Written by Yen Ling

What is preterm birth?

Preterm birth is defined as birth occurring before 37 weeks of gestation. Babies born unusually early have higher risks for functional impairments (social, behavioural, dan learning disabilities), breathing problems, cerebral palsy and death.

 

What are the risk factors?

Factors that increase the risk of preterm birth include the following:

  • Chronic conditions (e.g. diabetes and high blood pressure)
  • Lifestyle factors such as substance abuse, smoking, and low pre-pregnancy weight
  • History of preterm birth
  • Lack of prenatal care
  • Maternal age (<20 years or > 35 years)
  • Multiple pregnancies

 

What are the signs and symptoms of preterm labour?

Please call your healthcare professional if you notice any of these:

  • Belly cramps with or without diarrhea
  • Regular or frequent contractions or uterine tightening that may or may not be painful
  • Frequent low, dull backache
  • Change in vaginal discharge (bloody, mucus, or watery)
  • Your water breaks

 

What are the treatment options provided if I have preterm labour?

The goal of treatment is to give the new-born the greatest chance of survival with the least complications. If your healthcare provider has identified that preterm labour has started, certain medications may be given (e.g. corticosteroids, magnesium sulphate, and tocolytics).

 

Corticosteroids

These are medications that help speed the development and maturation of the foetus’s lungs. These also help reduce risks of bleeding in the brain and other complications, which affect the circulatory system and digestive organs.

 

Magnesium Sulphate

It helps to reduce risks of future neurological impairment of the child (e.g. cerebral palsy).

 

Tocolytics

These are medications used to prolong the time to delivery by relaxing the uterine muscles and stopping contractions. They are meant to prolong delivery up to 48 hours while the corticosteroids or magnesium sulphate takes effect or for you to be transferred to a tertiary care facility that offers specialized care.

 

How do I prevent preterm birth?

One of the most important things to do would be to stop harmful habits (e.g. smoking and substance use), eat healthy meals with optimal nutrition, and managing medical conditions under doctor’s supervision.

 

Preventive treatment with progesterone (normally an injection) can reduce the risks of preterm birth. This is usually recommended for women with prior history of preterm birth at less than 37 weeks of pregnancy. Progesterone supplementation is generally initiated between 16 and 26 weeks of gestation and continued through 36 weeks.

 

Daily vaginal progesterone supplement can be used in women with no history of spontaneous preterm delivery if they found to have a short cervix before 24 weeks gestation.

 

In high-risk women with a shortened cervix, an encircling suture placed around the cervix prior or during pregnancy (referred to as a cerclage) is used to help correct cervical weakening and correct structural defects.

References

  • Moore, Mary Lou. “Preterm Birth: A Continuing Challenge.” The Journal of Perinatal Education, vol. 11, no. 4, 2002, pp. 37–40, 10.1624/105812402X88948.
  • Moster, Dag, et al. “Long-Term Medical and Social Consequences of Preterm Birth.” New England Journal of Medicine, vol. 359, no. 3, 17 July 2008, pp. 262–273, 10.1056/nejmoa0706475.
  • Rundell, Kristen, and Bethany Panchal. “Preterm Labor: Prevention and Management.” American Family Physician, vol. 95, no. 6, 2017, pp. 366–372, www.aafp.org/afp/2017/0315/p366.html. Accessed 30 Oct. 2019.
  • Schleußner, Ekkehard. “The Prevention, Diagnosis and Treatment of Premature Labor.” Deutsches Aerzteblatt Online, 29 Mar. 2013, 10.3238/arztebl.2013.0227. Accessed 1 Mar. 2019.
  • World. “Preterm Birth.” Who.Int, World Health Organization: WHO, 19 Feb. 2018, www.who.int/news-room/fact-sheets/detail/preterm-birth.
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