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Preterm Labor and Birth

Preterm Labor and Birth
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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.

If your health-care provider determines that you are in preterm labor, you may be admitted to the hospital. You'll probably be given intravenous fluids (through a needle in your arm). The most common medications used to stop or slow labor contractions are magnesium sulfate, ritodrine (the only FDA approved medication for premature labor) and terbutaline. A number of other medications are still being investigated for this use, including prostaglandin synthetase inhibitors (indomethacin), calcium-channel blockers, aminophylline and progesterone. You are often given an antibiotic prophylactically, even if you have no obvious infection. Also, you'll usually be given steroid medications to speed up your baby's lung development.

If your contractions are successfully stopped, you may be sent home from the hospital, sometimes with an oral medication. You'll probably be asked to decrease your activity level, or even to stay on bedrest, until you get closer to your due date.

Sometimes when you are in premature labor, your doctor may choose to allow you to deliver the baby early, rather than trying to stop labor. This choice is usually made when the mother is suffering from an infection of the amniotic fluid and uterus, or has illnesses such as severe preeclampsia or eclampsia (forms of high blood pressure that occur during pregnancy). Delivering the baby prematurely may also be preferable if fetal evaluation shows that the fetus is not doing well, if there is placenta previa (placenta covering the cervix) that bleeds a lot, if there is abruptio placentae (detachment of the placenta) or if certain birth defects or malformations are identified.

Prevention

The most important thing you can do to try to have a healthy baby is to get early and adequate prenatal care. In fact, the best prenatal care begins even before you are pregnant. That way, you can be sure that you are in the best of health before pregnancy. Your practitioner will screen you for risk factors of premature delivery and discuss which precautions you could take. Measuring the length of the cervix using a special transvaginal ultrasound probe can predict a woman's risk of delivering prematurely. This is usually done in the doctor's office between 20 and 28 weeks of pregnancy. Researchers are studying vaginal secretions called cervicovaginal fetal fibronectin as a possible predictor of preterm labor. A woman at increased risk for premature delivery can be forewarned about what to do if symptoms occur, and may undergo further screening tests.

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