For many decades, the March of Dimes has worked to reduce the number of premature births in the United States. It is estimated that over 500,000 infants will be born too soon this year. Approximately 1 in 8 infants will be born before their 37th week of gestation. Infants born too soon can suffer from myriad problems, including low birth weight, breathing difficulties, higher rates of infection, and underdeveloped organ systems. Many premature infants do not survive; in fact, prematurity is the leading cause of infant death. Those who do survive may have life-long health problems and learning disabilities.
Preventing premature birth begins with addressing the problem of premature labor. Premature labor is defined as uterine contractions that cause the cervix to dilate between the 20th and 37th week of pregnancy. All pregnant women should be aware of the signs of premature labor so that they can seek immediate medical advice if necessary. While some women fall into a higher risk group for premature labor, half the women who will experience premature labor do not.
Some premature labor risks factors are out of one’s control. For instance, women who have experienced previous preterm labor or preterm birth are at increased risk of subsequent preterm labor. Pregnant women with multiples or women with certain uterine or cervical abnormalities are also at higher risk. Pregnant women with chronic conditions like diabetes and hypertension can also experience higher rates of premature labor. If you are overweight or underweight when you become pregnant, that can increase your chances of premature labor. Women under the age of 17 or over the age of 35 are at increased risk of both premature labor and premature birth. Women who develop certain types of infection during pregnancy may also have an increased risk of going into premature labor. Most of these circumstances are beyond something you can control; however, many women will face premature labor because of factors and situations that they can avoid.
Studies show that women who smoke, drink alcohol, and use illicit drugs during pregnancy put themselves at greater risk of developing premature labor. Women who do not receive prenatal medical care are also at greater risk. Premature labor and births are also more prominent in women who experience extreme stress or do not have adequate emotional support during pregnancy. Whether or not you fall into one of these high risks groups, in order to have the healthiest pregnancy possible, it is important to try to reduce your chance of premature labor. It is also important to know the signs of premature labor.
Symptoms to look for include: contractions which occur at least ten minutes apart or occur more than 8 times in 1 hour; change in vaginal discharge or leaking of fluid or blood; low dull back pain; cramping that feels like a period with or without diarrhea, nausea, or vomiting. Any one of these symptoms alone can be a sign that you are in premature labor. It is very important to notify your health care provider if you have any of these symptoms. Of course, these symptoms can be indicative of some other condition in pregnancy, but it is important for your provider to determine if you are in labor.
Once contacted, your health care provider will ask you to elaborate on your symptoms and may recommend that you come into the office or go to the hospital to be evaluated further, particularly if you are leaking fluid or blood. In the case of contractions, your provider may recommend that you stop any activity, lie on your left side for one hour, and drink a couple of glasses of water or juice. You may also be advised to avoid sexual intercourse until your symptoms have subsided.
These steps may stop the contractions. However, if your symptoms continue, it is imperative that you notify your provider. If your symptoms stop with these measures but return, you should also contact your provider.
In an office or hospital setting, your health care provider will measure contractions with an external uterine monitor, which measures both uterine contractions and the fetal heartbeat. He or she may also check to see if your cervix is dilated. In some instances, ultrasonography may be used to measure the cervical length and assess fetal development. Pregnant women between 22 and 34 weeks may be given a fetal fibronectin (fFN) test to determine whether a protein is present in the cervix or vagina. This protein, which helps to bond the fetal sac to the uterus, is usually not present during these weeks of pregnancy. This test is good at predicting which symptomatic women are not in preterm labor, often saving women needless medical interventions like bed rest or medical interventions. Fewer than 5 percent of symptomatic women with a negative fFN test will deliver in the following two weeks.
If premature labor stops, your health care provider may want to monitor your pregnancy more frequently until you reach full term. However, if labor does not stop, your provider will need to discuss with you which options are available. Depending on the causes of labor, the number of weeks along, and the maturity of the fetus, your health care provider will let you know what the next step will be.
Premature labor is a complex condition which is always being studied and researched. Next month, I will discuss the various treatment options that are currently being used to stop premature labor and prevent premature birth.
Dr. Hardy is a solo physician in practice with Atlantic Ob/Gyn with locations in Chesapeake and Va. Beach. Call 757-463-1234 or visit www.atlanticobgyn.com.