Premature Labor & Delivery

Introduction

Premature delivery is a birth that takes place three weeks before a baby’s due date.  In some cases, premature birth happens for no known reason.  However, regular prenatal visits can help to reduce the risk factors that you can control.  Premature babies are at risk for medical complications because they are not fully developed.  You should contact your doctor immediately if you suspect you are experiencing premature labor.  Your doctor may take steps to help prevent labor and allow your baby more time to develop.

Anatomy

Labor and delivery usually takes place between the 38th and 42nd week of pregnancy, counting from the first day of the mother’s last menstrual period.  Labor usually begins when hormones cause the uterine to contract.  The initial uterine contractions cause the cervix to dilate.  The contractions become stronger, and with the help of the mother bearing down, the baby is moved through the birth canal during a vaginal delivery. 

Causes

A premature birth is one that takes place more than three weeks before the due date.  Pregnancy usually lasts 40 weeks, counting from the first day of the mother’s last menstrual period.  A premature baby may have medical and developmental problems from being born too soon.  About one in eight babies are born prematurely, according to the March of Dimes.

Many factors can increase the risk for premature labor and birth.  Fortunately, many of the risk factors can be identified in prenatal care visits and reduced.  In some cases, premature labor occurs for no known reason.  You should contact your doctor immediately if you suspect you are having preterm labor.  Your doctor may be able to take steps to help prevent premature birth, allowing your baby more time to develop.

Symptoms

Signs and symptoms of labor include cramps, similar to menstrual cramps, or labor contractions.  You may experience nausea, diarrhea, or indigestion.  You may have lower back pain or a dull lower backache.  Your pelvic floor, thighs, and groin area may ache or feel pressure or tightening.  There may be a change in your vaginal discharge.  Your vaginal discharge may be thin, watery, pinkish, brownish, or contain blood.  You may or may not pass a mucus plug.  A trickle or rush of fluid from your vagina can indicate that “your water has broken,” meaning that the membrane surrounding your baby has ruptured and the amniotic fluid is leaking out.

You should contact your doctor if you suspect you are experiencing labor.  Call your doctor or go to the hospital immediately if you have bleeding with cramps and pain, watery vaginal discharge, or regular contractions that are 10 minutes apart or less.

Diagnosis

Depending on your symptoms and condition, your doctor may make recommendations over the phone and have you wait and monitor your condition or your doctor may have you come into the office for an examination.  Your doctor will check to see if your cervix has dilated or if the fetal membrane has ruptured.  Ultrasound may be used to check the length of your cervix.  Your doctor may analyze a swabbed sample from your cervix for fetal fibronectin  (FFN) , a substance that is present during labor.   A positive test does not necessarily mean you have preterm labor but is correlated with your cervical length by ultrasound.  A negative FFN is 97% predictive that you do NOT have preterm labor.  

Treatment

The treatment that you receive depends on your symptoms, stage of labor, and the gestational week of your pregnancy.  In some cases, fluids and bed rest can help stop premature contractions.  Your doctor may prescribe medication to help stop contractions called uterine tocolytics.  These medications include: magnesium sulfate given IV or calcium channel blocker or nifedipine to relax the uterus..

If it appears that premature birth is likely, you may receive medications to help your baby’s lungs mature, mature the small blood vessels located in the baby's body and reduce risk of complications from an early birth.   These medications are called antenatal steroids.  The most common drug used is Betamethasone given 12 mg  one dose per day for 2 days.  An alternative medication is Dexamethasone 6 mg given every 12 hours for 2 days.   After birth, your baby will likely be admitted to the neonatal intensive care unit (NICU) for 24-hour care from neonatal specialists. Your baby will probably be placed in an incubator to keep him or her warm. Ventilators may be used to help your baby breathe. Your baby may receive nutrition from feeding tubes until he or she is strong enough to suck from a bottle or breast feed.  Longview Regional Medical Center is a limited Level III NICU and can safely take care of babies delivered at 32 weeks or later.  

Prevention

Attending regular prenatal care appointments and a healthy lifestyle may help prevent premature labor and birth.  Follow your doctor’s advice for healthy eating, exercise, relaxation, sexual activity, and rest.  Do what you can to control diabetes and high blood pressure.  Check with your doctor before taking any prescription or over-the-counter medications.  You should not smoke, drink alcohol, or use illegal drugs.  If you have problems quitting smoking, drinking, or drug use, ask your doctor for resources that may help you.  Contact your doctor if you suspect you have a urinary or vaginal infection.  Contact your doctor if you experience the symptoms of premature labor.

