Introduction:
Regular contractions resulting in the opening of the cervix between week 20 and 37 of pregnancy is known as preterm labor. Preterm labor results in premature birth, causing greater health risks for the baby. Most premature babies require special care in the neonatal intensive care unit (NICU). Preterm labor can also cause long-term mental and physical disabilities.
Still, the specific cause of preterm labor is not clear, and certain risk factors increase the chances of preterm labor, but pregnant women with no known risk factors can also have preterm labor.
What Are the Symptoms of Preterm Labor?
The symptoms of preterm labor are,
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Constant dull backache.
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Regular sensations of abdominal contractions.
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Mild abdominal cramps.
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Light bleeding or vaginal spotting.
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Pelvic abdominal pressure.
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Preterm rupture of membranes or continuous thin flow of fluid after the membrane around the baby tears.
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A change in vaginal discharge like mucus, watery, or bloody.
What Are the Risk Factors of Preterm Labor?
Many factors are associated with an increased risk of preterm labor; they are,
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When the most recent pregnancy is preterm labor, or more than one previous pregnancy is preterm labor.
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Problems with the placenta or uterus.
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Shortened cervix.
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Gestation with twins, triplets, or more.
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Smoking or using illicit drugs.
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Chronic conditions, such as diabetes, autoimmune disease, depression, and high blood pressure.
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Vaginal bleeding during pregnancy.
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Infections of the lower genital tract and amniotic fluid.
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Stressful events, such as the death of loved ones.
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Increased amniotic fluid (polyhydramnios).
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Presence of a congenital disability.
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When the mother is too young or old.
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Black race and ethnicity.
What Are the Complications of Preterm Labor?
The complication of preterm labor is delivering a preterm baby. This can cause several health concerns for the baby, such as,
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Low birth weight.
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Breathing difficulties.
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Vision problems.
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Underdeveloped organs.
Prematurely born children have a higher risk of learning disabilities, cerebral palsy, and behavioral problems.
How Is Premature Labor Diagnosed?
The doctor will review the medical history and risk factors for preterm labor, and then correlate them with the signs and symptoms. When you are experiencing regular uterine contractions and the cervix has begun to soften and dilate before 37 weeks of pregnancy, then you will likely be diagnosed with preterm labor. The tests used to diagnose preterm labor are,
1. Pelvic Examination:
The doctor evaluates the baby's size, position, firmness, and tenderness of the uterus. When the water has not broken, the doctor will also do a pelvic examination to determine whether the cervix has begun to open. Also, the doctor will check for uterine bleeding.
2. Ultrasound:
An ultrasound can be used to check,
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The baby or placenta.
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Baby's position.
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The volume of amniotic fluid.
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Estimate the baby's weight.
3. Uterine Monitoring:
The uterine monitor will be used to measure the duration and spacing of the contractions.
4. Laboratory Tests:
The swab of the vaginal secretions will be taken to check for the presence of certain infections and fetal fibronectin, which is a substance between the fetal sac and uterus lining, and it is discharged during labor.
These results will be reviewed with other risk factors, and also a urine sample will be taken for the presence of certain bacteria.
How Is Premature Labor Treated?
1. Medications:
There are no surgical procedures or medications to stop the delivery other than temporarily. The doctor might recommend the following medications. They are,
a) Corticosteroids - Corticosteroids help to promote the baby's lung maturity.
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Between 23 and 34 weeks, the doctor will recommend corticosteroids when at increased risk of delivery in the next seven days.
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Between 34 and 37 weeks, the doctor may recommend steroids when at risk of delivery.
b) Magnesium Sulfate - Between 24 and 32 weeks of pregnancy, the doctor may recommend Magnesium Sulfate when at high risk of delivery. Some research says that it will reduce the risk of cerebral palsy for babies born before 32 weeks of pregnancy.
c) Tocolytics - Tocolytic medication is given to slow the contractions temporarily. It is used for 48 hours to delay preterm labor and to allow corticosteroids to provide the maximum benefit. When necessary, this medicine is given to help the patient until transported to a hospital to provide specialized care for the premature baby.
But it does not address the underlying cause of preterm labor and has not been shown to improve baby's outcomes. This medication is not given in conditions such as pregnancy-induced high blood pressure (preeclampsia).
2. Surgical Procedures:
Cervical cerclage is a surgical procedure that is done when at risk of preterm labor due to a short cervix. Cervix is stitched in this procedure, and the sutures are removed after 36 weeks of pregnancy.
This procedure is also recommended when you are less than 24 weeks pregnant with a history of early premature birth, cervix opening, or cervical length is less than 25 millimeters.
How Is Premature Labor Prevented?
Premature labor can be prevented by,
1. Regular Prenatal Care - The doctors make prenatal visits to monitor the health of the mother and the baby. During the visit, tell all the signs or symptoms you experience. When there is a history of preterm labor or developing the signs or symptoms of preterm labor, more frequent doctor visits during pregnancy are needed.
2. Eating a Healthy Diet - Healthy pregnancy generally needs good nutrition. A diet rich in polyunsaturated fatty acids is associated with a low risk of premature birth. Polyunsaturated fatty acids are found in nuts, fish, seeds, and seed oils.
3. Avoid Certain Substances - Quit smoking if you are a smoker. Tell your doctor and ask for a smoking cessation program.
4. Consider Pregnancy Spacing - Consider talking about pregnancy spacing with the doctor because pregnancies spaced more than 59 months apart or less than six months apart have an increased risk of premature birth.
5. Cautious About Assisted Reproductive Technology (ART) - When planning to use assisted reproductive technology to get pregnant, be aware of how many embryos are implanted as multiple pregnancies have a high risk of preterm labor.
6. Manage Chronic Conditions - Certain conditions, such as diabetes, obesity, and high blood pressure, increase the risk of preterm labor, so it is necessary to keep them under control. When the doctor determines that you are at high risk of developing preterm labor, they will recommend taking additional steps to reduce the risk.
Conclusion:
Preterm labor is a multifactorial condition associated with a high risk of morbidity and mortality, particularly at early gestational ages. Prevention is directed towards the identification of women at risk and comprises screening and treatment for bacterial vaginosis, cerclage to prevent premature birth, and the consideration of Progesterone prophylaxis. So have regular prenatal checkups and reach a doctor when there are unusual symptoms.
