Pregnancy monitoring prevents preterm birth

The month of November is National Prematurity Awareness Month. Pregnancy typically lasts 40 weeks. Preterm labor is defined as labor that begins before 37 weeks of pregnancy.

Every year, 15 million babies are born prematurely, accounting for more than one-tenth of all babies worldwide.

Anyone can experience preterm labor without prior notice. However, there are some elements that raise the risk of preterm birth, such as:

• Previous preterm birth

• Small uterus in early pregnancy

• Previous gynecological conditions or surgeries

• Current pregnancy complications

• Lifestyle factors

Previous preterm birth and being pregnant with multiples are the two most common risk factors for preterm birth, though it can occur in women without any risk factors too, as the cause is unknown in some.

The earlier the premature birth happens, the greater the health risks for your baby. Many premature babies need special care in the neonatal intensive care unit. Premature lungs, difficulty regulating body temperature, poor nutrition, and slow weight gain are all complications of premature birth. Prematurity is also linked to longterm sequalae like behavioral phenotype and personality profile that includes shyness, social withdrawal, overcontrolling, and a refusal to take risks or have fun. Premature birth can also disrupt the pituitary-gonadal axis(ovaries or testes), resulting in infertility.

Going into preterm labor does not necessarily imply that a woman is preterm. Preterm labor is diagnosed based on the patient's signs and symptoms. Besides:

  • Mild abdominal cramps, with or without diarrhea

  • Change in the type of vaginal discharge—watery, bloody, or mucous

  • Increase in amount of discharge

  • Pelvic or lower abdominal pressure

  • Constant, low, dull back pain

  • Regular or frequent contractions or uterine tightness, often painless

  • Ruptured membranes (your water breaks with a spill or trickle of fluid)

Preterm labor only ceases on its own in three out of ten women; the other seven need early detection and treatment.

Tests to confirm preterm labor include a pelvic exam to evaluate the uterine status, an ultrasound(transvaginal) for cervical length, to check for problems with the baby or placenta, confirm the baby's position, assess the volume of amniotic fluid, and estimate the baby's weight and a vaginal swab to check for fetal fibronectin.

Prevention

-Seek regular prenatal care.

-Eat a healthy diet - some research suggests that a diet high in polyunsaturated fatty acids (PUFAs) is associated with a lower risk of premature birth. PUFAs are found in nuts, seeds, fish and seed oils.

-Avoid risky substances.

-Consider pregnancy spacing.

-Be cautious when using assisted reproductive technology (ART). - Multiple pregnancies carry a higher risk of preterm labor.

-Manage chronic conditions. Certain conditions, such as diabetes, high blood pressure and obesity, increase the risk of preterm labor

Management:

The gestational age of the pregnancy is a major factor in the management. Once you're in labor, there are no medications or surgical procedures to stop labor, other than temporarily. Drugs may be administered if the fetus would benefit from a delayed delivery.This reduces the risk of certain complications, speeds up foetal lung development.

Corticosteroids, magnesium sulphate, and tocolytics are medications that aid in preparing the foetus for preterm birth. The development of the fetal lungs, brain, and digestive system is sped up by corticosteroids. Women at risk of giving birth in less than seven days, such as those with ruptured membranes and those carrying multiple foetuses, may be advised to take a single course of corticosteroids between 24 and 34 weeks of pregnancy. Magnesium sulphate may lessen the risk of cerebral palsy and movement issues in preterm births that occur at less than 32 weeks' gestation and those that are intended to be delivered within 24 hours. Tocolytics are medications that can delay delivery by up to 48 hours.

Cervical cerclage might be recommended if pregnancy is less than 24 weeks, having a history of early premature birth, and cervical length is less than 25 mm on ultrasound. Recent research suggests that vaginal progesterone is as effective as cervical cerclage in preventing preterm birth for some women who are at risk.In addition, weekly injections of progesterone called hydroxyprogesterone caproate, starting in second trimester and continued until 37th week of pregnancy can be given.

If you have a history of preterm labor or premature birth, you're at risk of a subsequent preterm labor. Work with your health care provider to manage any risk factors and respond to early warning signs and symptoms, thereby preventing preterm delivery and the associated morbidity.


Dr Sree Ramya Kantipudi

Consultant gynaecologist

and fertility specialist

Kamineni hospital Vijayawada




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