Authored By: Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician & Gynaecologist,

High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)


WHAT IS PRETERM LABOR?
Preterm labor is when the contractions starts before the 37th week of pregnancy. Along with contractions, cervical changes also starts. The cervical thinning begins, a process called effacement, and it starts to dilate so that the baby can enter the birth canal.

Who is at risk of preterm birth?
Factors that increase risks of delivering a baby early-

Factors related to previous history:

  • Being pregnant with multiple babies
  • Having babies close together
  • Repeated urinary tract infections, especially strep, urinary tract infections,
  • vaginal infections, and infections of the baby or placental tissues
  • Abnormal structure of the uterus
  • Previous history of preterm birth or abortion
  • History of having a short cervix
  • Use of fertility medications to conceive

Factors related to mother:

  • Experiencing health-related complications during pregnancy, like gestational diabetes. pregnancy induced hypertension
  • A weak cervix that cannot stay closed as the baby grows larger
     or previous pregnancy with short cervix
  • Abnormal structure of the uterus
  • Anaemia that is low haemoglobin

What are the signs and symptoms of preterm labor?
Symptoms of preterm labor are very similar to labor occurring at term. Every woman experiences them differently.

  • Five or more contractions in an hour. These feels like menstrual cramps, or they might be less painful.
  • Watery fluid leaking from vagina, as a gush or trickle of fluid – this may indicate your water has broken.
  • Dull, low backache felt below the waistline. It may be constant, or intermittent.
  • Intestinal upset, nausea, or diarrhoea
  • Pelvic pressure that may feel like baby is pushing down. The pressure may also feel like you need to have a bowel movement.
  • Vaginal spotting or bleeding.     

Contact your doctor immediately even in case of slight doubts about preterm labor. Don’t worry about a possible false alarm. In case of preterm labor, the sooner the treatment starts, the better chance there is for a good outcome.

HOW TO AVOID PRETERM LABOUR
Women who get pregnant within six months of their previous pregnancy are at an increased risk for delivering a baby prematurely. So, to reduce risk of preterm birth is tospace out your pregnancies at least 18 months apart. Using an effective contraceptive and spacing gives your body time to recover after pregnancy. Find out contraceptive that’s best for you with help of your Doctor. While mostly preterm birth can’t be attributed to a specific cause, certain chronic health conditions, like obesity, diabetes, and high blood pressure, can increase your risk. To reduce the risk achieve a healthy body mass index through exercise and a nutritious diet—both of which are important for maintaining your health during pregnancy.
Avoid Smoking and recreational drug use. So,start now to quit.Take help of healthcare provider to stop smoking or using recreational drugs.
A Uterine infection is a common cause for preterm and often the most obvious cause for early birth. So, any infection can compromise your immune system, increasing risk of health problems. And infections, like sexually transmitted infection (STI), can directly affect your baby. That’s why STIs are ruled out in early pregnancy. A preterm delivery may not always be preventable. But proper care can give better outcome.

What treatments are there for preterm labor?
If you are less than 34th week of pregnancy, you might have to stay at the hospital and take bed rest along with monitoring. You will need more frequent hospital visits if you are allowed to return home.
Depending on your condition and severity, you might receive one or more medications. These may be to stop or slow contractions, speed up the baby’s development, or to help you feel better. Commonly used medications for preterm labor include:  

Magnesium sulfate: This is given as injectable, initially in high dose followed by small continuous dose for 24-48hrs. This is usually used for pregnancies less than 32 weeks pregnant and at risk for early delivery within the next 24 hours. This helps reduce the frequency of contractions along with reducing the risk of cerebral palsy in babies born early.

Corticosteroids: These cross the maternal-placental blood barrier, and they are given to help speed the baby’s lung and brain development before birth. These are mostly used between 28-34weeks of pregnancy.Tocolytic medications: Tocolytics help to delay delivery upto 48 hours, so corticosteroids and magnesium sulfate have time to work. If your labor does not stop and delivery appears imminent, your baby will need care from specialists such as a neonatologist and a neonatal intensive care unit. So, these gives us sufficient tie to shift the mother to a centre where above facilities can be provided.

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