Pregnancy - SpeedyLook encyclopedia

Fecundation

The first stage of the pregnancy starts with a sexual relation (or Coït) during which the Gamète S males (the Spermatozoïde S) are emitted (by ejaculation) in the Vagin. The Sperme is composed not only of spermatozoa but also of Sucre S (mainly of the Fructose), of Protéine S and other substances being used to maintain the elements cellular in life. Human sperm survives approximately 48 hours in the body of the woman (sometimes more). The spermatozoa have a length Flagelle (a kind of “tail”) which they use to move, being thus only human cells equipped with an organoid of displacement. These cells are Haploïde S, being divided at the time of the Méiose of germinal cells in the Testicule S of the male, and having thus only half of the Chromosome S of the cells of the body. Human ejaculation includes/understands between 100 and 300 million spermatozoa ( to see Spermogramme ).

The ovule, or the ovocyte, is the cell haploid egg (i.e. it contains only one half of the genetic material) female. Its role is to amalgamate with a spermatozoon, thus becoming a fertilized Zygote which will grow then in the Utérus and will become Embryon then Fœtus. The ovule is created by Méiose in the ovary of the female, and remains in a state of suspension until the hormonal fluctuations of the menstrual cycle (hormonal peak at the 14th day of the cycle at the woman, more commonly called Ovulation) cause its release and its emission in the Fallopian tube. Usually, only one ovule is released by menstrual cycle (a release of two ovules and their later fecundation give rise to “forgeries Jumeau X”, i.e. twins resulting from two different eggs fertilized by two different spermatozoa).

At the time of ovulation, the fringe ( fimbriae ) of the Fallopian tubes covers the ovary to receive the released ovule. In the event of fecundation, sperm usually meets the ovule in the Fallopian tube, on the level of his external third (in the bulb ); the spermatozoa must then cross the higher vagina, the uterine collar, the uterus and the Fallopian tube before meeting the ovule, which represents a considerable distance in comparison with the size of the spermatozoon.

The spermatozoa which reach that point try to fertilize the ovule. Each spermatozoon carries at its cephalic end, contained in a vacuole, lytic Enzyme S which it uses to dissolve part of the layer external of the ovule. This stage, when she arrives in her term, can take approximately 20 minutes. Once the ovule amalgamated with a spermatozoon, its wall cellular changes composition, thus making it possible to inhibit the penetration of another spermatozoon. The fusion of the cores of the ovule and the spermatozoon creates a cell Diploïde (i.e. including/understanding all the genetic material necessary to its multiplication, of which a half of maternal origin and a half of paternal origin), supplementing the first stage of the pregnancy.

Alternative means of fertilization, whose Artificial insemination and In vitro fertilization, are sometimes used in the cases of sterility. In France, the access terms with the Procréation médicalement assisted impose the need for an alive couple, in age to procreate, of different sex, being able to justify at least two years of common life.

The Ectogénèse is the externalisation like the oviparous animals. It is not (still) at the point technically.

Development

Period of preimplantation

At this time the zygote is only one original cell totipotente with the capacity to create a whole organization. The cellular division by Mitose is the next process: each cell is duplicated to produce another cell diploïde. The zygote divides to produce two cells smaller, known as Blastomère S, approximately every 20 hours. These cells redivisent approximately 3 times (16 cells). This cluster of cells, known as the Morula (because of its aspect, which one can bring closer to a blackberry), leaves the Fallopian tube and enters the uterus.

Postimplantation

The cells involutes are distributed around the Blastocèle, a liquid cavity in the middle of the cells. The cells become, progressively of their divisions by mitosis, increasingly small. This structure including/understanding the zygotic cells and the blastocèle is called the Blastocyste. The cells start to be different between the cells interior and external with the blastocyste. In 24 to 48 hours, the wall of the blastocyste, the pellucid Zone, breaks. The cells external of the blastocyste then start to secrete an enzyme which erodes the epithelium of the uterus and creates a site for the establishment. The blastocyste secretes also the chorionic gonadotrophine (HCG), a Hormone which stimulates the yellow Corps of the ovary of the mother to produce Progestérone, which maintains the lining of the uterus to nourish the embryo. The glands in the uterine coating grow in answer to the blastocyste, and the growth of the capillaries is stimulated in the area, ensuring the provision of vital nutrients and oxygen the blastocyste.

