τους. Αυτά τα προβλήματα συνδέονται κυρίως με αναπνευστικά προβλήματα λόγω υποπλασίας των εμβρυικών πνευμόνων, καθώς και πιθανή ανάπτυξη νοητικής στέρησης, πρόβλημα σίτισης κλπ.
Υπερηχογραφική πρόγνωση και διάγνωση πρόωρου τοκετού
Μία από τις κυριότερες εφαρμογές του υπερηχογραφήματος στον πρόωρο τοκετό είναι ο έλεγχος του τραχήλου της μήτρας. Είναι γνωστή η σχέση μήκους τραχήλου κατά το 2ο τρίμηνο της κύησης και κινδύνου για πρόωρο τοκετό. Γνωρίζουμε ότι όσο μικρότερο το μήκος του τραχήλου της μήτρας τόσο μεγαλύτερος είναι ο κίνδυνος για πρόωρο τοκετό.
Η πλέον αξιόπιστη μέθοδος διερεύνησης είναι το διακολπικό υπερηχογράφημα. Η μέθοδος αυτή έχει αποδείξει την αξία της τόσο σε εγκύους χαμηλού, όσο και υψηλού κινδύνου για προωρότητα. Είναι επίσης, πλέον αποδεδειγμένο ότι υπάρχει άμεση συσχέτιση μεταξύ του μήκους του τραχήλου και της έκβασης του πρόωρου τοκετού.
Από τις 12 εβδομάδες κύησης μπορούμε να κατηγοριοποιήσουμε μετρώντας το μήκος του τραχήλου διακολπικά, ποιες γυναίκες είναι σε αυξημένο κίνδυνο να γεννήσουν πρόωρα. Η ίδια εξέταση επαναλαμβάνεται με πολύ μεγαλύτερη αξιοπιστία στις 22 εβδομάδες.
Γνωρίζουμε ότι ένας φυσιολογικός τράχηλος κατά τη διάρκεια της κύησης πρέπει να είναι κλειστός και να έχει μήκος 30-40mm. Από τις πιο πρόσφατες μελέτες έχει τεθεί ως όριο κοντού τραχήλου τα 25mm. Οποιαδήποτε μέτρηση κάτω των 25mm θεωρείται ότι αυξάνει τον κίνδυνο πρόωρου τοκετού.
Παράγοντες κινδύνου για πρόωρο τοκετό
- Από τη μητέρα (προεκλαμψία–εκλαμψία, χρήση ναρκωτικών, νοσήματα κολλαγόνου κ.α.)
- Από το έμβρυο (πολύδυμη κύηση, χρωμοσωμικές ανωμαλίες, ενδομήτρια καθυστέρηση ανάπτυξης, ενδομήτρια λοίμωξη κ.α.)
- Από τον πλακούντα (αποκόλληση πλακούντα, αιμορραγία προδρομικού πλακούντα, ανωμαλίες πλακούντα κ.α.)
- Από το αμνιακό υγρό (ολιγάμνιο, πρόωρη ρήξη εμβρυικών υμένων, χοριοαμνιονίτιδα)
- Από τη μήτρα (μεγάλα ινομυώματα, ανεπάρκεια τραχήλου κ.α.)
- Ιατρογενή (χειρουργικές επεμβάσεις τραχήλου κ.α)
Αντιμετώπιση
- Περίδεση τραχήλου: πρόκειται για χειρουργική επέμβαση με γενική αναισθησία (το ράμμα αφαιρείται πριν τον τοκετό).
- Κολπικά υπόθετα προγεστερόνης: μελέτες έχουν δείξει ότι προλαμβάνουν περαιτέρω μείωση του μήκους του τραχήλου της μήτρας.
- Ξεκούραση
- Αντιβιοτική θεραπεία σε περίπτωση λοιμώξεων.
Μέτρηση Μήκους Τραχήλου
- Πρόκειται για ένα διακολπικό υπερηχογράφημα απόλυτα ασφαλές για την κύηση για τη μέτρηση του μήκους του τραχήλου της μήτρας.
Συνιστάται σε γυναίκες που διατρέχουν υψηλό κίνδυνο για πρόωρο τοκετό, συμπεριλαμβανομένων των πολλαπλών κυήσεων, με προηγούμενο πρόωρο τοκετό, ανωμαλίες της μήτρας ή του τραχήλου της μήτρας, προηγούμενη χειρουργική επέμβαση. - Η εξέταση αυτή διεξάγεται συνήθως κατά το χρόνο του γενετικού υπερηχογραφήματος (β΄ επιπέδου), αλλά σε γυναίκες με προηγούμενο πρόωρο τοκετό μπορεί να είναι απαραίτητη μια σειρά υπερηχογραφημάτων παρακολούθησης ξεκινώντας από την 16η εβδομάδα
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