A full term pregnancy is a pregnancy that last for 40 weeks (calculated from the first day of the mother’s last periods). All the same, a delivery that happens between 38 to 42 weeks is also considered as a full term, as the baby will be healthy and developed well enough. Deliveries that take place more than three weeks before the due date are collectively called premature deliveries.
How Is A Premature Delivery Defined?
As explained above, a premature delivery happens before the beginning of the 37th week of gestation. A premature delivery has a negative impression on the health of the child. Nevertheless, the severity depends on how early the delivery takes place. Earlier the delivery, more severe and long lasting and risky the health issues of the baby will be.
Depending on the gestational age,premature deliveries are categorized as:
- Late preterm: Delivery happens between 34- 36th weeks of pregnancy
- Moderately preterm: Delivery happens between 32-34th weeks of pregnancy
- Very preterm: Delivery happens before 28-32nd week of pregnancy
- Extremely preterm: Delivery happens before the 28th week of pregnancy
Types Of Preterm Deliveries
A preterm delivery can be-
- Planned premature delivery: Because of maternal or fetal or because of both maternal and fetal issues, if the pregnancy poses danger and difficulty, your medicinal group may choose to induce labor early or perform a C- section before the full term of pregnancy. This is known as planned preterm delivery. A severe or worsening preeclampsia, infections, placental abruption, dropping of fetal heart rate, multiple pregnancies,etc. are only a few among such factors that demand planned preterm delivery
- Spontaneous premature delivery: Spontaneous preterm delivery is performed if some unexpected issues that happen in the course of the pregnancy arise suddenly. Conditions such as the premature rupture of the membrane resulting in amniotic fluid leakage, premature uterine contractions, cervical insufficiency, etc. fall into this category
What Are The Chances Of Premature Delivery?
Surveys done by WHO (World Health Organization) estimate that every year, 15 million infants are delivered prematurely. One million babies die due to the complications raised as a consequence of premature delivery. In a study conducted worldwide, various health issues happen because of the preterm birth and they are a leading cause of death to occur among the children aged under five. (Source)
In India, annually, 35 lakh babies are born preterm and out of these 3.03 lakh babies die as a result of a complication of preterm birth. An alarming fact is that, in spite of the development in the medical field, and increased knowledge about healthy lifestyle among the pregnant women, the rate of preterm delivery is increasing. (Source)
What Are The Signs and Symptoms Of A Premature Delivery?
Here are some significant signs of preterm delivery. Never pause to seek medical care if any of the following symptoms appear before the 37th week of pregnancy:
- Vaginal bleeding or even spotting can be an indication of preterm delivery
- Lower back ache, even though dull, should not be ignored
- Feeling pressure in the pelvic area. This could be the indication of the baby pushing his way down
- Changed vaginal discharge both in quantity (excessive) and appearance
- Menstrual like cramping
- Feeling more than four contractions per hour can be an indication of preterm labor. If you are feeling contractions it is quite possible to be Braxton hicks contraction or you can mistake preterm birth contraction as Braxton hicks contractions. Either way, it is better to confirm it with your doctor
- Abdominal cramps, possibly with diarrhea
- Water breaking or rupture of membrane
What Are The Risk Factors For A Premature Delivery?
More often, a particular reason for the premature delivery is hard to trace. Only 50% of the preterm deliveries are accountable with known risk factors. Obviously, without knowing the proper causes, prevention of all preterm deliveries is difficult. Nevertheless, there are various factors, which may build the danger of preterm delivery. If some of the following factors are applicable to you, you will be more prone to premature delivery.
