A premature baby will be born at less than 37 weeks gestation (before day 260 of pregnancy).

Worldwide, the incidence of premature births is increasing. Approximately 5-10%, according to Wikipedia.

The reasons are different:

• Social:
  External factors:
  - bad habits;
  – lack of education of parents;
  – constant stress; poor nutrition;
  – hard work, etc.
• Genetic:
  – Mental disabilities of the parents or early age of the father or mother.

The dangerous period for conception is considered to be the age before 18 and after 35.

– genetic diseases;
– termination of pregnancy, miscarriage;
- parental relationship.

• Clinical:
  – Advanced forms of the disease or their incorrect and incomplete treatment, especially infectious and sexually transmitted diseases.
  – Viral lesions of the body that lead to degenerative processes in the formation of the baby.

Stages

Babies born early require special care. From birth, their lives depend entirely on the attentiveness of their parents and the competence of doctors. We'll talk about this further.

Behavior of a premature baby

A distinctive feature of preterm babies and full-term babies is a constant state of sleep. The child reacts only to the touch of the parents. They must provide all the care:

1. choose the right temperature;
2. rational feeding.

Depending on the timing and stage, the doctor sets rules for caring for the child.

Movements

Slowness of movements and large-amplitude manipulations of the limbs are observed. It is not uncommon to experience alternating movements of the upper extremities and spasms of the lower extremities.

Parents need to do massage and exercises to develop joints and increase the baby’s mobility.

Breath

Very fast (depending on the degree of prematurity): The smaller the body weight, the more intense the breathing.

• The upper airways are narrow, the diaphragm is high, and the chest is pliable.
• Breathing is not regular, apnea may occur.

If a child has difficulty inhaling and exhaling air, he is transferred to artificial ventilation until breathing stabilizes.

If this problem does not occur, it is necessary to provide the child with unobstructed access to air.

Dream

Constant. As they grow older, the frequency and duration decrease, and the child independently switches from one sleep phase to the activity phase.

In the first weeks after discharge, keep track of the hours your baby sleeps. So that in case of the slightest violations, the pediatrician can analyze and compare the norms with the established ones.

Crying and screaming

From the first days after birth, premature babies show emotions. They cry with their eyes closed or with their eyes open. Parents need to be attentive to such manifestations in order to accurately determine the problem of discomfort (wet diaper, uncomfortable position in the crib, unnecessary objects, loud sound, etc.).

It is important to prevent prolonged crying, since it negatively affects the vascular network that has not yet fully strengthened.

To calm your baby, rock him in your arms, speak gently, feed him if necessary, and check his diaper.

Development by months

Nutritional Features

The digestive system is poorly developed, so overfeeding can harm the fragile body. To control what is eaten, parents are advised to weigh the baby after each feeding.

The number and amount of milk consumed is determined by the doctor, taking into account all the developmental characteristics of the child.

Mothers can calculate the required portion using a formula.

Rommel's formula

V=n+10, where V is the amount of milk in ml for every 100 g of the child’s body weight, and n is the number of days of life.

Breast-feeding

Algorithm for weaning

1. Skin to skin contact. Try to provide the opportunity to feel the mother’s body and skin more often and for longer.
2. The mouth and nose are closer to the nipple when the baby sleeps on the mother's chest.
3. Express a few drops of milk onto the baby's lips; he will reflexively grab the nipple.
4. The baby may latch on to the nipple, but not take sips. Lean back a little and control the breast in your baby's mouth, holding it slightly.
5. The child may allow pauses during which he will actively search for the nipple. This is a sign that he is still hungry.
6. Over time, the sucking reflex progresses significantly and there are no difficulties with feeding.
7. Feeding on baby's demand. Mom keeps track of nutritional needs and follows a set schedule.
8. Feeding at the request of the baby and mother. By this period, the child is completely accustomed to feeding, he has a full-fledged sucking reflex, so the mother can control the frequency of feeding based on personal and child indicators.

Bottle feeding

In medicine, there are many adapted mixtures that are suitable for “children born early.” Make your choice under the guidance of a doctor; the mixture should contain sufficient amounts of calcium and protein.

You can accustom a baby to a bottle in the same way as with breastfeeding, only instead of a nipple, apply a pacifier to the baby's lips.

