Preterm Birth

Introduction

 Preterm Delivery

• H/o of preterm births.
• Chronic maternal illness. like heart, liver, kidney disease.
• General infection like STD, urinary, cervical or kidney infection.
• Age : teens / over 35 (good nutrition and prenatal care.
• Multiplicity.
• Premature cervical shortening. Treatment Progesteron gel or suppositories.
• Pregnancy complications like gestational diabetes,, pre eclampsia, excessasive amniotic fluid, placenta previa, or placenta abruption
• Too little or too much weight gain.
• Not enough  nutrients i.e. folic acid deficiency.
• Too much standing or heavy physical labour. (Stay active)
• Extreme emotional stress.
• Alcohol and drug use.
• Smoking.
• Gum infection.
• Cervical insufficiency, cervical incompetence.

Diagnosis

• Preterm labor . Examine cervix and vaginally secretions for a substance known as fFN ( fetal fibronectin)
• Another screening test is one for cervical length, via ultrasound  before 30 weeks, the length of cervix is measured  to see if  there is any sign that the cervix is shortening  or opening . A short cervix  put you at an increase risk of pre term labor., especially if it began shortening early in pregnancy.

Giving the hormone progesterone as weekly shorts starting at 16 weeks of pregnancy and continuing through weeks 36 reduces the risk of preterm  birth in women who've delivered early before and who are carrying only one baby.

• Fetal Fibronectin Screening test (fFN) Screening test
• Which looks for signs of preterm labor in women who have risk factors for having a preterm baby(such as previous preterm delivery). Fetal fibronectin is the glue your body makes to hold your baby in your uterus. If the test-which is done on your practitioner's office-come back negative (meaning the fFN hasn't started to break down yet and therefore detectable). It means the odd of delivery within the next two weeks are less than1 percent (as you can breathe easy). If it's positive, your risk of going into preterm labour is significantly higher, and your practitioner may take steps to prolong your pregnancy and prepare your baby's lungs for an early delivery.
• Cervical Length :The length of your cervix is measured via ultrasound, and if there are any signs that the cervix is short. Your practitioner may prescribe a daily progesterone gel. It comes in a tampon like applicator that you place in a vagina- starting at week 20 of pregnancy and continuing until 37 weeks. If you are already on progesterone shorts due to a prior premature birth and ultrasound shows that your cervix has  shortened midway through pregnancy. Your practitioner may recommend cerclage (Stitching the cervix to prevent it from dilating prematurely)
• Too little or  too much weight gain :

Gaining too little weight can increase the chances your baby will be born early, but so can packing on too many pounds. Conceiving in your ideal body weight and gaining just the right number of pounds for your pregnancy profile can provide your baby  with a healthier , more nurturing uterine environment and ideally a more better chance of  staying more safely until term. So act an ideal weight gain goal with your practitioner- and than try your best to meet it.

• Not enough nutrients

Giving your baby the healthiest start in life isn;t just  about gaining the right number of pounds. Its about gaining about right number of pounds- its about gaining them on  the right type of foods. A diet that lack neccessary nutrients (specially folate (the dietary version of folic acid) increases your risk of premature delivery, while a diet that is nutritional packed decreases that risk.

• Too much standing or heavy physical labor

Definitely no need to sit out pregnancy, in fact staying active is just what the doctor orders for most moms to be, and everyday kind of standing- like when you are shopping at the mall or in the line at the movie-isn't a problem in a normal pregnancy. But if you job evolves long hours on your feet everyday especially if it involves heavy physical labor or lifting- check with your practitioner to see if you should cut back or request a change in work duties, especially late on pregnancy.

• Extreme emotional stress

Link between extreme emotional stress (not your everyday life in the fast lane, (my work is never done stress) and premature labor What's the difference between a normal stress level, and extreme stress. Normal stress may keep you on your toes- let's face it even on the run- but its manageable and you can thrive on it. Extreme stress, on the other hand is unhealthy- it drains and depilates you keeps you from sleeping well, keep you from eating well, keeps you from enjoying life. Sometimes the cause of such excessive stress can be eliminated or minimized (by quitting or cutting back at an unhealthy high-pressure job for example), and sometimes it is unavoidable (as when a lost job leaves you with a pile of unpaid bills or there's been an illness or a death in a family. Still many kinds of stress can be reduced with relaxation techniques, a healthy diet, a balance of exercise and rest and by talking over the problems that are getting you down with your spouse or friends your  practioner or a therapist.

• Alcohol and drug use

Mom to be who are alcohol and illegal drug, increases their risk of having a premature delivery.

• Smoking

Smoking during pregnancy may be linked to an increased risk of premature delivery. Quitting before conception or as early as possible in pregnancy is best, but quitting at any time in pregnancy is definitely better than not quitting at all.

• Gum infection

Gum infection is associated with preterm delivery. Bacteria that cause inflammation in the gums can get into the blood stream reach the fetus and initiate early delivery. Another proposed possibility the bacteria that caused inflammation in the gums can also trigger the immune system to produce inflammation the cervix and uterus, triggering early labor. Regularly brushing and flossing and staying up to date on dental cleansings and other dental care can prevent infections. Treating existing infections before pregnancy may also help lower the risk for a variety of complications, including preterm labor.

• Cervical insufficiency

The risk of premature delivery as a result of an incomplete cervix in which a week cervix opens early- can possibly reduce by stitching the cervix and by closely monitoring the lenth of the cervix via ultrasound.

• H/O of Preterm Birth

Your chances of preterm labor are higher if you have had in past. Your practitioner may prescribe progesterone shots or gels during this pregnancy to avoid a repeat preterm birth. Your following risk factors aren't controllable, but in some cases, there can be somewhat modified. In others, knowing they exist can help you and your practioner beat manage the risks as well as greatly improve the outcome, if an early birth becomes inevitable.

• Multiples

The optimal time for twins is 38 weeks, but many moms of twins deliver earlier.Good prenatal care , optimum nutrition and the elimination of other risk factors along with restriction of activity and more time second  resting in the last trimester, may help prevent a too early birth.

• Premature cervical shortening

In some moms to be  for reasons unknown and apparently unrelated to cervical insufficiency, the cervix begins to shorten mid pregnancy, putting them at increased risk for preterm birth. A routine ultrasound of cervix mid pregnancy may uncover that increased risk. Treatment with progesterone gels or suppositories may be prescribed  in some cases to try to prolong pregnancy.

• Pregnancy complications

Gestational diabetes, preeclampsia and excessive amniotic fluid as well as problem with  the placenta such as placenta previa or placental abruptions, can make an early delivery more likely.Managing these conditions as best as possible may help pregnancy reach term.

• Chronic Maternal Illness

Chronic conditions and heart liver or kidney disease may raise the risk for pre term delivery. But good care may help prevent complications.

• General infections

Certain infections (some STD, urinary. cervical, vaginal and kidney infections can increase the risk of pre term labor. When the infection is one could prove harmful to the fetus. Early labor may be body's way of  attempting to rescue a baby  from an unhealthy environment . Preventing the infections or  promptly treating may prevent a too soon birth.

• Age

Teen moms to be are often at a higher risk for preterm delivery. Older mom over age of 35  are also more likely to give  birth early.  Good nutrition and prenatal care  can help reduce the risk 

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