Premature birth is a serious medical, social and economic problem. Its consequences are multiple health complications leading to high neonatal mortality worldwide. Respiratory insufficiency and surfactant deficiency significantly increase the risk of developing Hyaline Membrane Disease (HMD) and other forms of Respiratory Distress (RDS). These are the most common causes of death in premature babies. In prenatal and neonatal medicine, new and adaptive prophylaxis is being implemented to reduce the risk of death of premature babies and reduce the development of health complications. The goal of effective corticosteroid prophylaxis is to reduce mortality, reduce complications in prenatal new-borns, and shorten their stay in neonatal and intensive units respectively. A retrospective study of 167 preterm infants was conducted, of which 89 (53.3%) had prophylaxis with dexamethasone. In 25 (15%) of preterm infants, there was a Hyaline Membrane Disease (HMD) and 101 (60.5%) developed other forms of Respiratory Distress Syndrome (RDS). The results obtained show that the incidence of HMD in preterm infants is mediated by the early gestational age and advanced age of the mother, and decreased by corticosteroid therapy.
Premature birth is a significant medical, social and economic problem worldwide. In the 21st Century in developed countries, this problem accounts for over two thirds of neonatal deaths. In Bulgaria, statistics show that 10-12% of all pregnancies end with premature birth. Despite the number of studies in this field and the efforts made by obstetricians and gynecologists, the tendency to increase the number of preterm births has continued in the last decade. Its consequences are multiple complications who lead to a high neonatal mortality in the national and global world. Preterm birth is characterized by complex and vague etiology. A specific cause of premature birth can not be defined, but a set of risk factors is considered, divided into three main groups of etiological factors: socio-economic, medical-biological, and behavioral. Associated with preterm birth socio-economic and behavioral risk factors include poverty, unemployment, low education, poor prenatal care, harmful habits such as smoking, alcohol, drugs and other harmful substances, unhealthy family environment, severe and prolonged stress, excessive physical exercise (lifting weights), trauma (hits or violence), new pregnancies less than 6 months after previous birth, unhealthy diet and low mother BMI, etc. Essential for the preterm birth is also the medico - biological etiological factors. One of these is uterine enlargement, as the main reason for this may be the presence of: multiple pregnancies that occurred naturally or after using assisted reproductive technologies or polyhydramnios (increased amount of amniotic fluid). Other risk factors include: placenta previa, incorrect position of the fetus, myoma, uterine cervix malformations (including cerebrovascular insufficiency), preeclampsia, uterine contractions, acute infections during pregnancy (vaginal - chlamydia, trichomonas, mycoplasma , toxoplasmosis, bacterial vaginosis, viral rubella, cytomegalovirus, herpes, influenza, adenovirus infection, chronic diseases (hypertension, cardiovascular diseases, diseases of the lungs, liver or kidney anemia and etc.), genetic factors, previous premature birth, etc. These risk indicators are subject to detailed analysis in the work of a number of authors. To limit preterm births, a number of studies have been conducted to identify and identify the risk factors that are relevant to it. Identifying and recognizing their effects and impact leading to premature birth will significantly reduce the severe health, economic and social consequences as well as reduce the risk of neonatal death. In order to reduce the frequency of preterm births, adequate and specialized prenatal care is essential. They must be individually tailored for each particular case of pregnancy and take into account the complex of risk predispositions.
Pre-existing diabetes mellitus (Types 1 and 2) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. The aim of this study was to evaluate and compare the lifestyle habits of pregnant women with pre-existing diabetes mellitus (PDM) and GDM. A comparativedescriptive study on diabetes self-management during pregnancy was carried out using pre-validated self-administrated questionnaire. A total of 99 women with PDM and GDM participated in the study. The questionnaire provided information about patient demographics, obstetric history, diabetes history, self-monitoring of blood glucose (SMBG), dietary habits and physical activity. The two groups of pregnant women did not differ significantly with regard to demographic and obstetric characteristics. Only 26.8% of the women in GDM group adhered to strict SMBG and were tested daily (compared with 83.7% in PDM group, p<0.001). There were significant differences regarding dietary habits-91.1% of the women in GDM group reported eating healthy balanced meals compared with 62.2% in PDM group, p=0.001. Physical activity habits were similar between both groups. This study confirms the importance of self-care and healthy lifestyle habits during pregnancy. Every pregnant woman with PDM or GDM should obtain appropriate diabetes self-management education and support.
Preterm birth is a vital global health-economic problem. Health disorders provoked by it generate a high neonatal mortality rate. Prenatal corticosteroid prevention aims to reduce postnatal complications in premature infants. This survey covered two basic baby groups: work group of 89 premature infants that had been subjected to prenatal corticosteroid prophylaxis and a control group of 78 premature babies without prenatal prevention. The analysis of the pharmacoeconomic aspects of prenatal corticosteroid prevention enabled the comparison of clinical and therapeutic results, treatment costs, therapeutic expenditures, shortterm therapeutic effect, benefits and sequences from premature infants’ therapy. The analysis of clinical data obtained during this survey enabled the conclusion that when analyzing the combined effect of Dexamethasone prophylaxis, gestation week at birth and the age of the mother of premature infants with RDS, respiratory obstuction occurrence was mediated by the earlier gestation week at birth, older mother’s age and, at this background, it was restricted to a certain extent by prenatal corticosteroid administration. Conclusions: Prenatal corticosteroids cause reduction of premature infants’ treatment costs. The implementation of a smaller number of dexamethasone applications leads to smaller expenditures for premature infants’ treatment and care compared to those that have more dexamethasone applications.
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