When 'Labor Day' Comes Early
July 23, 2001 -- From cancer to diabetes to heart disease,
medical advances have been impressive over the past few decades. But there is
one area where doctors have not made as much progress -- preventing preterm
For many reasons -- increasing maternal age, rising rates of
multiple births thanks to advances in fertility -- the rate of early deliveries
has risen sharply in the U.S., with an increase of 23% in the past 20
"The national controversy is what to do about it," says
Fung Lam, MD, chief of gynecology and vice chairman of obstetrics and
gynecology at California Pacific Medical Center in San Francisco. "The
pendulum is swinging back and forth, and currently the national view that's
holding sway is that interventions are not successful."
But Lam and others on the frontlines of neonatal care say this
is not true. There are many medications and tactics doctors can employ to
extend a pregnancy if preterm labor is diagnosed.
'A Major, Major Problem'
Each day in the United States, 1,239 babies are born preterm --
that is, less than 37 weeks into the pregnancy. A normal pregnancy lasts 40
weeks after the first day of the last menstrual period. Infants born early are
more likely to be low weight and suffer complicated health problems including
underdeveloped lungs. They are 13 times more likely to die in their first year
of life than other newborns.
"It is still a major, major problem," says James Martin
Jr., MD, president of the Society for Maternal Fetal Medicine and director of
maternal-fetal medicine at the University of Mississippi Medical Center in
"The thrust of a lot of research is to better diagnose the
patient at risk and to intervene effectively ... so baby can safely remain in
utero for a longer amount of time," Martin tells WebMD.
But premature labor can be difficult to diagnose. Symptoms can
include contractions, backache, a feeling of pelvic pressure, abdominal cramps,
gas, and/or diarrhea.
And it's expensive. Consider that neonatal intensive care units
cost at least $3,000 per day, and preterm infants who survive spend many weeks
or months there.
Exactly why it occurs is not fully understood, but women are
more likely to experience preterm labor or deliver prematurely if they have
done so in the past, are carrying multiple babies, and/or have certain medical
conditions that can complicate pregnancy.
"Doctors get a failing grade at how well we understand the
process, and we are not much better at treatment," says Stephen Chasen, MD,
director of high-risk obstetrics at New York Weill-Cornell Center.
The Pharmaceutical Approach
If a women comes in with uterine contractions before 34 weeks,
doctors typically assess the cervix to document contractions and/or other
changes to the cervix.