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Preterm Labour

 

Description of Preterm Labour

Labour that begins prior to 37 weeks is defined as preterm labour. There must be both painful and regular contractions, and a change in the cervix.

Contractions that occur prior to 37 weeks BUT do not change the cervix are called preterm contractions. Preterm contractions do not usually need to be treated unless the woman is very preterm and the contractions are very frequent and strong.

Signs of preterm labor are:

  • Regular cramping-like menses or intermittent back aches.
  • Increase in discharge
  • Blood discharge
  • Increased pelvic pressure
  • Risks for preterm labour are
  • Twins, triplet or more
  • Prior preterm delivery (not preterm labor)
  • Sexually transmitted diseases
  • Placenta previa and abruption (bleeding in the second and third trimesters)
  • Severe infections during pregnancy such as pyelonephritis
  • Medical complications of pregnancy
  • Many women with preterm labor have no risk factors.
  • Impact on Pregnancy
  • Preterm labour may result in preterm delivery.
  • Babies born after 32 weeks do very well in the nursery. They have very high survival and usually don’t have long term complications.
  • Most babies born prior to 24 weeks have very little chance of survival. As pregnancy progresses, the survival rate increases and the chance of permanent problems decreases.
  • At 24 weeks, about 50% will survive.
  • 50% of survivors will have permanent problems due to being born preterm.
  • Babies that are born at hospitals with neonatal intensive care units (NICU) do best.
  • If a hospital does not have a NICU, women are often transferred prior to delivery of the baby to hospital that has a NICU.

Medications are often used to stop labour. A common medication is Magnesium Sulfate. It is given through an IV. A large dose is initially given. It causes a feeling of flushing and nausea. This feeling goes away. A smaller continuous dose is then given for 12-24 hours or more. Magnesium Sulfate crosses the placenta, but it does not hurt the fetus.

Oral medications are often used to prevent preterm labour from happening again.

Research studies have not shown that these medications prolong pregnancy. These medications will decrease the frequency of contractions, and may make women feel better. Because oral medications do not prolong pregnancy, many doctors do not use them.

Steroids are often given to help the fetus’ lungs mature quicker. They cross the placenta. Two steroids are used in the United States: Betamethasone and Dexamethasone. Betamethasone is used more frequently, because fewer doses are needed. Two shots, usually 24 hours apart are given. The shots are given into the muscle. Sometimes repeat shots are given after 1 week. The number of repeat shots that are needed, or even necessity of the repeat shots is unknown. These steroids will not cause growth of facial hair or muscle development. Women with diabetes often have very high blood sugars after the steroid shots. This is not a reason to avoid the shots. However, blood sugars will need to be tested frequently, and more insulin may be needed.

Special Considerations

Women in preterm labour are often transferred to hospital with neonatal intensive care units (NICU). This means being further from family and friends. Baby’s born at hospitals with a NICU do better. Women with preterm labour and early dilation of the cervix are sometimes put on bed rest until the pregnancy progresses further. In extreme cases of cervical dilation, bed rest may be in the hospital. Bed rest is a frustrating experience.
At the first sign of increased bleeding you may need a caesarean section.

If the opening of the uterus is completely covered by the placenta, a caesarean section is the only way the baby can be delivered safely.

How can I take care of myself?

Report any bleeding to your doctor. Limit your regular activity or rest in bed to prevent bleeding. It is important to not put anything into your vagina, like a tampon, to prevent more bleeding. Also, you should not have intercourse.

If your doctor prescribes iron, be sure you take it. Iron is best taken after meals so it will not upset your stomach.

What can be done to help prevent placenta previa?

There is nothing you can do to prevent placenta previa. You can help prevent complications of a previa by following your doctor's instructions, lying down most of the time, and telling your doctor if you have any pain, contractions, or bleeding.

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