Premature labor, sometimes called preterm labor, is when labor occurs after week twenty, but before week thirty seven (after week thirty seven the baby is considered full term).
Babies born this early are at risk because their internal organs, including the lungs, and fat to keep them warm have not fully developed. But with each advance in modern medicine, the chances of survival for the baby are increasing.
Babies born before week twenty four and weighing about 2lbs have a fifty percent (1 in 2) chance of surviving given the appropriate treatment in a neonatal intensive care unitPart of a hospital that is dedicated to the care and attention of newborn infants that are seriously ill or premature. It contains a variety of specialized equipment and is staffed by a team of nurses and neonatologists who are specially trained in the pathophysiology of the newborn.
Visit our comprehensive glossary for more pregnancy terms and definitions., or NICU, but are at increased risk of mental and physical defects, such as cerebral palsy. This can be a frightening and worrying experience for many mothers, but specialists, called neonatologists, are trained to bring their experience and care to the neonatal intensive care unitPart of a hospital that is dedicated to the care and attention of newborn infants that are seriously ill or premature. It contains a variety of specialized equipment and is staffed by a team of nurses and neonatologists who are specially trained in the pathophysiology of the newborn.
Visit our comprehensive glossary for more pregnancy terms and definitions.. These dedicated professionals will do everything they can to ensure that the outcome is a happy one.
By week twenty eight, the chances of survival are over ninety percent (9 in 10), and every week that the baby remains in the uterus and gains weight increases the likelihood of a successful outcome. By the time your baby weighs more than 3lbs, the chances of survival are ninety five percent.
Premature labor often begins without warning, and it can be very difficult to know if it has started. Even your doctor may have trouble confirming the diagnosis. The problem is that medical centers may have different criteria for determining whether premature labor has begun, and many of the warning signs are also part of a normal and healthy pregnancy.
Premature labor may begin like normal labor, often with the rupture of the membranesRupturing of the amniotic sac releasing the amniotic fluid. It is usually one of the first signs of the onset of labor. Also called breaking of the waters.
Visit our comprehensive glossary for more pregnancy terms and definitions., and a clear and watery or mucusy and bloody vaginal discharge. You may then begin to feel contractions, but they will feel more like a tightening of the uterus.
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The contractions will be just like regular labor contractions, and you will feel your uterus hardening, with the contractions lasting between 60 and 90 seconds. A contraction will occur at least every ten minutes. But at this stage of your pregnancy, labor contractions may not be as strong as they would be at term.
Other symptoms of premature labor you should look for include a dull lower backache, that is impossible to relieve even if you change your position. This vague ache will not be the same as your regular lower back pains, instead it may be rhythmic and constant. You may also feel increased pelvic pressure, and gas pains, digestive problems and maybe diarrhea.
The most common causes of repetitive contractions or cramps at this stage in your pregnancy is dehydration, a full bladder or too much activity. Try going to the bathroom, then drinking a couple of glasses of water or juice. Rest for an hour and see if the contractions disappear.
If the signs of premature labor are still present, you should contact your doctor or midwife immediately, even if it is the middle of the night. Your doctor will encourage you to drink plenty of fluid to ensure that you are hydrated, or you may be placed on an IVThe delivery of fluid, often glucose, directly into the vein using a plastic catheter, and bag of fluid.
Visit our comprehensive glossary for more pregnancy terms and definitions.. The nurses will record your weight, blood pressure and temperature and a urine sample will be analyzed to try and determine why you are cramping. A sample from the back of your vagina may be cultured for bacteria and tested for fetal fibronectin, a chemical that is produced by the fetal membranes. If you test negative for fetal fibronectin it is unlikely that you will enter labor for at least two weeks, but a positive test does not indicate an imminent delivery.
Instead, a pelvic exam will be performed and your cervix will be examined for signs of effacementA term used to describe the process during labor whereby the vagina shortens and the walls of the cervix thin as it is stretched by the fetus. At its finish, the cervix becomes one with the lower segment of the uterus. Doctors measure the extent of effacement during labor by vaginal examination and express its progress as a percentageof full effacement.