Psychological state of the child

Signs of stress:

• Shifts the gaze from one point to another;
• often cries and is capricious;
• hiccups;
• burps

Be careful if vomiting occurs! Contact your doctor immediately.

• arches his back;
• squeezes his arms and legs.

If any sign is present, the mother can rock the child in her arms, talk to him affectionately, and make eye contact.

If your baby clenches his arms and legs (signs of fatigue), you need to stimulate him less. You can rock your baby more slowly, stop talking, and avoid looking him in the eyes for a while. This will give him the opportunity to relax and cope with a difficult situation for him.

Appearance

Red or purple spots on a child's skin are called hemangeomas. These are wide, red, raised spots that form from dilated blood vessels. As the child develops (around 4 years of age), they disappear on their own. If any changes or thickening of the spots are observed, you should consult a doctor.

How often to see a doctor

After discharge from the hospital, children need constant medical supervision.

Examinations and anthropometry are carried out weekly in the first month.

In the first month of life, children should be examined:

• surgeon;
• orthopedist;
• neurologist;
• cardiologist;
• ophthalmologist.

From 1 year of age, children need consultations with a speech therapist and psychiatrist.

Regular consultations with a pediatrician will help prevent deviations that are invisible to parents.

You can visit a doctor as needed or as prescribed, but observation must be systematic.

Examinations of a premature baby

Observation is established for up to 7 years. Constant consultations with a pediatrician and neurologist are necessary.

1. During the first 2 years, a cardiologist monitors the baby, systematically performing an electrocardiogram.
2. After 2 years, rickets is prevented, vitamin D is introduced, massage and hardening.

When to vaccinate

Russia has a system for vaccinating premature babies. Typically, such children begin to be vaccinated when their body weight reaches 2200 grams.

1. Do not heat your child with heating pads or electrical appliances.
2. If your baby constantly cries for no reason, swaddle him.
3. Any behavioral disturbances are a reason to call a doctor or consult.
4. Check your breathing - watch your chest, count the number of breaths per minute.
5. Relieve your baby of stress, do not escalate the situation or make irritating noises, and dim the lights.
6. Hold your baby to your chest more often, so he will feel safe and connected with his parent.

What should be the temperature in the children's room?

Early born babies have poor thermoregulation, so it is important to maintain an optimal temperature in the room of 22-24 degrees.

You can check your body temperature periodically; it should be 36.6-37.4 degrees for premature babies. Avoid direct sunlight on your child's skin, avoid drafts and cold winds.

Tricks for parents

1. Try to sleep when your baby sleeps.
2. Divide care between the two parents in turns.
3. Rest periodically and spend time without the child, short breaks are necessary.
4. Communicate with parents of premature babies, exchange experiences.
5. Worry less. Everything that is not related to the baby’s health should not cause you panic or fear.

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The birth of a premature baby is a difficult test for parents, and besides, in this case the risk of developing all kinds of diseases increases. The incidence of premature babies is approximately 6-10%. This article will be useful to mothers who want to find an answer to the question of why some children are born prematurely and how to care for a premature baby in hospital and at home.

Signs of immaturity and weight of a premature baby

At 37-38 weeks of pregnancy, the baby in the mother’s womb is already quite ready for life. Children born before this period are considered premature. 35-37 weeks of pregnancy - 1st degree of prematurity (baby weight can be from 2 to 2.5 kg). Doctors determine the second degree of prematurity at 32-34 weeks; the weight of a premature baby is one and a half to two kilograms.

Term 29-31 weeks - 3rd degree of prematurity, newborns weigh one to two kilograms. And finally, the 4th degree of prematurity is the birth of a baby at less than 29 weeks and weighing less than one kilogram.

Sometimes it happens that a premature baby is born with a normal weight, but the following signs of immaturity may be observed:

• faint cry;
• irregular or weak breathing;
• underdeveloped subcutaneous fat layer;
• wrinkled and dry skin covered with fluff;
• open small and lateral fontanelles;
• soft ears that fit tightly to the head;
• muscle hypotonicity;
• absent or significantly reduced physiological reflexes.

When these factors are identified, a newborn child requires special medical supervision.

Problems and causes of the birth of a premature baby

Doctors name the following reasons for the birth of a premature baby:

• intrauterine fetal diseases and malformations;
• extragenital pathology in the mother;
• isthmic-cervical insufficiency;
• gestosis;
• premature placental abruption;
• occupational hazards and bad habits of the mother;
• abnormalities in the structure of the uterus.

