Premature Birth

The normal gestation period for humans is about 40 weeks. Some babies are born before 40 weeks. Any birth that occurs more than three weeks before the due date, or before 37 full weeks, is defined as a premature birth.

Amniotic Sac

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There are many reasons why a woman would go into labor before her scheduled due date, including:

• Having previously delivered prematurely
• A ruptured amniotic sac (ruptured membranes)
• Infections of the urinary tract or cervix
• A weak cervix—especially if there have been prior surgical procedures
• Abnormalities in the uterus, including fibroids and malformations of the uterus
• Twins or higher number of fetuses
• Smoking, drinking, or using drugs during pregnancy—especially cocaine
• Poor nutrition during pregnancy
• Too much amniotic fluid (polyhydramnios)
• Chronic diseases like:
  • Diabetes
  • High blood pressure
  • Kidney disease
  • Lupus

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of delivering prematurely:

• Having had a previous premature birth
• Having multiple births (twins, triplets, quadruplets, etc.)
• Having a chronic disease—For example, if you have poorly controlled asthma, this may increase your risk.
• Having poor prenatal care or poor nutrition during pregnancy
• Abusing drugs during pregnancy (especially cocaine)
• Taking certain medicines during pregnancy (eg, benzodiazepines)
• Being overweight or obese

Symptoms

Symptoms include:

• Abdominal pain that feels something like menstrual cramps
• Dull pain in the lower back
• Pressure in the pelvis and tightening in the thighs
• Vaginal bleeding or spotting, or watery discharge

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your obstetrician will want to see if your cervix has dilated and if fetal membranes have ruptured. Regularity of any contractions will also be monitored, and an ultrasound may be performed.

Sometimes special tests are done, such as an ultrasound, to measure the cervix length, or fetal fibronectin (fFN).

The definition of preterm labor requires increase in the dilation of the cervix under the influence of uterine contractions. Prior to actual preterm labor, the phrase "threatened preterm labor" may be used. Threatened preterm labor is potentially reversible.

Treatment

Depending on how premature the pregnancy is, the doctor will talk to you about the risks associated with proceeding with the labor. If the fetus has developed enough to be able to live successfully outside of the uterus, the doctor may recommend proceeding with the labor. If it is too early and too risky to deliver, the doctor will try to stop the labor. Stopping labor is not simple. Often, the medicines are not effective in preventing a preterm birth.

Sometimes when there is a risk of preterm deliver, the doctor will suggest giving a steroid medicine to the mother. The medicine can reach the fetus and cause maturation of the surfactant (a substance which prevents lung collapse) in the lungs.

If you are diagnosed as likely to to deliver your baby prematurely, follow your doctor's instructions .

Prevention

To help reduce your chances of delivering your baby prematurely, take the following steps:

• Get the proper prenatal care throughout your entire pregnancy.
• Eat a healthy, balanced diet with plenty of vitamins, minerals, and other nutrients.
  • Ask your doctor if you should take a daily calcium supplement. In women who have a low calcium intake, supplementation may reduce the risk of pre-eclampsia, eclampsia, and premature birth.
• Avoid smoking, alcohol, and drugs.
• Keep chronic diseases under control.
• Reduce your stress level.
• Stay active during your pregnancy. Your doctor can give you exercise guidelines that are right for you.
• Follow your doctor's recommendations about having sex during pregnancy.