One out of eight babies are born prematurely which is more than a half million babies each year. Premature babies are those born before the completion of the 37th week of pregnancy. A normal term pregnancy lasts 40 completed weeks counting from the first day of the last menstrual period.
Premature babies are at increased risk of breathing problems, jaundice, and other complications. The more premature the baby is, the more likely is the baby to have health problems. (1)
The cause preterm of preterm birth is unknown in roughly one-third of the cases. In about one-third of the cases, there is premature rupture of the membranes. And in one third of the cases there are problems with the mother’s health or with the fetus’s health or development. (2)
It is important that all pregnant patients know the symptoms of possible preterm labor. If they are having any symptoms that could be preterm labor, they need to be evaluated at the doctor’s office or at the labor and delivery area of the hospital.
The warning signs are— (1)
Contractions (abdomen tightens like a fist) every 10 minutes or more often
Change in vaginal discharge (leaking fluid or bleeding from the vagina)
Pelvic pressure—the feeling that the baby is pushing down
Low, dull backache
Cramps that feel like a menstrual period
Abdominal cramps with or without diarrhea
The purpose of early diagnosis of preterm labor is to postpone delivery if possible while medicines allow the lungs to mature and/or to allow transfer the mother and fetus to a hospital with a neonatal intensive care unit for delivery there.
The evidence now strongly suggests that ultrasound examination of the cervix is superior to digital examination of the cervix. “Ultrasonography to determine cervical length, fFN testing or a combination of both is the most useful tools in determining women at high risk for preterm labor. However, their clinical usefulness may rest primarily with their negative predictive value given the lack of proven treatment options to prevent spontaneous preterm labor (SPB). Bearing in mind the excellent negative predictive value of such tests (when fibronectin is negative and cervical length by ultrasound is 42.5 cm) we recommend that tocolytic therapy and steroid prophylaxis should be withheld.” (3)
Premature rupture of the membranes (PROM) occurs when the amniotic fluid that surrounds the fetus in the uterus leaks out before labor starts. It exposes the fetus to a number of risks and accounts for about 20% of all perinatal deaths.
One risk of PROM is placental abruption. Placental abruption is seperation of the placenta from the wall of the uterus prior to delivery of the infant and it compromises the fetus’s well-being.
Infection of the mother or fetus is another complication of PROM.
It is important to diagnose PROM when it occurs so that the proper treatment can be started. Sometimes the diagnosis is easy but sometimes (perhaps in 47% of cases according to recent data) the diagnosis is difficult, meaning it is unclear.
When the diagnosis of PROM is unclear, the AmniSure ROM test is recommended in the European guidelines as the best test for PROM. (3)
Unfortunately, the American College of Obstetrics has chosen to make its guideline on the management of preterm available only to members of its association. All that is available to nonmember physicians and to midwives is a summary. (4)
(1) Preterm Birth from the Centers for Disease Control available at
https://www.cdc.gov/features/prematurebirth/.
(2) Indian Health Service ANMC Women’s Health Service Guidelines For The Management Of Preterm Labor. February 2011 available at
https://www.ihs.gov/medicalprograms/MCH/F/documents/Pretermlabor2711.pdf
(3) Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth. May 20ll available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267524/pdf/djmf24-659.pdf.
(4) Management of Preterm Labor from the American College of Obstetrics and Gynecology. 2003, reaffirmed 2008 available at
https://www.guideline.gov/content.aspx?id=3993.
