PRETERM LABOR

Preterm labor, also known as premature labor, is a concerning condition wherein a pregnant woman’s body begins to prepare for childbirth too early, before the 37th week of pregnancy. This premature onset of labor can lead to the birth of a baby who may not be fully developed, posing potential health risks for both the infant and the mother. It is considered premature if it starts more than three weeks before your due date.

While premature labor can result in an early birth, medical interventions can often delay delivery. Allowing your baby to continue growing inside the womb until closer to the due date can significantly reduce the likelihood of complications after birth.

Causes of Preterm labor

Preterm labor can result from a myriad of factors, some of which are within your control, while others are not.

Major Risk Factors for Preterm Labor:

Previous Preterm Birth: If you’ve previously given birth prematurely, you’re at an increased risk of experiencing preterm labor again.
Multiple Pregnancy: Carrying twins, triplets, or more significantly elevates the risk of preterm labor.
Uterine, Cervical, or Vaginal Issues: Any existing or historical complications with the uterus, cervix, or vagina can predispose you to preterm labor.

Additional Pregnancy-Related Risk Factors:

Persistent Vaginal Bleeding: Experiencing vaginal bleeding throughout pregnancy can indicate a heightened risk of preterm labor.
Assisted Reproduction: Being pregnant through in vitro fertilization (IVF) may increase the likelihood of preterm labor.
Suspected Congenital Disability: Pregnancies involving fetuses suspected of having congenital disabilities are associated with a higher risk of preterm labor.
Short Pregnancy Spacing: Having short intervals between pregnancies can increase the risk of preterm labor.

Age and Race-Related Risk Factors:

Extreme Maternal Age: Being younger than 17 or older than 35 elevates the risk of preterm labor.
Ethnicity: Individuals of Black ethnicity are more prone to preterm labor.

Lifestyle-Related Risk Factors:

Inadequate Prenatal Care: Failing to receive adequate prenatal care can contribute to preterm labor.
Nutritional Status: Being underweight or overweight before pregnancy, inadequate weight gain during pregnancy, or consuming a poor diet can increase the risk of preterm labor.
Substance Use: Smoking cigarettes, consuming alcohol, or using illicit drugs during pregnancy are significant risk factors for preterm labor.
Occupational Factors: Engaging in physically demanding jobs that involve prolonged standing or working long hours may heighten the risk of preterm labor.
Stress and Anxiety: High levels of stress or anxiety during pregnancy can contribute to preterm labor.
Exposure to Harmful Substances: Being exposed to teratogens such as chemicals, lead, radiation, or other harmful substances can increase the risk of preterm labor.

Medical Risk Factors:

Untreated Infections: Untreated vaginal infections, including urinary tract infections and sexually transmitted infections, can lead to preterm labor.
Connective Tissue Disorders: Conditions like Ehlers-Danlos syndrome (EDS) increase the risk of preterm labor.
Placental Issues: Problems with the placenta, such as placental abruption or placenta previa, can contribute to preterm labor.
Amniotic Fluid Abnormalities: Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid may increase the risk of preterm labor.
Uterine or Cervical Abnormalities: Conditions like a short cervix or irregularly shaped uterus can predispose you to preterm labor.
Previous Surgeries: Prior surgeries on the cervix or uterus can increase the risk of preterm labor.
Medical Conditions: Preexisting medical conditions such as diabetes, high blood pressure, or blood clotting disorders may heighten the risk of preterm labor.
Intrahepatic Cholestasis of Pregnancy (ICP): This liver condition occurring during pregnancy is associated with an increased risk of preterm labor.

Prevalence:

Preterm labor is a significant public health concern globally. According to the World Health Organization (WHO), an estimated 15 million babies are born prematurely each year, accounting for approximately 1 in 10 births worldwide. The prevalence varies across regions and is influenced by socioeconomic factors, access to healthcare, and maternal health status.

Symptoms

It’s crucial to be aware of the symptoms of preterm labor. Contact your healthcare provider immediately if you experience any of the following symptoms, especially if they persist for an hour or are severe:

Four or more contractions within an hour that persist despite changing positions or attempting relaxation.
Consistent lower back pain that may be intermittent or constant and isn’t alleviated by changing positions.
Abdominal cramping resembling gas pain, possibly accompanied by diarrhea.
Increased pressure in the pelvis or vagina.
Menstrual-like cramps that persist.
Heightened vaginal discharge, particularly if it’s mucus-like or tinged pink.
Fluid leakage from the vagina, potentially indicating amniotic fluid loss.
Vaginal bleeding.
Flu-like symptoms, such as nausea and vomiting.
Decreased fetal movements, especially if you don’t feel at least six movements within an hour.

Monitoring Contractions

Determining whether you’re experiencing contractions involves distinguishing between Braxton Hicks contractions and true labor contractions. Unlike Braxton Hicks contractions, real contractions become more frequent, intense, and continuous over time, unaffected by rest or changes in position. If you’re uncertain about the nature of your contractions, contact your healthcare provider for guidance.

