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Preterm Labor and Birth

Preterm Labor and Birth

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Symptoms

  • Contractions (tightening and hardening of the uterus), occurring more than four per hour (may be painless).
  • Low cramps, similar to menstrual cramps.
  • Low backache.
  • A feeling of pelvic pressure.
  • Abdominal cramps, gas or diarrhea.
  • A change in quality or quantity of vaginal discharge, especially any gush or leak of fluid.

Causes

Premature delivery may be preceded either by contractions or premature rupture of the fetal membranes (PROM), when the water breaks before labor begins. Although there have been many advances in caring for premature babies, there has been no improvement in solving the problem of preterm labor or PROM. We don't completely understand why some women go into labor or break their bag of water too early. We are often unable to accurately predict which women will do so, and we are limited in preventing these women from giving birth prematurely. In some cases, an infection may be involved; in others, it may be an abnormally short cervix or a combination of factors. In about half of all cases, no cause can be found. The number of babies born prematurely in the United States has actually risen in the last 10 years.

Diagnostic and Test Procedures

If you go to your health-care provider or a hospital because you think you may be in preterm labor, monitors will be placed on your abdomen to measure your baby's heart rate and record any uterine contractions that you have. The doctor will do a pelvic examination to check if your cervix is dilating. If you report that you think your water has broken or if the doctor sees any fluid coming from the cervix, he or she will take a small sample of fluid in order to determine whether it is truly amniotic fluid. If it is, a sample may be sent to a laboratory to determine how mature your baby's lungs are. Alternatively, your doctor may choose to perform an amniocentesis, which can provide information about your baby's lung development. Swabs of your cervix will be sent to a laboratory to test for infection, such as the presence of beta Strep. Your practitioner will want to test your urine for infection. You may be asked to provide a urine specimen, or your practitioner may put a tiny tube in your bladder (catheter) to remove a urine sample.

Treatment

If you get to the hospital early in labor, your practitioner can stop labor from progressing with hydration, bed rest, muscle relaxants or other drugs, possibly requiring hospitalization. The intent is to stave off labor to allow the baby's lungs and other organs more time to develop and reach maturity. Furthermore, if doctors can prevent delivery for even a little while, the mother can be given steroids to speed up the baby's lung development.

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