The shorter the pregnancy, the higher the likelihood of developing characteristic diseases that are associated with the incomplete development of the baby’s systems and organs. We list the most common problems of premature babies:

• Undeveloped lungs due to the lack of surfactant, a substance that prevents the alveoli from collapsing and ensures the proper functioning of the organs. Doctors administer drugs containing surfactant to prematurely born babies, then the lungs adapt to independent breathing.
• Retinopathy is a damage to the retina of the eye that can lead to blindness.
• High susceptibility to infections, including opportunistic microorganisms due to insufficient development of the immune system.
• Patent ductus arteriosus requiring surgical or medical treatment.
• Problems with digestion of food due to insufficient hemoglobin.

So, the main feature of a premature baby is the immaturity of all the baby’s systems and unpreparedness for life outside the mother’s body, so he needs special care.

Care for a premature baby in a hospital setting

In the first days, babies need to be provided with the necessary conditions for further development. First of all, in a hospital setting, an optimal temperature regime is created for the baby, since the child’s body has difficulty retaining heat.

If children weigh up to one and a half kilograms, they are placed in an incubator, where a constant air temperature is maintained (34-35.5 degrees Celsius). As the baby adapts, the temperature is reduced. The skin of a premature baby is dry, and the mucous membranes and lungs are not prepared, so the incubator operates a device that maintains air humidity at 75-80%.

Medical care for a premature baby requires a huge number of medical procedures, so doctors try to minimize or compensate for stress in the following ways:

• Eliminate excess noise. 10% of premature babies are born with deafness and sensorineural hearing loss. Noise disrupts the formation of the auditory pathways, and lowering the noise level reduces the likelihood of developing hearing loss.
• Eliminate bright light. To do this, the incubators are covered with light-proof diapers.

Caring for a premature baby at home

If a premature baby is born into a family, the program for caring for an immature baby must necessarily include the following points:

• Air humidity and temperature. The room where the baby is located should be warm (at least 25 degrees Celsius). The air humidity in the room should be about 50%. This indicator can be monitored using a hygrometer.
• Feeding - It is important to feed a premature baby breast milk, as it provides him with the necessary substances, protecting him from infections. Immature babies need to be fed every three hours, day and night. If the baby is sleeping, you need to wake him up by lightly tickling his nose or ear.
• Close contact with mother. Closeness with the mother is important in caring for a premature baby. In order for an early toddler to develop faster and get sick less, it is necessary to lay him on his mother’s stomach as often as possible, and cover him with a warm blanket on top.
• If the weight of a premature baby does not exceed one and a half kilograms, you can take him out into the fresh air two weeks after birth, if the weather is warm outside and the air temperature is not lower than 22 degrees Celsius. The first time you are allowed to walk for no more than ten minutes, increasing the duration of the walk by 5 minutes every day.
• Bathing. If a premature baby was born weighing more than one and a half kilograms, doctors recommend bathing him only 10 days after birth. For water procedures, you need to use boiled water (temperature 38 degrees Celsius).

In general, maternal love is the most important moment in caring for a premature baby. If the mother loves the baby with all her heart and believes that everything will be fine, then most likely it will be so.

A newborn child, regardless of body weight at birth, is considered premature if born from the 22nd to 36th week of intrauterine development (for a full-term child this period is 37-40 weeks). The degree of maturity of a newborn depends on its ability to live outside the womb and adapt to environmental conditions. The concept of maturity is most closely related to gestational age (term of intrauterine development). This indicator is the main one when assessing the nature of intrauterine development of the fetus. Based on gestational age, there are four degrees of prematurity: I degree - gestational age 36-35 weeks, II degree - 34-32 weeks, III degree - 31-29 weeks, IV degree - 28-22 weeks. Body weight at birth is not an absolute indicator of prematurity: premature babies are often born with a body weight of more than 2500 g. Low birth weight children are divided into children with low body weight (2500-1500 g), very low weight (1500-1000 g) and extremely low body weight (less than 1000 g).