The biological diagnosis of the pregnancy is done by the blood or urinary research of the beta fraction of the chorionic gonadotrophine, better known under the name of beta-HCG. The tests of pregnancy urinary available in pharmacy propose a qualitative proportioning of this hormone, their reliability is from 90 to 99%. Proportioning blood, quantitative, of beta-HCG allows a diagnosis of certainty and a dating of the beginning of the pregnancy (the rate of this hormone doubles every 48 hours at the beginning of pregnancy).

Circulatory system of the placenta

The cells around the blastocyste start to destroy cells of the uterine coating, producing small puddle pools of blood and thus stimulating the production of new capillaries. It is the first stage in the development of the Placenta. The interior cells of the blastocyste grow quickly and form two layers. The roadbase will become the Embryon and the amniotic cavity, and the sub-base will create a small “bag”, the vitelline Vésicule. A few days later, of placental villosities choriales anchor the blastocyste in the uterus. A blood system develops compared to the placenta, close to the site of the establishment: the future zone of exchange between maternal circulation and fetal circulation is set up. The vitelline blister in the blastocyste starts to produce the first Hématie S (or “red globules”). During the 24 hours which follow, of conjunctive fabric develops between the placenta and the fetus, which will become later the Umbilical cord, connecting the ventral face of the embryo to the placenta (it contains a Veine and two Artère S).

Cellular differentiation

Then, a thin layer of cells develops at the surface of the embryo, announcing the beginning of the Gastrulation. It is a process during which the three layers of the fetus, the Ectoblaste, the Mésoblaste (or mésoderme) and the Endoblaste, develop. The layer of cells starts by stimulating the growth of the endoblaste and the mésoblaste; the ectoblast starts to grow quickly thanks to stimulative chemical substances produced by the overlying mésoblaste.

These three layers will develop to form all the structures of the body of the embryo. The endoblaste will give the mouth, the Langue, the digestive Tract, the Poumons, the Vessie and several Glande S. the mésoblaste gives the interior of the lungs, the Cœur, the Rate, and the system of reproduction and Excrétion. It will also help with the production of the blood lines. The ectoblast (become neurectoblaste at the 4th week) will become the Peau, the Ongle S, the Poil S and hair, the Yeux, the internal and external coating of the Oreille S, the Nez, the sine, the Bouche, the Anus, the Dent S, the glands mammaires, and all the parts of the Nervous system (Cerveau, Spinal-cord, Nerf S).

Approximately 18 days after fecundation, the embryo produced the majority of the shapes of the fabric which it will need. It with the shape of a pear, with the head (the cephalic pole) larger than the tail (the caudal pole). The nervous system is one of the first structures to be developed. Within the neurectoblaste, created a depression whose banks rise then amalgamate themselves to give a tube at the origin of the Gouttière neurale, extended from the cephalic pole to the caudal pole of the embryo, first axis of the organization of the future nervous system. The blood system is set up starting from the mésoderme produces networks allowing the distribution of blood in the embryo, of the blood cells are in production and circulation in the embryo. Secondary vessels develop around and in the placenta to provide for the needs increasing for the embryo in nutrients. The blastocèle produces blood cells and cells which will become blood-vessels. Cells endocardiales develop within the mésoderme, they are intended to form the internal layers of the heart.

Approximately 24 days after the fertilization a primitive Cœur is set up (at this stage a simple S-shaped tube), which starts to beat and make circulate blood in the embryonic vessels.

Adaptations of the maternal organization during the pregnancy

Cardiovascular adaptations

One notes an increase in the blood flow of 30-40% during the pregnancy, with an increase in circulating volume being able to go until one or two liters more at the time of the childbirth.

Immunizing adaptations

From an immunological point of view, the fetus is with half " soi" and with half " not soi".

