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Preterm Births - A Common Phenomenon

Dr. Ranjit Chakraborti

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According to gynaecologist, Dr. Ranjit Chakraborti, Prematurity is defined as a gestational age of less than 37 weeks calculated from the first day of the last menstrual period (less than 259 days).

Premature births are associated with many problems of major clinical significance. Hence, it is necessary to find measures for reducing the incidence of prematurity. Successful prevention depends on knowledge of causation and identification of risk factors. Dr. Chakraborti opined, An increased risk of prematurity has been noticed among mothers who had a history of previous abortion and a history of previous twin pregnancy. Moreover, mothers who had a history of premature delivery were nearly 32 times at risk of prematurity. The rate of prematurity has increased steadily in the past 15 years due to factors such as multiple births, often a result of fertility enhancement; multiple births is an important risk factor for prematurity. One in nine babies, about 436,000 a year, are born prematurely. He went on to explain, The brain, heart and lungs are particularly prone to delayed development or injury in prematures. A study published in the New England Journal of Medicine in August 2000 found that severe disability is common among children born extremely premature. It said that more than half of children born at 25 weeks or) had severely delayed development when evaluated at 30 months of age and about 10% had severe neuromotor disability Dr., Chakraborti feels prompt recognition of preterm labor may help in preventing premature birth. Even months before the due date, be on the lookout for: " Regular contractions of your uterus (You’ll feel a tightening sensation in your lower abdomen, often reminiscent of menstrual cramps.) " Low, dull backache " A sensation of pelvic pressure " A tightening sensation in the thighs " Vaginal spotting or bleeding " Watery vaginal discharge (This may be amniotic fluid, which surrounds your baby in the womb. A leakage may indicate that the membranes around your baby have ruptured.) Dr. Chakraborti shared Women may often have a medical condition that contributes to early labor, such as:

" Ruptured amniotic sac. Normally, the fluid-filled sac that surrounds your baby in the womb ruptures during labor or just before labor begins. But sometimes the sac may rupture for no apparent reason weeks or even months before your due date. In that case, there’s a high risk that labor will begin within a few days. A ruptured amniotic sac also increases the risk of infection for both you and your baby. " Certain infections. Infections of the cervix or urinary tract are associated with preterm rupture of the membranes and preterm labor. " Weak cervix. In a normal pregnancy, the cervix softens late in pregnancy and opens (dilates) in response to uterine contractions. But for some women, the cervix opens earlier – perhaps due to the weight of the baby and amniotic fluid. This problem can be associated with previous surgery involving the cervix, such as a dilation and curettage (D and C) or a cone biopsy. It’s somewhat more likely to occur when you’re pregnant with twins or other multiples. " Certain chronic diseases. Diseases such as high blood pressure, diabetes, kidney disease and lupus may increase the risk of preterm labor. If complications arise, labor may need to be induced early. " Uterine abnormalities. An abnormally shaped uterus may increase the risk of preterm labor. " A previous premature delivery. Women who’ve had a premature delivery are at higher risk of preterm labor. For many women, though, early labor happens only once. " Substance abuse. These include smoking, drinking alcohol or using illicit drugs. " Malnutrition. Women who are undernourished or anemic are more likely to give birth prematurely. " Excess amniotic fluid. Too much amniotic fluid can contribute to early labor Premature babies are at risk of the following conditions: " Bleeding in the brain (intracranial hemorrhage). If this occurs, it’s usually in the first week to 10 days of life. The more severe the bleeding, the greater the likelihood that the child will develop serious problems, including developmental delays, seizures, learning disabilities and fluid accumulation in the brain. " Retinal problems. Another complication seen in the youngest and most vulnerable premature babies is retinopathy of prematurity (ROP), an abnormal growth of blood vessels in the retina – the light-sensitive inner lining of the eye. ROP probably occurs because the vascular system in the baby’s eye hasn’t fully developed. Many cases of ROP improve on their own, but the condition can lead to scarring or some degree of vision impairment. The most serious cases may be treated with laser surgery to help prevent retinal detachment. " Intestinal problems. Preemies also have an increased risk of a potentially severe intestinal problem known as necrotizing enterocolitis (NEC). In the most serious cases, this condition can be life-threatening. Infants who have NEC need to be fed intravenously and given antibiotics. " Sudden infant death syndrome (SIDS). Premature babies have a higher risk of SIDS, the sudden and unexplained death of an infant during sleep. For some premature babies, difficulties may not appear until later in childhood. Not performing well in school is often a prime concern. But not all preemies have medical or developmental problems. By 28 to 30 weeks, the risk of serious complications is much lower. And for babies born between 32 and 35 weeks, most medical problems are short-term. Treatment may focus on women in preterm labor, on babies still in the womb or on newborns in neonatal intensive care units (NICUs).

Dr. Chakraborti goes onto add, If you’re experiencing preterm labor, treatment depends on your stage of pregnancy and how far labor has progressed. Sometimes bed rest and extra fluids are enough to stop premature contractions. If you have a weak cervix early in pregnancy, a surgical procedure known as cervical cerclage may help prevent preterm labor. Using strong sutures, your doctor stitches the cervix closed. The sutures are removed in the last month of pregnancy. In other cases, your doctor may recommend medication. Sometimes medications that block the calcium channels in muscle cells can stop contractions.

Hospital NICUs are designed to provide care for premature babies and full-term babies who develop serious problems after birth. In the NICU, babies receive round-the-clock intensive care from doctors, nurses and respiratory therapists specially trained to care for newborns with medical problems. In the NICU, your baby will probably be kept in an incubator that’s kept warm to help your baby maintain normal body temperature. Because preemies have immature skin and very little body fat, they often need such care to stay warm.

Sensors may be taped to your baby’s body to monitor blood pressure, heart rate, breathing and temperature. Caregivers may also use ventilators to help your baby breathe. This high-tech equipment may seem overwhelming at first, but it’s all designed to help your baby. At first your baby may receive fluids and nutrients through an intravenous tube. Milk feedings may be given later through a tube passed through your baby’s nose and into his or her stomach. When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible. The antibodies in breast milk are especially important for premature infants. Dr. Chakraborti suggests that a healthy lifestyle can go a long way toward preventing preterm labor and birth. " Seek regular prenatal care. Mention any signs or symptoms that concern you, even if they seem unimportant. " Eat healthy foods. During pregnancy, you’ll need more folic acid, calcium, iron, protein and other essential nutrients. " Manage chronic conditions. Remember, uncontrolled diseases such as diabetes and high blood pressure increase the risk of preterm labor. Work with your doctor to keep any chronic conditions under control. " Limit stress. Set reasonable limits – and stick to them. Set aside some quiet time every day. Ask for help when you need it. " Follow your doctor’s guidelines for activity. If there are problems with your pregnancy, your doctor may suggest working fewer hours or spending less time on your feet. Sometimes it makes sense to scale back other physical activities, too. " Ask your doctor about sex. Sex may be off limits if you have certain complications – such as vaginal bleeding or problems with your cervix or placenta. " Avoid risky substances. Smoking may trigger preterm labor. Alcohol and recreational drugs are off limits, too. Even over-the-counter supplements and medications deserve caution. Get your doctor’s OK before taking any medications or supplements