Premature labor: Why it is caused and how it can be prevented

You are going through the period of pregnancy, one of the most important periods of your life, and you are looking forward to the birth, to hold your baby in your arms. But what happens when you are faced with a premature birth and how can you prevent or deal with it?

Preterm labor describes the condition of the birth of the fetus before the 37th week of pregnancy and concerns approximately 12% of pregnancies. It manifests itself with severe pain and more than three uterine contractions in half an hour, which if not treated, lead to dilation of the cervix and finally to the birth of the fetus. About 25% of premature births are the result of a doctor’s decision that it is not safe to continue the pregnancy. In these cases we speak of iatrogenic prematurity.

The causes of premature birth

Many times the etiology of such a development cannot be determined, but there are some factors that have been linked to premature birth, such as: age (very young or very advanced), history of premature birth, previous operations on the cervix (e.g. cone resection), diseases of the mother, such as diabetes mellitus, anatomical abnormalities of the uterus (double uterus, cervical insufficiency, fibroids), premature rupture of membranes, preeclampsia, multiple pregnancy, intrauterine fetal growth retardation, premature placental abruption, placenta previa, urinary tract infections, other types of infections, history of miscarriage, injury, smoking, drugs, alcohol, bleeding before 24 weeks, while the psychological factor can also play a role.

Prevention and treatment

Nowadays, the risk of premature birth can be predicted. The measurement of the length of the cervix by transvaginal ultrasound, the performance of which is recommended both during the examination of the cervical transparency and during the examination of the B’ level, but also the control of various biochemical indicators, such as fetal fibronectin, which is located in the vaginal secretions with special kits, are tests that can detect such a possibility in time.

If it is diagnosed that such a development is possible, then the doctor can proceed with a series of interventions, such as:

• cervical ligation, when uterine insufficiency is detected. It is performed in the operating room under general anesthesia and involves the placement of a suture around the inner opening of the cervix. Cervical ligation can be prophylactic and decided at 14 weeks of pregnancy or urgent and done if dilatation is detected.

• the administration of progesterone transvaginally, in order to reduce the possibility of premature birth in cases where pregnant women have a history of premature birth or have a heavy cervix.

• Early detection and treatment of bacterial vaginitis or asymptomatic bacteriuria before 20 weeks.

If the process of premature labor has started, the administration of tocolytic medication is recommended, so that it is either stopped or delayed as much as possible. Also, the fetus is monitored with obstetric ultrasound and cardiotocogram. In the event that the tocolytic treatment ultimately fails and premature labor develops, then the administration of corticosteroids is necessary, which will help in the best possible preparation of the fetus and especially in the maturation of its respiratory system, while limiting the possibility of cerebral hemorrhages, but and the possibility of neonatal death. Also, if the membranes have ruptured, antibiotics must be administered to reduce the risk of infection.

After premature birth, the infant is placed in an incubator and monitored by neonatologists, while all actions are taken for its rapid and proper development.

When a newborn is very premature, they can develop a range of problems, from gastrointestinal disorders and metabolic problems to breathing difficulties. In most cases all these are treated effectively. In more serious cases, but less common, there may be cardiovascular and brain problems, vision or hearing problems, and blood disorders. Pregnant women should do all the necessary tests and have close cooperation with their doctor, especially if there is a relevant history. Only in this way will they be able to minimize the risk of premature birth or delay it as much as possible, if this is not a threat to them and the fetus. At the first sign of premature labor, the immediate search for immediate medical assistance is imperative.