Adaptations of the hémostase

Adaptations endocriniennes

Adaptations of the digestive system

The expectant mother often suffers from the nausea occurring the morning, in particular during the first quarter. HCG is suspected like principal factor of this effect.

The diagnosis of the Pregnancy

Diagnoses of the pregnancy in laboratory or in residence:

Principle: Rest on detection in the urine or the plasma of the expectant mother of a specific hormone produced by placental fabric: the chorionic hormone gonadotrophine (HCG) glycoprotéine consisted of two sub-units alpha and beta.

It appears very quickly in blood and the urines after fecundation, its concentration grows the first three months of the pregnancy, then decrease and disappears after the childbirth. The radioimmunological proportioning of the beta fraction of the HCG practiced in laboratory can be positive as of the 6th day of fecundation.

biological Tests: The first tests of description of hormone HCG called upon an animal to which urine of woman supposed pregnant was injected.

The presence of HCG causing of the biological modifications, would make it possible to conclude to L existence of the pregnancy (Test of Galli-Mainini on the clamping plate, Ascheimzondeck on the mouse, Friedman on the lapine, etc) Abandoned.

immunological Tests: Earlier more precise and cheaper.

Resting on the visualization of the reaction occurring between a monoclonal antibody (anti-HCG antibody obtained by immunization in the animal) and a antigen. In the presence of HCG coming from the urine of the expectant mother, the anti-HCG antibody reacts with the antigen. Several methods: test of agglutination, test of inhibition of the hemaglutination, colorimetric test immunoenzymatic, test of immunoconcentration, test of upward immunoconcentration.

personal Tests: (Sold in pharmacy since 1973, not sold in large surfaces

Not refunded by the Social security MARKS: G.test (Chart or " Sceen") : the first were placed at the disposal of the women in 1973. They are usable as of the supposed day of the rules. The result appears into 2 to 5 minutes by the appearance of a pink line (negative result) or of 2 pink lines (positive test).

Medical supervision of the normal pregnancy

A normal pregnancy is the subject of a certain number of examinations. Some of these examinations must be practiced during precise time.

The duration of the pregnancy is indicated in weeks of amenorrhoea (SA) or in month of pregnancy (weeks of amenorrhoea = many weeks passed since the last rules, with the result that the term in weeks of amenorrhoea counts two weeks more than the term in weeks of pregnancy). The fact of speaking about weeks of amenorrhoea is an international convention. The following table gives the practical correspondence between weeks of amenorrhoea and month of pregnancy. For more clearness, this table also makes the correspondence with the number of weeks of pregnancy.

General principles

The principles stated below relate to only the monitoring of the pregnancy in France . This monitoring is marked by a strong intervention of the State, resulting in decrees and regulations.

Two examples are particularly striking: France is the only country in the world where the tracking of the toxoplasmose during the pregnancy is obligatory. Many countries do not practice any tracking or only at populations at risk.

It is into the same for the evaluation of risk of Trisomie 21 (Syndrome of Down) during the pregnancy by proportionings of the HCG and alpha-fetoprotein even if other methods are more powerful. This tracking is the regulation object published with the Official journal.

The number of echography during the pregnancy is of 3 in France but only one echography, in Norway, is practiced systematically around 18 weeks (the legal limit of the medical interruption in this country is 22 weeks), the others being done only on signs of call.

The objective of the regular monitoring is the early tracking of pathologies obstétricales (intra-uterine Retard of growth, gravidic arterial Hypertension for example). Serologies are made systematically to detect certain infectious illness being able to involve a embryopathy or a fœtopathy, in particular at the not immunized women. Seek irregular agglutinins every month among women of Rh negative.

The tracking of the trisomy 21 by the proportioning of HCG and the Alpha-fœtoprotéine must be proposed systematically with all the expectant mothers (but it is not obligatory).

Biological or bacteriological examinations are recommended to quite precise moments of the pregnancy.

The examination of the cervix via the examination vaginal is usually carried out during the normal pregnancy to detect theoretically the risks of premature birth. But the vaginal examination does not form part of the monitoring of the normal pregnancy in many countries in Europe (England, Spain, Netherlands, Finland, Sweden, Denmark) with rates of premature birth identical or lower than that of France. Finally certain countries regard this examination dangerous (Norway) and for this reason as a medical fault.