How to Check for Contractions

Spotting early labor involves checking for contractions, a vital aspect of monitoring your pregnancy. Here’s how you can do it:

Place your fingertips on your abdomen.
Feel for the tightening and softening of your uterus, indicating a contraction.
Time your contractions by noting the start time of one contraction and the subsequent contraction.
Take steps to alleviate contractions, such as getting off your feet, changing your position, relaxing, and hydrating with two or three glasses of water.
Contact your doctor or midwife if contractions persist every 10 minutes or more frequently, if symptoms worsen, or if you experience severe and persistent pain.

It’s important to recognize that many women experience harmless false labor known as Braxton Hicks contractions. These contractions are typically irregular, do not become closer together, and cease when you move or rest. If you’re unsure about the type of contractions you’re experiencing, seek medical advice.

Hospital Visit for Premature Labor

If your healthcare provider suspects premature labor, a hospital visit may be necessary. Upon arrival, you can expect the following:

Medical Assessment: Your medical history, including medications taken during pregnancy, will be reviewed. Vital signs such as pulse, blood pressure, and temperature will be checked.
Monitoring: Monitoring devices will be used to assess your baby’s heart rate and contractions. Fetal fibronectin may be swabbed to predict the risk of early delivery.
Testing: Tests may include urine or cervical swabs for infection and cervical examination to assess dilation.

Diagnosing Preterm labor

Preterm labor is typically diagnosed through a comprehensive assessment, focusing on the condition of the cervix and monitoring for signs of labor. Your healthcare provider employs various diagnostic techniques to evaluate your situation, including:

Pelvic Examination: Your healthcare provider conducts a pelvic exam to assess the cervix. Effacement (thinning) and dilation (opening) of the cervix suggest the onset of preterm labor.
Ultrasound: An ultrasound scan is performed to evaluate the size and position of the fetus within the uterus. Additionally, it helps identify any potential issues with the placenta or abnormalities in the amniotic fluid.
Contractions Monitoring: Your provider may connect you to a contraction monitor, which measures the frequency, duration, and intensity of contractions. This monitoring helps determine if you’re experiencing preterm contractions.
Fetal Fibronectin Test: A sample of vaginal fluid is collected to conduct a fetal fibronectin test. Fetal fibronectin is a protein that plays a role in attaching the amniotic sac to the uterus. Detection of fetal fibronectin in vaginal discharge may indicate the initiation of labor.

Treatments for Preterm labor

If you’re experiencing preterm labor, your healthcare provider may intervene with various strategies to mitigate the risk of premature delivery and ensure the best possible outcome for both you and your baby. The management of preterm labor typically involves the following approaches:

1. Medications to Halt Labor Progression:

a. Tocolytics: These medications are administered to temporarily halt contractions and delay preterm birth for up to 48 hours. This delay provides crucial time for administering other interventions and transferring the mother to a facility equipped with a neonatal intensive care unit (NICU).

b. Magnesium Sulfate: Given intravenously, magnesium sulfate helps reduce the risk of cerebral palsy and neurological complications in premature infants, particularly if delivery is anticipated within the next 24 hours and the mother is less than 32 weeks pregnant.

c. Corticosteroids: Administered between 24 and 34 weeks of pregnancy, corticosteroids aid in the maturation of the fetus’s lungs, digestive organs, and brain, enhancing their readiness for early delivery.

2. Evaluation of Pregnancy Progress:

Your healthcare provider will assess various factors, including the gestational age of the fetus, the safety of early delivery, and the underlying reasons for preterm labor (such as medical conditions, placental issues, or infections).

3.Delivery Decision:

If preterm labor progresses and cannot be halted, delivery may become necessary. In such cases, your healthcare provider will carefully weigh the risks and benefits of early delivery to determine the most appropriate course of action.

Home Care Tips

While preterm labor often requires medical intervention, there are some measures pregnant women can take at home to reduce the risk:

Stay hydrated: Drink plenty of water throughout the day to maintain hydration and prevent dehydration-induced contractions.
Bed rest: Resting at home or in a hospital setting may be recommended to reduce physical activity and minimize stress on the uterus.
Avoid risky behaviors: Refrain from smoking, consuming alcohol, or using illicit drugs, as these substances can increase the risk of preterm labor.
Monitor symptoms: Pay attention to any unusual symptoms such as contractions, abdominal pain, or vaginal bleeding, and report them promptly to your healthcare provider.

Prevention

Preventive Medications: For individuals with a history of preterm birth, preventive medications may be recommended to reduce the risk of recurrent preterm labor. The most commonly prescribed medication for this purpose is progesterone, which is typically administered via vaginal suppositories. In some cases, a cervical cerclage procedure may be recommended, involving the surgical stitching of the cervix to prevent premature dilation.