The reasons for premature birth of children are numerous and sometimes difficult to identify. Usually they are not isolated, but combined with each other. There are main groups of causes and provoking factors for premature birth: 1) data from a burdened obstetric history (three or more previous terminations of pregnancy, short intervals between births, multiple pregnancies, breech presentation, surgery); 2) severe somatic and infectious diseases of the mother; 3) diseases of the fetus (intrauterine infections, chromosomal diseases, immunological conflict between the pregnant woman and the fetus); 4) socioeconomic factors (primiparas under 18 years of age and over 30 years of age, height less than 150 cm, body weight 45 kg, low social status, genetic predisposition). Provoking moments include physical and mental trauma, heavy lifting, falling and bruising of a pregnant woman. Anatomical and physiological characteristics (AFP) of a premature baby. Morphological signs of prematurity. The appearance of premature babies has a number of characteristics that are directly dependent on the duration of pregnancy. The younger the child’s gestational age, the more pronounced they are and the more of them there are. Some signs are used to determine gestational age. These include: skin, ears, nipple areolas, furrows on the feet, sexual characteristics. A very premature baby has thin, wrinkled skin of a dark red color, abundantly covered with fluff (lanugo). The auricles are soft, adjacent to the skull, and with a short gestation period they lack relief and are shapeless due to the underdevelopment of cartilage tissue. The areolas of the nipples are underdeveloped, less than 3 mm, and with severe prematurity they may not be detected. The furrows on the feet are sparse, short, shallow, appear at the 37th week of gestation, and at the 40th week of gestation they become numerous. The scrotum in boys is often empty, the testicles are located in the inguinal canals or in the abdominal cavity. Girls are characterized by a gaping genital slit - the labia majora do not cover the labia minora, and the hypertrophied clitoris is clearly visible. A premature baby is small in size and has a disproportionate build (relatively large head and torso, short neck and legs, low umbilical ring). The brain skull predominates over the facial skull. The sutures of the skull and fontanels are open. The subcutaneous fat layer is not expressed. Functional signs of prematurity. Premature babies are characterized by immaturity of all organs and systems, the severity of which depends on the duration of pregnancy. Neurological signs of prematurity are muscle hypotonia, decreased physiological reflexes and motor activity, impaired thermoregulation, and weak cry of the child. Children are periodically restless, with intermittent tremor of the chin and limbs. Breathing is 40-90 respiratory movements per minute, uneven in rhythm and depth, interrupted by convulsive breaths and pauses (apnea) lasting up to 10-15 seconds, which is more often observed in very premature infants with hypoxic lesions of the central nervous system. If breathing stops for a longer period of time, asphyxia (suffocation) may develop. The pulse is labile, from 100 to 180 per minute. Blood pressure does not exceed 60-70 mm Hg. Art. Thermoregulation in a premature baby is imperfect. Children quickly cool down and overheat just as quickly. The peculiarity of the temperature reaction is manifested in the fact that when overheated, the body temperature can rise to 40˚C, and in response to the introduction of an infection, premature infants may not respond with an increase in temperature. Sucking and swallowing reflexes are underdeveloped. There is often a lack of coordination between sucking and swallowing. There is a tendency to regurgitation, vomiting, flatulence, and constipation. The absence of a cough reflex promotes aspiration of food. Due to imperfect immunity, premature babies are prone to infectious diseases. Increased permeability and fragility of blood vessels contribute to the occurrence of cerebrovascular accidents and hemorrhages. Borderline physiological states are unique in premature infants: physiological erythema, loss of initial body weight, and jaundice are more pronounced and prolonged. Mild jaundice may be accompanied by severe bilirubin encephalopathy. The umbilical cord remnant falls off later than in full-term infants (on the 5-7th day of life), the umbilical wound heals by 12-15 days, with a weight of less than 1000 g - 1-2 weeks later.

Organization of medical care. The problem of caring for premature infants is extremely complex, since children are not yet mature enough to exist outside the mother’s body. To preserve the viability of premature infants, it is necessary to create special conditions both at the time of birth and during the subsequent adaptation of the child. For this purpose, assistance to premature babies is provided in stages: provision of intensive care and treatment in the maternity hospital (stage I of nursing); nursing in a specialized department (stage II); dynamic observation in a children's clinic (stage III). The main goal of stage I is to save the child’s life. In the first hours and days after birth, intensive therapy is provided, if necessary, and careful care and monitoring are provided. No later than 1 hour after birth, the child is transported to the neonatal unit (to the ward for premature babies) or, in case of severe condition, to the intensive care unit. Healthy babies with a birth weight of more than 2000 g are discharged home from the maternity hospital, all other premature babies are transferred to a specialized department for the second stage of nursing.

