Here’s all you want to know about preterm labour
Susan is worried. Should she be hitting the panic button? She is only 8 months pregnant but since this morning she has been having lower abdominal pain. In the beginning, it felt like menstrual cramping but now there is squeezing pain which comes every 10 minutes. Could Susan be in preterm labour?
What is preterm labour?
When labour begins before 37 weeks of pregnancy, it is considered preterm or premature. The exact causes of preterm labour are not known.
Warning signs of preterm labour
If preterm labour is recognided early enough, delivery may be prevented or postponed in some cases. This will give the baby extra time to grow and mature. Even a few more days may mean a healthier baby. It is important to call your doctor or go to the hospital right away if you notice any of these symptoms:
Watery, mucoid, or bloody vaginal discharge
Sudden increase in amount of vaginal discharge
Pelvic or lower abdominal pressure
Constant, dull, low backache
Mild abdominal cramps like menstrual cramps
Regular or frequent contractions or uterine tightening, sometimes painless
A trickle or gush of fluid from the vagina
Am I in preterm labour?
It is common to have Braxton-Hicks contractions, which are painless tightening of the abdomen in the last three months of pregnancy. With rest, they usually subside within an hour or so. If there are frequent contractions, i.e. at least 4 times every 20 minutes or if there have been 8 contractions in an hour and which have been persisting for more than an hour, you need immediate medical attention. Preterm labour can be confirmed by finding out if thinning and dilatation of the cervix (mouth of the uterus) have occurred.
Preventing preterm labour
Initiating regular antenatal checkups early in your pregnancy and continuing regular checkups with your obstetrician can help prevent preterm labour. Women who have had a previous preterm delivery may be given injectable progesterone, a hormone to help prevent another preterm delivery. This is usually started from the 16th week of pregnancy. In most cases, women at risk for preterm labour do not have to be at bed rest and many of them can continue to work. You may be advised to avoid overexerting yourself and lifting heavy objects. Having intercourse during pregnancy may sometimes cause contractions so you may be advised to avoid intercourse.
Treatment of preterm labour
Once preterm labour is suspected, your obstetrician will admit you to the hospital for observation. The objectives of treating preterm labour are twofold. One is to try and stop labour, as long as it does not jeopardise the mother’s health. The other is to ensure that if the baby is born in spite of preventive measures, then its lungs should be mature enough for it to survive.
Tocolytics are medicines which can stop contractions. The commonest and most effective medicines used are nifedipine and ritodrine.
Steroids are administered if it appears that the chances of the baby being born early are high. Steroids cross the placenta and help the baby’s lungs mature and also prevent bleeding into the brain. Steroids increase the baby’s chance of survival. Steroids are most likely to help the baby when used between 24 and 34 weeks of pregnancy.
A vaginal delivery will be attempted if the preterm labour is progressing well and does not seem to be presenting any risk to the foetus. It may also be preferred if the chances of the baby surviving are very slim. If there is reason to believe that the preterm baby may not be able to tolerate the stresses of labour, or if there are any maternal complications, then a caesarean section may be advised.
Care of the preterm baby
Many preterm babies are very small and require special care. Preterm babies are kept in an incubator to keep them warm.
Surfactant is a medication that when administered, can prevent breathing difficulties in the baby and save the baby’s life. You or your baby may be moved to a different hospital that can provide this type of care.
Today, with special care in a neonatal intensive care unit (NICU), even babies born between 28-30 weeks have a reasonable chance of survival. Babies born between 31-36 weeks have a better chance of survival.
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)