The existence of a consultation intended for the couples before the startup of a pregnancy would be highly desirable: the big number of couples which one of the elements is carrying a genetic disease forces to inform them of the possibilities of prenatal diagnosis. An effective prenatal diagnosis often forces to know in a precise way the change in question. The prevention of certain anomalies of the central nervous system passes by the catch of vitamins several weeks before fecundation.

First quarter

First consultation

As soon as a woman knows her state of pregnancy, it is desirable that she profits from a consultation before two months. During this first consultation will be carried out:

a interrogation:

Search for previous family of genetic diseases or Malformation S which can is to profit from a Prenatal diagnosis or a genetic Conseil. The search for family antecedent thrombo-embolic is also important for the tracking of the Thrombophilie S because the pregnancy is one high-risk period thrombogene;

the recurrence of certain family malformations is known. Certain malformations can be avoided by a preventive medication such as for example the regulation of Folic acid for the prevention of the Spina bifida;

the number and the normal course or not of the preceding pregnancies, their term as well as the weight of the children to the birth will be noted. Lastly, the mode of the childbirth and the existence of complications supplement the interrogation making it possible to distinguish the pregnancies “at the risk”;

the existence of maternal pathology or catch of Drug S (regular or occasional) before and in the beginning of the pregnancy, must be taken into account because of the side effects possible on the child to come. It is important to rule on the treatments in progress, opportunity of continuing them, of stopping them or of modifying them. The repercussion of pathology on the pregnancy and the pregnancy on pathology must also be evoked;

a clinical examination:

a cardiovascular examination with cardiac Auscultation is carried out;

the Weight and the blood Pressure will be raised;

the smear of tracking:

the Frottis of Dépistage for the Cancer of the collar of the Utérus will be carried out at any woman not profiting from a regular gynaecological follow-up;

dating of the pregnancy:

It has a double interest, medical and legal, indeed:

Médicalement, it makes it possible to detect the anomalies of the fetal development, the anomalies of the amniotic liquid (hydramnios, oligamnios), to know the date envisaged of the term of the pregnancy (41 weeks of amenorrhoea or 39 weeks of pregnancy) and to pose the diagnosis of going beyond of term or of prematurity,
Légalement, it influences a possible request for IVG (maximum legal term of 14 SA in France), the declaration of pregnancy (16 SA at the latest), the viability of the fetus (a spontaneous interruption of pregnancy beyond 22e SA makes it possible to declare a child still-born child with the civil statue)
Méthodes of dating pregnancy:

By the interrogation, as from the first day of the last rules (which determines the number of weeks of amenorrhoea). The design occurs 14 days later, at the time of ovulation,

By echography, by measuring the crânio-caudal length of the embryo. This method is possible 7th with 12th SA, and is precise with a margin of 3 days. It rests on a basic concept: at the time of the first quarter, the growth is the same one for all the embryos (it is dependant only on factors uterine, and not on genetic factors or hormonal),

systematic complementary Examens: serology Toxoplasmose and Rubella (in the absence of a proof of former immunization), serology of the Syphilis, Blood group, Group rhesus, search for irregular agglutinins, Kell phenotype, urinary strip (search of Glucose, Nitrite S, Leucocyte S and Ketone S in the urines);
Of other examinations is sometimes prescribed: Numération formulates blood (early tracking of a Anémie), search for hepatitis B and C and AIDS;
Of the councils of hygiene of life is given:

To have a balanced Food, rich in Calcium and fresh vegetables, to avoid the Cheese S and dairy produces with believed milk (prevention of the Listeriosis), to avoid eating raw meat.

In the event of nonimmunization against the toxoplasmose, one advises to avoid the contact with the cats and their excrements, to wash the fruits and vegetables well, to cook well the meat,

Arrêt of the Tabac and complete abstinence with respect to the alcohol (see Syndrome of fetal alcoholization). If need be, one will switch the patient towards a consultation anti-tobacco,

Maintien of an sports activity adapted at the end of the pregnancy. The catch of weight is of twelve kilograms on average in a pregnancy.

