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Topic of the month : Preterm Labor

The average length of pregnancy (gestation) is 40weeks.  When a woman delivers between 20-37 weeks gestation this is considered a preterm birth. The incidence is 109/1000 births.  Preterm labor and birth is a serious complication because of the multiple effects it can have on a baby.  Short term complications include bleeding inside the baby’s head, intestinal and other infections, need for a respirator to assist with breathing, and feeding difficulties.

The list of long term effects is lengthy and includes developmental delay, hearing and vision impairment, chronic lung disease, and cerebral palsy.  Child abuse and parental separation are also more common in these families.

There is no one cause of preterm birth, but contributing factors include infection of the vagina, cervix or amnion, pre-ecclampsia, placental abnormalities, twins, abnormal volume of amniotic fluid, fetal malformations, maternal diabetes, drug use, poor nutrition, insufficient prenatal care, teenage pregnancy or being older 40yrs.

Despite this very long list, more than ½ of preterm deliveries occur in women who have no apparent risk factors!  Perhaps the most important risk factor is a previous history of preterm labor.  Be sure to tell your doctor if you had problems with early labor with a previous pregnancy.

Symptoms of preterm labor can sometimes be confusing.  Pelvic pressure, backache, vaginal discharge and menstrual-like cramps are very common discomforts of pregnancy.
Most women will also have contractions before they are full term.  Studies have shown that women contract more often at night or after intercourse and get better with rest.

So when are the above symptoms concerning?  When they are associated with a change in the cervix.  This can often only be diagnosed by monitoring a patient for a period of time and performing a vaginal exam to check her cervix, or by performing a fetal fibronectin test.  Fetal fibronectin is a protein that acts as a glue attaching fetal membranes to the uterus.  Subtle changes associated with labor disrupt the glue and the protein can be detected in vaginal secretions.  There are other things besides labor that can make fetal fibronectin be present, so the real utility is if the fFN is negative.  A negative fFN is very reassuring that a women is not at risk of delivering within the next 2 weeks.

For women with risk factors but no obvious signs of early labor, vaginal ultrasound can measure the length of the cervix and can help predict risk with the current pregnancy.

Unfortunately there is no medication that has been shown to prevent preterm delivery.  However, there are medications which can prolong a pregnancy at least 48hrs so that steroids can be given to the mother to help the baby mature.  A steroid shot given to the mother has benefits to the baby:  it helps the lungs mature, prevents intracranial bleeding, and minimizes the chance of intestinal infections.