Pregnancy is a period of joy and great expectations. However, it can also be a period of uncertainty. Therefore, staying watchful all through pregnancy is vitally important. One of the vital events that can pop up (mostly) during the third trimester of pregnancy is preterm labour. Premature labour occurs in approximately 12% of all pregnancies. Nevertheless, by understanding and recognising the signs and staying away from risk factors, an expecting mother can lessen her chances of going into labour before time.
What Is Premature Labor?
A normal pregnancy keeps going 38 to 40 weeks. Labour that starts around the 38th week of pregnancy is considered as normal. Preterm labour happens if the labour begins before the 37th week of pregnancy. The uterine contractions and the dilation and thinning out of the cervix will start. This can be considered as a medical emergency, and immediate medical attention is inevitable, because, if no necessary steps are taken to delay the labour, the baby will bear before completing its development- as a preemie. The preemies experience several health issues, and some problems can be fatal too.
What Are The Causes Of Preterm Labor?
There is no specified reason for preterm labour, though research is still on in this field. However, there are some medical issues, which can trigger preterm labour. 50% of preterm labours are spontaneous, which can occur out of blue when you are least expecting it. The preterm labour is mainly (but not limited to) caused due to:
- Uterine bleeding that occurs due to the rupture of the fetal membrane because of the issues like placental abruption or placenta previa (when the placenta fully or partially covers the cervix) will trigger preterm labour
- Physical and emotional stress can tamper with the endocrine system and result in the releasing of hormones, which trigger uterine contractions
- Overly stretched uterus due to, multiple pregnancies, polyhydramnios, etc. can start the uterine contraction much earlier than the due date
- As a consequence of some infections and associated inflammation, which happens in or progresses to the uterus, uterine contractions occur which can end in preterm labour
Hence, it is really significant to know the signs of preterm labour, mainly if you belong to the “50%” who hold a medical risk (mentioned below) of undergoing labour far before the due date.
Am I At The Risk Of Preterm Labor?
Although the specific causes of premature labour are not yet known, certain factors (like some unhealthy lifestyle and medical conditions) may increase a woman’s risk of having early labour. What you have to keep in mind is that just because a few risk factors explained below are closely connected to you or are experienced by you, it does not mean that you are definitely going to undergo premature labour. Similarly, having no apparent reason for preterm labour does not mean that you are on the safe side either.
You are at the highest risk for premature labour if:
- You have a case of multiple pregnancies
- You are underweight
- You have experienced multiple inexplainable abortions during the first and second trimester
- You have high blood pressure
- You have unhealthy habits like smoking, drinking alcohol, etc.
- You experienced preterm labour during your previous pregnancy
- You develop anaemia in the course of pregnancy
- You are experiencing polyhydramnios
- You got pregnant soon after your last delivery
- You put on too much weight or didn’t achieve optimum weight in the course of pregnancy
- You are experiencing stress due to domestic abuse or other emotional issues that can trigger preterm labour
- Your career demands physical and mental strain (like standing for a long time, unachievable targets, unsolvable financial issues, etc.)
- You have other medical conditions like preeclampsia, UTI, abnormally structured uterus, gestational diabetes, cervical incompetence, etc.
- Preterm births run in your family
If you experience any of the above risk factors, it is significant to recognise the symptoms of premature labour and what to do if it happens.
What Are The Signs Of Premature Labor?
Early recognition of preterm labour is hard as the initial symptoms are often gentle and normally take place in the course of normal pregnancy too. Therefore, usually, women wait until their next appointment to mention it to the doctor, or, even dismiss the early warning signs as “normal occurrence” in pregnancy. The warning signs include:
- Abnormal cramps
- Increased vaginal discharge with or without a change in its appearance
- Diarrhoea without any known reasons
- Persisting lower backache, which will not ease even after changing your position
- More than four contractions per hour
- Vaginal bleeding or spotting
- Water break
- Feeling the pressure in the pelvic area
Are There Any Tests That Can Predict Preterm Labor?
Yes, though not with 100% accuracy, there are some tests, which can predict the chances of premature labour. However, only when your doctor thinks that your chances of preterm labour are high, these tests are conducted.
