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When baby is in a hurry

Here’s all you want to know about preterm labour

Susan is worried. Should she be hitting the panic button? She is only 8 months pregnant but since this morning she has been having lower abdominal pain. In the beginning, it felt like menstrual cramping but now there is squeezing pain which comes eve ry 10 minutes. Could Susan be in preterm labour?

What is preterm labour?

When labour begins before 37 weeks of pregnancy, it is considered preterm or premature. The exact causes of preterm labour are not known.

Warning signs of preterm labour

If preterm labour is recognided early enough, delivery may be prevented or postponed in some cases. Even a few more days may mean a healthier baby. It is important to call your doctor or go to the hospital right away if you notice any of these symptoms: Watery, mucoid, or bloody vaginal discharge Sudden increase in amount of vaginal discharge Pelvic or lower abdominal pressure Constant, dull, low backache Mild abdominal cramps like menstrual cramps Regular or frequent contractions or uterine tightening, sometimes painless A trickle or gush of fluid from the vagina

Am I in preterm labour?

It is common to have Braxton-Hicks contractions, which are painless tightening of the abdomen in the last three months of pregnancy. With rest, they usually subside within an hour or so. If there are frequent contractions, you need immediate medical attention.

Preterm labour can be confirmed by finding out if thinning and dilatation of the cervix (mouth of the uterus) have occurred.

Preventing preterm labour

Initiating regular antenatal checkups early in your pregnancy and continuing regular checkups with your obstetrician can help prevent preterm labour. Women who have had a previous preterm delivery may be given injectable progesterone, a hormone to help prevent another preterm delivery. In most cases, women at risk for preterm labour do not have to be at bed rest and many of them can continue to work. Treatment of preterm labour

Once preterm labour is suspected, your obstetrician will admit you to the hospital for observation. The objectives of treating preterm labour are twofold.

One is to try and stop labour, as long as it does not jeopardise the mother’s health. The other is to ensure that if the baby is born in spite of preventive measures, then its lungs should be mature enough for it to survive.

Steroids are administered if it appears that the chances of the baby being born early are high. Steroids cross the placenta and help the baby’s lungs mature and also prevent bleeding into the brain. Steroids are most likely to h elp the baby when used between 24 and 34 weeks of pregnancy.

Preterm delivery

A vaginal delivery will be attempted if the preterm labour is progressing well and does not seem to be presenting any risk to the foetus. If there is reason to believe that the preterm baby may not be able to tolerate the stresses of labour, or if there are any maternal complications, then a caesarean section may be advised.

Today, with special care in a neonatal intensive care unit (NICU), even babies born between 28-30 weeks have a reasonable chance of survival.

GITA ARJUN

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)

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