A full pregnancy lasts approximately 40 weeks, while premature birth is defined as convulsions that cause the opening of the cervix before the 37th week, that is, three weeks before the estimated date of birth of the child.
Depending on how early a baby is born, he or she may be:
1. Late preterm, born between 34 and 36 completed weeks of pregnancy.
2. Moderately preterm, born between 32 and 34 weeks of pregnancy.
3. Very preterm, born at less than 32 weeks of pregnancy.
4. Extremely preterm, born at or before 25 weeks of pregnancy.
Most premature births occur in the late preterm stage.
Symptoms of premature labor.
The signs of premature labor cannot be mistaken for some women. However, sometimes the signs are less clear and therefore it is necessary to notice the following symptoms of premature labor:
▪️ Cramps appearing in the lower abdomen, more than 8 times an hour. These cramps cause the stomach to expand and remind us of period pain.
▪️ Dull pain in the lower back.
▪️ A feeling of increased pressure in the pelvic area.
▪️ Vaginal bleeding.
▪️ Fluid coming out of the vagina.
Causes and risk factors of preterm labor.
Premature labor may occur in every woman and in every pregnancy. However, there are cases in which the prevalence of preterm labor is higher.
The causes of premature labor include:
_ Premature birth in the past.
_ Twin or triplet pregnancy.
_ Disturbances of the vagina, womb or placenta.
_ Smoking cigarettes, drinking alcohol and using drugs.
_ Various infections, especially those affecting the amniotic fluid or the reproductive system.
_ Chronic diseases such as high blood pressure and diabetes.
_ Loss or increase in weight before pregnancy, and also, slight or large weight gain during the same period of pregnancy.
_ Stressful life events, such as recent death or exposure to particularly violent life events.
_ Recurrent miscarriages in the past.
_ A period of less than six months between pregnancy and another.
_ Pregnancy through in vitro fertilization.
_ Having had a miscarriage or induced abortion several times.
Although the exact cause of preterm birth is often unknown, there are some things that can be done to help women — especially those who have an increased risk — to reduce their risk of preterm birth, including:
▪️ Progesterone supplements. Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.
▪️ Cervical cerclage. This is a surgical procedure performed during pregnancy in women with a short cervix, or a history of cervical shortening that resulted in a preterm birth.
During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it’s time to deliver the baby.
Some problems may be apparent at birth, while others may not develop until later.
In the first weeks, the complications of premature birth may include:
1. Breathing problems. A premature baby may have trouble breathing due to an immature respiratory system.
Premature babies may also develop a lung disorder known as bronchopulmonary dysplasia. In addition, some preterm babies may experience prolonged pauses in their breathing, known as apnea.
2. Heart problems. The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension).
3. Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage.
4. Temperature control problems. Premature babies can lose body heat rapidly. They don’t have the stored body fat of a full-term infant, and they can’t generate enough heat to counteract what’s lost through the surface of their bodies.
Hypothermia in a premature baby can lead to breathing problems and low blood sugar levels. In addition, a premature infant may use up all of the energy gained from feedings just to stay warm.
5.Gastrointestinal problems. Premature infants are more likely to have immature gastrointestinal systems, resulting in complications such as necrotizing enterocolitis (NEC).
6. Blood problems. Premature babies are at risk of blood problems such as anemia and newborn jaundice. Anemia is a common condition in which the body doesn’t have enough red blood cells.
Newborn jaundice is a yellow discoloration in a baby’s skin and eyes that occurs because the baby’s blood contains excess bilirubin, a yellow-colored substance, from the liver or red blood cells. While there are many causes of jaundice, it is more common in preterm babies.
7. Metabolism problems. Premature babies often have problems with their metabolism. Some premature babies may develop an abnormally low level of blood sugar (hypoglycemia). This can happen because premature infants typically have smaller stores of stored glucose than do full-term babies. Premature babies also have more difficulty converting their stored glucose into more-usable, active forms of glucose.
8. Immune system problems. An underdeveloped immune system, common in premature babies, can lead to a higher risk of infection. Infection in a premature baby can quickly spread to the bloodstream, causing sepsis, an infection that spreads to the bloodstream.
In the long term, premature birth may lead to the following complications:
1. Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or posture that can be caused by infection, inadequate blood flow or injury to a newborn’s developing brain either early during pregnancy or while the baby is still young and immature.
2. Impaired learning. Premature babies are more likely to lag behind their full-term counterparts on various developmental milestones. Upon school age, a child who was born prematurely might be more likely to have learning disabilities.
3.Vision problems. Premature infants may develop retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually scar the retina, pulling it out of position.
4. Hearing problems. Premature babies are at increased risk of some degree of hearing loss. All babies will have their hearing checked before going home.
5. Dental problems. Premature infants who have been critically ill are at increased risk of developing dental problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.
6. Behavioral and psychological problems. Children who experienced premature birth may be more likely than full-term infants to have certain behavioral or psychological problems, as well as developmental delays.
7.Chronic health issues. Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants. Infections, asthma and feeding problems are more likely to develop or persist. Premature infants are also at increased risk of sudden infant death syndrome (SIDS).
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Prevention of Preterm Labor./www.mayoclinic.org