All to Know about Premature Birth
A premature birth is a birth that takes place more than three weeks before the baby is due. In other words, a premature birth is one that occurs before the start of the 37th week of pregnancy. Normally, a pregnancy usually lasts about 40 weeks.
Premature birth gives the baby less time to develop in the womb. Premature babies, especially those born earliest, often have complicated medical problems.
Depending on how early a baby is born, he or she may be:
- Late preterm, born between 34 and 36 weeks of pregnancy
- Moderately preterm, born between 32 and 34 weeks of pregnancy
- Very preterm, born at less than 32 weeks of pregnancy
- Extremely preterm, born at or before 25 weeks of pregnancy
Most premature births occur in the late preterm stage.
What Increases Your Risk
Lots of different things can increase your risk of premature labor. Some of them are:
- Being very overweight or underweight before pregnancy
- Not getting good prenatal care
- Drinking alcohol or using street drugs during pregnancy
- Having health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, or infections
- Being pregnant with a baby that has certain birth defects
- Being pregnant with a baby from in vitro fertilization
- Being pregnant with twins or other multiples
- A family or personal history of premature labor
- Getting pregnant too soon after having a baby
To stop premature labor, you need to know the warning signs. Acting fast can make a big difference. Call your midwife or doctor right away if you have:
- Backache, which usually will be in your lower back. This may be constant or come and go, but it won’t ease even if you change positions or do something else for comfort.
- Contractions every 10 minutes or more often
- Cramping in your lower abdomen or menstrual-like cramps. These can feel like gas pains that may come with diarrhea.
- Fluid leaking from your vagina
- Flu-like symptoms such as nausea, vomiting, or diarrhea. Call your doctor even about mild cases. If you can’t tolerate liquids for more than 8 hours, you must see your doctor.
- Increased pressure in your pelvis or vagina
- Increased vaginal discharge
- Vaginal bleeding, including light bleeding
Some of these may hard to tell apart from normal symptoms of being pregnant, like backache. But you can't be too cautious. Get any possible warning signs checked out.
Some babies born early are fine; they are just small. But often when a baby is born preterm, his organ systems may not have had time to fully develop.
According to Tommy's, the majority of preterm births occur without any obvious cause or known risk factors. However, there are some known risks for premature births:
The overstretching of the womb that occurs in the case of twin or triple pregnancies is thought to increase the risk of premature labor.
Not a major factor, but it is recognized that mothers under 20 or over 35 years old have a slightly higher risk of preterm labor.
If the baby is not thriving in the womb, for example, if the placental blood supply is impaired or there is evidence of growth retardation, then this can lead to premature birth.
The mother's lifestyle can increase the risk of having a premature baby. For example, smoking, using recreational drugs, having a high caffeine intake, having a poor diet or being underweight, and engaging in over-strenuous physical activity.
Previous gynaecological history
Women who have had surgery on their cervix may have suffered damage to the opening of the womb. This can cause the cervix to open too soon in pregnancy, resulting in premature labor.
Pregnancy-specific maternal disease
Examples of this include pregnancy-induced diabetes and pre-eclampsia (itself a cause of at least 15% of all pre-term births) and obstetric cholestasis (liver disease characterized by extreme itching).
Maternal medical conditions
Certain pre-existing medical conditions in the mother have been linked to an increased risk of premature labor. They include systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), or renal disease.
This is another potential trigger of preterm labor. Vaginal infections, such as gonorrhoea, chlamydia, trichomonas, bacterial vaginosis and group B streptococci have all been linked to preterm labour. Bladder infections can also trigger early labor if left untreated.
In some women the cervix, the opening to the womb, will shorten and open too soon and labour will spontaneously follow.
There are also circumstances where premature delivery is initiated by medical staff. For example, if the mother is suffering from pre-eclampsia or the baby is not thriving in the womb, if there is a bleed and either the health of the mother or baby is at risk, then premature delivery of the baby may be the recommended option.
