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Preterm Birth: Causes, Symptoms and Treatment

Preterm birth refers to the birth of a baby before 37 completed weeks of pregnancy. It is one of the most common complications in obstetrics and often requires intensive neonatal care.

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Things worth knowing about "Preterm birth"

Preterm birth refers to the birth of a baby before 37 completed weeks of pregnancy. It is one of the most common complications in obstetrics and often requires intensive neonatal care.

What is Preterm Birth?

Preterm birth is defined as the birth of a baby before 37 completed weeks of gestation. It is a leading cause of neonatal morbidity and mortality worldwide. Depending on the gestational age, preterm birth is classified into several categories:

Extremely preterm: before 28 weeks
Very preterm: 28 to 31 weeks
Moderately preterm: 32 to 33 weeks
Late preterm: 34 to 36 weeks

Premature babies frequently require care in a neonatal intensive care unit (NICU), as their organs -- particularly the lungs, brain, and digestive system -- are not yet fully developed.

Causes and Risk Factors

Preterm birth is often the result of multiple interacting factors, including:

Infections: Bacterial infections of the uterus or amniotic fluid are among the most common triggers.
Cervical insufficiency: Premature shortening or opening of the cervix.
Multiple pregnancies: Twins, triplets, or higher-order multiples significantly increase the risk.
Premature rupture of membranes: Early breaking of the amniotic sac before 37 weeks.
Previous preterm birth: Women who have had a preterm birth before are at increased risk.
Chronic medical conditions: Hypertension, diabetes, or kidney disease in the mother can contribute.
Lifestyle and social factors: Smoking, alcohol use, low body weight, stress, and inadequate prenatal care are additional risk factors.

Symptoms and Warning Signs

Pregnant women should seek immediate medical attention if they experience any of the following warning signs:

Regular, painful contractions before 37 weeks of pregnancy
Pressure or pain in the lower back or pelvis
Changes in vaginal discharge (increased, bloody, or watery)
Rupture of membranes (leaking amniotic fluid)
Changes in fetal movement

Diagnosis

The diagnosis of threatened preterm birth is made using several assessments:

Transvaginal ultrasound: Measurement of cervical length; a shortened cervix is a key risk indicator.
Cardiotocography (CTG): Monitoring of the baby's heart rate and uterine contractions.
Fetal fibronectin test: A biochemical test from vaginal secretions that helps assess the risk of preterm birth.
Laboratory tests: Blood count and inflammatory markers to detect infection.

Treatment and Prevention

Tocolytic Therapy

In cases of premature contractions, tocolytic agents (medications that suppress contractions) may be used to delay birth and allow time for further interventions. These include atosiban, betamimetics, or calcium channel blockers.

Lung Maturation

To promote lung development in the baby, corticosteroids (e.g., betamethasone) are administered to the mother when preterm birth is threatened between 24 and 34 weeks. This treatment significantly reduces the risk of severe respiratory distress in the newborn.

Cervical Cerclage

In cases of diagnosed cervical insufficiency, a surgical procedure known as cervical cerclage may be performed to stitch the cervix closed and prevent further dilation.

Progesterone

Vaginal progesterone supplementation can help reduce the risk of recurrent preterm birth in women with a short cervix or a history of preterm delivery.

Care for the Premature Baby

Premature babies are cared for in a neonatal intensive care unit (NICU) depending on their degree of prematurity. Care measures include respiratory support (e.g., CPAP or mechanical ventilation), temperature regulation in an incubator, specialized nutrition, and close monitoring of organ functions. The kangaroo care method (skin-to-skin contact) plays an important role in the development and bonding of premature infants.

References

World Health Organization (WHO) - Born Too Soon: The Global Action Report on Preterm Birth. Geneva: WHO Press, 2012.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet. 2008;371(9606):75-84.
American College of Obstetricians and Gynecologists (ACOG) - Practice Bulletin No. 171: Management of Preterm Labor. Obstetrics and Gynecology. 2016;128(4):e155-e164.

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