Written by :
Senior Consultant, Obstetrics & Gynaecology,
Indraprastha Apollo Hospital,
What is premature labour?
A normal pregnancy should last about 40 weeks. Occasionally, labour may begin prematurely before the 37th week of pregnancy because of uterine contractions that cause the cervix to open earlier than normal. When this happens, the baby is born premature and can be at risk for various health problems. Fortunately, due to advances in research, technology and medicine, the health of premature babies is improving.
What are the risk factors for a premature delivery?
Certain factors may add to a woman's risk of having premature labour. However, having a specific risk factor does not mean a woman is predetermined to have premature labour. A woman may also have premature labour for no apparent reason. The following are the know risk factors:-
- Being pregnant with multiples.
- Having had a previous premature birth.
- Uterine or cervical abnormalities.
- Recurring bladder and/or kidney infections.
- Urinary tract infections, vaginal infections, and sexually transmitted infections.
- Infection with fever (greater than 101 degrees F) during pregnancy.
- Unexplained vaginal bleeding after 20 weeks of pregnancy.
- Chronic illness such as high blood pressure, kidney disease or diabetes.
- History of multiple first trimester abortions or one or more second trimester abortions.
- Being underweight or overweight before pregnancy.
- Short time between pregnancies (less than 6-9 months between birth and beginning of the next pregnancy).
- Lifestyle factors like smoking, drinking alcohol and using illegal drugs.
- Having suffered domestic violence, including physical, sexual or emotional abuse.
- Lack of social support or support from the family.
- High levels of stress and having worked for prolong hours with long periods of standing.
What are the warning signs?
- A contraction every 10 minutes, or more frequently within one hour (five or more uterine contractions in an hour).
- Watery fluid leaking from your vagina (this could indicate that your water bag is broken).
- Menstrual-like cramps felt in the lower abdomen that may come and go or be constant.
- Low, dull backache felt below the waistline that may come and go or be constant.
- Pelvic pressure that feels like your baby is pushing down.
- Abdominal cramps that may occur with or without diarrhoea.
- Increase or change in vaginal discharge.
If you experience any of these signs, call your doctor or rush to your maternity centre.
What does a contraction feel like?
As the muscles of your uterus contract, you will feel your abdomen harden. As the contraction goes away, your uterus becomes soft. Throughout pregnancy, the layers of your uterus will tighten irregularly which are usually not painful. These contractions are usually irregular and do not open the cervix. If these contractions become regular or more frequent (one every 10-12 minutes for at least an hour) they may be premature labour contractions, which can cause the cervix to open. It is important to contact your doctor immediately.
What should I do if I feel I am having premature labour?
- Call your doctor immediately and your husband or other family members if you are alone at home.
- Empty your bladder.
- Lie down tilted towards your left side; this may slow down or stop signs and symptoms.
- Avoid lying flat on your back; this may cause the contractions to increase.
- Drink several glasses of water because dehydration can cause contractions.
- Monitor contractions for one hour by counting the minutes that elapse from the beginning of one contraction to the beginning of the next.
What impact does premature labour have on the baby?
The longer your baby is in the womb, the better the chance she will be a healthy child. Babies who are born prematurely are at higher risks for brain and other neurological complications, as well as respiratory and digestive problems. Some premature babies grow up with a developmental delay, others might have learning difficulties in the school. The earlier a baby is born, the more health problems are likely to develop.
Premature labour does not always result in premature delivery. Some women with premature labour and early dilation of the cervix are sometimes put on bed rest until the pregnancy progresses further.
Most babies born prior to 24 weeks have little chance of survival. Only about 50% will survive and the other 50% may die or have permanent problems. However, babies born after 32 weeks have a very high survival rate, and usually do not have long term complications. Babies born at hospitals with neonatal intensive care units (NICU) do best.