Exams and Tests
A premature infant may have signs of the following problems:
- Bleeding into the brain or damage to the brain's white matter
- Infection or neonatal sepsis
- Low blood sugar (hypoglycemia)
- Neonatal respiratory distress syndrome, extra air in the tissue of the lungs (pulmonary interstitial emphysema), or bleeding in the lungs (pulmonary hemorrhage)
- Newborn jaundice
- Problems breathing due to immature lungs, pneumonia, or patent ductus arteriosis
- Severe intestinal inflammation (necrotizing enterocolitis)
A premature infant will have a lower birth weight than a full-term infant. Common signs of prematurity include:
- Abnormal breathing patterns (shallow, irregular pauses in breathing called apnea)
- Body hair (lanugo)
- Enlarged clitoris (in female infants)
- Less body fat
- Lower muscle tone and less activity than full-term infants
- Problems feeding due to trouble sucking or coordinating swallowing and breathing
- Small scrotum that is smooth and has no ridges, and undescended testicles (in male infants)
- Soft, flexible ear cartilage
- Thin, smooth, shiny skin that is often transparent (can see veins under skin)
Common tests performed on a premature infant include:
- Blood gas analysis to check oxygen levels in the blood
- Blood tests to check glucose, calcium, and bilirubin levels
- Chest x-ray
- Continuous cardiorespiratory monitoring (monitoring of breathing and heart rate)
Treating a premature infant
Doctors often try to prevent a premature birth by giving the mother certain medications that can delay delivery.
If premature labor can’t be stopped or a baby needs to be delivered prematurely, doctors then prepare for a high-risk birth. The mother may need to go to a hospital that has a neonatal intensive care unit (NICU). This will ensure the infant receives immediate care after birth.
In the first few days and weeks of the premature baby’s life, hospital care focuses on supporting vital organ development. The newborn may be kept in a temperature-controlled incubator. Monitoring equipment tracks the baby’s heart rate, breathing, and blood oxygen levels. It may be weeks or months before the baby is able to live without medical support.
Many premature babies can’t eat by mouth because they can’t yet coordinate sucking and swallowing. These babies are fed vital nutrients either intravenously or using a tube inserted through the nose or mouth and into the stomach. Once the baby is strong enough to suck and swallow, breast-feeding or bottle-feeding is usually possible.
The premature baby may be given oxygen if their lungs aren’t fully developed. Depending on how well the infant can breathe on their own, one of the following may be used to deliver oxygen:
- ventilator, a machine that pumps air into and out of the lungs
- continuous positive airway pressure, a treatment that uses mild air pressure to keep the airways open
- oxygen hood, a device that fits over the infant’s head to supply oxygen
Generally, a premature infant can be released from the hospital once they can:
- breast-feed or bottle-feed
- breathe without support
- maintain body temperature and body weight
Although the exact cause of preterm birth is often unknown, there are some things that can be done to help women — especially those who have an increased risk — to reduce their risk of preterm birth, including:
- Progesterone supplements. Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.
- Cervical cerclage. This is a surgical procedure that helps prevent premature birth in women pregnant with only one baby who have a history of premature birth or who have a short cervix or both.
During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it's time to deliver the baby. Ask your doctor if you need to avoid vigorous activity during the remainder of your pregnancy.
Although not as well-studied as progesterone supplements and cerclage, there's also some evidence that the following things may help reduce the risk of premature birth:
- Eat a healthy diet even before you get pregnant. Although it's no guarantee of a full-term pregnancy, eating a healthy diet containing several servings of protein-rich foods, fruits and whole grains before you get pregnant may reduce your risk of premature birth. But, a diet high in fat, sugar and processed foods, such as chips and white bread, before pregnancy has been linked to a higher risk of premature birth.
- Calcium supplements. Taking 1,000 milligrams (mg) or more of calcium daily may lower your risk of preeclampsia — a serious complication of pregnancy — and preterm birth, especially for women who normally consume low amounts of calcium in their diets.
- Daily low-dose aspirin. Beginning late in the first trimester, taking a low-dose aspirin — 60 to 80 mg — daily appears to help certain women reduce the risk of premature birth. Women who may benefit from low-dose aspirin therapy include those with a history of preterm birth or preeclampsia, as well as women with chronic high blood pressure.
- Cervical pessary. Women pregnant with just one baby who have a short cervix may reduce their risk of premature birth with a cervical pessary. A pessary is a silicone device that fits around the cervix and may help support the uterus.
- Reduce chemical exposure. Exposure to phthalates — chemicals used to manufacture many products such as plastic, canned foods, cosmetics, nail polish and hairspray — is associated with a higher risk of premature birth. It isn't yet known if reducing exposure to these products would reduce the risk of premature birth, but it's a good idea to limit your exposure whenever you can.