Preterm birth is defined as birth before 37 completed weeks of Pregnancy. Approximately 15 million babies are born preterm each year worldwide, and 1 million among these die.
Many survivors of preterm birth face a lifetime disability; including learning, visual and hearing problems.
Preterm births can take an emotional toll and can be a financial burden to the family and society.
Major Risk factors:
- High or Low BMI(underweight or overweight)
- Smoking
- Pregnancy Interval(<18 months and >60months)
- Low Blood Supply to placenta as in case of Diabetes and hypertension
- Birth Defect in Uterus of mother
- Previous Pre Term Birth
- Infections in uterus and vagina.
- Multiple pregnancy
- Previous surgery on cervix.
What to do
Early detection and preventive measures during the pregnancy can drastically reduce the chances of Pre Term Birth.
Before pregnancy
Life style modification like prepregnancy weight reduction, cessation of smoking and alcohol
During pregnancy
Risk assessment play an important role in planning of prenatal care. It should be based on a combination of all risk factors including previous pregnancy history and screening tests.
- Screening of vaginal infection: Infections during pregnancy like bacterial vaginosis is a major cause and hence screening for vaginal infections followed by antibiotics can significantly reduce the rates of Pre Term Birth.
- Cervical length screening: A short mid-pregnancy cervical length (<2.5mm) is associated with a high risk of preterm birth. Screening for cervical length by transvaginal ultrasound (between 16-24 week of pregnancy) is recommended in high-risk group.
- Fetal fibronectin :- Fetal fibronectin levels is used to predict delivery within next 7 days inwomen presenting with symptoms of Pre Term Labor. Patient may thus be admitted immediately under observation till delivery.
- Education about warning signs of preterm labour allows women to attend hospital in time to prepare the baby for an early delivery.
Treatment and Management:
Progesterone:-Progesterone is a hormone known for its role in maintaining pregnancy. It is given to women with:-
- History of previous preterm birthbetween 20-34 week of pregnancy
- Short cervix detected with ultrasound.
- Cervical cerclage: A cervical cerclage is a surgical procedure that place securing suture around the cervix to prevent cervical shortening and opening. It is considered for women in whom
- Transvaginal ultrasound show short cervix
- History of preterm birthbetween 20-34 week of pregnancy
- History of injury to cervix.
WHO recommendations:
for treatment during pregnancyand newborn period for improving outcomes for preterm infants.
These are:-
- Steroid injections to mother for maturity of baby lungs if there is threat of pre term birth.
- Antibiotic therapy :- in cases of rupture of water sac before 37 weeks of pregnancy.
- Magnesium sulfate :-for women at risk of preterm birth before 32 weeks of gestation for prevention of cerebral palsy.
- Treatment for the newborn baby – thermal care, feeding support, (e.g. kangaroo mother care), safe oxygen useto help babies breatheeasily.
- New developments in screening for PTB which are currently under research.
- Bio markers as screening parameter-for early detection of risk of preterm birth at 10-12wk of pregnancy.
- Probiotics as preventive measure – Probiotics can reduce infections hence are currently under research for reducing risk for pre term birth.
Ongoing Medical trials:-
- Cervical pessary with progesterone – for cases of short cervix.
- Aspirin – for increasing placental blood flow.
Prevention of Pre Term Birth is one of the main goals.Researchers, doctors, patient’s organizations, and governments must collaborate in the prevention of Pre Term Birth. By doing so, we give babies the best start in life and ensure lifelong health benefits.
So be in regular follow up with your doctor for effective reduction into chances for Pre term Birth and don’t hesitate to discuss.