Premature labor and premature birth

What is premature birth?

If you've made the 37th week of pregnancy, then your baby is ""ready"" for delivery. Babies who are born before the end of the 37th week of pregnancy are considered to be immature. Most preemies are born after the 32nd week (HES online 2012a) and have a good chance of growing up healthy.

Intensive care for premature babies has improved dramatically in recent years, improving the chances of survival as well as the chance of a healthy life (Kyser et al 2012, RCOG 2014). A life that may be accompanied by long-term sequelae, such as cerebral palsy or learning disabilities (RCOG 2014).

Babies born between the 34th and 36th week of pregnancy tend to thrive and are fine. However, there is little risk of developing longer-term developmental problems compared to babies born on schedule (Boyle 2012, Engle and Kominariak 2008).

Generally, the longer your pregnancy lasts, the more mature your baby is. Its organs are more developed, the lungs mature for independent breathing and it has more power for sucking in food intake.

How common are premature births?

In Germany, well over nine percent of all babies are born too early (March of Dimes et al 2012). However, most only a few weeks before the end of the 37th week of pregnancy, only about one percent of premature babies are born before the 28th week (HES online 2012a).

If you are healthy and your pregnancy is going well, you are likely to give birth to your baby around the calculated due date (38th-42nd week). However, only two percent of these problem-free pregnancies lead to premature labor (Haas 2011).

How is a premature birth?

The majority of premature births begin with premature labor without rupture (Norman et al 2009, RCOG 2013, Romero et al 2013). Whereby a quarter of all premature births are planned - either vaginally by induction or by cesarean section. The health reasons are either with the mother or the child (Norman et al 2009).

Premature births are more common in twin or multiple pregnancies (HES online 2012b, NCCWCH 2011a). There is sometimes no explanation for early delivery in pregnancies with a baby (Haas 2011).

Reasons for premature labor may be:

  • A very plump, tight uterus (uterus), as is common in twin or multiple pregnancies, or you may have too much amniotic fluid (polyhydramnios).
  • Cervical weakness or a shortened cervix. Your gynecologist can tell by a palpation or ultrasound scan.
  • A previous spontaneous premature birth.
  • A bacterial infection in the uterus or amniotic fluid.
  • Your amniotic bladder is bursting prematurely.
  • Heavy bleeding.
  • Abnormal changes in the uterus.
  • (Haas 2011, Romero et al 2014)

The timing of pregnancy as well as your lifestyle can increase the risk of premature birth. You have an increased risk if:

  • The time interval between two pregnancies is low (Shacherand Lyell 2012)
  • You are in an emotional and / or financial emergency during your pregnancy (Haas 2011)
  • you smoking (Been et al 2014, Flood and Malone 2012) or consuming drugs, especially cocaine (Gouin et al 2011)
  • who are underweight (Dekker et al 2012, Han et al 2011) or severely overweight (Jeyabalan 2013, Torloni et al 2009a, b)
  • Why could my baby be born too soon?

    A birth before the calculated date of birth may be necessary for medical reasons. In this case, the birth is either initiated or performed by caesarean section. This is true in about a quarter of premature births (Norman et al 2009).

    Doctors recommend or prescribe an earlier birth if your baby:

    • does not grow
    • has abnormal symptoms

    Or if you:

    • have pre-eclampsia or diabetes
    • have a medical condition requires you to get your baby earlier to protect it (Haas 2011, Romero et al 2014)
    • You have fallen

    It does not have to be one of those reasons necessitating a premature birth, but it increases the risk of that it can happen.

    What should I do if I have premature labor?

    Even if you're not sure if it's premature labor, please be careful. Call your doctor or midwife or the ambulance at the hospital if:

    • Your amniotic sac bursts
    • if you have contractions before the 37th week of gestation

    You will probably get the information immediately Hospital to come. Ask a person you trust to take you there. Or arrange transport with the ambulance.

    What happens in the hospital?

    When you arrive at the hospital you should be informed by the staff about the progress. However, if you are prone to anxiety, ask everything that is on your mind. That's the only way you can make informed decisions later, if they are needed.

    Your doctor will ask you for a detailed account of the situation and ask if you have had those symptoms in a previous pregnancy.This is followed by a vaginal examination, often with ultrasound (RCOG 2006, 2012b). It is checked if your cervix (cervix) is shortened or already open.

    You may also be offered a fetal fibronectin test. This test can detect fibronectin in the vagina between weeks 22-34 weeks by vaginal examination. This special protein is located between the tissue layers of the uterus and amniotic sac. Announces the birth, the protein dissolves and gets into the vagina. This test and measurement of the cervix will tell you whether the birth is already on or just the wrong alarm (DeFranca et al 2013, van Baaren et al 2014).

