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Tag: preterm

  • Preterm Causes

    Preterm Causes

    What triggers normal, full-term labor is not yet fully understood, so the actual cause of preterm labor is not completely understood. In over half of preterm labors, the cause is unknown. However, there are some factors which are known to increase a woman’s risk of experiencing preterm labor.

    Many preterm births (30-40%) are the result of preterm premature rupture of the membranes (PPROM), in which the amniotic sac that holds the baby breaks too soon, leading to preterm labor. Preterm labor usually begins shortly after PPROM occurs. Sometimes, when a slow leak is present and infection has not developed, contractions may not start for a few days. On occasion, a leak high up in the amniotic sac may reseal itself so that preterm labor does not start or subsides.

    A mother’s age may play a role in preterm labor. Women in their teens or women over 35 are at an increased risk. Also, some recent studies have found a link between severe stress and stressful life situations (including things like: domestic violence or death of a close family member) and preterm labor, as well as standing for long periods of time or extremely tiring jobs.

    Infections can cause preterm labor, including certain sexually transmitted diseases (STDs) such as: gonorrhea, syphilis, chronic active hepatitis, trichomoniasis and chlamydia, as well as any illness with a fever. Severe urinary tract infections (UTI), undetected or untreated, Group B Strep and bacterial vaginosis (BV) are also possible triggers of labor before term. Other conditions that may be related to preterm labor include certain chronic maternal illnesses such as: diabetes, high blood pressure, kidney disease/infection and sickle cell anemia.

    Illegal or non-prescription drug abuse (especially cocaine), cigarette smoking, alcohol consumption are all risk factors for delivering a preterm baby. Not gaining enough weight during pregnancy, having a pre-pregnancy weight of less than 100 pounds, and inadequate nutrition and prenatal care may cause preterm labor and delivery of a premature infant.

    A multiple pregnancy (expecting twins, triplets or more) puts you at a much higher risk for preterm labor. The increased size of the mother plays a role in the increased risk. Women who’ve had a previous preterm labor or premature baby, 3 or more first-trimester miscarriages or 1 second-trimester miscarriage are considered at a higher risk as well.

    Cervical trauma is a major cause for preterm birth, the most common being from cervical injury due to elective abortions. Women with a history of multiple first-trimester abortions or one or more second-trimester abortions are at a considerably increased risk of delivering before term. Uterine defects due to an incompetent cervix, uterine fibroids, excesses amniotic fluid (making the uterus extra large), previous cervical cone biopsy surgery, placenta previa and diethylstilbestrol (DES) exposure can lead to preterm labor, as well as a pregnancy that occurred while using an IUD (contraceptive device).

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  • Preterm Labor and Complications

    Preterm Labor and Complications

    asthma-pregnancy1-163x140Prematurity is the most common cause of sickness and death among newborns. Babies born before the 37th week of pregnancy are often called preterm or “premature”, babies born before the 32nd week are considered very premature, babies born before the 28th week are considered extremely premature. Generally, babies born after the 25th week of pregnancy have a survival rate of between 50-60% (although they will stay an extended period of time in intensive care), which increases dramatically to over 90% after the 28th week.

    Premature Babies

    Babies born earlier at the 22nd week of pregnancy have less than a 2% chance of survival, while babies born before the 20th week are said to be miscarried and cannot survive outside the womb, even with our improved medical technology. The more mature babies are at birth, the more likely they are to survive and the less likely they are to have health problems. In addition to age, the baby’s size tends to influence how well he or she does; larger babies generally do better.

    Many times, babies born preterm face weeks and sometimes even months in the neonatal intensive care unit (NICU), depending on their gestational age, size and overall medical condition. Usually, premature babies are too sick and too small to go home until close to their original estimated due date.

    Preterm Health Problems

    Preterm babies are at risk for a variety of health problems, serious complications and even death. Some have lasting disabilities (depending on their degree of prematurity) such as cerebral palsy, mental retardation, reading and learning problems (or developmental delay), chronic lung disease and blindness or deafness.

    Other babies, usually those born closer to term, have no long-term problems and grow up completely healthy. Sometimes, babies born closer to term (34-36 weeks) still have certain complications, as well as suffer 2-3 times the infant mortality rate during the first year as full-term babies. Mortality rates during the first year for babies 32-33 weeks are 6 times higher than those born full-term.

    Preterm Labor Treatment

    Babies born before 34 weeks often need to be on a ventilator (and may need a medication called surfactant) to help them breathe, because of respiratory problems. A common condition for these preterm babies is called respiratory distress syndrome (or hyaline membrane disease), which is a serious breathing problem caused by immature lungs, making it difficult or impossible for their air sacs to stay open, due to the lack of surfactant in the lungs.

    Apnea is also common, especially in babies born before 30 weeks. Apnea causes babies to stop breathing for short periods of time, due to their immature respiratory and nervous systems. Intraventricular hemorrhage (IVH) sometimes happens in the first few days of life and is quite common in very premature babies. This condition is when bleeding in the brain occurs, which can potentially cause seizures and brain damage.