The main area of ​​work of the specialized department is treatment and rehabilitation. Therapeutic measures are aimed at eliminating hypoxia, preventing anemia, rickets, and malnutrition. Important means of rehabilitation for children with central nervous system damage are therapeutic exercises, massage and exercises in water. Discharge from the department of the second stage of nursing is approached individually. The main criteria for deciding on discharge are the absence of diseases, restoration of initial body weight and its satisfactory increase, normal hemoglobin levels, and a favorable home environment. All information about the child is transferred to the pediatric department on the day of discharge. Features of care. Premature babies are cared for taking into account physiological characteristics: imperfect thermoregulation, reduced tolerance (endurance) to food, a tendency to asphyxial conditions, insufficient resistance to infection, immaturity of organs and systems. When caring for premature babies, it is necessary to create comfortable microclimatic conditions. Cooling a premature baby in the delivery room often dooms all further care for him to failure. The temperature in the room should be 24-26˚C; humidity -60%. In the first days and weeks of life, very premature babies or premature babies in serious condition are nursed in incubators. They maintain a temperature from 36˚С to 32˚С, air humidity in the first day is up to 90%, then 60-55%, the concentration of humidified oxygen is about 30%. The optimal temperature regime is a regime in which it is possible to maintain body temperature within 36.5-37˚C and prevent overheating and cooling of the child. The level of oxygenation is selected individually: it is advisable to ensure a minimum excess oxygen concentration, at which the signs of hypoxemia disappear (cyanosis of the skin and mucous membranes, low motor activity, rare breathing with prolonged apnea, bradycardia). It is not recommended to create an oxygen concentration of more than 38% in the incubator due to the possibility of damage to the lungs, retina and central nervous system. The duration of oxygen supply should also be monitored. Disinfection and change of incubators take 2-3 days. A child in need of incubation is transferred to a clean incubator. Transfer to a crib is carried out in the absence of respiratory disorders, maintaining a constant body temperature, and the premature baby’s ability to cope with minimal oxygenation. For additional heating, heated cots, thermal mattresses, thermal protective film, and heating pads are used. When performing short-term procedures, heated changing tables and radiant heat lamps (“Ameda”) are used. Children nursed in cribs are dressed in vests with sewn-up sleeves. Particular attention should be paid to monitoring the child’s condition, monitoring the temperature and humidity of the room, operating parameters and handling of the incubator, and observing the strictest sanitary and hygienic and anti-epidemic measures. The protective regime is of great importance: limiting painful stimuli, protecting the child’s sleep, careful toileting and manipulation, strict adherence to the sequence of diagnostic and treatment procedures. The mother must follow the rules of personal hygiene and maintain proper sanitary conditions when caring for the child. The feeding of premature infants has a number of features. They are due to the child’s high need for nutrients and the immaturity of his gastrointestinal tract, which requires careful introduction of food. Depending on the stage of pregnancy, breast milk changes in composition. Therefore, mother's milk is most suitable for the needs of the child and ensures maximum success in nursing. The newborn should receive it, even if the amount of milk is minimal. To stimulate milk production, frequent pumping is recommended (at least 8 times a day). In the absence of milk, premature infants are provided with donor milk; in exceptional cases, adapted milk formulas intended for feeding premature infants are used (“Enfalakt,” Nenatal, “Pretutteli,” “Prenutrilon,” “Prepilti,” “TreHiPP,” “SMA- Premi”, “Novolakt-MM”, “Detolakt-MM”, “Humana O”, etc.), as well as “Alesya-1”, mixtures enriched with biological additives. The time of the baby's first feeding is determined individually. Depending on the severity of the condition of the premature infant, they are fed by breast, spoon or from a cup, through a tube. The frequency of meals depends on the method of feeding, the baby’s ability to retain milk in the stomach and the activity of sucking. Children with a weak sucking reflex receive milk through a gastric tube. The frequency of tube feeding is usually 7-8 times per vessel. When prolonged tube feeding using a syringe dispenser or infusion system, the time of milk administration should not exceed 3 hours. Children with a swallowing reflex and a weak sucking reflex are fed from a spoon or cup. The spoon is partially filled and controlled so that the milk pours over the tongue and is swallowed without accumulating under the tongue. Feeding from a pacifier makes breastfeeding more difficult in the future. As the general condition improves and the sucking reflex appears, the baby is put to the breast. Breastfeeding and close contact with the mother are even more important for premature babies than for babies born at full term. If the condition allows, it is recommended to place the naked baby on the mother’s chest as early and often as possible (kangaroo method). A premature baby cannot suckle effectively and is supplemented with expressed milk. Babies with active sucking are breastfed. During breastfeeding, the baby should be helped to find the correct position and the mother should be warned that milk should not remain in the newborn's mouth due to the risk of aspiration. In the event of aspiration, immediately stop feeding, suction the contents from the upper respiratory tract, place the child in an elevated position, provide oxygen supply, and notify the doctor. The amount of food per feeding on the first day of life is usually 5-10 ml of milk, on the second - 10-15 ml, on the third - 15-20 ml. The daily amount of food in the first 10 days of life can be calculated using the Romell formula: (10+n) x m: 100, where n is the number of days of life, m is the mass of the child and in scales. For example, on the 4th day for a child weighing 1600 g, the daily amount of milk is: (10 + 4) x 16 = 224 (ml). Every day its quantity increases and by the 15th day of life the daily milk requirement is 1/7 of the body weight, by the end of the 1st month - 1/5 of the weight. The daily amount of food can be determined using the calorie method. The calorie requirement until the 10th day of life is (10xn) kcal x kg body weight per day, where n is the number of days of life; by the 15th day - 120 kcal/kg, at the age of 1 month - 140 kcal/kg, by 1 year - 120 kcal/kg. The calorie content of 100 ml of breast milk is 70 kcal (colostrum - 140 kcal). For example, a 1 month old child weighs 2500 g and therefore needs 3500 kcal/day. The daily amount of food is 350 kcal x 100 ml: 70 kcal = ml. To meet the increased need of premature infants for vitamins and mineral salts, earlier introduction of corrective supplements and complementary foods is recommended.

