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Premature Labor Diagnosis And Treatment

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Premature Labor

Triggered premature labor can be difficult to recognize. The patient should contact the emergency doctor if signs portend a possible premature labor. In any period of pregnancy the specialist advice is required if there is any increase in vaginal discharge quantity, there is a sudden and large fluid loss (fluid loss can be confused with bladder incontinence or excess cervical mucus), vaginal bleeding or spotting (small blood spots on underwear), dysuria occurs (difficulty in urination), pollakiuria (frequent urination), cloudy urine, or foul-smelling urine.

Premature Labor

Between 20 and 37 weeks of pregnancy, see your gynecologist if you have:

  • Regular contractions (with or without pain), 4 in 20 minutes or 8 per hour, which last longer than 2 hours and which do not resolve after changing position or after ingestion of liquids
  • Back pain or pelvic pressure, apparently without explanation
  • Intestinal cramps with or without diarrhea
  • Uterus sensitivity, unexplained fever (febrile syndrome of unknown etiology), weakness (possible symptoms of infection), the baby stops moving or moves less than usual.

Premature Labor Diagnosis

Mother Investigations

Sensitivity of the pregnant uterus will be investigated. The pulse, temperature, respiratory rate will also be checked. Depending on your symptoms, one or more of the following tests will be performed:

  • Vaginal examination to check if the cervix is opened (dilated)
  • Vaginal sample from secretions for evidence of vaginal infections, as they can lead to infections of the uterus and can cause premature labor or severe infections in the newborn (pregnant women with bacterial vaginosis have a double risk of giving birth prematurely, compared with those without this condition)
  • Highlighting the amniotic fluid, amniotic sac has ruptured
  • Fetal fibronectin whose absence indicates that the labor has not started, this test is not specific only for premature labor, but for all births.
  • Other tests to detect a possible infection: full blood count, using a blood sample, urinary cultures using a urine sample. If an infection is detected the pregnant women will receive antibiotics.

Fetus Investigations

Fetal heart rate monitor is an electronic device which will record uterine contractions and shows the reaction of the fetus. Fetal ultrasound is used to:

  • To check the uterus for multiple fetuses
  • Estimation of gestational age, fetal weight and position
  • Position and degree of maturation of the placenta
  • Length of the cervix: a short cervix is a sign for labor onset
  • Amniocentesis consists of taking a sample of amniotic fluid, this investigation is useful for: signs of infection, detection of substances that indicate the baby’s ability to breathe without assistance, in case of premature births.

All this information helps your doctor and midwife to decide whether to intervene and delay delivery or not.

Premature Labor Treatment

The treatment for premature labor is started if:

  • Gestational age, pregnancy is between 23 and 34 weeks
  • Uterine contractions lasting more than 45 seconds and occurring at intervals of 2 to 10 minutes
  • Cervix is opened (dilated) more than 2 cm.

Triggered premature labor does not always require treatment. If the pregnancy is near term (more than 37 weeks) or when the mother and fetus are in pain, doctors will let the pregnant woman give birth. To decide whether or not to intervene, the doctor will take into account the following:

  • Age and fetal weight: ideally triggered premature labor will be delayed until the fetus becomes mature enough so risk of complications is low after birth (over 34 weeks gestation)
  • The health status of the pregnant woman : severe hypertension and preeclampsia, HELLP syndrome, chronic diseases, infection or bleeding.
  • Health of the fetus: development of signs of fetal distress require immediate delivery
  • Spontaneous premature rupture of membranes
  • Labor stage and rate of progression: for example, when the cervix is well dilated over 4 cm, tocolytic medication, used to delay labor is no longer effective
  • Distance to a hospital equipped with intensive care unit for newborns, labor delaying can be done during transport to the nearest hospital
  • Tocolytic medication-administration, used to delay childbirth can be dangerous for mother and fetus.

Treatment of premature labor

Premature labor requires hospitalization. Whether membranes were ruptured before or after the beginning of contractions, pregnant women will be led to the delivery room. If the amniotic sac has not been broken yet, the patient will be placed under observation for another hour or two, for the doctor to see if your cervix is dilated and the contractions continue:

  • If the cervix does not change and the contractions cease the pregnant women can be discharged
  • If the cervix changes, pregnant women will be led in the delivery room.

If pregnant is headed to the delivery room, the doctor may take one of the following decisions:

  1. To use medication to stop or slow contractions and to prevent deletion and cervix dilation, short-term use of tocolytic drugs is the most common form of therapy, if proven effective when delivery can be delayed for more than 48 hours
  2. To treat or prevent infections by administering antibiotics
  3. Help mature the fetal lungs quickly using antenatal corticosteroids (administered to the mother), these drugs must be administered 24 to 48 hours before birth to be effective.

Keep in mind!

Dehydration is a common cause of contractions. At the first sign of contractions, the pregnant woman is advised to drink fluids. If this was the reason the contractions will stop. Tocolytic medications can delay the birth 1 or 2 days, offering other drugs (corticosteroids) the chance to help fetal lungs mature faster. However, there is no evidence that proves that tocolytic medication prolongs pregnancy and improves fetal survival when administered over a longer period of time. They may also have notable side effects on both mother and fetus.

Ineffective treatments for premature labor

  • Bed rest: strict rest in bed for 3 days or more increases the risk of thrombosis (blood clots in vessels) located in the legs and lungs. There is no evidence that prolonged bed rest can prevent premature birth
  • Cervical cerclage is surgical closure of incompetent cervix (a rare cause of premature birth). While some researchers suggest that cerclage reduces the likelihood of premature birth before 33 weeks in women at risk, others believe that it has no effect; A recent study showed that cerclage used to close a shortened cervix is ineffective in preventing premature labor and birth, also it increases the risk of infection and spontaneous abortion.
  • Fetal-monitoring at home: research has shown that fetal monitoring at home is expensive and ineffective in delaying the onset of premature birth.