This article first appeared on Smart Parenting magazine in August 2004
One of the things expectant parents dread the most, aside from pregnancy complications, is giving birth prematurely. Martin P. Manahan, M.D., an OB-gyne at the Makati Medical Center, shares some vital information on premature birth and ways to prevent it.
Causes of early labor Premature labor, or labor before term, can be caused by several factors. Some of these are:
1. Infection The most common are infections in the reproductive organs and in the urinary tract. When there is an infection that could harm the fetus, the mother’s body reacts by shielding the baby from possible danger and manifests through early labor, says Manahan.
2. Incompetent cervix A condition in which the cervix dilates prematurely, without any contraction. “There should only be 10 percent smooth muscle in the cervix. When there is too much, the cervix becomes too soft and tends to dilate,” Manahan adds. This is common among women who experience painless miscarriages.
3. A history of endometriosis A condition wherein the menstrual blood and inner uterine lining go into the tubes and deposit in the pelvic area instead of going out through the vagina. “This condition causes the production of prostaglandin which causes preterm labor,” Manahan says. Menstrual cramps are a symptom of this condition. Doctors can check for this through internal exams, clinical history and ultrasound.
4. Antiphospholipid Antibody Syndrome (APAS) This is a rare autoimmune disease. In a normal pregnancy, the body doesn’t react to the fetus adversely. “Here, the body reacts by recognizing the baby as a foreign body or object and fights it. The body reacts by clotting the blood, killing off the blood supply to the baby. In such a case, we give the mother blood thinners or anticoagulants,” Manahan says.
Signs and symptoms “Crampy pain in the abdomen and heaviness in the pelvic area are common signs of preterm labor,” explains Manahan. “There may be unusual blood or water discharge. If your stomach hardens regularly, that is also a sign of labor.”
More dangerous than obvious premature labor is when there are no signs of labor. A pregnant woman may not feel anything wrong, not realizing that her preterm baby may soon come out or is already in some distress. If not detected on time, a miscarriage or a premature delivery could result.
Doctor detection Labor before 20 weeks of gestation is known as threatened abortion. “Very early in pregnancy, the doctor checks for signs of infection through a pap smear, a urinalysis, and a complete blood count,” Manahan shares. “If there is suspicion, an ultrasound may be performed to see if there is funneling or if the cervix is already starting to thin out.”
If premature labor is experienced in early pregnancy, the mother is usually given progesterone, a hormone that helps support pregnancy. She may also be given uterine relaxant to prevent contractions.
Labor at 20 weeks or more of gestation is called premature labor. If a woman shows signs of premature labor, she is first put on complete bed rest. If this persists, she is given oral medication. If it is not enough, she is brought into the hospital and a fetal monitor or ultrasound is used to observe her and her baby. She is treated through tocolysis —- a procedure wherein a uterine relaxant is given intravenously to prevent contractions and to take care of any infection that may be present.
Common complications The first thing doctors look out for in premature infants is hyaline membrane disease. With this condition, “the lungs of the infant cannot handle being outside the womb. It doesn’t produce enough surfactant, which enables the lungs to expand,” says Manahan.
Neurologic deficit (a decrease in the function of the brain, spinal cord, muscles, or nerves) may later on manifest in a child born prematurely. This can be detected and treated by a pediatrician. A premature infant who is confined in the nursery for a prolonged period is also susceptible to infections.
To the mother, the possible physiological complications are the same whether delivery is premature or at full term. There is, however, a very real risk of psychological damage or trauma to the mother who experiences unwanted abortion or miscarriage. “In this situation, the woman may feel a strong sense of guilt. We assure her that we did everything we could possibly do and that she didn’t do anything wrong,” Manahan explains.
Preemie prevention A pregnant woman who will feel symptoms of premature labor should contact her doctor immediately and go to the hospital or delivery room, Manahan strongly advises. “Don’t eat or drink, in case an operation needs to be done. Don’t just sit and wait. If you know there is a possibility of premature labor, be vigilant. The earlier you catch it, the better. There is no household remedy for it,” he adds.
To help avoid premature labor, women should do their best to stay healthy. Manahan advises maintaining one’s level of activity before pregnancy, unless there is pain. “Just don’t start something more strenuous than what you’re used to. Take lots of fluids. Eat healthy. Avoid being around sick people. And definitely no smoking!” he says.