- Monitoring uterine contractions: Even though on certain occasions, some doctors go for it, this is not a well-accepted procedure to predict the preterm labour. Uterine contractions can be monitored by wrapping a belt around the abdomen and being connected to a machine called a tocodynamometer. Uterine monitoring depends on the possibility that the recurrence of contractions (per hour) increases as the labour begins. Its drawback is that it cannot read mild contractions, which are relevant in predicting the possibility of preterm labour
- Study of cervical sonography: Cervical sonography during pregnancy can detect cervical effacement. It will happen around the 32nd week of normal pregnancy (a delivery that takes place around the 38th week of gestation) and as early as 16–24 weeks for preterm deliveries. Getting the measure of the cervix will also assist. A short cervix increases the risk of preterm labour
- Detecting the amount of fetal fibronectin: Fibronectin, which acts like a paste that joins the fetal membranes to the underlying uterine decidua – the thick layer of the reformed mucous membrane, which covers the uterine lining during pregnancy and is shed with the fetal membrane during delivery. Fibronectin is usually found in the cervicovaginal secretions prior to 16–18 weeks of pregnancy, and again towards the end of normal pregnancy (as labour approaches). It is not normally found in the cervicovaginal secretions in between the 22nd and 37th weeks. The vaginal discharge is tested for this substance. An increased level of fibronectin indicates the chances of preterm labour
What Are The Possibilities Of Treating Preterm Labor?
No environment invented by modern science could be as perfect as the mother’s womb. Hence, the priority of the treatment of preterm labour will be delaying the delivery as late as possible. Every second the baby spends in the uterus counts. It significantly increases the chance of the survival of the baby. It also decreases the chances and the intensity of the possible lifetime health challenges. You necessarily do not have to experience all the symptoms. A lot of times Braxton Hicks contractions are mistaken for preterm labour.
- The doctor will first check whether you are onto real labour
- If not, she will weigh the signs of some other issues, and the treatment will be concentrated on that one as otherwise, the chances are high that preterm labour will follow
- If the signs are of labour, the doctors will try their best to find a fast solution thereby, stopping the labour from progressing more
- If the water breaks and you are not having a contraction, antibiotics will be given to prevent the possible infection and closely monitor mother and child and if they are healthy, will delay delivery as long as possible
- The doctor will order a strict rest. He will ask you to lie down on your left side for unhindered blood flow
- The doctor will order to increase the intake of fluid; if needed, he will start IV. Staying well-hydrated is significant to delay the labour.
- If the water does not break and the contractions start, fetal fibronectin test is conducted and diagnosed with preterm labour, and your medical team will try to stop the contractions
- If the preterm birth is inevitable, Tocolytics drugs will be given, which will help to delay the delivery for another 48 hours, which
will give ample time to transfer the women to a hospital specialising in neonatal care
In between proceeding with the treatments to delay the labour and delivery, certain medicines are administrated to make the baby strong enough to survive a preterm birth. The most commonly used medicines are listed below:
- Magnesium sulphate: To reduce the risk of the particular type of damage that can happen to the brain, which increases the chances of issues like cerebral palsy
- Corticosteroids: To speed up the process of lung development
How Can A Possible Preterm Labor be Prevented?
During your meeting with your doctor in the course of pregnancy, by analysing your history, health, the way the pregnancy is progressing, if your doctor detects that you are prone to undergo preterm labour, there are some preventive measures that could be taken to prevent the contraction of the uterus and dilation of the cervix. Preventive measures include:
- Injections: Weekly progesterone injections (starting between the 16th and the 21st week of gestation) are found to be very helpful in delaying the pregnancy until the 37th week
- Cerclage: Cervical incompetence is a condition in which the cervix dilates without any pain. It is most of the time discovered during the routine monthly visit. If not recognised on the right time, it can result in pregnancy loss or preterm labour, which ends with premature delivery. In such cases, the doctor will place a stitch around the cervix – cerclage. If the cervical incompetence is diagnosed for the first time, it is implemented during the second trimester. Whereas, if you have a previous history, the placement of cerclage will be done by the end of the first trimester itself
- No to sex and travel: Restricting sexual activities and long travels (especially on bumpy roads) are other preventive measures
- Lie down on your side: Never lie down on your back, especially if you are at the risk of preterm labour. Lie down preferably inclining towards the left side
Preterm labour does not necessarily mean premature birth. Around 30% to 50% of woman who develops preterm labour are found to complete their pregnancy successfully with appropriate medical care.