Premature birth basics

In honor of Prematurity Awareness Month, The March of Dimes recently announced its 2012 Premature Birth Rate Report Card.

The United States as a whole scored a “C” grade, with 11.7 percent of births being premature. Nebraska earned a “B” with 10.6 percent, a much better showing than in recent years. The national target, as set by the March of Dimes, is 9.6 percent by 2020, while Nebraska has vowed to reach 8 percent by 2014.

The issue is complicated due to the difficulty in pinpointing the reason for premature births. Various medical issues and lifestyle decisions can impact a woman during pregnancy, but many of the signs and symptoms associated with premature birth are also commonly associated with a normal pregnancy.

Medical causes:

  • Stretching of the uterus, which can occur with multiples
  • Excessive fluid
  • Congenital uterine anomalies
  • Abnormal pap smear that resulted in surgery prior to pregnancy
  • History of preterm delivery
  • Uterine bleeding in the second or third trimester
  • Infections or inflammation
  • Maternal or fetal stress

Lifestyle factors:

  • Lack of prenatal care
  • Smoking, drinking or drug use
  • Poor nutrition
  • Periodontal disease
  • Maternal age of 18 or less or 40 or older
  • Extremely stressful activities or situations

I’m a big stickler about smoking. If a pregnant patient comes to me as a smoker I strongly urge her to quit. If this just isn’t feasible, I urge her to cut back dramatically on the number of cigarettes per day. When it comes to women who are in extremely stressful relationships, we work with them to get the support and counseling they need.

When should I be concerned?

If you’re having eight to 10 contractions in an hour, earlier in the pregnancy then you should, then you need to contact your physician. Other signs of preterm labor include menstrual like cramping, low back pain, vaginal pressure or discharge.

When a patient comes in with these symptoms, I first monitor and determine the extent of the contractions, then conduct a vaginal exam. Then I’ll order an ultrasound of the cervix to see if it’s shortening.

Finally, I may do a test swab, called a Fetal Fibronectin, to determine if she is at risk for premature delivery within the next two weeks.  Fetal fibronectin is a glycoprotein which is thought of as the “glue” between the uterine-lining and fetal sac. 

If the test comes back negative (protein not detected) then we know with a high probability that she will not go into labor in the next 1-2 weeks.  Positive tests are less reliable. They doesn’t mean definitively that she will go into labor, so management of this situation will vary.  

If there is enough cause for concern, I will co-manage a patient’s care with our Perinatology team who will do additional testing.

A new option available for those with a history of premature birth is progesterone supplementation. Progesterone is produced in the ovary early in pregnancy until the placenta takes over in the second trimester.  The role of progesterone later in pregnancy is less clear; however, it has been shown to reduce recurrence of preterm birth. 

While there is still some mystery surrounding premature delivery, we certainly do our best to help both mom and baby reach a safe delivery date.