    Certain blood and metabolic problems may occur in babies born before term. Anemia (low blood counts), which may require a blood transfusion is not uncommon.

    Early babies may develop jaundice, due to their livers being too immature to normally process bilirubin, which may turn them yellow or orange in color. Cardiovascular conditions may occur, such as patent ductus arteriosus (PDA), which is a heart condition that causes blood to divert away from the lungs. With this, a blood vessel near the heart (that normally closes after delivery) stays open and may need to be closed with surgery, if medication doesn’t work.

    Feeding difficulties are common for preterm babies, since many are unable to suck, due to undeveloped suck and swallow reflexes. Often, they require tube feedings, in which a tube is placed in the mouth or nose that goes down into the stomach. You can still pump your breast milk for your baby, which is ideally the best for your tiny little one. Preterm babies typically are cared for under special heaters or in enclosed incubators that help maintain a stable body temperature, due to temperature instability from low body fat and thin skin.

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  • Preterm Labor

    Labor that begins anytime before the 37th week of pregnancy is preterm labor (or “premature labor”). Ideally, pregnancies (under normal circumstances), last for approximately 40 weeks from the first day of the last menstrual period, give or take 2 weeks. Most babies are considered “full-term” if they are born after the 37th week of pregnancy. If you have contractions sufficient enough in strength and frequency to start to efface (thin out) and dilate (open up) your cervix or if your water breaks (preterm premature rupture of the membranes or “PPROM”) between 20-37 weeks along, you’d be considered in preterm labor.

    It is estimated that as many as 10-12% of pregnant women in the U.S. will suffer from preterm labor, not including twin or triplet pregnancies. Approximately 60% of twins and about 90% of triplets are born preterm. Overall, the rate of preterm births are rising, mainly due to the large numbers of multiple births in recent years. Twins and other multiples are six times more likely to be preterm than single birth babies. The rate of premature single births is slightly increasing each year. Between 1992 and 2002, the rate of babies born before 37 weeks increased almost 13%. In 2002, there were over 480,000 preterm births (about 1 in 9 live births). The preterm birth rate was highest for black babies (over 17%), followed by Native American babies (almost 13%), Hispanic babies (over 11%), Caucasian babies (over 10%) and lowest for Asian babies (over 9%).

    Early detection of preterm labor is very important, so steps can be taken to stop labor from progressing and to prevent preterm delivery. Being informed and aware of early warnings signs can make all the difference. The early signs of labor can be subtle and hard to detect; some women experience preterm labor without noticing any uterine contractions at all. Don”t hesitate to call your doctor or midwife immediately if you think you are experiencing any symptoms of labor and you are less than 37 weeks along. Always call if you have any reason to suspect you might have preterm labor or you are confused or concerned about what you are feeling. Some symptoms can be especially confusing, because they may occur normally as typical pregnancy discomforts (including pelvic pressure and lower backache).

    Symptoms of preterm labor that you want to watch for include: uterine contractions that are fairly regular (whether they are painless or not) that occur 4 times or more within an hour and abdominal menstrual-like cramping (constant or occasional), with or without diarrhea. It may be difficult to tell the difference between Braxton-Hicks (or “practice”) contractions and the real thing. Monitor your contractions, by timing them (from beginning of one to the beginning of the next) and writing down your results. More than 4 in an hour, especially accompanied by other symptoms definitely warrants a call to your doctor or midwife, to be on the safe side. Other common preterm labor symptoms include: persistent, lower back pain (especially if you don’t typically have back pain), sudden increase in vaginal discharge (particularly gushes or a trickle of watery, mucus-like or blood-tinged fluid), any vaginal bleeding or spotting (some spotting is common after pelvic exams), persistent and/or increased pelvic pressure (painless or not) and frequent diarrhea.

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  • Preterm Labor Treatment

    Depending on how far along you are in your pregnancy, your doctor or midwife may not attempt to stop your preterm labor. If you aren’t close to term, one of the first things that may be done is re-hydration. You may be given fluids and possibly an IV. Preterm contractions can many times be directly related to dehydration. If your contractions stop after re-hydration, you will more than likely be discharged with orders to increase your fluid intake and follow up with a visit with your doctor or midwife, without any medications. If you are thought to be in labor preterm (before the 37th week of pregnancy), you may be given antibiotics to prevent (or treat) possible infection, especially if your membranes have ruptured.

    If re-hydrating you doesn’t stop contractions, then you will most likely be given medication. There are typically two types of medications given to women who are having preterm labor. The first type helps to slow down or stop labor contractions if given early enough (they are called “tocolytics”) .The second type helps the baby’s lungs mature before birth (“corticosteroid” medications).

