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Preterm Labour and Birth

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Overview

Preterm labour also known as premature labour is the occurrence of regular contractions resulting in your cervix opening after the 20th week but before the 37th week of your pregnancy (3 weeks before your expected due date). Preterm birth is defined as the birth of live babies due to preterm labour (before the 37th week of pregnancy).  It is estimated that around 15 million babies are born preterm every year and this number is constantly increasing.  

Types of Preterm Labour and Birth

Preterm labour can be unplanned or induced. Due to several risk factors, preterm labour can occur in any pregnancy. In certain situations, the obstetrician might also induce preterm labour if it is considered necessary for the health of the baby and/or mother.  

Based on the gestational stage (stage of the pregnancy) preterm birth can be classified into the following categories: 

  • Extremely Preterm- Birth of a preterm baby less than 28 weeks into the pregnancy 
  • Very Preterm- Birth of a preterm baby less than 32 weeks into the pregnancy but more than 28 weeks 
  • Moderate or Late Preterm- Birth of a preterm baby after the 32nd week of the pregnancy but less than 37 weeks into the pregnancy 

Depending on how preterm the baby is, the more the complications involved. Due to this reason, if the preterm birth is planned, the obstetrician may decide to transfer the patient to a facility specializing in neonatal care.  

About The Condition

The ideal gestation period for a human pregnancy is 40 weeks during which time, the fetus grows and develops. In some cases, contractions can start earlier, opening the cervix, preparing for birth before full term. If this occurs before the 20th week of the pregnancy, it is considered a miscarriage. If possible, the obstetrician would try to delay the birth as preterm babies are at significant risk for multiple health problems. Preterm babies would also need special neonatal care as they are prone to infections and might have several developmental issues based on how premature they are.  

In certain cases, the obstetrician could also induce preterm labour if it is thought to be the best option for the mother and child. In such a situation the benefits and risks would be discussed in detail with the mother and the family. 

Risk of Preterm Labour

Preterm labour can occur in any pregnancy. Several factors have been known to increase the risk of preterm labour; these are: 

  • Multiple pregnancy (twins, triplets or others) 
  • Shortened cervix 
  • History or preterm labour or preterm birth  
  • Cigarette smoking or consumption of other narcotics 
  • Infections especially involving the lower genital tract or amniotic fluid 
  • Previous surgery on the uterus or cervix 
  • Low or high pregnancy weight 
  • Smaller interval between two pregnancies (less than 18 months) 
  • Pregnancy conditions such as gestational diabetes, gestational or hypertension, preeclampsia and excessive amniotic fluid as well as complications with the placenta like placenta previa or placental abruption 
  • Increased stress levels 
  • Maternal age (younger than 17 or older than 35 years of age) 
  • Vaginal bleeding in the second or third trimester 
  • Any abnormalities in the fetus such as spina bifida 
  • Physical injury to the mother 

Symptoms

Symptoms of preterm labour include: 

  1. Abnormal vaginal discharge (bloody, watery or mucus) 
  2. Increase in the amount of vaginal discharge 
  3. Lower abdominal pressure 
  4. Throbbing and chronic backache 
  5. Abdominal cramps (possibly accompanied with diarrhea) 
  6. Regular and frequent contractions  
  7. Fluid from the vagina might indicate ruptured membranes

Diagnosis of Preterm Labour

Preterm labour can be diagnosed by monitoring the frequency of contractions and how long they last. Apart from this the doctor might also diagnose preterm labour by: 

  •  Cervical exam to look for any changes in the cervix 
  • Physical examination to find the baby’s position 
  • Transvaginal ultrasound to measure the length of the cervix 
  • Check for amniotic fluid to see if the amniotic sac is broken

Treatment of Preterm Labour

In case there is a high risk of preterm labour, the doctor might recommend the following treatments: 

  • Corticosteroids: these medications are prescribed if there is increased chance of delivery in the next seven days. It is used to promote the baby’s lung maturity.  
  • Magnesium Sulfate: The doctor might prescribe magnesium sulfate if there is a high risk of delivery between week 24 and 32 of the pregnancy. Certain studies indicate that it might also lower the risk of cerebral palsy for babies born before the 32nd week of the pregnancy 
  • Tocolytics: This medication is prescribed to slow the contractions. It may be used for 48 hours to delay labour so corticosteroids may provide maximum benefit or if there is a need to transfer to patient to a specialized healthcare facility 
  • Preventive medication: If there is a history of premature birth or increased risk of the same, the obstetrician might prescribe weekly dose of progesterone starting from the second trimester till week 37 of the pregnancy. Vaginal progesterone might also be prescribed to prevent preterm labour 
  • Surgery: In certain situations, if the risk of preterm labour is due to a short cervix, the doctor might suggest cervical cerclage. In this procedure, the cervix is sewn shut with strong sutures which are removed after 36 weeks of the pregnancy unless they must be removed sooner.
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Prevention

Preterm labour may be avoided by taking steps to promote a healthy full-term pregnancy. Some of the measures that can be taken are: 

  • Healthy diet: Maintain a balanced diet rich in polyunsaturated fatty acids (found in nuts, seeds, fish etc.). You can design a diet tailor-made to your needs with the help of your doctor and nutritionist.  
  • Avoid substances known to increase risk of preterm labour: This includes smoking, consumption of alcohol and other narcotic substances. 
  • Seek regular prenatal care: Regularly visit your health care provider to monitor your pregnancy. In case you manifest any symptoms of preterm labour you might have to make your visits to the obstetrician more frequent.  
  • Monitor and manage chronic conditions: In case you have any chronic conditions such as diabetes, hypertension or obesity monitor it closely and take measures to keep them under control.  
  • Reduce stress: when possible, avoid anything that causes stress either mentally or physically. Do not overexert yourself and try relaxation techniques such as meditation to calm yourself.  

If you are at a higher risk of preterm labour, seek medical advice for additional precautionary steps that can be taken. 

FAQs

1. What are Braxton Hicks contractions?

Braxton Hicks are also called false labour pains. These can be felt for the first time around mid-pregnancy, increasing in frequency as the pregnancy progresses. They are considered to be practice contractions.

2. How do I differentiate between Braxton Hicks and regular contractions?

Braxton Hicks contractions are irregular and should subside by changing positions. Real contractions on the other hand will grow stronger and closer together with time.

3. What are the health conditions that are common in preterm babies?

Preterm babies are prone to infections and many health complications such as breathing difficulties and developmental problems. The more preterm the baby is, the greater the risk of complications like cerebral palsy, Intellectual and developmental disabilities, low birth weight, underdeveloped organ systems and infections. They would need to stay in the neonatal intensive care unit for the required treatment. 

4. How can I make sure that I don’t go into preterm labour

There are no methods to ensure that you don’t go into preterm labour. However, if you are at a higher risk of going into preterm labour, your obstetrician might suggest certain precautions to minimise the risk. Focus on maintaining a healthy pregnancy lifestyle and avoid stress.

 
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