Pregnancy Monitoring Prevents Preterm Birth: Dr M Niharika

• By Dr. M Niharika, Consultant Fertility Specialist, Kamineni Fertility Centre

November is National Prematurity Awareness Month. A pregnancy normally lasts for about 40 weeks. Some risk factors for a premature birth include having a previous premature birth and being pregnant with multiples. Complications associated with premature birth include immature lungs, difficulty regulating body temperature, poor feeding and slow weight gain.

Every year, 15 million babies are born prematurely – that’s more than 1 in 10 of all babies around the world. Prematurity has also been associated with a behavioral phenotype and personality profile that includes being timid, socially withdrawn, over-controlling and disinclined towards risk-taking or fun-seeking. Premature birth can also affect the pituitary gonadal axis in ovaries or testicles, which can lead to reproductive insufficiency.

Preterm labour is labour that starts before 37 weeks of pregnancy. Going into preterm labour does not automatically mean that a woman will have a preterm birth. Diagnosis of preterm labour is by signs and symptoms that the patient shows.

These include:

• Mild abdominal cramps, with or without diarrhea
• A change in type of vaginal discharge—watery, bloody, or with mucus
• An increase in the amount of discharge
• Pelvic or lower abdominal pressure
• Constant, low, dull backache
• Regular or frequent contractions or uterine tightening, often painless
• Ruptured membranes (your water breaks with a gush or a trickle of fluid)
• Only in 3 in 10 women preterm labor stops on its own; the remaining need early detection and treatment

Preterm labour can happen to anyone without warning. But there are some factors that can increase the risk of preterm labour, including:

• Preterm birth in a past pregnancy
• Having a short cervix early in pregnancy
• Past gynecologic conditions or surgeries
• Current pregnancy complications
• Lifestyle factors

Tests to be done to diagnose preterm labour are pelvic examination to assess status of cervix, ultrasound and vaginal swab to test for fetal fibronectin presence.

Management:

Management depends mainly upon the gestational age of pregnancy. If the fetus would benefit from a delay in delivery, medications may be given to:

• Help the fetal lungs to mature more quickly
• Reduce the risk of certain complications
• Attempt to delay delivery for a short time

Medications that help prepare a fetus for preterm birth include corticosteroids, magnesium sulfate, and tocolytics. Corticosteroids can help speed up development of the fetus’s lungs, brain, and digestive organs. A single course of corticosteroids may be recommended between 24 and 34 weeks of pregnancy for women who are at risk of delivery within 7 days, including for women with ruptured membranes and those carrying more than one fetus. When given before preterm birth of less than 32 weeks and intended delivery in 24 hours, magnesium sulfate may reduce the risk of cerebral palsy and problems with physical movement. Tocolytics are medications used to delay delivery, sometimes for up to 48 hours.

Prevention of preterm birth can be done by frequent and close monitoring of pregnancy, progesterone support and cervical cerclage in indicated cases.