In France: declaration of the pregnancy before the 16th week of amenorrhoea to the Social security and the allowance office family.

the First echography

It allows:

to make sure of the vitality of the pregnancy by the presence of an embryo presenting a cardiac activity;
to affirm the single character of the embryo or multiple. If there exist two embryos, it is about a twin Grossesse. In the event of twin pregnancy it is important for the correct follow-up of the pregnancies to know if there exists a Placenta or two placentas which feed the embryo. One speaks in this case about pregnancy monochoriale if there exists a Placenta and of pregnancy bichoriale if there exist two placentas;
to date, in a precise way, the pregnancy by the length of the embryo;
to evaluate the risk which the embryo is carrying chromosomal anomaly like the Trisomie 21 per measurement of the Clarté nucale;
to see certain malformations or pathologies with early echographic expression.

Second quarters

Individual maintenance of the 4th month

This maintenance is made to accompany the parents more effectively. In addition to the general assessment and obstétrical, and of the preparation to the birth comprising of the preparatory meetings to the childbirth, he is proposed with all the expectant mothers and to the future parents an individual maintenance, or in couple, during the 4th month. He is carried out under the responsibility mainly of the midwives.

Second consultation: 4th month

maternal Assessment: Pulse, blood Pressure, urinary strip (albuminuria, glycosurie), uterine Height, weight, vaginal examination;
fetal Assessment: fetal active movements (perceived as of the surroundings of the 20th week), noises of the fetal heart;
Sérologie of the toxoplasmose if it were negative.

Third consultation: 5th month

maternal Assessment: Pulse, blood pressure, urinary strip, weight, vaginal examination;
fetal Assessment: uterine height, fetal active movements, noises of the fetal heart;
Sérologie of the toxoplasmose if it were negative;
complete Morphology.

The second echography

fetal Growth by the study fetal biometrics;
fetal Morphology;
Localization of the placenta;
Practical of a study of the blood circulation of the uterine Artery S by Doppler.

Fourth consultation: 6th month

maternal Assessment: Pulse, blood pressure, urinary strip, weight, vaginal examination;
fetal Assessment: fetal active movements, uterine height, noises of the fetal heart;
Sérologie of the toxoplasmose if it were negative;
Research of the antigen HBsAg (antigen of surface of the virus of hepatitis B);
Numération formulates blood, SPOKE in the event of antecedents of blood Transfusion;
Search for a Diabetes gestationnel by test of O' Sullivan: Glycemia one hour after the ingestion of 50 grams glucose. If the glycemia is higher than 1,4 the test is known as positive and one practices (ideally in the week following the test) a caused Hyperglycémie per bone (HGPO). If the venous glycemia is higher than 2 grams per liter, it is useless to practice HGPO one can speak about diabetes gestationnel.

Third quarters

Fifth consultation: 7th month

maternal Assessment: Pulse, blood pressure, urinary strip (albuminuria, glycosurie), uterine height, weight, vaginal examination;
fetal Assessment: fetal active movements, noises of the fetal heart;
Sérologie of the toxoplasmose if it were negative;
Echography of the 3rd quarter: of growth;
Prevention of a deficiency in vitamin D;
2nd determination groups, rhesus, SPOKE;
Treatment of a possible anemia.

Sixth consultation: 8th month

maternal Assessment: Pulse, blood pressure, urinary strip (albuminuria, glycosurie);
fetal Assessment: fetal active movements (perceived as of the surroundings of the 20th week), noises of the fetal heart, uterine height, weight, vaginal examination (determination of the cephalic presentation, or in seat);
Sérologie of the toxoplasmose if it were negative;
a vaginal taking away is made systematically for the search for a bearing of the Streptocoque agalactiae. In the event of positive test, a antibiothérapie will be made during the childbirth.
Prévoir a consultation of Anesthésie if the future mother wishes an anesthesia Péridurale;
Leave of Maternity: carried legally at 6 weeks antenatal, then 10 weeks postnatal. It can be lengthened in the event of complicated pregnancy (8 weeks antenatal), of multiple pregnancy, or third child. The paternity leave is him 11 days, 18 days in the event of multiple pregnancy. This vacation is dealt with by the Social security and compensated to a total value of 100% for the wages within the limit for the section social security (2 has; 476 euros in 2004).