Visit our comprehensive glossary for more pregnancy terms and definitions. or dilationThe opening of the cervix during labor, caused by the contractions of the uterus. The cervix dilates so that it will be large enough for the baby to pass through the birth canal during delivery.
Visit our comprehensive glossary for more pregnancy terms and definitions., which would indicate the onset of uterine contractions. If there no changes to the cervix, your doctor may perform regular pelvic exams at frequent intervals or place you on an external fetal monitor to measure your contractions.
Premature labor is easier to stop the sooner it is diagnosed. Using the external fetal monitor you will be checked for contractions every five to ten minutes lasting for thirty seconds or more within an hour. Cervical dilation of more than 1 inch (2.5cm) and more than three quarters effaced are also necessary to confirm the diagnosis. Only about one third of women who think they are in premature labor have actually entered labor.
Premature labor occurs in about five to ten percent (1 - 2 in 20) pregnancies. The cause in over half of cases is unknown. About twenty to thirty percent (2 - 3 in 10) of cases are triggered by premature rupture of membranes, or PROM, but this is often the result of some other problem.
Statistically, there are many factors that may put you at risk of premature labor, and they can be broadly categorized as general health problems, medical history problems and obstetrical complications.
Your general health will be carefully monitored throughout your pregnancy by your healthcare provider. While unusual, it is possible that your premature labor is not premature at all, but simply the result of an incorrect calculation of your due date. If you have had no prenatal care, there is an increased risk of premature labor because of poor general health.
Women who have a history of premature labor are more likely to enter premature labor in a subsequent pregnancy. Your doctor will examine your medical history for factors which may increase your risk of premature labor.
Premature rupture of membranes or PROM is the most common trigger of premature labor, but other obstetrical problems may also be risk factors.
If you are experiencing uterine contractions, but the cervix has not yet effaced or dilated your doctor will check to see if the membranes are intact. If they have not yet ruptured, there is a good chance that the labor can be stopped or delayed. While the decision to stop premature labor is a controversial one, it is considered beneficial for the baby and does reduce the risk of complications.
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At first your doctor or midwife will prescribe bed rest and plenty of fluids. In many cases, simply rehydrating the body and resting on your side (the left is considered the most effective) is enough to halt the progress of premature labor. If you are in hospital, an IV may be administered to provide fluids. Bed rest and rehydration effectively stops premature labor in about half of cases.
If bed rest does not prove effective, it may be necessary to administer tocolyticA term used to describe the medical interruption and halting of contractions during premature labor.
Visit our comprehensive glossary for more pregnancy terms and definitions. medications to relax the uterus and slow the contractions. Used safely since the 1970s, there are three types of drugs to arrest premature labor including magnesium sulfate, beta-adrenergics such as ritodrine (Yutopar) and terbutaline (Brethine) and sedative-narcotics. These drugs are effective in stopping premature labor in about seventy percent (7 in 10) cases.
Like all such drugs, they must be administered in a hospital or birthing center, and carry the risk of side effects including increased heart rate and palpitations, lowered blood pressure, anxiety and tremors. If successful, your doctor may prescribe continued medication orally at home.
The decision to use drugs is a difficult one, that is based on both your physical health and the stage of pregnancy. Many doctors feel that the labor should be allowed to continue without the intervention of drugs after week thirty two or week thirty four. Before administering any tocolytic medicationsA term used to describe the medical interruption and halting of contractions during premature labor.
Visit our comprehensive glossary for more pregnancy terms and definitions. medications, your doctor will want to check your medical record to make sure you are healthy.
If your doctor feels that premature labor may cause you or your baby more harm than the tocolytic medications, then they may still be administered. Labor after week thirty five will not be arrested if your membranes have ruptured and your cervix has dilated more than four centimetres. An L/S ratio and phosphatidyl glycerol test will be performed to check the maturity of your baby's lungs.