While it’s challenging to entirely prevent preterm labor, certain measures can help reduce the risk of its occurrence. Here are some strategies you can implement to lower your risk:

Avoid Harmful Substances: Refrain from smoking cigarettes, consuming alcohol, using recreational drugs, or misusing prescription medications, as these substances can increase the likelihood of preterm labor.
Maintain a Healthy Lifestyle: Attain a healthy weight before pregnancy and aim to gain an appropriate amount of weight during pregnancy. Focus on consuming nutritious foods, take prenatal vitamins, and find effective ways to manage stress, such as staying active, reading, or engaging in relaxation techniques.
Attend Regular Prenatal Appointments: Ensure you attend all prenatal appointments and schedule regular dental cleanings. Good gum health is linked to a reduced risk of preterm labor.
Manage Medical Conditions: Seek treatment for any existing medical conditions, such as hypertension, gestational diabetes, depression, or vaginal infections, to help minimize the risk of preterm labor.
Optimal Pregnancy Spacing: Space your pregnancies by at least 12 to 18 months to allow your body adequate time to recover between pregnancies.
Avoiding infections: Practice good hygiene, use protection during sexual activity, and seek prompt treatment for any infections.
Maintain Oral Health: Practice good dental hygiene by brushing and flossing your teeth daily. Research suggests a link between gum disease and preterm birth.
Consider Progesterone Therapy: In certain cases, progesterone treatment may be recommended to prevent preterm birth. This therapy may involve vaginal progesterone for individuals with a short cervix or progesterone injections throughout pregnancy for those with a history of preterm birth.

Effects of Premature Birth

If your baby is born prematurely, they may face unique challenges. Here’s what to expect:

Developmental Milestones: Premature babies may reach developmental milestones at a slower pace compared to full-term infants. They may require additional time to achieve skills such as rolling over, grasping objects, or speaking.
Long-Term Health Risks: Premature infants have a heightened risk of long-term health issues, including autism, intellectual disabilities, cerebral palsy, respiratory problems, and sensory impairments. Some may experience behavioral or learning difficulties later in life.
Neonatal Intensive Care Unit (NICU) Care: Depending on the gestational age at birth, premature infants may require specialized care in the NICU. Babies born earlier than 7 months gestation typically face more significant health challenges and prolonged NICU stays.

Post-Hospital Care for Premature Infants

After discharge from the hospital, it’s essential to monitor your premature infant closely. Here are some considerations:

Feeding: Premature babies may have difficulty feeding and may need frequent, smaller feedings. Seek guidance from healthcare professionals if feeding challenges arise.
Sleep Patterns: Premature infants may exhibit sleepiness and may need to be awakened for feedings. Follow safe sleep practices and place your baby on their back to sleep.
Respiratory Health: Monitor your baby’s breathing patterns and seek medical attention if breathing difficulties occur.
Temperature Regulation: Premature infants may struggle to maintain body temperature. Keep the environment warm and monitor for signs of temperature instability.
Jaundice: Watch for signs of jaundice, such as yellowing of the skin or eyes, and seek prompt medical evaluation if symptoms are present.
Infections: Premature infants have an increased susceptibility to infections due to an immature immune system. Monitor for signs of illness and promptly contact your healthcare provider if concerns arise.

When to See a Doctor

Knowing when to seek medical attention is crucial if you suspect preterm labor. Contact your healthcare provider immediately if you experience any of the following symptoms:

Abnormal Vaginal Discharge or Bleeding: Notify your healthcare provider if you observe any unusual vaginal discharge or experience bleeding.
Contractions or Cramping: Inform your healthcare provider if you notice contractions or cramping, with or without diarrhea, particularly if they are persistent or intensify.
Lower Back Pain: Ongoing pain in the lower back could indicate preterm labor and warrants prompt evaluation by your healthcare provider.
Pelvic or Abdominal Pressure: Feelings of pressure in the pelvis or abdomen should be reported to your healthcare provider, as they could be indicative of preterm labor.
Rupture of Membranes: If your “water breaks” or you experience a sudden gush of fluid, contact your healthcare provider immediately.

Prompt evaluation by a healthcare provider can help determine the appropriate course of action and optimize outcomes for both mother and baby.

Outlook/Prognosis

The outlook for preterm labor depends on various factors, including gestational age at delivery, the overall health of the mother and baby, and the presence of any complications. With timely intervention and proper medical care, many preterm babies go on to lead healthy lives. However, preterm birth can increase the risk of short-term and long-term health issues for the infant, including respiratory problems, developmental delays, and neurodevelopmental disorders.

Sources

World Health Organization (WHO) – Preterm birth
American College of Obstetricians and Gynecologists (ACOG) – Preterm Labo
March of Dimes – Preterm Labor and Birth
Centers for Disease Control and Prevention (CDC) – Preterm Birth
Mayo Clinic – Preterm Labor