The third echography

Much country does not make the third echography systematically. In France, the third echography is made ideally between 7 months and 7,5 months are 32 to 34 weeks. It allows:

to check the growth (Tracking of the late delays of growth of appearance or of the macrosomes);
to make sure of the to be fetal Well;
to detect a Placenta low inserted;
to make sure of the absence of certain malformations to late echographic translation;
to make sure of collapses physiological of the fetus i.e. of the position upside down. In the event of absence of collapses physiological, collapses it will be checked two weeks later. If the spontaneous version were not done one with the patient a Version by external operation will propose.

Seventh consultation: 9th month

It is during this consultation that one determines the possibility of being confined normally.

maternal Assessment: Pulse, blood pressure, uterine height, urinary strip (albuminuria, glycosurie), weight;
fetal Assessment: fetal active movements, noises of the fetal heart;
Checking of the fetal Presentation: which is the part of the body of the fetus which presents to the entry maternal Bassin. This checking of the presentation is done by palpation or the vaginal examination. Lastly, one checks the position of the back of the fetus. If the back is on the left, the childbirth will be faster and easy;
Sérologie of the toxoplasmose if it were negative;
To explain to the patient the circumstances which must lead it to arise in maternity: rupture of the Pocket of water, uterine contractions regular during at least two hours, reduction in the active movements of the fetus;
To give an appointment for the day of the theoretical term: Monitoring within the framework of a going beyond of term, and possibly release of work.

Postnatal consultation

It is made in the 8 weeks following the childbirth, it informs about:

the existence of urinary or sexual disorders secondary to the childbirth.
Examination of the scar of possible a episiotomy;
Discussion on the Contraception if the return of layers took place (begun again Menstruation S);
indications of a rehabilitation périnéale so necessary, or abdominal.

Childbirth

Sexuality during the pregnancy

No restriction except contrary medical opinion. The period of the pregnancy is also a period very opening out for sexuality and the couple. Moreover certain men acknowledge being maïeusophiles.

Sexuality during the pregnancy is quite as good for the parents that for the child because that enables him to be rocked in the amniotic liquid.

Food during the pregnancy

The food of the mother during the pregnancy must, if all occurs well, being the food of a person in good health: the majority of the usual nutritional councils thus apply also to the expectant mother: to balance Glucids - Lipids - Protids, to eat varied, and each day to take several fruit and vegetables. Some specific councils are however necessary:

Before the fecundation and at any beginning of pregnancy, a sufficient contribution in folates (folic acid: Vitamine B9) makes it possible to strongly decrease the risk of Spina bifida (not closing of the tube neural), a very serious anomaly of the embryonic development. One finds folates in the sheets , and particularly in the spinach.

the fetus has particularly important requirements in Fer and Calcium. The expectant mother must thus be attentive to eat sufficient dairy produces (calcium) and red meat (iron) if it is not vegetarian. Its doctor will generally recommend to him to take iron supplements (seals), because much of young women are slightly deprived of iron (Anémie). The metabolism of calcium is correct only if the woman receives enough Vitamine D, that the woman synthesizes when it is exposed to the sun (15 min per day are enough, at least in the south of France, or in summer). Certain expectant mothers make edema, and one recommends to them not to eat too much salt, without inevitably following a désodé mode.

It seems that the regular fatty fish consumption (sardine, mackerel, salmon) during the pregnancy allows a better cerebral and retinal development of the baby: the fatty-acids omega 3 with long chain are essential in the membrane of the neurons. One should not however misuse it, “the large” fish like tuna which can bring toxic matters: mercury, Dioxane S. the ingestion of sufficient fluorine during the pregnancy and young childhood prevents the dental carie. The preventive amounts are tiny, the strong fluorine amounts being in addition toxic.

