A preterm baby is born before 37 weeks of pregnancy. It has further sub-categories. They are – extremely preterm (less than 28 weeks), very preterm (28 to 32 weeks) and moderate to late preterm (32 to 37 weeks).
Only a baby that has completed 40 weeks of pregnancy is said to be full-term.
According to the World Health Organisation, an estimated 15 million babies are born preterm every year, and this number is rising. Approximately one million children die each year due to complications of preterm birth and many survivors face a lifetime of learning disabilities and visual and hearing problems.
Because babies born pre-term face health risks, mothers need to know if they are at risk and how.
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Preterm labour in pregnancy: Who’s at risk?
Preterm labour usually happens when regular contractions result in the opening of the cervix after week 20 and before week 37 of pregnancy.
Though it is still not very clear why some women go into preterm labour, there may be certain factors that influence this.
“PTD (preterm delivery) causes in the mother can be high blood pressure, infection in the uterus and premature breakage of the water bag which can be dangerous for the mother,” says Dr Sunita Varma, director, obstetrics and gynaecology, Fortis Hospital, Shalimar Bagh, Delhi.
A pregnant woman needs to watch out for:
- Previous premature birth
- Pregnancy with twins, triplets or other multiples
- In vitro fertilisation (IVF) pregnancy
- Less than six months gap between babies
- Multiple miscarriages/abortions
- Issues in the uterus, cervix or placenta
- Smoking, drugs, alcoholism
- High BP, diabetes
- Weight issues
- Infections in amniotic fluid and lower genital tract
- Stress, injury, trauma
Preterm birth: reasons can be elusive
Preterm labour and delivery can happen because of the risk factors mentioned above. But sometimes, the reasons could be unexplained too, like in the case of Tarini Shah.
“I had just entered my seventh month (of pregnancy) and didn’t have any of the risk factors associated with PTD,” says Shah, a 34-year-old writer. She was 28 when she was pregnant. “But after a routine check-up, my doctor said the baby’s head was very low and delivery could happen anytime. She advised complete bed rest for the remaining few weeks till delivery as it was important to delay it,” says Shah.
“I had to put my feet raised on three pillows and keep my head flat on the bed. I was also given lung strengthening injections for the baby twice,” she adds.
Despite all care taken, the baby was born in the 36th week and currently has learning and developmental disabilities.
The signs of preterm labour
The common signs of preterm labour are regular or frequent sensations of abdominal tightening (contractions), vaginal spotting or light bleeding, backaches, cramps, pelvic pressure, preterm rupture of membranes or even a watery, mucus-like or bloody vaginal discharge.
The risks of preterm births in pregnancy
Though not all premature babies experience complications, they are at risk.
“The more preterm a baby is, the more immature the baby’s organs will be. There could be problems like breathing difficulties, digestive issues, feeding problems like difficulty breastfeeding, tube feeding and the need for intravenous fluids and ventilatory support. Also, problems like eye retinopathy, if not corrected early can lead to blindness in the baby,” says Dr Varma.
The other condition a preterm baby could develop is necrotising enterocolitis (NEC), an inflammation of the intestinal tissue. A hole (perforation) may form in the baby’s intestine, and bacteria can leak into the abdomen (belly) or bloodstream through the hole. This condition might need a surgical procedure.
“The brain (of the preterm baby) is also not well developed, so it can lead to neurological abnormalities. Some develop cerebral palsy and physical or intellectual disability,” says Dr Varma.
The survival rate of the babies also depends on how premature they are. So, in very early births like 27 or 28 weeks, there is only a 50 to 70 per cent survival rate.
Natural ways to decrease the risk
Women can prevent or reduce the risk of premature birth by adopting a healthy lifestyle; avoid tobacco, smoking, e-cigarettes, second-hand smoke, alcohol and drugs.
Exercising for 30 minutes daily can help. Medical conditions like diabetes and high blood pressure should be under control.
Weight matters too; being either obese or underweight cannot help and it is important to be at a healthy weight. Managing stress is also crucial. Doing yoga and meditation, investing in support groups, balancing work and personal life and having a healthy relationship with one’s partner can go a long way in bringing down stress.
One should eat a diet rich in foods containing iron and folic acid.
A cross-sectional analysis published in the journal, BMJ Open, analysed the relationship between national PTB (pre-term birth) rates and omega-3 PUFA intake norms from 184 countries for the year 2010. The paper points out that PTB rates decrease linearly with increasing omega-3 levels up to 600 mg/day.
“In addition to lung strengthening injections, we also advise drugs called tocolytics to relax the uterus to stop uterine contractions and to stop the progress of preterm labour so that we get at least 48 hours for the lung strengthening injections to act. Secondly, we may sometimes prescribe antibiotics if we find any evidence of infection which is also the reason that preterm labour starts,” says Dr Varma.
She adds that sometimes in preterm labour, there are no contractions. “We may then advise surgical treatments like cervical cerclage, which is a stitch that we put around the mouth of the uterus to prevent it from opening.”
Dr Varma also stresses the need for hydrating the mother. Sometimes IV fluids are administered for this purpose.
“If the blood flow is not good, a condition called Foetal Growth Restriction (FGR) might develop,” says Dr Varma. This condition could inhibit the supply of nutrients to the foetus.
This can happen if there is a problem with the placenta (the tissue that brings nutrients and oxygen to the developing baby) or improper blood flow in the umbilical cord, which connects the baby to the placenta.
In such a case, Dr Varma says they take the baby out to prevent complications of suffocation inside the uterus. “It’s done to save the life of the baby, sometimes the life of the mother,” she says.