the cervix .
If the cervical dilatation ≥ 2 cm , there are palpable contractions and the mother is less than 37 weeks of gestation then a diagnosis of preterm labour is confirmed . If the cervix is not dilated an Ultrasound can also be performed to determine the cervical
Interesting to note is that there are several risk factors for preterm labour but these are not necessarily the cause of preterm labour . They include :
• Premature Rupture of Membranes i . e . the waters have broken early
• Premature before 37 weeks , in a previous pregnancy
• Previous late miscarriage ( after 14 weeks of pregnancy )
• Vaginal bleeding after 14 weeks in current pregnancy
• An abnormality in the shape of your womb
• Twins or triplets or more babies
• Excess fluid around the baby polyhydramnios
• A short cervix
• Smoking
• Alcohol
• Use of recreational drugs ( narcotics )
• Mothers who have had fertility treatment
• Mothers nutritional status
• Race ( preterm birth highest in Blacks and Phillipinos )
• Iatrogenic i . e . early induction of labour for medical conditions such as preeclampsia , diabetes , asthma , heart disease and so on . length as it is unlikely for the mother to deliver if her cervix is ≥3cm in length .
How is preterm labour managed / controlled ?
There are several issues to consider and as long as it is confirmed that there is no infection and especially this side of the world where adequate resources to manage preterm labour are limited ( can CBA take effect ASAP ), it is in the best interest to try and stop the labour and prolong the period prior to delivery .
Tocolytics : So the first is use of tocolytics ( drugs that stop uterine contractions ). The aim of this is twofold : to give time to transfer mother to a centre that can handle premature babies ( premmies ), to give time for steroids to work .
Steroids : Steroids : are used to prevent or reduce the severity certain complications in the preterm baby namely breathing problems ( respiratory distress syndrome - RDS ), bleeding in the brain ( intrventricular haemorrhage ), immature gut or intestines ( necrotizing enterocolitis ), and non closure of an opening in the babies heart ( patent ductus arteriosus ).
Magnesium sulphate : This is a wonderful drug as it has two functions the first being tocolysis but in preterm labour especially before 30 weeks of gestation it is used to reduce bleeding in the babies brain and thereby reducing the possibility of cerebral palsy and developmental problems in the baby .
Complications in the new born
- Neurological problems such as cerebral palsy , other developmental delays , learning disabilities and so on .
Heart problems arising from non closure of the ductus arterious .
- Breathing or lung problems such r espiratory distress syndrome ( RDS or IRDS ) ( previously called hyaline membrane disease ), chronic lung disease .
- Gastrointestinal and metabolic issues can arise from neonatal hypoglycemia , feeding difficulties , rickets of prematurity , hypocalcemia , inguinal hernia , and necrotizing enterocolitis ( NEC ).
- Problems in the babies blood such anaemia low platelettes and
- Infection , including sepsis , pneumonia , and urinary tract infection
Prognosis
The chance of survival at less than 23 weeks is close to zero , while at 23 weeks it is 15 %, 24 weeks 55 % and 25 weeks about 80 %. The chances of survival without long term difficulties is less . In the developed world overall survival is about 90 % while in low income countries survival rates are about 10 %.
Can preterm labour be prevented ?
There are several strategies . Prior to pregnancy they include good nutrition , cessation of alcohol , cigarettes and narcotics , weight management and treatment of preexisting conditions .
During pregnancy , the strategies prior to pregnancy will continue but use of progesterone / McDonald stitch in patients identified with short cervix less than 3 cm and screening for and treating identified infections will come in handy .
With that I hope I have helped in improving your understanding of some aspects related to preterm labour and hope it will be useful to you or someone close to you .
After meetings there are usually AOB ’ s and mine is to wish you a prosperous 2017 and cognizant that this is election year to positively impact on those around you to vote peacefully and wisely
Dr . Maureen Owiti is a Gynaecologist based in Nairobi . You can commune with her on this or related matters via mail at : Drmaureenowiti @ gmail . com .