Preterm birth

Pregnancy is usually a time of happiness and anticipation, but it can also be a time of uncertainty. Many women worry about what is happening to their child and wonder, "Is everything okay?" Some women are afraid of premature birth. Preterm birth occurs in about 12% of all pregnancies. However, by knowing the symptoms and avoiding certain risk factors, a woman can reduce her chances of having a preterm birth.

What is preterm birth?

A normal pregnancy lasts about 40 weeks. Sometimes labor begins prematurely, before the 37th week of pregnancy. This is because uterine contractions cause the cervix to open earlier than normal. Consequently, the baby is born prematurely and may be at risk of health problems.

Fortunately, research, technology and medicine have helped improve the health of premature babies.

What risk factors increase the risk of preterm birth?

While the specific causes of preterm birth are not yet known, certain factors can increase a woman's risk of preterm birth. However, the presence of a certain risk factor does not mean that a woman will have a premature birth. A woman may have a premature birth for no apparent reason.

If you have any of the following risk factors, it's important to know the symptoms of preterm labor and what to do if it happens:

Women are at higher risk of preterm birth if:

They are pregnant with multiples
They have had a previous premature birth
They have certain uterine or cervical abnormalities

Medical risk factors include:

Recurring bladder and/or kidney infections
Urinary tract infections, vaginal infections, and sexually transmitted infections
Infection with a fever greater than 38 C during pregnancy
Unexplained vaginal bleeding after 20 weeks of pregnancy
Chronic illness such as high blood pressure, kidney disease, or diabetes
Multiple first trimester abortions or one or more second-trimester abortions
Underweight or overweight before pregnancy
Clotting disorder (thrombophilia)
Being pregnant with a single fetus after in vitro fertilization
The short time between pregnancies (less than 6-9 months between birth and beginning of the next pregnancy)

Lifestyle risks for preterm birth include:

Little or no prenatal care
Smoking
Drinking alcohol
Using illegal drugs
Domestic violence, including physical, sexual, or emotional abuse
Lack of social support
High levels of stress
Low income
Long working hours with long periods of standing

What are the warning signs and symptoms?

Preterm labor can be prevented by knowing the warning signs and calling your healthcare provider if you suspect you may be having a preterm labor.

Warning signs and symptoms of preterm labor include:

Five or more uterine contractions per hour.
Watery fluid is leaking from your vagina (this may indicate that your water has broken)
Menstrual cramps in the lower abdomen, which may come and go or be constant.
Dull pain in the lower back below the waist that may come and go or be constant
Pelvic pressure that feels like your baby is pressing down
Abdominal cramps, which may occur with or without diarrhea.
Increase or change in vaginal discharge.

What does a contraction look like?

As the uterine muscles contract, you will feel your stomach harden. When the contractions subside, the uterus becomes soft. Throughout pregnancy, the layers of the uterus thicken unevenly, which usually does not cause pain.

These are known as Braxton-Hicks contractions; they are usually irregular and do not open the cervix. If these contractions become regular or more frequent, such as every 10 to 12 minutes for at least an hour, it could be preterm labor, which can lead to dilatation of the cervix.

If this happens, it is important to see a doctor as soon as possible.

How to check contractions?

In the supine position, feel with your fingertips how the uterus tightens and softens. This is called "palpation". During the contraction, the stomach will be hard in everything, not just in one area. However, as your baby grows, you may feel like your stomach is hardening in one area and then soft again.

What should I do if I suspect I am having a preterm labor?

If you think you have signs and symptoms of preterm labor, call your doctor right away.

It's natural to be a little anxious during this time, but by being aware of the symptoms and taking the following steps, you can help prevent preterm labor:

Empty your bladder.
Lie down tilted towards your left side; this may slow down or stop signs and symptoms.
Avoid lying flat on your back; this may cause contractions to increase.
Drink several glasses of water, because dehydration can cause contractions.
Track contractions for an hour, counting the minutes from the start of one contraction to the start of the next.
If symptoms worsen or do not go away after an hour, call your doctor again or go to the hospital. When you call your doctor, be sure to tell him or her that you are concerned that you may go into labor prematurely.

The only sure way to know if you're having preterm labor is to examine your cervix. If the cervix has opened, preterm labor may be the cause.

What is the treatment to prevent premature labor from starting or continuing?

Magnesium sulfate is an intravenous medicine that can temporarily cause nausea. First, a large dose is administered, then a smaller dose is administered over 12–24 hours or more.
A corticosteroid is a drug given 24 hours before birth to help speed up the maturation of the baby's lungs and brain.
Sometimes oral medications are used to reduce the frequency of contractions, which can help women feel better.

How does preterm labor affect my pregnancy?

The longer your baby stays in the womb, the better his chances of being healthy. Babies born prematurely are at higher risk of brain and neurological complications, as well as breathing and digestive problems.

Some premature babies grow up with developmental delays and/or have difficulty learning in school. The earlier a baby is born during pregnancy, the more likely it is to develop health problems.

Preterm birth does not always lead to preterm birth. Some women with preterm labor and early dilatation of the cervix are given rest until the pregnancy progresses. Most babies born before 24 weeks have little chance of survival.

Only about 50% will survive, and the remaining 50% may die or have permanent problems. However, babies born after 32 weeks have a very high survival rate and usually do not have long-term complications.