The start of labor before the completion of the 36th week of pregnancy is called preterm birth (EDT), while the labor that results in the birth of the baby is called preterm birth or premature birth. A baby born prematurely is called premature (immature).
Approximately 8% of all pregnancies result in premature birth.
In a premature baby, the organ systems, and especially the lungs, are not fully mature, and therefore premature birth is among the leading causes that require intensive care for the baby and/or lead to the baby's death in the early period after birth.
If the diagnosis of preterm labor is made early, it can be stopped. Therefore, it is important for every expectant mother to be informed about the threat of premature birth and to be sensitive to the symptoms.
- Why does labor start early?
There are many factors that start labor early. The most effective among these are multiple pregnancy and polyhydramnios (the baby's fluid is more than normal) These two conditions can cause the uterus to stretch beyond its capacity and contract before term to "get rid" of this great load. In twin pregnancies, it is a rule that labor begins earlier than in single pregnancies, and in some cases, labor may begin before the 36th week.
Breaking of waters before term, that is, premature rupture of membranes (EMR), is another factor that initiates labor. Some substances released by the breaking of waters and the added infection trigger premature labor.
Genital system infections (especially infections caused by group B streptococci, bacterial vaginosis and vaginitis due to trichomonas, infections caused by chlamydia, anaerobic bacteria, ureoplasma and mycoplasma) and urinary system (urinary tract ) infections can initiate premature labor.
In cases such as placenta previa (placenta blocking the birth canal), ablatio placenta (early separation of the placenta), labor may start earlier.
The nutrition of the expectant mother may occur earlier. inadequate, low socioeconomic level, geographical region Factors such as birth defects, severe anemia in the expectant mother, and smoking may also be effective in initiating labor.
- Premature birth by doctor's decision:
Approximately 30% of all preterm births The pregnancy is terminated upon the doctor's decision.
In every case where the mother's life is in danger, birth is performed by induction (artificial pain) or cesarean section, regardless of the baby's maturity level. Conditions such as severe preeclampsia, eclampsia, HELLP syndrome, where the continuation of pregnancy is undesirable, the expectant mother having severe heart disease, or bleeding placenta previa and ablatio placenta can be given as examples of this situation.
Delivery is also performed in cases where it is undesirable for the fetus to continue living in the uterus. The best example of this is the development of fetal distress. In case of severe fetal distress, before the baby dies or asphyxia develops, an emergency cesarean delivery is performed, if necessary, and the baby is given the necessary treatment.
- Which expectant mothers are at risk?
Ostensibly obstetric (pregnancy-related) or medical An expectant mother who has no problems and continues regular antenatal check-ups has a low risk of premature birth. In our society, expectant mothers prefer to act very anxiously and cautiously during their pregnancies, as if the more anxious and stressed they are, they think they are doing the best thing for their pregnancies. Hormones disrupt the biochemistry in the baby-mother exchange, increasing the risk of premature birth. The more peacefully they spend their pregnancies and the more they communicate with their unborn babies, the more healthy they will have pregnancies. If statistics say that 90 out of 100 pregnancies give birth on time in a healthy manner, My advice to our pregnant women is to never stop looking at the issue from the whole point of view. They should be able to say that my probability of giving birth prematurely is statistically low (8-10% probability). A carefree and peaceful pregnancy, It is the biggest investment made both in the course of pregnancy and in the future baby.
Expectant mothers who have previously given birth prematurely or have received treatment due to the threat of premature birth are at risk in the current pregnancy. The risk of recurrence of this condition in subsequent pregnancies for an expectant mother who has given birth prematurely once is between 25-50%.
The risk of preterm birth is increased in expectant mothers who have had recurrent miscarriages, especially second trimester miscarriages.
Deformities in the uterus. The risk is increased in expectant mothers with (such as double uterus, uterus bicornis, septum within the uterus).
Congenital damage to the cervix or as a result of a surgical intervention applied to the cervix (such as conization). The risk is increased in expectant mothers with emerging cervical insufficiency.
The risk is increased in expectant mothers with multiple pregnancies and in expectant mothers diagnosed with polyhydramnios.
Abdominal surgery during the current pregnancy (appendicitis, or ovarian cyst surgery). The risk of premature birth is increased in expectant mothers who have had uterine myomas (especially those who have many myomas, whose myomas grow during pregnancy, or who have large myomas from the beginning).