    Tocolytic medications often used include terbutaline (or brethine), ritodrine, nifedipine, magnesium sulfate, or indomethacine. Each of these medications work in a different way, but the goal is to minimize the strength and number of contractions which may cause the cervix to dilate and efface. They may be given in an injection, by IV, under the skin or in the form of a pill. Your doctor or midwife may prescribe your medication to be administered by a ‘pump’, which delivers a small amount automatically through a device similar to that used by insulin dependent diabetics, while you stay in the hospital. Tocolytic medications are not as successful later in labor, if your membranes have broken, or if your cervix is already dilated beyond 2 centimeters. Tocolytics are not used if you have chorioamnionitis (an infection in the membranes around the baby), bleeding, abruptio placenta, severe preeclampsia or eclampsia, cardiac disease or other severe medical illnesses.

    Like other drugs, these medications are associated with side effects for you, as well as your baby. Before choosing a medication, you and your doctor or midwife must weigh the risks and benefits of each. Possible side effects of some of these drugs include (but are not limited to): drowsiness, dizziness, headaches, muscle weakness, irregular or fast heartbeat, nausea, vomiting, nervousness, restlessness, insomnia, shaking, shortness of breath, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium), double vision, fluid in the lungs, fever, hallucinations and heart attack. Possible side effects for the baby include: fast heart rate, high or low blood sugar after birth, loss of muscle tone, slow breathing, drowsiness, enlarged heart, jaundice and bleeding within the brain or heart. You and your baby should be monitored very closely while taking any of these medications.

    By delaying preterm labor with tocolytic medications, doctors and midwives can use other medications to help speed up the baby’s lung development and improve the baby’s chance of survival. Corticosteroid (or steroid) medications are given, particularly if delivery appears to be inevitable. Betamethasone (also called celestone) or dexamethasone are given by injection into muscle tissue.

    Sometimes, if an incompetent cervix has been diagnosed, a cervical cerclage may be done. This is a procedure where the cervical opening is stitched to keep it closed. Early cerclage placement has a significantly higher success rate than those performed after effacement and dilation have occurred. Bedrest (either at home or in the hospital) may be recommended, with varying levels of activity (from limited to none). It is important for you to discuss with your doctor or midwife what range of activity you may participate in when bedrest is prescribed.

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  • Signs of Labor

    It’s not known what brings labor on, but it’s believed that hormones such as prostaglandins stimulate uterine activity and trigger oxytocin release, softening and thinning the cervix. Your body goes through a series of changes when it’s preparing for labor. Although the signs vary from woman to woman (as well as from pregnancy to pregnancy), once your labor has begun, the strong, painful contractions will ultimately give you a clue that it’s time for your little one to be born.

    At first, especially if this is your first pregnancy, you may not know the difference between true labor and false labor signs, making you unsure of what exactly you are experiencing. Becoming familiar in advance with the signs of labor will help you to distinguish the difference when the time comes. If you think you may be going into labor, don’t feel embarrassed to call your doctor or midwife to ask questions, no matter what time of day or night, or go to the hospital.

    Diarrhea, Nausea, Increased Energy

    Labor can start out with signs as simple as experiencing frequent diarrhea and nausea/upset stomach. Some women find themselves suddenly flooded with energy, when the nesting instinct kicks in full-force. Lower back pain and abdominal cramping aren’t uncommon either.

    Rupture of Membranes

    If you’re water breaks, that’s a definite sign that your time is drawing near of holding your little one. When your membranes rupture, it can feel like a little trickle or a big gush of fluid. This is the amniotic fluid that has surrounded your baby in the amniotic sac for nine months. Many times, your water won’t break until later stages of labor, or may even have to be broken manually by your doctor or midwife at the hospital. If you think your water has broken, call your doctor or midwife, because they will most likely want you to come to the hospital. The longer between when your water breaks and when delivery occurs, the greater chance of infection. Use a towel or pad to make you feel more comfortable, never use tampons while pregnant.

    Loss of Mucus Plug

    You may experience the loss of your mucus plug or “blood show” at the onset of labor, although it can occur as early as 2-3 weeks before delivery. This mucus-like discharge may be thick, bloody and stringy. This “plug” is the barrier that seals the opening of your cervix throughout pregnancy, preventing infection. Sometimes it dislodges as your cervix begins to thin and dilate (open). Make sure to let your doctor or midwife know if this happens, especially if it’s heavy and bright red, which could indicate something serious.

    Contractions

    Labor contractions start out similar to Braxton-Hicks contractions, beginning mild and relatively painless. But unlike Braxton-Hicks, they progressively get stronger and longer in duration. Also, true labor contractions will not let up by changing positions or resting, which false labor contractions tend to do. They continue and don’t go away, no matter what you do, they may even get stronger and intensify with activity. When you are really in labor, your contractions gradually become more regular and typically develop a pattern. They commonly begin in your lower back and radiate forward, like waves. False labor contractions are usually just centered in your abdomen and stay there. Your abdomen will feel very hard (usually much harder than Braxton-Hicks), like a basketball during these contractions, which you can feel by placing your hand on your belly. And unlike false labor contractions, real contractions will dilate and efface your cervix.

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