Premature Labor

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Premature Labor

Definition

Premature labor is the term to describe contractions of the uterus that begin at weeks 20-36 of a pregnancy.

Description

The usual length of a human pregnancy is 38-42 weeks after the first day of the last menstrual period. Labor is a natural series of events that indicate that the birth process is starting. Premature labor is defined as contractions that occur after 20 weeks and before 37 weeks during the term of pregnancy. The baby is more likely to survive and be healthy if it remains in the uterus for the full term of the pregnancy. It is estimated that around 10% of births in the United States occur during the premature period. Premature birth is the greatest cause of newborn illness and death. In the United States, prematurity has a greater impact on African-Americans.

Causes and symptoms

The causes of premature labor cannot always be determined. Some research suggests that infection of the urinary or reproductive tract may stimulate premature labor and premature births. Multiple pregnancies (twins, triplets, etc.) are more likely to result in to premature labor. Smoking, alcohol use, drug abuse, and poor nutrition can increase the risk of premature labor and birth. Adolescent mothers are also at higher risk for premature delivery. Women whose mothers took diethylstilbestrol (DES) when they carried them are more likely to deliver prematurely, as are women who have had previous surgery on the cervix.

The symptoms of premature labor can include contractions of the uterus or tightening of the abdomen, which occurs every ten minutes or more frequently. These contractions usually increase in frequency, duration, and intensity, and may or may not be painful. Other symptoms associated with premature labor can include menstrual-like cramps, abdominal cramping with or without diarrhea, pressure or pain in the pelvic region, low backache, or a change in the color or amount of vaginal discharge. As labor progresses, the cervix or opening of the uterus will open (dilate) and the tissue around it will become thinner (efface). Premature rupture of membranes (when the water breaks) may also occur.

An occasional contraction can occur anytime during the pregnancy and does not necessarily indicate that labor is starting. Premature contractions are sometimes confused with Braxton Hicks contractions, which can occur throughout the pregnancy. Braxton Hicks contractions do not cause the cervix to open or efface, and are considered "false labor."

Diagnosis

The health care provider will conduct a physical examination and ask about the timing and intensity of the contractions. A vaginal examination is the only way to determine if the cervix has started to dilate or efface. Urine and blood samples may be collected to screen for infection. A vaginal culture (a cotton-tipped swab is used to collect some fluid and cells from the vagina) may be done to look for a vaginal infection. A fetal heart monitor may be placed on the mother's abdomen to record the heartbeat of the fetus and to time the contractions. A fetal ultrasound may be performed to determine the age and weight of the fetus, the condition of the placenta, and to see if there is more than one fetus present. Amniocentesis will sometimes be performed. This is a procedure where a needle-like tube is inserted through the mother's abdomen to draw out some of the fluid surrounding the fetus. Analysis of the amniotic fluid can determine if the baby's lungs are mature. A baby with mature lungs is much more likely to survive outside the uterus.

KEY TERMS

Braxton Hicks contractions— Tightening of the uterus or abdomen that can occur throughout pregnancy. These contractions do not cause changes to the cervix and are sometimes called false labor or practice contractions.

Cervix— The opening at the bottom of the uterus, which dilates or opens in order for the fetus to pass into the vagina or birth canal during the delivery process.

Contraction— A tightening of the uterus during pregnancy. Contractions may or may not be painful and may or may not indicate labor.

Treatment

The goal of treatment is to stop the premature labor and prevent the fetus from being delivered before it is full term. A first recommendation may be for the woman with premature contractions to lie down with feet elevated and to drink juice or other fluids. If contractions continue or increase, medical attention should be sought. In addition to bed rest, medical care may include intravenous fluids. Sometimes, this extra fluid is enough to stop contractions. In some cases, oral or injectable drugs like terbutaline sulfate, ritodrine, magnesium sulfate, or nifedipine must be given to stop the contractions. These are generally very effective; however, as with any drug therapy, there are risks of side effects. Some women may need to continue on medication for the duration of the pregnancy. Antibiotics may be prescribed if a vaginal or urinary tract infection is detected. If the membranes have already ruptured, it may be difficult or impossible to stop premature labor. If infection of the membranes that cover the fetus (chorioamnionitis) develops, the baby must be delivered.

Prognosis

If premature labor is managed successfully, the pregnancy may continue normally for the delivery of a healthy infant. Once symptoms of preterm labor occur during the pregnancy, the mother and fetus need to be monitored regularly since it is likely that premature labor will occur again. If the preterm labor cannot be stopped or controlled, the infant will be delivered prematurely. These infants that are born prematurely have an increased risk of health problems including birth defects, lung problems, mental retardation, blindness, deafness, and developmental disabilities. If the infant is born too early, its body systems may not be mature enough for it to survive. Evaluating the infant's lung maturity is one of the keys to determining its chance of survival. Fetuses delivered further into pregnancy and those with more mature lungs are more likely to survive.

Prevention

Smoking, poor nutrition, and drug or alcohol abuse can increase the risk of premature labor and early delivery. Smoking and drug or alcohol use should be stopped. A healthy diet and prenatal vitamin supplements (prescribed by the health care provider) are important for the growth of the fetus and the health of the mother. Pregnant women are advised to see a health care provider early in the pregnancy and receive regular prenatal examinations throughout the pregnancy. The health care provider should be informed of any medications that the mother is receiving and any health conditions that exist before and during the pregnancy.