Nursing at home. When nursing premature babies, you should ventilate the room more often, maintain the air temperature in the room at 20-22˚C, when bathing - 22-26˚C, depending on the maturity of the child. Children are bathed daily at a water temperature of 38-39˚C. In the warm season, walks begin immediately after discharge, in the cold season - from 1-2 months of age with a body weight of at least 2500-3000 g and an air temperature of at least 1-3˚C. Most premature babies no longer need special heating by the end of the 1st month. The child needs a gentle sleep and wakefulness regime. Training methods of hardening (air baths, contrast dousing after bathing, etc.) are carried out in the second half of life. Of the physical exercises until physiological muscle hypertension disappears, only stroking and reflex exercises are allowed. The proper development of premature babies is facilitated by a favorable home environment, individual classes, games, balanced nutrition, and strict adherence to sanitary and hygienic conditions.

Features of development of premature babies. The physical development of premature infants is characterized by a higher rate of increase in body weight and length during the first year of life compared to children born at term. The exception is the first month of life, when there is a low increase in body weight due to a greater loss of initial weight than in full-term infants. Growth during the first year increases by 27-38 cm. Despite the high rates of development, in the first 2-3 years of life, premature babies lag behind peers born full-term in terms of body weight and height. During the first 1.5 years of life, the pace of psychomotor development of premature infants is delayed, the formation of the leading lines of neuropsychic development is shifted in time to a later age stage. This delay depends on the gestational age of the baby. Most premature babies have normal mental development, but may have an unstable mental state, negativism reactions, anxiety, insomnia, appetite disturbances, and difficulty eating solid foods.

Forecast. In recent years, there has been an improvement in the survival rates and quality of life of surviving preterm infants, including those born with very low birth weight. There are many problems associated with nursing and subsequent development of the nervous system in children with a body weight below 1000 g and a gestational age of less than 29 weeks. The mortality rate in such children continues to remain high, as does the incidence of nervous system disorders and disability (cerebral palsy, visual and hearing defects, mental retardation). Prevention of premature birth of children. It provides for the following: protecting the health of the expectant mother, starting from early childhood; prevention of medical termination of pregnancy; creating favorable conditions for pregnant women in the family and at work; timely identification of pregnant women at risk of premature birth and monitoring them during pregnancy.