Thursday, June 9, 2011

General Preemie Information

Every day, thousands of families experience the joy that comes with the birth of their new baby. However, sadly, every year, thousands more families experience the pain of losing their baby or seeing their tiny child fight for their life. Premature birth, is the birth of a baby, before 37 completed weeks of gestation. Babies are considered to be full term from 37 weeks of pregnancy and will have the best chance of healthy development if they are born after this point. Premature labor affects 12.5% of all births in the US, and despite vast improvements in neonatal care, the number of premature babies born each year has not decreased since the 1960s. It remains very difficult to identify the women at risk of premature delivery because the causes are still very miss-understood. Research has concluded that babies born very early (before 25 weeks) are more likely to survive than in the past, but survival of these babies has led to an increase in disability.

Lifestyle influences that may cause pre-term labor:
Recreational drug use
High caffeine intake
Poor diet (or being underweight)
Over strenuous physical activity

Medical conditions
Conditions experienced prior to pregnancy (such as systemic lupus or renal disease).
Pregnancy related conditions (such as pre-eclampsia, pregnancy-induced diabetes, or obstetric

Previous pregnancy problems
Previous pre-mature children

Gynecological history
Cervical surgery
Cervical or uterine abnormalities
Cervical weakness 

Vaginal infections (such as gonorrhea, Chlamydia, bacterial vaginosis or
group B streptococcus)

Current pregnancy
Multiple pregnancies
What are the risk factors associated with premature birth?
Many women with no identified risk factors will go on to experience premature delivery, however
there are some factors that are known to increase your risk of having a premature baby.
It is important to note that while many of these conditions are risk factors for premature birth and may
cause early labor, there are also circumstances where premature delivery is initiated by medical staff. For example, if a woman suffers from pre-eclampsia, the baby is not thriving in the womb, or if there is an ante-partum bleed and either the health of the mother or baby is at risk, then premature delivery of the baby may be the only option. The exact cause of many premature births remains unknown, but there are some conditions and factors that may increase your chances of having a premature baby.

Stop smoking
Ideally you should stop smoking. This is probably the single most important thing
you can do to reduce your risk of having your baby early. Smoking cigarettes, or
breathing in somebody else’s smoke reduces the amount of oxygen in your
blood stream which in turn deprives your baby of oxygen. There is a huge
amount of evidence showing that smoking is definitely related to premature
delivery. Ideally both you and your partner should stop smoking before trying
for a baby, but it’s never too late to stop. 

Don’t take recreational drugs
Using recreational drugs, particularly cocaine, during pregnancy is a risk factor for
premature delivery. It is important to stop either prior to pregnancy or as soon as you discover you are
pregnant. However, if you use recreational drugs on a regular basis please seek professional help to overcome it, as without it you may risk endangering both your health and that of your baby.

Avoid caffeine
High levels of caffeine have been shown to increase the risk of miscarriage and premature birth.
Government guidelines therefore recommend reducing your caffeine intake to less than 300 mg per
day, which is roughly three average, sized caffeinated drinks. These include coffee, tea,
chocolate drinks and bars and some soft drinks and energy drinks.

Avoid stress and over-strenuous activity
Research suggests that stress leads to high blood pressure, which can be a cause of premature birth
and miscarriage. It’s important to manage the amount you take on during your pregnancy and to give
yourself plenty of time to rest and relax. Standing for long periods or shift work may become difficult for
pregnant women, and it is sensible to avoid strenuous or tiring situations. Exercise is great for reducing stress and maintaining fitness as you get ready for labor. It is very important, however not to over-exert yourself. Check any planned exercise routine for safety (swimming, walking and yoga are excellent, low-impact, forms of exercise), and make sure your instructor knows you are pregnant.

All pregnant women should attend regular appointments. This is particularly important as regular contact can help to identify women at risk of premature delivery and also allows the progress of the pregnancy to be closely monitored. Women who are at greater risk of having a premature baby will most likely be referred to maternal fetal specialist early in their pregnancy. This appointment will enable you to discuss any tests that are available at your hospital regarding prematurity, and plan the care for your pregnancy.   Some tests include the following.

Detecting and treating infection
Research has shown that some urinary and vaginal infections are commonly related to preterm labor. These can sometimes be present with no symptoms so it is very important to attend your appointments where you will be tested for infection, and given appropriate treatment if infection is detected.

Urinary testing
You may be asked for a urine sample for testing at each visit. If an infection is suspected following a test, a further sample may be sent to a laboratory to confirm infection, and so appropriate antibiotics can be prescribed. Common symptoms of a urine infection are burning or stinging when passing urine, increased frequency of passing urine, unpleasant smell, backache and sometimes feeling just ill. Your urine will also be tested for the presence of protein which can be an indication of a complication in Pregnancy, called pre-eclampsia.

Vaginal swabs
Vaginal swabs are sometimes taken if a vaginal infection is suspected, and antibiotic treatment may be prescribed. However, at present there is limited evidence regarding their effectiveness. It is therefore important for you to seek medical advice if you are concerned about your discharge in pregnancy. If you notice creamy, yellow, green or brown discharge, itchiness, or an unpleasant smell, you should talk to your doctor. Remember that vaginal discharge in pregnancy may be heavier than normal, but if it is clear or white and causes no discomfort, it is probably normal.

Cervical assessment
One of the early signs of labor is the shortening of the cervix. In some women, this cervical change
occurs prematurely, leading to preterm labor. For women at risk of pre-term birth, changes in the
cervix can be monitored, so that appropriate care can be offered.

Transvaginal ultrasound
Traditionally, cervical changes have been detected by either vaginal or speculum examination.
However, a new and more reliable test is being developed to examine and measure the cervix using
transvaginal ultrasound (internal scan). 

Cervical cerclage (Stitch)
A cervical cerclage operation is performed under anesthetic in an attempt to keep your cervix closed
by putting a stitch around the neck of your womb. This is usually carried out vaginally, during the early
weeks of your pregnancy

Premature labor care
If you’re at all worried that you might be in premature labor, or your ‘waters’ break (ruptured
membranes), even if you have no labor pains, contact your nurse/dr immediately for advice. Ruptured membranes can be the first sign of preterm labor, and it is very important to ensure you receive appropriate care immediately to prevent possible infection and to ensure any onset of labor is monitored carefully. Tocolytic drugs are administered to women whose labor spontaneously starts prematurely. These drugs delay labor allowing time for the woman to be transferred to a specialist neonatal unit if
necessary, or for steroids to be administered. Steroids have been given to women at risk of preterm
delivery since the 1970s. They are given to improve the baby’s lung function, helping them to
establish breathing at birth.

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