What Are the Preterm Labor Complications in Mothers and Babies?

Introduction:

A normal pregnancy lasts for about 40 weeks. The process undergone by a body to give birth to a baby is known as labor. Preterm labor is the early labor that occurs before completing 37 weeks of pregnancy. Preterm labor is also known as premature labor. Preterm labor can result in the premature birth of the baby. However, all preterm labor does not automatically result in premature birth. But preterm labor is an emergency that needs immediate medical attention.

What Is Preterm Labor?

Preterm labor is the labor that occurs after 20 weeks and before 37 weeks of pregnancy. Regular contractions during this period may lead to thinning and opening of the cervix. Preterm labor can be further subdivided into early or late preterm. Preterm labor before 33 weeks of pregnancy is known as early preterm labor, and preterm labor between 34 and 36 weeks is known as late preterm labor. The chances of premature birth are high in preterm labor. In addition, premature birth can cause health problems in babies, which need special medical attention.

What Causes Preterm Labor?

The definitive cause of preterm labor is not known. However, the known causes are as follows:

• Vaginal bleeding.

• Hormone changes.

• Stretching of the uterus due to the presence of a large baby, twin babies, or high levels of amniotic fluid (a liquid that surrounds the unborn baby during pregnancy).

• Long-standing health conditions like infections or diabetes.

• A time span of fewer than 18 months between pregnancies.

• Preeclampsia (increased blood pressure during pregnancy).

• Drug or alcohol abuse.

• Problems with the cervix or uterus.

What Are the Symptoms of Preterm Labor?

The commonly seen symptoms of preterm labor are as follows:

• Constant dull backache.

• Light bleeding or vaginal spotting.

• Abdominal cramps (similar to menstrual cramps).

• Constant sensations of abdominal tightening (more than four in one hour).

• Watery, mucus-like, or bloody vaginal discharge.

• Continuous flow or a sudden burst of fluid from the vagina (mostly due to the preterm rupture of the membrane around the baby).

• Pressure in the lower belly region.

• Diarrhea.

What Are the Complications of Preterm Labor?

Preterm labor can cause complications for both the mother and the baby. The most common complication of preterm labor is delivering a preterm baby. Babies born before 37 completed weeks of pregnancy are prone to severe health problems. Babies born before 28 weeks are at the greatest risk for problems. Babies born prematurely are often small with low birth weight as they are born before their body and organ systems have matured. They usually weigh less than 2,500 grams or 5.5 pounds at birth. As a result, they need help for breathing, fighting infections, eating, and staying warm.

What Are the Maternal Complications of Preterm Labor?

• The premature birth of a baby can have an emotional impact on the mother and the entire family. Women who enter preterm labor are more likely to have postpartum depression, anxiety, post-traumatic stress disorder (PTSD), and problems bonding with the baby.

• Women who go into preterm labor are prone to severe infections that may require intravenous antibiotic treatment.

• During preterm labor, most women require C-sections (cesarean section) as the premature babies are mostly breeched or lying in some unusual position inside the womb.

• Preterm labor has been linked with an increased risk of cardiovascular mortality and morbidity in mothers years after the delivery.

What Are the Preterm Labor Complications in Babies?

Babies born from preterm labor can have both short-term and long-term health complications.

The short-term complications are as follows:

• Breathing Complications:

  • The immature respiratory system in premature babies can lead to breathing difficulties.

  • Some babies lack surfactant (a substance that allows lung expansion), which may lead to respiratory distress syndrome due to the inability of the lungs to expand and contract normally.

  • Babies may develop lung disorders like bronchopulmonary dysplasia and prolonged pauses in breathing called apnea.

• Brain Complications:

  • Premature babies have a high risk of bleeding in the brain, called intraventricular hemorrhage.

  • Babies with heavy brain bleeding may end up with permanent brain injury.

• Heart Complications:

  • The common heart problems experienced by premature babies are patent ductus arteriosus (PDA) and low blood pressure.

  • Untreated PDA may lead to a heart murmur, heart failure, and other complications.

• Gastrointestinal Complications: Premature babies often have immature gastrointestinal systems that can lead to complications like necrotizing enterocolitis (NEC), characterized by the injury of the cells lining the bowel wall that occurs once after the baby starts feeding.

• Blood Complications:

  • Premature babies are at greater risk of developing anemia and newborn jaundice (yellowish discoloration of the eyes and skin of the babies due to excess bilirubin in the liver or red blood cells).

  • Anemia is a condition characterized by the deficiency of red blood cells. While all babies experience a drop in the red blood cell count in the first few months after birth, premature babies experience a greater decrease in the red blood cells.

• Temperature Control Complications:

  • Premature babies lose body heat rapidly as they do not have the stored body fat of a full-term infant.

  • When the body temperature dips too low, hypothermia (abnormally low core body temperature) may result.

  • Hypothermia may lead to low blood sugar levels and breathing problems in premature babies.

The long-term complications are as follows:

• Vision Complications:

  • Premature babies may develop prematurity retinopathy, a condition characterized by the swelling and overgrowth of blood vessels in the light-sensitive layer of nerves at the back of the eye.

  • Sometimes, the abnormal retinal vessels scar the retina and pull it away from the back of the eye resulting in retinal detachment, which may cause impaired vision and blindness.

• Learning Complications: Premature babies lag behind developmental milestones and are more likely to have learning disabilities.

• Hearing Complications: Premature babies are at high risk of developing hearing loss.

• Cerebral Palsy: Cerebral palsy is a disorder of muscle tone, movement, or posture caused by inadequate blood flow, infection, or injury to the baby’s developing brain during pregnancy or while the baby is young.

• Dental Complications: Premature babies risk developing dental complications like tooth discoloration, delayed tooth eruption, and improperly aligned teeth.

• Behavioral and Psychological Problems: Premature babies are more prone to develop psychological or behavioral problems and developmental delays.

• Chronic Health Issues: Premature babies tend to develop health issues like asthma, infections, and feeding problems more than full-term infants. Premature babies are also at greater risk of developing sudden infant death syndrome (SIDS).

How to Diagnose Preterm Labor?

The common ways of diagnosing preterm labor in pregnant women are as follows:

• If preterm labor is suspected, the doctor will check for the frequency and duration of the contractions through an electronic monitor. The monitor consists of a device called a transducer placed on the patient's belly. The device detects and sends information about the contractions to the monitor. The heart rate of the baby is also monitored.

• Cervical examination.

• Transvaginal ultrasound.

• Testing for amniotic fluid.

• Testing for fetal fibronectin (fFN).

What Is the Treatment for Preterm Labor?

The treatment options for preterm labor may include the following:

• Bed Rest: Bed rest can be done either at home or hospital.

• Corticosteroids and Antibiotics: The lungs of premature babies may not function on their own. Corticosteroids help in the growth and development of the lungs of babies. Antibiotics are used in treating infections.

• Cervical Cerclage: This procedure involves stitching the cervix closed. This procedure is done when the cervix is weak and cannot stay closed.

• Tocolytic Medicines: These medicines that are given intravenously or as injections are used to slow down or stop contractions.

• Cesarean Delivery: If treatments do not prevent preterm labor or the baby is in danger, the doctor would suggest cesarean delivery of the baby.

Conclusion:

Preterm labor can be very dangerous to both the baby and the mother. Any signs of preterm labor, increased vaginal discharge, bleeding, pelvic pain, and labor like repeated contractions should be reported immediately to the doctor. The longer the baby stays in the uterus, the lesser the chance of complications. Hence, staying healthy during pregnancy and managing existing health issues is the best way to overcome preterm labor.