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Premature birth or Preterm delivery is certainly a not so good outcome for the mother and the baby . It is associated with complications to the baby and threat to its life as the baby is very small and may not be able to sustain .Also many babies can suffer from growth lag and future longterm serious consequences . A large number of premature deliveries can be prevented by proper knowledge to the mother and the family .This is the purpose of this blog .
Preterm deliveries are a huge burden on the society and the family .This is because a lot of resources are necessary to help the baby survive and then rehabilitate to be able to reach the standard outcomes . Such deliveries have multifactorial causes and some treatments not essentially effective . A lot of respite can be sort if all are aware of the causes and are able to take care of their own self through this awareness .
With the purpose of education of women have penned this article .In addition I must mention that I have been through a preterm delivery myself and have been successful in managing it 21 years back despite not so effective resources then as they are today .
What is premature birth or preterm delivery ?
Birth before the stipulated duration of 37 weeks and after the completion of viability at 20 weeks is preterm delivery /labour / birth .Such a delivery is associated with serious complications and sometimes inability to survive in the newborn as it is not capable of an independent existence . Within the spectrum of preterm births if they occur at or after 34weeks and the baby birth weight is more than 1200 to 1500 g the babies have a better chance of survival and less possibility of remnant disorders .
Why is there preterm delivery What are the causes of premature birth ?
Commonly found factors are some problems in the mother such as anaemia ( HB less than 9 g/dl ) , body weight : low maternal BMI ( ( less than 18 ) or high BMI ( > 26), poor diet leading to protein , calcium and micronutrient deficiencies , certain infections such as generalised , oral( tooth and gum) , urinary tract and genital tract infections . Other abnormalities such as raised blood pressure , diabetes , chronic asthma or respiratory infections can cause preterm deliveries . Many a times poor hygienic practices such as dental health , intimate hygiene , etc can be contributory . In addition the cause is classified as either unknown when nothing obvious is identified or multifactorial as many reasons can be contributing .
What measures can be taken to prevent or reduce preterm deliveries or premature birth ?
During pregnancy proper nutritional practices ,compliance to the medications subscribed by the doctor are important . There are certain warning signs which when occur immediate help can be taken . Preterm delivery can be prevented to some extent by observing precautions as mentioned and seeking help early .There are no effective medicines to prevent preterm delivery once it sets in .These medications may help if started early . Also in situations where the foetus is extremely premature these medications may not help . Nutritional(dietary) corrections go a long way in delivering a healthy baby of a healthy mother and it matters in the context of premature delivery as the outcome of the baby depends on the birthweight considerably . Diet should be replete with correct calories , calcium ,protein and iron content should be appropriate .
Are there any dangers associated with preterm deliveries or premature birth ?
Situations such as PPROM ( Preterm Premature Rupture of Membranes ) that is water break, continuation of pregnancy is unlikely. So also if the baby is distressed ( jeopardised) or the placenta is separated ( placental abruption ) the pregnancy is discontinued and not conserved .
Are there any early warning signs of preterm delivery or premature birth ?
Therefore care has to be taken throughout pregnancy such as noting the change in the vaginal discharge to sticky or watery , lower backache , cramps pain in the womb, excessive movements of the the baby , vaginal bleeding ,pain in the tummy etc:
Are there any precautions I can take to prevent before i plan pregnancy or during pregnancy to prevent preterm delivery ?
It is worth while to embark on a pregnancy with proper planning and pre-pregnancy assessment of health . Checking once hygiene practices , correction of weight , inculcation of proper positive attitude and some physical activity and healthy eating habits help in reducing these occurrences considerably . Anaemia if found in the first thee months of conception has been identified to be an important risk factor for preterm delivery .
Some women may have inherently weak womb ( abnormal womb or weak opening of the womb called the cervix) which can make them go in labour very early during pregnancy and this can be cured by taking a stitch on the cervix( cervical insufficiency . incompetent cervix) .Sometimes some medications may be prescribed for keeping the womb quiet .
Regular screening for metabolic syndrome ( obesity and related disorders ) ,diabetes , hypertension ,infections and hypothyroidism is done during pregnancy likewise assessment of the cervical parameters are done by sonography which can guide the doctor to offer the right treatments .screening and treatment for vaginal and urinary infections too are needed .
What are the consequences in the baby ?
Immediate problems are inability to feed , maintain temperature , infections in the lungs and the digestive system and generalised sepsis need of special medicines to help in breathing called as surfactant , need of assistance for breathing like a ventilator , need of an incubator and NICU .
What is NICU ? Why do premature babies need to be kept there ?
NICU is neonatal intensive care unit where premature babies or very sick babies need to be kept for breathing assistance , feeding assistance and temperature control . Premature babies being born early and small need special structured environment to protect them till they are able to sustain themselves .
Do the premature babies have any longterm complications ?
Preterm babies are at risk of developing illnesses in adulthood and therefore all measures should be taken to ensure that every pregnancy reaches term that means a duration of 37 weeks and beyond .
It has been observed that many women are not immunised adequately before embarking on pregnancy and this is a very simple preventive measure that can be taken .Immunisation against rubella , hepatitis B and HPV are advocated before marriage or pregnancy . When a couple plans a pregnancy it is important that assessment of woman health , understanding of the fertile period and corrections in existing diseases are done .
Its a dream to make women realise that healthy mother will deliver a healthy baby and a healthy generation will be born . We owe it to the society as women to deliver healthy offsprings and this little drop in the ocean can go a long way in creating a healthy society devoid of diseases .
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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