    If your amniotic sac has not burst yet and there's no sign that you're about to give birth soon, you can probably go home. Frequently, premature labor stops and the pregnancy persists until the expected date of birth (van Baaren et al 2014). But if the birth is already in progress, it can not be stopped. (RCOG 2011)

    What happens when the birth starts?

    If you are between 24 weeks and 34 weeks pregnant, you will be given injections of steroids to speed up your child's lung maturity. (RCOG 2006, 2010, 2012b, c) This can help reduce early problems (RCOG 2006, 2010, 2012b) with breathing. The injections are useful if they have been administered at least twice 24 hours before birth (RCOG 2010).

    Tokolytics may also be used (RCOG 2006, 2011). These are contractions that can postpone a birth for a few days. You can suppress contractions until you have been given lung-injections for your baby, or your referral to a perinatal center is complete (RCOG 2011).

    Your doctor will not prescribe to you any tocolytics after the 34th week. Similarly, if he / she feels that it is medically more acceptable if your child is born prematurely. This is prescribed if your baby is not growing properly, if the birth is already in progress, or if you have a uterine infection or are seriously ill.

    If your amniotic sac has already burst, the midwife will take a swab from your vagina to check for infections (RCOG 2006, 2012b). B. with group B streptococci (GBS).

    Doctors often recommend antibiotics, even if there is no infection. On the one hand to prolong the pregnancy and on the other hand to protect the baby from transfers (RCOG 2006, 2013). If streptococci are found, the antibiotics can also be administered intravenously during labor to prevent transmission to the baby at birth. (RCOG 2012d)

    Your baby's heartbeat is being monitored. You can ask for painkillers. If the birth is already advanced, you are advised against pethidine or other opiates.Opiates can affect your child's breathing after birth. Epidural anesthesia is usually the drug of choice.

    Your doctor will probably suggest a vaginal delivery. Caesarean section is recommended if complications occur or are already present, such as: Eg, heavy bleeding, or your baby in distress (NCCWCH 2011b). Caesarean section is also advised if your baby is in a breech position.

    What happens after the birth?

    When your baby is born:

    • Extremely early (27 weeks or earlier) born babies need intensive care in a neonatal department, which probably requires relocation to a specialized clinic (perinatal center). Your little one needs a lot of warmth to keep him from hypothermia. His blood pressure and blood sugar must be monitored and protected against infection. In addition, his breathing probably needs support (Tommy's 2014).
    • Very Early (28 weeks to 31 weeks) , These babies probably need an incubator (Incubator: even though they are stronger than extreme preemies, there is still a risk of hypothermia, low blood sugar, or infection Babies need intensive care.
    • Moderate early (32 weeks to 33 weeks) The infant may have breathing, feeding or infection problems, in which case he may need special help
    • Early (34 weeks to 36 weeks) , The baby probably does not need any special treatments, he is smaller and more delicate, but he can often stay with you, maybe even temporarily Depending on your condition, your eating habits, and your values, your hospital's nursing home.

    If your baby needs immediate help after giving birth You might just take a quick look at it. This can be very scary and you stress. They therefore need sufficient support. Once your baby is stable, you can see it at any time. And despite intensive care, you can do a lot for your child, such as feeding, holding, stroking, massaging, talking to him and changing diapers.

    Babies born between the 23 and 25 weeks, unfortunately, have little life chances due to their level of development. Much depends on your birth weight and state of health at birth. (RCOG 2014) The more advanced the pregnancy, the better the chances of survival.

    The medical staff will do their utmost to give your child the best care and help. Sometimes it has to be discussed with the parents, whether a premature baby should be resuscitated or not. These are difficult decisions and subject to legal regulations, but also the long-term welfare of the child must be considered, not just short-term survival (RCOG 2014).

    In this difficult situation, your child needs both the medical care and the closeness and affection of his parents.

    Breastfeeding is optimal for all babies, but especially for premature babies who are at high risk of infection. Breast milk meets all the needs of a baby and provides extra protection. Some babies are still too small and tender to be able to aspirate, but the midwife shows you how to squeeze or pump out the milk. But it may also be that your baby gets a nasogastric tube. About that then the breast milk can be administered.

    Further suggestions, information and support: Family teasing and premature babies. Here you will find perinatal centers.

    You can also find help from other mothers or parents in our community!

sources

Been JV, Nurmatov UB, Cox B, et al. 2014. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet 383 (9928): 1549-60

Boyle EM, Poulsen G, Field DJ, et al. 2012. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 344: e896.