- Previous preterm delivery, especially spontaneous one, increases the risk of preterm delivery in following pregnancies
- Mother’s conditions like preeclampsia, cervical insufficiency, issues with the placenta, gestational diabetes, vaginal bleeding during more than one trimester of pregnancy, uterine or vaginal infection, untreated or ignored urinary tract infection, gum infections, etc. increases the risk of preterm delivery
- Uterine abnormalities like a bicornuate uterus, a unicornuate, a didelphicuterus, etc. can increase the risk of premature delivery
- Fetal conditions like irregular development, intrauterine growth restriction, etc. can result in premature delivery
- A previous history of multiple miscarriages also increases the risk of premature delivery
- If the mother has a history of cervical surgery, which results in removing a significant portion of the cervix, it increases the risk of preterm delivery due to cervix insufficiency
- Usage of alcohol and the habit of smoking in the course of pregnancy increases the risk of preterm delivery
- If, for some reason, the expecting mother gets no prenatal care or late prenatal care, it increases her risk of preterm delivery
- Multiple pregnancies mostly end with premature delivery
- Chronic stress releases a hormone, which triggers uterine contraction, and hence domestic abuse (even without physical trauma), or death of the loved ones, can result in preterm delivery if the mind of the mother is badly affected
- Some studies put forward a theory that the women performing physically and mentally stress- causing jobs have an increased risk of undergoing premature delivery
- In some cases, it is seen that premature delivery runs in family, indicating its genetic cause, though scientifically not proven yet.
- If the expecting mother was underweight while getting pregnant or if she doesn’t gain enough weight during the pregnancy due to poor nutrition, it increases the risk of experiencing premature delivery
- Obesity of mother increases her chances of premature delivery
- Less spaced pregnancies (getting pregnant before the sixth month of a previous delivery) poses increased chances of preterm delivery
- Getting pregnant as early as before 17 years or as late as after 35 years increases the risk of preterm delivery
Even though you possess risk factors of premature delivery, you necessarily don’t have to undergo one. With good pregnancy care and correct medical care, you can still bring your chance down.
Can Preterm Delivery Be Prevented?
By going through the risk factors mentioned above, you may get an idea that many of them are not in your control. Anyone can (anytime) undergo a premature delivery. However, definitely some of them can be rectified by taking some healthy measures thereby, decreasing your risk of undergoing premature delivery, like:
- Choosing a healthy lifestyle (like say no to alcohol and smoking)
- Take measures to catch the infections. Cleanliness and nutritious food help to keep several infections at bay for some extend
- Increasing the space (at least 2 years)between the pregnancies
- Not gaining too much weight during the gestation period
- Taking the prenatal vitamins prescribed by the doctor
- Giving proper dental care especially take necessary measures to prevent gum infections
- Staying well hydrated by taking plenty of fluids. Remember, dehydration triggers the contractions
- Try to recognize and treat the infections on time
How Can Premature Delivery Be Delayed Through Treatment?
The primary goal of the treatment of preterm labor is to delay the delivery as long as possible. The more the baby remains in the uterus, more the chances of the baby to survive lessening the risk of its health. Delaying the delivery also helps to transfer the mother to a hospital offering facility like NICU (neonatal intensive care unit) for caring premature baby. The treatment involves:
- Medicines to stop contraction and relax uterine muscle
- Medicines to speed up the development of the fetal lungs
- Intravenous fluids are induced for better hydration
- Strict and complete bed rest
Can A Premature Delivery Be Detected Medically?
Two screening tests might be helpful in foreseeing whether you are in danger for preterm birth. However, it is not tested routinely for all pregnant women. Both tests are suggested for those who pose a higher risk of premature delivery because positive test outcomes are not an exact indicator of early delivery and a negative result can ease the anxiety of the expecting mother.
- Cervical length measurement: An ultrasound is performed to measure the cervix and closely examined for any significant changes. If it starts to efface or dilate, it is an indication of premature delivery
- Fetal fibronectin screening: A substance called fetal fibronectin is discharged when the fetal membrane starts to change before the labor. If between 24th and 34th week of gestation, the cervical and vaginal secretion shows a significant quantity of this substance, the mother is thought to be at higher danger for premature delivery
By performing these tests, more likely, your doctor will get chances to delay (if possible) the delivery as much as possible.
What Complications Can Be Experienced By A Premature Newborn?
Premature newborns(preemies) will be kept in the NICU. The duration of the baby in the NICU depends on, how early the delivery was and the severity of the complications. The premature babies more often have immature lungs. This develops complications such as:
- Respiratory distress syndrome(RDS)
- Bronchopulmonary dysplasia (BPD)
- They are also more prone to infections such as jaundice as their immunity level is very very low
- As the body fat will be less than a term baby, preemies are unable to maintain body heat
- Premature newborns are born with an excessively immature gastrointestinal system, making it impossible to absorb the nourishment effectively
- Cardiac issues are also commonly found among the preemies
Read more on premature babies and how to take care of them in our section.