Apart from these basic risk factors, the risk is increased in expectant mothers who have bleeding after the first trimester, who do heavy work (works that require heavy lifting, smokers, especially those who smoke 10 or more a day).
Excessive weight loss in a short time, having a febrile illness, severe physical or mental stress (fatigue), being under 18 years of age or over 40 years of age at the time of pregnancy, body weight less than 50 kilograms at the time of pregnancy, height Being shorter than 150 cm, having anemia (hematocrit<34), having a urinary tract infection during pregnancy, having a baby under one year old, living in a very low socioeconomic environment, having two or more young children at home. Being present and being separated from your partner are other factors that may increase the risk of premature birth, although it is not certain.
- What are the symptoms of premature labor?
The main condition for premature birth is the presence of uterine contractions. Cervix dilation without contraction little. While contractions manifest themselves with pain in some pregnant women, they may not cause any pain in others. The pain threshold is different for everyone. The expectant mother should look for answers to the questions "Do I have contractions, if so, are they regular, and are they becoming more frequent?" To do this, take a resting position for 10-15 minutes, touch the palm of your hand to your abdomen, and see if there is a contraction (the baby from the inside). Even when you move, innocent contractions may occur. If so, you should check whether they are regular, how long they last, and how frequent they are. If contractions occur four times an hour or more frequently, you should consult your doctor.
- Other symptoms:
Other important symptoms of threatened premature labor include a feeling of fullness in the pelvis, cramp-like pain similar to menstrual pain, headaches that do not go away with changing positions, increased vaginal discharge or Change in its characteristics (appearance of more mucous, watery or bloody discharge), intestinal cramps that occur with or without diarrhea. In this case, control your contractions manually. These symptoms do not have any meaning on their own without contraction. However, if you have any of these symptoms and you are not sure whether you are having contractions, you should consult your doctor.
- How is the diagnosis of threatened premature birth made?
It is not always easy to diagnose True Preterm Birth Threat (EDT). Diagnosing an expectant mother with EDT when she does not actually have EDT results in the expectant mother being treated with medications that can have serious side effects and having to stay in the hospital for long periods of time. On the contrary, failure to diagnose the candidate with EDT results in the birth of a premature baby. Premature babies face conditions that require intensive care and even the risk of death. For this reason, it is treated very sensitively and EDT is diagnosed in more cases than necessary. When EDT is suspected, careful evaluation of the risk factors and clinical findings of the expectant mother may reduce the number of cases unnecessarily diagnosed with EDT.
First reviews: One of the wrong beliefs in our society is 'Doctor v. It is the belief that she examined aginally, that's why I gave birth prematurely or had a miscarriage.'In case of threat of miscarriage or premature birth, there is no harm in transvaginal examination, on the contrary, it leads us to diagnosis and real treatment. Therefore, as the first examination, transvaginal cervix (cervical length) findings of shortening and cupping provide a long way to go in early diagnosis and treatment.
If there is no vaginal bleeding in an expectant mother who presents with contractions, the first examination to be performed is a sterile vaginal touch after the general anamnesis and pregnancy examination. Just before vaginal touch, a speculum is placed on the cervix and a fluid sample is taken from the depths of the vagina. By measuring the pH of this taken liquid, premature membrane rupture (EMR) investigation is performed. This examination is important because some of the premature births may begin after EMR, which may or may not be noticed by the pregnant woman. Apart from the routine examinations performed on all pregnant women (complete blood and complete urine examination, urine culture), if necessary, vaginal cultures are taken for gonorrhea, group B streptococcus and chlamydia.
If the cervix dilation is above a certain level (approximately four cm.), the diagnosis of EDT is definitive. Since there is no chance of stopping the labor with medication at this stage, the labor is left to its own course. The birth must take place in a hospital with intensive care facilities for the premature baby.
If the cervix is dilated at the touch and the opening is four cm. If it is below the cervix, if there is a thinning of the cervix, contractions are monitored. For this purpose, contraction monitoring is either done manually or a cardiotocography (NST) device is used. If four or more contractions are detected during the 20-minute examination, the diagnosis of EDT is definitive. The expectant mother is hospitalized and tocolysis treatment is started. Sometimes it may even be necessary to put stitches on the cervix.
Cases that present with contractions and have active contractions during follow-up, but whose cervix findings show very slight progression, create problems in diagnosis. In this case, follow-up is performed in the hospital to confirm the diagnosis. The expectant mother should be laid on her left side and an intravenous line should be established.
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