Timing and types of premature birth
Prematurity is divided by age: the earlier the baby is born, the higher the risks. About half of the cases begin spontaneously with contractions, some with the rupture of water, the rest are associated with medical indications when continuing pregnancy is more dangerous for the mother or child, for example, with severe preeclampsia or fetal growth restriction. Separately, there is a threat of premature birth - contractions without changes in the cervix.
- Very early - 22–27 weeks
- Early – 28–31 weeks
- Premature - 32–33 weeks
- Late – 34–36 weeks
- Spontaneous and for medical reasons
Causes and risk factors
The strongest risk factor is a history of premature birth. The length of the cervix is important: if it is less than 25 mm in the second trimester, the likelihood of premature birth increases. Urinary tract and genital infections, asymptomatic bacteriuria, and inflammation of the membranes can trigger contractions. Multiple pregnancies and polyhydramnios overstretch the uterus. Some factors, such as smoking, can be eliminated.
- Previous premature birth or late miscarriage
- Short cervix, cervical surgery
- Multiple pregnancy, polyhydramnios
- Urinary tract infections and bacterial vaginosis
- Bleeding during pregnancy
- Smoking, underweight or overweight
Signs of the onset of labor
Contractions during premature birth may be subtle: they are felt as periodic abdominal tension, menstrual-like pain or aching pain in the lower back. Training contractions in the second half of pregnancy are irregular, do not intensify and pass at rest. If contractions become regular, painful, or accompanied by discharge, you need to urgently seek help without waiting for the morning.
- Regular tension or pain in the lower abdomen
- Aching pain in the lower back
- Feeling of pressure in the vagina
- Watery, mucous, or bloody discharge
- Outpouring of waters
Diagnostics and prevention
Women at risk have their cervical length measured by transvaginal ultrasound, usually between 16 and 24 weeks. For a short cervix, vaginal progesterone is prescribed, and in some cases, suturing the cervix or an obstetric pessary. All pregnant women have their urine checked for asymptomatic bacteriuria and treated for it. If the onset of labor is suspected, a hospital examination, CTG, ultrasound of the cervix, a test for rupture of water and smears for infections are carried out in the hospital.
- Transvaginal cervicometry
- Urine culture for asymptomatic bacteriuria
- Smears for infections and microflora status
- CTG to assess contractions and fetal heartbeat
- Test for leakage of amniotic fluid
Treatment and assistance for the child
If labor begins before 34 weeks, doctors try to delay it by at least 48 hours with the help of tocolytics - drugs that relax the uterus. During this time, corticosteroids are administered to mature the fetal lungs and, if necessary, the woman is transferred to a perinatal center with a neonatal intensive care unit. Magnesium is administered up to 32 weeks to protect the baby's brain. When water breaks, antibiotics are prescribed. After birth, the premature baby is under the supervision of a neonatologist, if necessary, in an incubator, with breathing and nutrition support. Mother's milk is especially valuable for premature babies.
- Tocolysis to gain time
- Corticosteroids for fetal lung maturation
- Magnesium for neuroprotection up to 32 weeks
- Antibiotics for rupture of water
- Childbirth in the perinatal center
- Nursing a newborn, breast milk
