Preterm Labour and Birth – Reasons, Signs & Treatment

Throughout the entire cycle of pregnancy, a baby proceeds through multiple stages of growths, right up to the very final weeks of the due date. However, there might be scenarios that labour is induced and the baby is born before it has had a chance to grow fully.

What is Premature Birth?

If a baby is born before it completes the requisite 37 weeks of pregnancy, such a birth is generally termed as a premature birth.

If a baby is born around the 35th week of pregnancy, he generally does not have any serious issues. A small percentage of such babies may develop some .

If a baby is born earlier than the 35th week but has completed 28 weeks of pregnancy, he still has its internal organs struggling to cope with the demands of a real life. He is generally very weak and find extreme difficulty in suckling milk or breathing properly.

But if a baby is born before 28 weeks of pregnancy are completed, the chances of it surviving are very low. Even the ones that do manage to survive develop complications and disabilities that can be debilitating ahead in life.

How Common is it?

Out of 100 babies that are born in India, nearly 13 babies are born prematurely. The number of premature births here constitutes for about a quarter of premature births taking place in the entire world.

What Causes Premature Childbirth?

The reasons for premature birth range from medical factors to social and lifestyle choices and cannot be conclusively pinpointed on a specific factor as such.

• The presence of twins in the uterus can slightly raise chances of a premature birth.

• A weak cervix is also known to cause preterm labour.

• If there is a bacterial infection inside the mother’s vagina, it could be a trigger to induce premature birth.

• If the mother bleeds heavily during pregnancy, the body could react to it by inducing premature birth.

• Certain abnormalities of the uterus could be a possible reason as well.

• A history of previous abortions is a known reason for having a premature birth later.

• If the mother has had miscarriages previously in early stages of pregnancy, they could be indicative of a premature birth for the current one.

• The early breaking of the water is a strong sign as well.

• If the mother has grown up in a violent family or has faced domestic violence, the chances of premature birth are slightly higher.

• Any woman with a history of smoking and drug abuse is known to face preterm labour.

• If the mother’s job involves long and arduous physical work, even during pregnancy, then the risk of premature delivery increase threefold.

• Being underweight or overweight can further increase the risk of complications, including preterm labour.

Signs and Symptoms Premature Delivery

Preterm delivery symptoms can be recognised by observing the baby closely for specific signs.

• The baby has a small sized body, but the head is extremely large and out of proportion.

• The features of the baby can be instantly recognized. This is because of a lack of fat for the baby’s growth, leading to the development of sharp facial features.

• The baby’s body is covered with a lot of fine hair.

• Since the baby’s body lacks the necessary amount of fat of a full growth cycle, its body temperature would be comparatively lower, especially right after the birth.

• The baby would struggle to breathe or seem to perpetually be in distress withdrawing in required amounts of air.

• The reflexes that a baby requires being able to suck for food and swallow it would be weak or missing. This further leads to difficulties in feeding the baby.

Diagnosis of Premature Birth

In most cases, doctors prefer to know the entire history of your current pregnancy as well as any previous ones. Certain tests such as urine tests, vaginal swabs, blood tests, amniotic tests, might be conducted to check various biological factors of the pregnancy.

The cervix might be examined by the doctor to check if it has reduced and started opening. Once labour has begun, it cannot be stopped either by medical professionals or by forcing yourself to rest. In case you have not completed 34 weeks of your pregnancy, a drug to delay your delivery temporarily might be administered.

A dose of steroids would have to be given to allow the baby’s lungs to mature properly. Since the lungs are not fully developed until 36 weeks of the pregnancy are complete, premature delivery is bound to cause breathing problems for the infant. Steroids help them grow in a shorter duration of time.

Preterm Delivery Complications

Some complications that may arise during preterm delivery are,

1. Short-Term Complications

• The weak respiratory system of the baby will result in breathing issues. If the lungs are missing the essential substance for expansion and contraction, termed as a surfactant, the baby might experience extreme respiratory distress. They may also develop lung disorders or have long pauses between their breaths, which is termed as apnea.

• Premature babies may also have a heart defect when they are born. Certain defects such as PDA, where an opening that exists between the aorta and the pulmonary artery, does not close off on its own, other untreated defects can lead to heart failure in certain cases. Babies may have low blood pressure leading to injection of IV fluids, medicines, or carrying out blood transfusions.

• If a baby is born very prematurely, he carries an extremely high risk of internal brain haemorrhage. Most of them are mild and do not have a large impact but the ones with a lot of internal bleeding might suffer from permanent brain injuries.

• Premature babies lack the fat that is necessary to generate energy and maintain the body heat. Hence, they have trouble maintaining the right body temperature which can sometimes dip too low and cause hypothermia. This further leads to breathing problems and a drop in blood sugar levels. Sometimes, the infants use up all energy just to maintain the body temperature and fail to leave anything for other aspects of their growth. In such cases, an incubator is used for these babies to help them maintain proper body heat levels.

• With immature gastric systems, premature babies face the risks of injuring cell linings in the bowels which can be a problem when they start feeding. Breastmilk is known to reduce chances of it.

• Most premature newborns suffer from anaemia or jaundice since they lack a good amount of red blood cells. Also, the skin and eyes of the baby might be yellow coloured due to excess bilirubin in the blood.

