A full term pregnancy is one that has progressed to 37 completed weeks. When labour starts prior to this time it is classed as premature.
Causes of Premature Labour
Any pregnant woman is at some risk of premature labour but there are certain groups that are of a higher risk. This includes:
- Women having a multiple pregnancy ie twins or triplets
- Women that have had a previous premature labour – this may be due to having an imcompetent cervix
- Infections ie; Chlamydia, Group B Strep, Trichomanas, Bacterial Vaginosis or urine infection
- Women with predisposing illness ie; diabetes, heart disease, or essential hypertension
- Antenatal haemorrhage ie placental abruption due to trauma or placenta praevia
- Fetal abnormalities or intra uterine fetal death
- Severe or sudden stress
- An abnormality of the uterus
- Smoking and taking drugs
- Women on low income with little support that do not access ante natal care
- Being underweight or overweight
- Waters breaking early
- Labour induced due to the baby having an abnormality or not growing well
Signs and Symptoms of Premature Labour
It can be difficult to diagnose premature labour. The only absolute proof is dilatation of the cervix. Unfortunately if dilatation has commenced, it is often difficult to stop and often labour is rapid. It is therefore important to seek advice if you think labour may be starting.
The main signs of labour can be very confusing as you may suffer with these symptoms in a normal pregnancy. You may lose part or all of your mucoid plug from your cervix. This can happen to lots of women during their pregnancy but does not mean labour will commence.
You may experience mild tightenings or lower backache, these could be Braxton Hicks or ‘practice’ contractions and are normal from 24 weeks onwards.
You may also with lower back pain due to the normal physiological changes in pregnancy or signs of a urine infection – which should be treated as soon as possible as this can cause premature labour.
The most likely indicator of premature labour is the membranes rupturing, as many women will labour within 48 hours of their waters breaking. Unfortunately this can often be confused with urine as it is fairly common that the baby can press on the bladder causing some urine to leak. If you are not sure if your waters have gone or if you have leaked urine it is important that you seek advice from your midwife.
Treatments for Premature Labour
Lots of things have been tried to prevent premature labour, unfortunately most are very ineffective.
- If you have suffered from previous miscarriages or premature labours your cervix may be incompetent and a suture may be placed around the neck of the cervix in an attempt to stop it dilating
- You may be given antibiotics to treat any known infection which, if started early enough, may have good results although it is important that the full course of treatment is completed
- If you are in hospital and premature labour is suspected, it is important to have a steroid injection which enables the baby’s lungs to mature earlier due to stimulation of surfactant to be produced.
- To enable the steroids to be effective they are given over 24 hours, therefore it is important to ‘slow’ labour down. To do this, you may be put on a drip containing a tocolytic which should decrease the contractions, until the steroids injections have done their job. This will help to reduce complications in your premature baby.
Complications to a Premature Baby
If your baby is born prematurely there are many risks and complication that may occur. These risks and complications are increased depending on how many weeks the baby is when it is born.
Babies born before 28 weeks are at the greatest risks. They may suffer from:
- Low blood sugar
- Respiratory distress syndrome
- Retinopathy which may lead to blindness
- Necrotising Enterocolites (NEC) inflammation of the bowel which in its extreme – may be fatal
Prevention of Premature Labour
Often there is very little you can do prevent the onset of premature labour. You can reduce the risks by ensuring that you:
- Access antenatal care
- Stop smoking
- Healthy diet and exercise
- Do not use drugs and alcohol
- Access your midwife if you feel unwell
- Avoid excessive stress
- Access treatment for any vaginal infections
Please remember that premature labour is relatively low. The incidence rate in the UK is nearly 8%. You can reduce your chances by following the simple steps above.
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