Diseases

Premature birth

Premature birth is the birth of baby before completion of the normal gestation period and proper development of foetus to full maturity. A full term baby is the one which has completed 37 weeks of gestation period. Baby born before 37 weeks is considered as preterm. Organs mature between 34 and 37 weeks. Thus a premature baby is also called as preterm as the organs are underdeveloped.

Published December 30, 2021

Causes and risk factors

Preterm birth is likely to occur if the woman has history of preterm delivery or abortions in the earlier pregnancies, in case of multiple pregnancy, abnormal shaped uterus or cervix, age of the pregnant lady below 17 or above 35, less than 6months interval between 2 pregnancies, being underweight, medical history like diabetes, kidney disease, heart disease, or any other infection, smoking, mental or physical stress.

Clinical presentation

A preterm baby has respiratory distress, difficulty in sucking and swallowing; it is small in size and has a large head not in proportion with rest of the body, fragile skin, sharp features, low body temperature, fine hair all over the body. Premature babies are susceptible to infections. Higher the prematurity higher the risk.

Investigation

Medical history by the patient and Clinical examination by the gynaecologist helps in diagnosis. Before 37 weeks of gestation following will indicate premature labour – Four or more uterine contractions in an hour, abdominal or back pain, bleeding per vagina in third trimester, watery discharge from vagina indicating premature rupture of membranes . Pelvic exam to determine dilatation and opening of cervix, ultrasound exam to measure the length of cervix, position of uterus, size, age weight of baby, foetal heart sound to determine well being of baby, amniocentesis, lab tests of vaginal secretions like fibronectin will help in diagnosing the possibility of preterm delivery.

Treatment

Cervical cerclage is a procedure done in early stages of pregnancy to prevent preterm birth where cervix is sutured and closed. The patient is advised strict bed rest for first 3 months of pregnancy. In later stages before 34 weeks if the patient is in active labour, she is advised hospitalisation. A premature baby is kept in incubator or radiant warmer in the NICU. Intravenous infusions, oxygen supplementation, ventilation is the treatment given to preterm babies in the NICU.

Recent updates

Encouraging breast feeding is recommended which reduces preterm mortality.