What is Premature Delivery by Dr Lathiesh Kumar Kambham

Depending on the gestational age, premature deliveries can be categorize into:

1. Late Preterm: Delivery happens between 34- 36th weeks of pregnancy.
2. Moderately Preterm: Delivery happens between 32-34th weeks of pregnancy.
3. Very Preterm: Delivery happens before the 28-32nd week of pregnancy.
4. Extremely Preterm: Delivery happens before the 28th week of pregnancy.

Types of Preterm Deliveries

Preterm delivery can be:

1. Planned Premature Delivery

Because of maternal or fetal or because of both maternal and fetal tissues, if the pregnancy poses a 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 called 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.

2. 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 the 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 preterm birth, and they are a leading cause of death to occur among children aged under five. (Source)

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.
• Even though dull never ignore lower backache.
• Feeling the 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.
• Abdominal cramps, possibly with diarrhea.
• Water breaking or rupture of membrane.

[Read : Premature Labor]

What Are the Risk Factors For a Premature Delivery?

More often, a particular reason for premature delivery is hard to trace. Only 50% of the preterm deliveries are accountable for 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.

1. Mothers Health Conditions and Life style Issues

• 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., increase the risk of preterm delivery.
• The obesity of a mother increases her chances of premature delivery.
• 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.
• Getting pregnant as early as before 17 years or as late as after 35 years increases the risk of preterm delivery.
• 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.
• Chronic stress releases a hormone that can result in preterm delivery if the mind of the mother is not healthy.

2. Previous Histories

• 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.
• Previous preterm delivery, especially spontaneous one, increases the risk of preterm delivery in following pregnancies.

3. Other Reasons

• Uterine abnormalities like a bicornuate uterus, a unicornuate, a didelphic uterus, etc., can increase the risk of premature delivery.
• Less spaced pregnancies (getting pregnant before the sixth month of a previous delivery) pose increased chances of preterm delivery.
• Fetal conditions like irregular development, intrauterine growth restriction, etc., can result in premature delivery.
• Multiple pregnancies mostly end with premature delivery.
• Some studies put forward a theory that women performing physically and mentally stress-causing jobs have an increased risk of undergoing premature delivery.
• In some cases, premature delivery runs in the family. This indicates its genetic cause, though scientifically not proven yet.

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 saying no to alcohol and smoking).
• Take measures to catch the infections. Cleanliness and nutritious food help to keep several infections at bay to some extent.
• Increasing the space (at least two 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 taking necessary measures to prevent gum infections.
• Staying well hydrated by taking plenty of fluids. Remember, dehydration triggers 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, the more the chances of the baby surviving to lessen 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 for premature babies.

The treatment involves:

• Medicines to stop contraction and relax the uterine muscle.
• Medicines to speed up the development of the fetal lungs.
• Inducing intravenous fluids for better hydration.
• Strict and complete bed rest.

[Read : Cervical Length: Why Does It Matter During Pregnancy]

Can a Premature Delivery Be Detected Medically?

Two screening tests might be helpful in foreseeing whether you are in danger of preterm birth. However, it is not a routine test. Only those who pose a higher risk of premature delivery have to undergo this test. This is because positive test outcomes are not an exact indicator of early delivery, and a negative result can ease the anxiety of the expecting mother.

1. Cervical Length Measurement

The doctor performs an ultrasound to measure the cervix. He closely examines the cervix for any significant changes. If it starts to efface or dilate, it is an indication of premature delivery.

2. Fetal Fibronectin Screening

When the fetal membrane starts to change before the labor, it discharges a substance called fetal fibronectin. If between the 24th and 34th week of gestation, the cervical and vaginal secretion show a significant quantity of this substance, the mother can be at a greater danger of premature delivery.

By performing these tests, more likely, your doctor will get chances to delay (if possible) the delivery as much as possible.

[Read: Common Health Issues Of Premature Babies]

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. Premature babies more often have immature lungs. This develops complications such as:

• Pneumonia
• 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
• The preemies may contract cardiac issues

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.

Read Also: Taking Your Premature Baby Home