The unintended birth of a baby before the 37th week of pregnancy, that is, not yet mature enough to live outside the womb, is called preterm birth. Births that occur before the 20th week of pregnancy are called miscarriages.
The onset of labor pains in this period, that is, before the 37th week, is called the threat of premature birth. This is observed in approximately 10% of all pregnancies. Premature birth is the leading cause of death and problems in newborn babies.
These babies are called premature babies.
The most important problem of premature babies is that they experience breathing difficulties as a result of insufficient lung development. Also, the earlier the baby was born, the greater the risk of problems with the central nervous system.
The risks to life of babies born with preterm birth decrease as the gestational week progresses. In recent years, developments in premature baby care are also quite high and the chances of survival of even very preterm babies are increasing.
However, premature baby births still bring serious problems all over the world. And the medical care costs required to care for these babies and to eliminate the complications that may develop are also quite high.
What are the causes of preterm birth?
It is generally thought that preterm labor has more than one cause and starts with more than one mechanism.
Among the reasons for the baby, there may be multiple pregnancy, early separation of the baby’s partner (placenta), excess or low water in the baby.
Maternal causes include being pregnant under the age of 17 and above the age of 34, high blood pressure during pregnancy, being overweight or underweight for height, infections in the lower genital tract, bleeding due to various reasons during pregnancy, uterine abnormalities, frequent pregnancies, maternal lung, heart disease. Various systemic diseases such as kidney, liver, anemia, severe nutritional deficiency, smoking and alcohol consumption, mental depressions, intense stress and sadness and heavy working conditions can be counted.
It is seen that there are many reasons that can cause premature birth. However, sometimes premature births can occur for no apparent reason.
One of the most important points is that pregnant women who have experienced the risk of preterm birth in their previous pregnancy or pregnancies should be aware that they are at significant risk in these pregnancies.
What are the symptoms of preterm birth?
Regular uterine contractions and their recognition are the primary signs of preterm labor.
You can feel the contraction of the uterus with your fingers on your stomach. This feeling may be in the form of a feeling of your uterus clumping and hardening in the abdominal wall or feeling more tense than usual.
It is especially important if the hardening is recurring at certain intervals. Initially, they are painless without causing discomfort. You should inform your doctor as soon as possible when they occur more than 3-4 times per hour.
It should not be forgotten that success in preventing preterm labor depends on its early detection.
Other symptoms;
• cramp-like pain in the groin areas, similar to menstrual pain,
• pains in the lower back or lumbar region,
• vaginal spotting or bleeding,
• a watery increase in vaginal discharge,
• downward pressure feeling.
The diagnosis of preterm labor is made by detecting uterine contractions. Before the 37th week of pregnancy, it is diagnostic if two contractions are palpated every 10 minutes in at least half an hour of observation. If the contractions cannot be detected manually or cannot be sure, they can be easily detected with the Uterine Monitor Test (Tocography) performed with the sensor over the abdominal wall.
What should be done when the risk of preterm birth is detected in the pregnant woman?
First of all, the pregnant should be taken to bed rest and fluid intake should be increased.
Then, it should be investigated whether there are any factors that may cause preterm labor and if it is detected, it should be treated as soon as possible.
It is possible to stop or delay preterm labor with medical treatment, except in some cases that require emergency delivery.
For this purpose, various treatment methods in order to stop the contractions and, if necessary, drugs to ensure the lung maturation of the baby are applied by the physician following the pregnant.
The treatment given to stop uterine contractions is called tocolysis in medical language.
There are various drugs available for tocolysis. These are muscle relaxant effects;
• ß agonist agents (terbutaline, ritodrine),
• magnesium sulfate,
• calcium channel blockers,
• Indomethacin group drugs can be used, which prevent the effect of contractile chemicals called prostaglandins.
Each group of drugs has various side effects. Therefore, tocolysis application is not an ordinary treatment. For this reason, especially intravenous (intravenous) treatment is applied in the hospital under the supervision of a doctor.
Especially in ritodrine group drugs, which is the most commonly used group; increased heart rate, low blood pressure, shortness of breath may occur. These side effects can be serious and require discontinuation of treatment.
It is generally not applied in the presence of heart disease, diabetes, hypertension, and hyperthyroidism in the expectant mother.
If the contractions stop completely after one of these treatment options is applied, the treatment with oral tablets can usually be continued, the expectant mother can be well informed about the contractions and the monitoring can be continued at home.
35-36. After the gestational week, drug therapy is usually discontinued.
Pregnant women who are discharged after receiving treatment due to the risk of premature birth should be sent home, provided that they are strictly followed.
It is useful to measure the length of the cervix at regular intervals, starting from the 24th week of pregnant women who are at risk for preterm birth (for example, pregnant women who gave birth prematurely, known to have cervical insufficiency or carrying a twin pregnancy).
In addition, taking cultures from the cervix during these periods in patients with significant risk and applying the necessary treatment is also among the preventive measures.
