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Consultancy corner: All you need to know about Preterm births

Preterm birth is the leading cause of neonatal mortality and a substantial portion of all birth-related short- and long-term morbidity.

Consultancy corner: All you need to know about Preterm births
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Dr Eswara Raja Thinakaran, Consultant Neonatologist, Gleneagles Global Health City

Chennai

The World Health Organisation defines preterm birth as a birth occurring either before 37 completed weeks of gestation or on or before the 259th day, counting from the first day of the last menstrual period. PTBs can be categorised into three major gestational age strata: those occurring at under 32 weeks (on or before 224 days) gestation, usually referred to as very preterm birth; those occurring between 32 and 33 weeks (between 225 and 238 days) gestation (a group with no specific name, but can be termed moderate preterm births) and those occurring between 34 and 36 weeks (239 to 259 days) gestation, referred to as late preterm births.


Preterm deliveries contribute to 10% of all the deliveries. India with majority of the population in the lower socio-economic strata thus increases in occurrence of infection, increased BP in pregnant women and other complications.


Aetiology and risk factors

Individual PTBs can be categorised into two major groups: Spontaneous PTB (accounting for up to 60 per cent of all PTBs), which occur after the spontaneous onset of preterm labour and Indicated PTB (accounting for about 40 per cent of PTBs), which rise from intervention by the health care team to reduce poor outcomes in the presence of specific medical, surgical or obstetric conditions and indications in the mother or foetus.


Risk factors for preterm birth

Behavioural and psychologicalcontributors include tobacco and alcohol, other drugs, nutrition, physical activity, employment, douching and stress (chronic, acute, life events).


The socio-demographic contributors are maternal age, marital status, race and ethnicity, socioeconomic conditions as well as community and neighbourhood.


There are also medical and pregnancy conditions that serve as risk factors. Maternal medical illness and conditions, underweight and low weight gain, foetal conditions, pregnancy conditions, as well as infections, fall under this category.  


It is always important to look out for the symptoms such as backache - which usually will be in your lower back. This may be constant or come and go, but it won’t ease even if you change positions or do something else for comfort. If you face contractions every 10 minutes or more often, it could be risky. Cramping in your lower abdomen or having menstrual-like cramps or having gas like pains that may come with diarrhoea are symptoms. If you have fluid leaking from your vagina, flu-like symptoms such as nausea, vomiting, or diarrhoea, it is important that you call your doctor even about mild cases. If you can’t tolerate liquids for more than 8 hours, you must see your doctor. Increased pressure in your pelvis or vagina, increased vaginal discharge, vaginal bleeding, including light bleeding, and the like are all factors that must not be taken lightly.


The environmental toxins responsible for pre-term birth, include lead or air pollution, gene- environment interactions, and the like.


There are steps that can be followed to prevent preterm birth. They are progesterone, cerclage: Cervical cerclage is a purse-string of the cervix intended to mechanically prevent cervical dilation, limited embryo transfer, multifetal pregnancy reduction, treatment of vaginal infection, treatment of periodontal disease and tocolytics.

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