Generally, a normal pregnancy takes 40-42 weeks term. In few cases, the duration of pregnancy gets shorter than 36 weeks of gestation resulting in early labour.
Australia, around 0.02% of pregnancies end with premature births. It is more
common in developing countries. Various studies and researches are being done
to understand the causes leading to premature birth which can be endangering
life of the expecting mother and the foetus.
What is Preterm Birth?
a normal pregnancy takes 40-42 weeks term. In few cases, the duration of pregnancy gets shorter than 36weeks of gestation
resulting in early labour known as preterm or premature birth. In short, birth
that occurs before the 37th week of pregnancy is known as preterm
birth is also called as preterm birth, premature labour, premmie (premature
of preterm birth
majority of the causes leading to premature birth/labour remain unknown.
However, a few medical conditions have been found to result in early labour.
These medical conditions include:
have shown that pregnant women of low socioeconomic class, young age, women
with eating disorders, previous history of preterm birth and anaemia etc. are
more prone to preterm birth/preterm labour. Studies have also shown that pregnant
women who smoke, drink alcohol or use illicit drugs are also more prone to end
up with premature birth or labour.
Signs and symptoms of
are few signs and symptoms of preterm birth which may be experienced by pregnant
Watery or bloody vaginal discharge
Lower abdomen Pressure
organ system (such as brain, lungs, heart or intestines etc.) of a foetus born before
weeks 37-38 of gestation is not completely developed. Generally, a baby born
with an underdeveloped organ system has a lower survival rate.
not all preterm births are complicated.
The earlier a baby is born, the harder it is for the baby to survive. Most
common consequences of preterm birth are as follows:
a premature foetus has underdeveloped lungs which lacks a substance called
‘surfactant’ which helps keep the lungs open up and expand on breathing in.
Baby may have breathing problems such as respiratory distress syndrome.
it is a brain disorder, resulting in impaired muscle movement, muscle tone. It
can be caused by any injury to the foetus’s developing brain. It is a long term
effect of premature birth which doesn’t go away with time.
defects- Patent Ductus Arteriosus(PDA) is the most common heart defect
seen in premature babies. It usually closes on its own by the time. But if left
untreated, it allows too much blood flow into the heart which may result in
defects- lack of oxygen to the under developed intestine leads to a
massive growth of bacterias over the intestinal linings and cause the intestinal
cells to die. It is a serious condition seen in premature baby’s due to
immature gastrointestinal system is ‘necrotizing enterocolitis’. Foetus
experiences impaired feeding , bloody stools, bloating and swelling of abdomen
and diarrhea occurs.
premmies experience anaemia and jaundice a lot more commonly than full term
babies. Anaemia is low red blood cells and jaundice is the breaking of red
blood cells shown with yellow tinge in the skin and eyes.
Temperature– baby’s body is
unable to produce enough heat to keep its body off the room temperature hence
baby is kept in a warm incubator till it starts building up its own warming up
Immune system defects-
foetus’s impaired immune system causes infections
,allergies and sepsis.
issues- very ill babies are more prone to develop dental problems such
as delayed dental eruption, tooth decaying and misaligned teeth.
issues-it has no obvious reason of behavioural issues seen more commonly
seen with premature births as compared to full term babies. Attention deficit hyperactivity disorder (ADHD) is such an example seen in premature babies more often than full term infants.
defects- all newborns are normally checked for any kind of hearing
defects before they leave hospital. But, in premature births, hearing deficits
are seen more often than full term births.
Diagnosis of Preterm Labour
preterm labour must be diagnosed carefully by the supervising doctor. Following
are the tests and examinations done to diagnose preterm labour in a women:
Pelvic exam - the physician does a pelvic exam which tells the
cervical thinning and dilatation, baby size, uterus size compared with the
gestational age. If the cervix has begun to thin and dilate this proves that
labour has started too early.
Ultrasound scan - ultrasound scans
show the number (single, twins, triplets), size and age of the baby, length of
the cervix, weight of the uterus and position of placenta.
Amniocentesis - screening with the amniotic fluid tap is done to
see the lung maturity and any infection and genetic disease. Chorionic villous
sampling and amniocentesis are the same technique, but are performed at
different weeks of gestation such as chorionic villous sampling is considered
safe if done between 12-15 weeks of gestation and amniocentesis is done between
Laboratory test- foetal fibronectin,
a substance which attached the foetal sac with the uterus is released during
labour. Identification of this substance will increase the chances of going
into preterm labour .This test is not confirmatory and is not reliable.
Management of Preterm
following measure s can be taken by the practicing physician to manage preterm
a weak cervix should be managed with cervical cerclage, which is a suture tied
around the cervix to keep it close till pregnancy reached its term. It is
removed earlier to delivery or labour. It is best for the pregnancy before 24
Tocolysis- a tocolytic therapy
is used when labour is established. Labour can be postponed for a day or two
days with the tocolytic therapy. This therapy is used under a specific
criteria, which includes:
Pregnancy less than 35 weeks
No placental abruption
Cervix is less than 5 cm dilated
Foetus is alive and should not have life threatening
therapy provides time and environment for the immature lungs to reach maturity.
Prevention of Preterm
women with previous history of preterm birth, monthly follow up, ultrasounds
must be done to keep check on the growth of the baby, size of uterus and cervix
Bed rest is encouraged in women at risk, which decreases the
chances of injury or damage to the foetus.
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