EA, Lewis DF, Odibo AO. 2013. Improving the screening accuracy for preterm labor: is the combination of fetal fibronectin and cervical length in symptomatic patients a useful predictor of preterm birth? A systematic review. Am J ObstetGynceol 208 (3): 233. e1-6

Dekker GA, Lee SY, North RA, et al. 2012. Risk factors for preterm birth in an international prospective cohort of nulliparous women. PLoS One 7 (7): e39154.

Engle WA, Kominiarek MA. 2008. Late preterm infants, early term infants, and timing of elective deliveries. ClinPerinatol 35: 325-41

Flood K, Malone FD. 2012. Prevention of preterm birth. Semin Fetal Neonatal Med 17 (1): 58-63

Gouin K, Murphy K, Shah PS. 2011. Effects of cocaine use during pregnancy on low birthweight and preterm birth: a systematic review and metaanalyses. Am J Obstet Gynecol 204 (4): 340. e1-12

Han Z, Mulla S, Beyene J, et al. 2011. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyzes. Int J Epidemiol 40 (1): 65-101.

Haas DM. 2011. Preterm birth. Clinical Evidence online: 4 Apr

HES online. 2012a. NHS maternity statistics, 2011-12. Health and Social Care Information Center.

HES online. 2012b. NHS maternity statistics, 2011-12 summary report. Health and Social Care Information Center, Hospital Episode Statistics.

Jeyabalan A. 2013. Epidemiology of preeclampsia: impact of obesity. Nutr Rev 71 Suppl 1: S18-25.

Kyser KL, Morris FH, Bell EF, et al. 2012. Improving survival of extremely preterm infants born between 22 and 25 weeks of gestation. ObstetGynecol 119 (4): 795-800

March of Dimes, PMNCH, Save the Children, WHO. 2012. Born Too Soon: The Global Action Report on Preterm Birth - country data and rankings for preterm birth data. Ed CP Howson, MV Kinney, JE Lawn. World Health Organization

NCCWCH. 2011a. Multiple pregnancy: the management of twin and triple pregnancy in the antenatal period. National Collaborating Center for Women's and Children's Health, NICE Clinical Guideline. London: RCOG Press.

NCCWCH. 2011b. Caesarean section. National Collaborating Center for Women's and Children's Health, NICE Clinical Guideline. London: RCOG Press.

Palmer KT, Bonzini M, Harris EC, et al. 2013. Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review. Occup Environ Med 70: 213-222

RCOG. 2006. Preterm prelabour rupture of membranes. Minor amendment October 2010. Royal College of Obstetricians and Gynecologists, Green-top guideline, 44. London: RCOG press.

RCOG 2010. Antenatal corticosteroids to reduce neonatal morbidity and mortality. Royal College of Obstetricians and Gynecologists, Green-top guideline, 7th London: RCOG press.

RCOG. 2011. Tocolysis for women in preterm labor. Royal College of Obstetricians and Gynecologists, Green-top guideline, 1b. London: RCOG press.

RCOG. 2012a. In vitro fertilization: perinatal risks and early childhood outcomes. Royal College of Obstetricians and Gynecologists, Scientific impact paper, 8th London: RCOG press.

RCOG. 2012b. Information for you: when your waters break early. Royal College of Obstetricians and Gynecologists.

RCOG. 2012c. Information for you: corticosteroids in pregnancy to reduce complications from premature birth. Royal College of Obstetricians and Gynecologists.

RCOG 2012d. The prevention of early-onset neonatal group B streptoccal disease. Royal College of Obstetricians and Gynecologists, Green-top guideline, 36. London: RCOG press.

RCOG. 2013. Preterm labor, antibiotics and cerebral palsy. Royal College of Obstetricians and Gynecologists, Scientific Impact Paper, 33. London: RCOG press.

RCOG. 2014. The Royal College of Obstetricians and Gynecologists, Scientific Impact Paper, 41. London: RCOG press. Romero R, Dey SK, Fisher SJ. 2014. Preterm lab: one syndrome, many causes.

Science 345 (6198): 760-5 Schleu├čner E. 2013.

Imminent premature birth: prevention, diagnosis and therapy. In: Deutsches Ärzteblatt. As of August 2015 Shacher BZ, Lyell DJ. 2012. Interpregnancy interval and obstetric complications.

ObstetGynecolSurv 67 (9): 584-96 Tommy's. 2014.

Gestational age and medical needs. Torlon MR, Betran AP, Horta BL, et al. 2009a. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis.

Obes Rev 10 (2): 194-203 Torloni MR, Betran AP, Thus S, et al. 2009b. Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis.

J Matern Fetal Neonatal Med 22 (11): 957-70 vanBaaren GJ, Vis JY, Wilms FF, et al. 2014. Predictive value of cervical length measurement and fibronectin testing inthreatened preterm laboratory.

ObstetGynecol 123 (6): 1185-92 Show Sources Hide Sources

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