• Premature babies may suffer from hypoglycaemia due to improper metabolism. As compared to fully grown babies, premature babies do not have large enough stores of glucose within them. They also struggle with converting stored glucose to active glucose that is necessary for metabolic activities.

• A major risk for premature babies is a heightened risk of infection, given that they have weak immunity. Any infection can instantly spread throughout the body through their bloodstream.

2. Long-Term Complications

• When the blood flow to the infant’s brain is not enough, the brain fails to develop as needed which results in a disorder called as cerebral palsy. This affects the bodily movements, muscle mass, and the general posture. It could also be a result of an infection or an injury to the brain.

• Most premature babies suffer from learning impairments causing them to not proceed at the pace of kids their age.

• Certain premature kids are known to have a visual disease called as retinopathy. This is where blood vessels grow in the light-sensitive area behind the retina in humongous quantities. These, over time, may scar the retina and detach it. If left untreated, this can cause full vision impairment, leading to blindness.

• Nearly all premature babies undergo a hearing test to check for hearing loss since that is one of the most common problems premature births have to face.

• Late tooth emergence, discolouration of teeth, and misaligned teeth are issues that premature babies are at a higher risk of.

• Beyond physical, premature babies can have certain psychological problems that can manifest later during their growth.

• Most children who were born prematurely, constantly fall ill with infections, suffer from asthma, primarily due to weak immunity. Certain infants may also have a risk of SIDS, termed as sudden infant death syndrome, requiring immediate hospital care.

Treatment for Premature Birth

Some treatment options for premature birth are,

1. Supportive Care

• An incubator will ensure that your baby is able to maintain a healthy body temperature throughout.

• Vital signs of your baby would be monitored using various sensors attached to it. In case of breathing issues, a ventilator would be used for your baby.

• Fluids and feeding might be conducted via an intravenous tube. Breastmilk would also be supplied externally through the tube until it is strong enough to start sucking it naturally.

• Bodily fluid balance and minerals will be maintained and monitored by replenishing them intravenously.

• If your baby is suffering from jaundice, he would be placed under special bilirubin lights. This helps break down the excess bilirubin in your baby’s blood. Your baby might wear an eye mask to sleep under those lights.

• If multiple blood tests are being conducted or your baby has circulation issues, blood transfusions might be undertaken.

2. Medications

• Surfactant might be administered to allow the lungs to function normally.
• Aerosolized mist and IV medications would be used to strengthen the baby’s heart rate.
• If ill and infected, antibiotics will be administered to the infant.
• Diuretics might be utilized as well to maintain a good urine output.
• The eye might be injected with medication to prevent retinopathy from occurring.
• Certain medications to help heart defects from healing might be administered, too.

3. Surgery

Doctors might advise you to undertake surgery for your baby to treat certain complications. It is necessary to understand the risks associated with each and the necessity of each procedure as well.

4. How to Take Care of Your Baby at Home

Once your baby is breathing fine, has a good and stable body temperature, can breastfeed, has shown weight gain, and is healthy, doctors might allow you to take your child home. Certain precautions related to the living arrangements at home, the baby’s siblings if any, other relatives and additional pediatric care might be suggested by the nursing professionals.

How Can You Reduce Risk of Premature Childbirth?

As to how to prevent premature birth from taking place, even though the exact causes are unknown, certain precautions can help reduce those chances.

• The presence of a short cervix or a history of premature delivery might require the use of progesterone supplements to reduce the risk of them happening again.

• A surgical procedure, termed as a cervical cerclage, might be undertaken, where the cervix is closed to provide extra support to the uterus.

Premature Baby at Different Gestational Ages

For Boys

Gestational age	Weight	Length	Head circumference
40 weeks	7 lbs., 15 oz. (3.6 kg)	20 in. (51 cm)	13.8 in. (35 cm)
35 weeks	5 lbs., 8 oz. (2.5 kg)	18.1 in. (46 cm)	12.6 in. (32 cm)
32 weeks	3 lbs., 15.5 oz. (1.8 kg)	16.5 in. (42 cm)	11.6 in. (29.5 cm)
28 weeks	2 lbs., 6.8 oz. (1.1 kg)	14.4 in. (36.5 cm)	10.2 in. (26 cm)
24 weeks	1 lb., 6.9 oz. (0.65 kg)	12.2 in. (31 cm)	8.7 in. (22 cm)

For Girls

Gestational age	Weight	Length	Head circumference
40 weeks	7 lbs., 7.9 oz. (3.4 kg)	20 in. (51 cm)	13.8 in. (35 cm)
35 weeks	5 lbs., 4.7 oz. (2.4 kg)	17.7 in. (45 cm)	12.4 in. (31.5 cm)
32 weeks	3 lbs., 12 oz. (1.7 kg)	16.5 in. (42 cm)	11.4 in. (29 cm)
28 weeks	2 lbs., 3.3 oz. (1.0 kg)	14.1 in. (36 cm)	9.8 in. (25 cm)
24 weeks	1 lb., 5.2 oz. (0.60 kg)	12.6 in. (32 cm)	8.3 in. (21 cm)

Source: https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730Source

Premature birth is unavoidable if it is bound to happen. However, with certain precautionary measures, and being prepared to handle any unforeseen consequences, one can ensure a healthy delivery of the baby and help the child lead a normal life no matter what.