GYN CHRONICLES
GYN CHRONICLES
PRE-TERM LABOUR
Dr . Maureen Owiti
Happy belated New Year , thanking God that Njaanuary is out of the way . He is truly faithful . In this issue we will discuss matters pregnancy and in particular preterm labour . Fortunately the title to me sounds self-explanatory but just in case it is a mouthful let ’ s break it down .
The joy of all expectant mothers is after 9 months of pregnancy the delivery of her beautiful bundle of joy . Fortunately this happens in more than 90 % of cases at term . Disaster strikes when this happens preterm . What is preterm labour ? This is the birth of a baby at less than 37 weeks of gestation . It is approximated that every year , an estimated 15 million babies are born preterm and still counting . Why are medics so paranoid about it ? Preterm birth complications are the leading cause of death among children under 5 years of age , responsible for nearly 1 million deaths in 2015 . It is known that 75 % of these could be saved with current , cost-effective interventions .
What exactly are preterm babies
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed . There are sub-categories of preterm birth , based on gestational age : extremely preterm (< 28 weeks ); very preterm ( 28 to < 32 weeks ); and moderate to late preterm ( 32 to < 37 weeks ). Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated .
What causes preterm labour ?
The exact cause of preterm labour is not known . There a 4 postulated theories : Early activation of babies hormonal system ; Overstretching of the mothers womb ( Uterus ); Bleeding in the placental bed ; and Infection or inflammation . It is thought that this process is slow and gradual occurring over several weeks and can involve one or all of the above mechanisms
How do you know you have preterm labour ?
Usually this is when prior to 37 weeks of pregnancy the mother starts to experience labour symptoms mostly uterine contractions at least 4 every hour with or without drainage of the amniotic fluid ( rupture of membranes ). Labour is sometimes accompanied with the passage of show which is a slight bloody discharge that usually has some mucus in it .
If this happens then the mother has to go to hospital where a history will be taken followed by a physical examination . Of importance are the temperature and pulse rate , the actual perception of contractions which are felt by an abdominal exam ( placing the hand on the mother ’ s womb ) and then a vaginal exam .
The most dreaded part is the vaginal exam which depending on likelihood of drainage of amniotic fluid will start with a speculum exam . This is the same gadget we use to do pap smears for those who have had one . The cervix is examined to rule out if there is any fluid coming from within it and sometimes it is obvious that the cervix is dilated .
Depending on the protocol for the unit several specimens are taken but most will be to rule out an infection . In “ bourgie ” institutions samples for fetal fibronectin can also be taken . This is a good marker as if its negative the likelihood of preterm labour is less than 90 % within the next 10 days .
If it is positive about one in five women will go into labour within the following 10 days .
After the speculum and it is confirmed that there is no drainage of the amniotic fluid , further examination ( digital – using the hands ) will be done to find out the exact dilatation of the cervix and the remaining length of
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