Prenatal Care

Preterm Birth Prevention

Diabetes in Pregnancy

Multiple Gestation

Prepregnancy Health

 


Preterm Birth Prevention

Preterm Delivery: In terms of its impact on infant health, preterm delivery (PTD) is the most significant complication affecting pregnancy. By definition, preterm refers to a gestational age of 37 weeks or less. A woman’s due date is 40 weeks from the first day of her last menstrual period. PTD may be medically indicated because of a maternal problem (e.g. hypertension) or a fetal problem. This situation is called indicated preterm delivery (IPTD) and is usually unavoidable. PTD that follows spontaneous onset of preterm labor is referred to as spontaneous PTD (SPTD). This needs to be medically evaluated and treated because of the high risk to the infant associated with SPTD. As spontaneous preterm labor occurs at progressively earlier gestational ages, the risk to the infant, if delivered, increases steadily. These risks include various problems that are the direct result of prematurity. They include breathing difficulty (respiratory distress syndrome (RDS), feeding problems, visual problems, kidney or intestinal problems, etc.

Causes
The cause of preterm labor is multifatorial. Preterm labor is more common in women who have uterine problems such as fibroids, uterine over distension (due to twins, triplets, or excessive amniotic fluid) or cervical weakness (incompetence). Other risk factors for spontaneous preterm labor include previous SPTD, smoking, multiple gestations, drug use and rupture of the bag of waters.

Signs and Symptoms
Signs or symptoms of spontaneous preterm labor include uterine contractions/cramps, backache, pelvic pressure, vaginal bleeding, and increased vaginal discharge. More recent indicators or markers of an increased risk for preterm labor include shortened cervical length measured by vaginal ultrasound examination and a laboratory test of cervical-vaginal secretions for a substance called Fetal Fibronectin (FFN).

Treatment
Treatment for preterm labor includes immediate medical evaluation, monitoring for uterine contractions, testing for the presence of infection and possibly hospitalization, medications to suppress contractions, antibiotics, and steroid medications (Betamethazone) to accelerate fetal lung maturity. This patient evaluation and treatment approach does not always prevent SPTD, but it has been shown to significantly reduce the risk associated with SPTD.

Women with preterm labor who are at risk for SPTD should be cared for in a hospital equipped to take care of their baby if the preterm labor cannot be stopped. A woman who is in labor at less than 33 weeks gestation should be cared for in a tertiary level hospital. A woman in labor between 34 and 37 weeks may be able to be cared for in a secondary level hospital. If a woman is initially seen in a primary or secondary level hospital for evaluation for preterm labor, she may need to be transferred to a tertiary level hospital depending upon the results of her medical evaluation. This type of a transfer (maternal-fetal transport) allows the woman and her fetus to be cared for in a setting that is best able to manage her preterm labor, as well as her infant, if she delivers preterm.

With appropriate patient evaluation and treatment along with care in a facility with personnel and equipment necessary to take care of a mother, and if preterm delivery occurs, the baby, one can expect ultimately a good outcome for both mother and baby.