Am I at Risk

There are many risk factors for preterm labor and delivery.  The more risk factors you have, the greater your risk for preterm delivery.  However, women without any risk factors and a healthy pregnancy may experience preterm labor and delivery.  You may increase your chances of carrying your baby to full term by eliminating the risk factors that you can control.  Prenatal appointments with your doctor are important for identifying and treating problems promptly.

Risk factors for preterm labor and delivery:

_____ Females under age 17 and women over age 35 have a higher risk for preterm labor and delivery.
_____ Alcohol increases the risk for preterm delivery. You should not drink alcohol while you are pregnant.
_____ Substance abuse increases the risk of preterm delivery. You should not use illegal drugs if you are pregnant.
_____ Certain medications can increase the risk of preterm delivery. Make sure you have your doctor review the medications that you are on before you become pregnant. Consult your doctor before taking medications after you know you are pregnant.
_____ Smoking is associated with preterm delivery. Quit smoking before you become pregnant or as early as possible in pregnancy. Smoking is not good for you or your developing baby.
_____ Not gaining enough weight during pregnancy may contribute to preterm delivery. Seek prenatal care so that your doctor can monitor your weight gain.
_____ Poor nutrition and inadequate vitamin intake is a risk factor for preterm delivery. Make sure to eat a well-balanced diet and take prenatal vitamins. Ask your doctor about healthy eating during pregnancy if you are not sure.
_____ Infections, including rubella, certain sexually transmitted diseases, vaginal infections, and urinary tract infections can cause premature delivery. Let your doctor know if you have a sexually transmitted disease or contact your doctor if you develop symptoms of an infection so that it may be treated.
_____ Chorioamnionitis is an infection of the amniotic fluid and a major cause of preterm delivery.
_____ A hormone imbalance can cause preterm delivery. Your doctor can test your hormones and prescribe hormones if necessary to help prevent preterm delivery.
_____ An incompetent cervix may dilate early and lead to preterm delivery. The cervix may be sutured closed (cerclage) at about the 14th week of pregnancy for women with a high-risk.
_____ Researchers suggest that uterine irritability may cause premature contractions in some women.
_____ Sexual intercourse and orgasm may trigger uterine contractions in high-risk women during the last few months of pregnancy.
_____ A low-lying placenta, termed placenta previa, may increase the risk of premature labor. The condition may be avoided with bed rest.
_____ A chronic condition in the mother may contribute to preterm labor and delivery. Such conditions include high blood pressure, heart disease, liver disease, diabetes, and kidney disease.
_____ Women carrying more than one baby have an increased risk for premature labor and delivery.
_____ Women with an abnormal shaped uterus have a higher risk for premature labor.
_____ Too much amniotic fluid increases the risk of premature labor.

Complications

Medications to prevent premature labor may produce side effects.  Your doctor will discuss the risks and benefits of medications with you.  There is little risk to the mother from preterm labor.  A premature baby is at risk for health complications or death.

The risk of health complications for premature babies depends mainly on the gestational age of the baby at birth.  Some premature babies may not experience problems.  However, the risks are greater for younger babies and less for babies with greater gestational age.  The risk of severe complications or morbidity is higher the younger the age delivered.  Babies that deliver prior to 32 weeks may be transferred before delivery to a capable hospital that can manage a severely preterm baby (23.4 weeks to 32 weeks).  

Premature babies are at risk for bleeding in the brain, retinal problems, intestinal disorders, and sudden infant death syndrome (SIDS).  Babies that are born as early as 23 to 26 weeks may survive, but they have a higher risk for health complications, including neurological disorders, vision problems, and developmental delay.  Some difficulties may not appear until later in childhood, such as poor school performance.

Advancements

Research suggests that progesterone shots may help reduce premature labor, although the effectiveness is not clear in all women.  Women with a prior preterm pregnancy and delivery are started on 17 Alpha-Hydroxyprogesterone or vaginal suppository equivalent starting at 16 weeks until 36 weeks of the pregnancy.  Close and coordinated care with a Maternal Fetal Medicine Specialist or Perinataologist can help prevent or early diagnosis of preterm labor.  Other forms of preterm labor from cervical incompetence (cervix dilates too early or with minimal contractions) may be prevented with surgical placement of a stitch or suture to keep the cervix closed.  It is removed at 36 weeks to allow for vaginal birth.