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There is no evidence of an increased risk of congenital abnormalities or developmental problems as a result of using ritodrine, terbutaline or magnesium sulfate. If your baby is delivered within twenty four hours of treatment using either ritodrine or terbutaline, its blood glucose level will be monitored for hypoglycemia, or low blood sugar. A sugar solution will be administered if necessary. Magnesium sulfate therapy may result in poor muscle tone during the first two hours after delivery.
Ritodrine and terbutaline may affect you for a day or two after treatment. While not dangerous you may experience increased heart rate, nausea and vomiting, headaches, insomnia, water retention in the lungs resulting in chest pains and breathlessness or dyspnea. You may experience similar side effects from magnesium sulfate therapy including fever, headaches, nausea and constipation.
If you show signs of infection you may be given an antibiotic before the tocolytic drugs are administered. Pain and anxiety may be reasons for your doctor to give you a mild sedative or antianxiety medication. Sometimes these medications used in combination with fluid administered intravenously can be enough to calm your contractions. Your doctor may consider using morphine or pethidine, but these drugs can aggravate the uterus and have a negative effect on your baby and are only used in cases of extreme pain.
After your labor has been stopped there are three different options for management. The treatment you receive will depend on your doctor's personal preference and other factors. If drugs were administered, you may remain in hospital for additional rest and observation for a couple of days. Your doctor may decide to let you return home, while you take oral tocolytic medication or receive terbutaline from a pump through a needle placed in the fat under your skin. Depending on your condition and the stage of pregnancy your doctor may recommend home uterine activity monitoring.
After the membranes have ruptured it is unlikely that labor can be arrested. Since there is an increased risk of infection, your doctor will recommend that you go to the hospital, where you will be monitored and given antibiotics if needed. The hospital will also be equipped with a neonatal intensive care unitPart of a hospital that is dedicated to the care and attention of newborn infants that are seriously ill or premature. It contains a variety of specialized equipment and is staffed by a team of nurses and neonatologists who are specially trained in the pathophysiology of the newborn.
Visit our comprehensive glossary for more pregnancy terms and definitions. or NICU, which is capable of providing the necessary care to your premature baby after delivery.
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Because the baby's head is smaller and softer when premature, labor is generally shorter and easier than a full term delivery. An episiotomyA surgical procedure in which an incision is made in the perineum to enlarge the vaginal opening and faciliate delivery of the baby or prevent tearing of the perineum. It is closed with absorbable sutures.
There are two types of episiotomy; the medilateral, cut at 45 degrees with midline, and median cut in the midline. The former offers more room for delivery but is more painful postpartum, while the latter heals more easily, but provides less room for delivery.
Visit our comprehensive glossary for more pregnancy terms and definitions. will probably be performed, and forceps used for delivery to protect your baby from pressure changes in the birth canal.
If there are no signs of contractions within one or two days, an oxytocinOxytocin is a pregnancy hormone that both stimulates breast milk production and stimulates uterine contractions. Synthetic oxytocins have been created to induce labor.
Visit our comprehensive glossary for more pregnancy terms and definitions. will be administered to stimulate labor. You will probably be given an epiduralA regional anesthetic introduced into the base of the spine used during labor and for cesarean sections. Also known as an epidural block.
Visit our comprehensive glossary for more pregnancy terms and definitions. instead of analgesic medicationsA form of painkilling agent that doesn't induce unconciousness in the patient.
Visit our comprehensive glossary for more pregnancy terms and definitions., which can depress the baby's respiratory sytem. Your baby will be closely monitored for signs of fetal distressA condition, usually discovered in labor, in which the fetal heartbeat follows an abnormal pattern. The fetal heartbeat is recorded using electronic fetal monitoring.
The acid balance of the fetal blood is measured, and labor is allowed to continue if it falls within prescribed ranges, and the abnormal heartbeat does not recur or persist.
If nescessary, attempts will be made to stabilize the fetus by administering oxygen to the mother, increasing her fluid intake or prescribing an agent to help the uterus relax. In some cases a cesarean section may be required.
Visit our comprehensive glossary for more pregnancy terms and definitions. resulting from a lack of oxygen, using electronic fetal monitoring and if necessary a cesarean section will be performed.
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