Early Birth
The normal pregnancy period is between 37-42 weeks. The World Health Organization defines preterm birth if labor pains start or the water breaks after the 20th gestational week and if birth occurs before the 37th gestational week. Approximately 50 percent of preterm births occur if the labor pains starts spontaneously, the other 30 percent due to laceration of the amniotic sac, the remaining 20 percent occur if required by the doctor because of mother and fetus related reasons. Its prevalence in the community is between 10 and 12 percent. This rate is much higher in patients with high risk of preterm delivery.
What is the importance of preterm birth?
Every year 13 million premature babies are born in the world and 1 million of them loss their life before the age of 1. 80 percent of fetus deaths or newborn (first 28 days) deaths are caused by preterm births. The babies which were premature born and managed to survive, carry the risk of neonatal respiratory problems, intracranial hemorrhage, neonatal retinopathy (blindness), mental and motor dysfunction, and bowel problems. Although today's modern medical facilities can help babies under 750 grams to survive, some of these infants may have low performance at school, visual motor dysfunction and social adaptation disorder. It is found that 50 percent of childhood neurological problems are caused by premature birth.
What are the reasons for preterm birth?
The main reasons of preterm labor are intrauterine and extrauterine infections, multiple pregnancies, excessive amniotic fluid, structural abnormalities of uterus, hemorrhage in decidua, genetic factors, early triggering of physiological mechanisms that give a start to birth.
What are the risk factors of preterm birth?
If the mother's age is under 17 or over 35, If the mother's previous birth ended with premature birth, if the mother has vaginal bleeding, stress, low socioeconomic status, smoking and other bad habits, low weight, excessive working conditions, and well-controlled systemic diseases (diabetes, heart, kidney and thyroid diseases, etc.) accompanying pregnancy,
If there are some vaginal and systemic infections during pregnancy.
It is possible to take precautions
The conditions above can be improved by being on ideal maternal weight and age, having ideal working conditions, keeping the duration between two pregnancies more than 1 year, quitting smoking and other bad habits, early recognition of premature labor symptoms (pain in low back and groin, raise of vaginal discharge, water breaking, vaginal bleeding), diagnosis and treatment of infections that cause premature birth, consulting a doctor. Multiple antibiotic therapy can help to temporize the pregnancy if there is laceration of the amniotic sac. Antibiotic therapy can be harmful if amniotic sac is normal and there is no infection.
Giving corticosteroid medication to patients who are expected to give birth soon may minimize respiratory problems, intracranial hemorrhage and intestinal problems due to insufficient development of the lungs in the baby and can help baby to survive.
In the recent years, it has been proven that the progesterone treatment during pregnancy significantly reduces the risk for pregnant women with a history of preterm birth. Recent studies have reported that progesterone treatment reduces the risk of premature labor in cases with short uterine length.
Can premature birth be predictable?
It is difficult to predict and diagnose the premature birth. The main reason for this is that the indications and symptoms of preterm birth can be seen also in normal pregnancies and some of the patient complaints can be well evaluated. Examination of cervical patency, frequency and duration of pain, ultrasonography methods, some biochemical indications in maternal blood and amniotic fluid are some of the methods used to predict preterm birth. With these methods the patients in preterm birth risk group can be detected before findings appeared, the patients with preterm birth indications can be diagnosed and evaluated. At Liv Hospital Ulus Perinatology Clinic, we aim to identify pregnant women who are at risk for preterm labor thanks to our program called “Prediction, treatment and prevention preterm birth program”. Particularly we focus on the patients with recurrent premature birth, patients with diagnosis of intrauterine infection or vaginal infection, patients with a history of early opening of the amniotic sac (premature rupture of the membrane), multiple pregnancies, IVF pregnancies, patients with reduced fetuses in the womb (triplets, quadruplets).
In this patient group, we begin follow-up at the beginning of and even before pregnancy, and we apply a frequent monitoring method in which the patient's individual risk is evaluated. At this stage, patients are evaluated according to their behavioral and demographic (age, number of births, pregnancy history, smoking, etc.), nutritional, current pregnancy and biophysical (cervical dilatation and ultrasonographic findings) characteristics. For these methods and follow-up, many parameters such as vaginal and intrauterine infection screening, biological fluids (fetal fibronectin and IGFBP-1 determination from the cervix), screening and measurement of some biochemical markers in the womb and amniotic fluid (AFP, CRH, interleukin-6, TNF-α), widespread use of cervical ultrasonography, patient education and information, etc.