Premature labor – causes, diagnosis, treatment

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Preterm labor covers the period from the end of the 24th week of pregnancy to the end of the 37th week. Obviously, the more advanced the pregnancy is, i.e. the closer to the biological termination of the pregnancy, that is, the greater the chance of the child’s survival.

What is preterm labor?

Preterm labor is when pregnancy ends between the 24th and 37th week of pregnancy. This issue remains a mystery to obstetricians, because even medical advances do not provide sufficient methods of preterm labor diagnosis, treatment and prevention. Some specialists also consider the child’s weight, which should not be more than 2500 g, and body length (at least 25 cm) as criteria. Preterm babies are much more ill and hospitalized. In addition, such children have poorer academic performance and sometimes neurological diseases, lung diseases, deafness and blindness. The risk of these complications increases the lower the gestational age at the time of delivery. Early diagnosis of this complication is very important, because proper treatment in many cases can stop premature labor and prepare the baby for an earlier life outside the mother’s womb. Premature labor is threatened by regular contractions of the uterine muscle or the discharge of the amniotic fluid from the genital tract, which is a symptom of rupture of the fetal bladder. In all these cases, the pregnant woman should be admitted to a hospital as soon as possible, where it is often possible to stop the labor after proper treatment. The chance of maintaining a pregnancy depends on many factors – including the advancement of contractile action, the presence of inflammation, the opening of the internal cervix or the presence of symptoms of amniotic fluid departure.

The prevalence of preterm labor varies greatly, with the highest prevalence observed in Africa and Asia, and the lowest in Europe (approx. 6,2%). In 2010, over 27 children were born prematurely in Poland.

The causes of premature labor

The reasons premature births are similar to miscarriages, though hard work is believed to be a significant trigger. The incidence has increased in recent years, amounting to 8–11%, and is associated with high infant mortality. Research has shown that the number of premature births has increased in recent years. According to researchers, this may be related to the later age of future mothers, because with age, diseases appear that significantly disturb the course of pregnancy and lead to an early termination. Such diseases include, among others:

1. diabetes
2. uterine fibroids,
3. hypertension,
4. cervical failure,
5. previous premature birth,
6. leading bearing,
7. defective structure of the uterus,
8. previous spontaneous miscarriages,
9. venereal diseases,
10. interval between pregnancies less than six months,
11. urogenital and even respiratory infections,
12. stress,
13. smoking,
14. alcohol addiction,
15. hard, stressful work,
16. bad diet,
17. injuries,
18. underweight / overweight during pregnancy,
19. father’s age over 45.

It should be taken into account that preterm labor is a multifactorial phenomenon, so it is impossible to identify only one mechanism responsible for its occurrence. The most common medical indications for early termination of pregnancy are: detachment of the placenta, pre-eclampsia, fetal hypoxia and lack of intrauterine growth.

Preterm labor diagnostics

The diagnosis of preterm labor is mainly based on the recognition of regular uterine contractions accompanied by dilation and cervical atrophy. However, in most women, the diagnosis is made earlier, when the above-mentioned criteria have not yet been met. Early detection is very difficult when the symptoms are not very severe and may also occur in the course of normal pregnancy. It happens that healthy women also report worrying ailments, while those at risk of premature birth often do not pay attention to suspicious signs. The diagnostics also uses the determination of the concentration of fetal fibronectin, i.e. a protein that is normally found in the cervico-vaginal discharge. Its concentration increases in women at risk of premature birth. Additionally, an ultrasound scan of the cervix is ​​performed.

Premature delivery – treatment

It is used in treatment tocolysis, i.e. inhibiting premature systolic function in women with a dilating and shortening cervix, between 24 and 37 weeks of pregnancy. This type of method is only used if there is a benefit to the baby after delaying the delivery. Most women can extend their pregnancy by two days (sometimes up to seven days); during this time, the patient is given hormones to accelerate the maturation of the fetal lungs and corticosteroids. Due to the use of tocolytic preparations, the duration of pregnancy can be slightly extended. However, it should be remembered that this preparation does not reduce the risk of perinatal mortality or the development of diseases in the newborn.

The tocolytic drug registered for use in Poland is atosiban – it is responsible for blocking oxytocin. Its effectiveness is similar to that of beta-mimetic drugs, but it is much better tolerated by pregnant women and does not cause side effects. Occasionally, only vomiting may occur. Additionally, it is safe for the newborn. Unfortunately, this preparation is very expensive, so it is not widely used.

Nitric oxide donors and calcium antagonists are also used in inhibiting premature contraction. Unfortunately, they are not registered in Poland for premature birth. Their use requires a doctor’s decision and a written consent of the patient herself.

Contraindications to the use of tocolysis are:

1. pre-eclampsia / eclampsia,
2. bleeding from the genital tract,
3. inflammation of the membranes
4. lethal defect of the fetus,
5. intrauterine threat to the fetus.

A woman at risk of preterm labor should rest in bed a lot, avoid excessive physical exertion and stress. In diagnosed cervical insufficiency, insertion is recommended obstetric passerwhich is in the form of a ring. In some patients, an alternative is assumed cervical seam (from 18-20 weeks of pregnancy). A patient at risk of preterm labor should be on the pathology of pregnancy

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