In addition the food can bring dangerous bacteria or parasites for the baby, in particular the Listeria and the toxoplasme (giving the Toxoplasmose). The rules of prudence to avoid these two dangers are practically the same ones: to wash the believed fruits and eaten vegetables very well, to cook very well the remainders, the meat and the pork-butcheries, to avoid cheeses with washed crust or believed milk (listeria), to change the litter of its cat the every day and to wash the hands after (toxoplasmose).

After the pregnancy

The period of the Post-partum (or continuations of layers) lies between the placental delivery and the return of layers, i.e. the return of the rule S. It is one period new at the same time psychic and family upheavals (key period for the installation of the relation mother-child, of discovered newborn, family changes), but also physical with the brutal loss of the physiological and anatomical reference marks related to the pregnancy.

The Post-partum is thus a period at the risk of complications related to the upheavals of all the reference marks of a woman, in particular when it is about a first child.

Medical supervision of the pregnancy in the world

Figures of the performances obstétricales in the world

Definitions

Premature birth

A premature birth is defined like any childbirth taking place before the 37^e week of amenorrhoea. The legal limit of reanimation of a premature Child in France east with 24 weeks of amenorrhoea, and 500 grams, as lower part of this term it is acted of a miscarriage.

The premature newborn is more fragile than a newborn in the long term (risk of infection). Smaller, it cannot only feed (thus by gastric probe), it requires sometimes a ventilatory help, and cannot only control its body temperature (installation out of incubator). the premature new-born babies are dealt with in reanimation néonatale or neonatalogy according to their term, weight and vital functions.

Let us announce the method known as “baby kangaroo”, invented in Colombia, which consists in maintaining the child premature in contact skin-with-skin permanent with his/her mother (or his/her father). Under various adaptations, this very effective method is used more and more in the industrialized countries. À to supplement with liens

Still birth

The still birth sometimes called mortinaissance is the birth of a fetus died after 24 weeks of pregnancy. When the fetus died or expelled before 24 weeks of pregnancy, it is not a question of a mortinaissance, but of an abortion or a miscarriage to the epidemiologic and not medical direction.

Its calculation is done by counting the number of mortinaissances recorded during one period given (in general the calendar year) for thousand live births and mortinaissances recorded during the same period: Rate of still birth.

Mortality néonatale

Mortality néonatale corresponds to the death of the children between the birth and until 28 days of life. One distinguishes early mortality néonatale for the deaths during the first week, and of late mortality néonatale for those the three weeks following.

Its calculation is done by counting the number of deaths of older children of less than 28 days recorded during one year given for 1000 live births: Death rate néonatale.

Perinatal mortality

Perinatal mortality is the sum of the still birth and early mortality néonatale.

Its calculation is done by counting the number of mortinaissances and deaths of older children of less than 7 days recorded one year given divided for 1000 live births: death rate perinatal.

Died maternal

The definition of WHO - according to the International Classification of the Diseases (CIM 9) used in France - maternal death during the pregnancy is " the death of a woman occurred during the pregnancy or within 42 day after its termination, whatever is the duration or the localization, for an unspecified cause determined or worsened by the pregnancy or the care which it justified, but neither accidental, nor fortuite".

Other countries, like the United Kingdom, use the CIM 10 which forces to include the deaths in the year following the birth. The choice of a definition has an appreciable incidence on the perinatal policy: indeed, if the first cause of maternal death, in France, is the Hémorragie postpartum, in the United Kingdom it is the Suicide.

Maternal deaths are divided into two groups:

Death by direct obstétricale cause: it is those which result from complications obstétricales (pregnancy, work and continuations of layers), of interventions, omissions, an incorrect treatment or a sequence of events resulting from any of the factors above.

Death by indirect obstétricale cause: it is those which result from a preexistent disease or an affection appeared during the pregnancy without it being due to direct obstétricales causes, but which was worsened by the physiological effects of the pregnancy.

The table below summarizes the data on some countries:

the maternal data come from this source unless otherwise specified.

The mortality of the countries in the process of development is very definitely higher than that of the industrialized countries, the great majority being concentrated in sub-Saharan Africa and Asia. This maternal death is in regular decrease in all the safe countries in sub-Saharan Africa where it stagnates

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