Prematurity is on the rise: 1 in 10 babies worldwide are born premature. These too early births present risks of complications and sequelae, more or less high depending on the stage of prematurity. Causes, management of premature babies, prevention of premature childbirth… The essentials to know about prematurity.

Prematurity is a birth that occurs before 37 weeks of amenorrhea (SA) or 35 weeks of pregnancy. The duration of a full term pregnancy is 41 weeks, or 39 weeks of pregnancy.

There are 3 categories of premature babies:

• The average premature baby (from 32 weeks to 36 weeks + 6 days)
• Very premature (from 28NT to 31NT + 6 days)
• Very premature baby (birth before 28NW)

Average prematurity represents the majority of prematurity cases.

Premature babies are small in weight and some of their organs are immature, including the lungs, digestive system, and brain.

The possible complications due to prematurity differ depending on the stage of prematurity.

Prematurity can cause health complications related to organ immaturity, including:

• Hyaline membrane disease
• Pneumothorax
• Respiratory distress
• Apneas
• Bronchodysplasia
• Hypotension
• Cerebral meningeal haemorrhage
• Heart murmur
• Hypothermia
• Hypoglycemia
• Anemia

In addition to these immediate complications, there may be neurological and psychomotor sequelae. The frequency of complications and the appearance of sequelae is increased in very premature babies and even more in very premature babies.

In the majority of cases, premature births are spontaneous, due to early contractions, the cause of which is rarely identified, or to the premature rupture of membranes, these ruptures sometimes being of infectious origin.

A small part of premature births corresponds to induced births. It is then a medical decision and the birth usually takes place by cesarean section. A premature birth can be decided because of a risk of death of the fetus or of the mother during the pregnancy (severe hypertension, severe intrauterine growth retardation, etc.)

Multiple pregnancies represent a third of premature deliveries.

Prematurity: why is it increasing?

4 factors explain the increase in premature deliveries:

• Scientific progress: more and more children are saved
• The development of medically assisted procreation (MAP): these techniques promote multiple births, more at risk of premature birth
• Women’s professional activity and lifestyle (stress, smoking, etc.)
• Raising the pregnancy age

The most fragile premature babies are placed in neonatal intensive care. They will then be transferred to intensive care and then to the neonatal department. Premature babies who do not need intensive care are hospitalized in the neonatal unit. They are placed in an incubator, at least initially. The incubator or incubator is a device that takes care of vital functions (breathing, temperature control) that the premature baby does not control.

If the baby cannot breathe on his own, he is helped by a respirator (CPAP) or oxygen glasses. He is fed until he can feed himself intravenously or with a tube that brings food directly into the stomach.

Premature babies have constant monitoring of blood pressure, heart rate, respiratory rate and oxygen saturation. The neonatal discharge is done when the premature baby is autonomous on the respiratory and digestive levels.

There are risk factors for premature birth: age under 18 or over 35, smoking, high multiparity (many pregnancies), poor socio-economic conditions, excessive professional and / or family fatigue, daily commuting, etc.

These risk factors must be taken into account in terms of prevention. It is thus possible to stop smoking, to arrange your working conditions with the occupational physician, etc. Multiple pregnancies benefit from special monitoring.

Threatened Premature Childbirth

Threatened preterm delivery (PAD) is a complication of pregnancy, defined as a risk of childbirth before 37 weeks. The signs ? Regular, painful urine contractions associated with changes in the cervix. The cervix shortens or even opens under the influence of contractions which leads to premature delivery without medical intervention.

MAP: the causes

Several causes can explain a threat of premature labor:

• Maternal infection, the most common being urinary tract infection
• An infection of the cervix and vagina
• A uterine malformation or fibroid
• Multiple pregnancy (very distended uterus)
• Placenta insertion abnormalities (placenta praevia…)

Socio-economic, psychological, environmental factors: long daily trips, several young children at home, stress, etc.

MAP: the solutions

In the event of a threat of premature labor, the first treatment consists in identifying and treating the cause (urinary tract infection for example). Then, strict rest helps reduce uterine contractions.

When the threat of premature birth is severe, the mother-to-be is hospitalized in a maternity unit associated with a pediatric department adapted to the end of the pregnancy (type III maternity if the pregnancy term is less than 34 weeks). The baby’s lungs can be prepared for birth: injecting the mother with corticosteroids matures the fetal lungs to prevent respiratory complications at birth.