Threat of Preterm Labour
Preterm Labour Diagnosis Frequency
The definition of the threat of preterm Labour, which is observed in 6-10% of all pregnancies, refers to the termination of pregnancy before the 36th gestational week. For the definition of this process, it would be appropriate to set a lower limit. Delivery between 24-36 weeks is called preterm birth. Because before the 24th week, the process should be defined as “immature birth”.
Preterm Labour Risk Factors and Causes
Here, the preterm delivery process may occur spontaneously in a normal pregnancy; also can be seen in:
* severe preeclampsia,
* placental detachment (early removal of the placenta),
* severe and unstoppable bleeding in the placenta previa (placement of the placenta below to close the cervix)
* the development of infection after the opening of the early water pouch called early membrane rupture
* It may also occur with medical obligations after fetal distress due to reasons such as placental insufficiency. In this case, 30% of preterm births occur due to a medical obligation.
*** The most important risk factor in determining the expectancy of preterm delivery is the presence of a preterm birth history. The risk of preterm birth of the expectant mother who has lost in the 2nd trimester may also increase. In addition, the bleeding history after the 12th week is considered as a factor that increases the risk. ***
One of the most important factors that initiate Labour automatically is the cases where intrauterine pressure is very high. These are as follows:
* polyhydramniosis (excessive increase of amniotic fluid)
* It is the presence of large babies.
Apart from this, urinary tract infections, which are frequently an important factor. Drinking plenty of water is an important recommendation for all pregnant women, as urinary tract infection screening should be one of the routine screening tests of early pregnancy.
Genital tract infections can be a provocateur just like urinary tract infections. The presence of B-hemolytic streptococcus, chlamidia, ureoplasma, trichomonas, bacterial vaginosis should be perceived as the presence of a risky genital infection.
Anatomically in the uterus (uterus) myomas that can initiate contractions in the uterus, congenital uterine anomalies (double uterus, full or incomplete partition in the middle of the uterus, etc.) and cervical insufficiency (previously painless loss of tissue from the cervix, such as conization or conization) operation history, etc.) is also among the causes of preterm birth.
The mother candidate’s;
* living and nutritional conditions,
* the presence of anemia,
* age under 17 or over 35,
* Conditions such as not being able to control pregnancy due to insufficient admissions to medical facilities are also effective on the risks of preterm birth.
In fact, if the chance to evaluate before pregnancy can be found, risk factors can be determined in many women and precautions can be taken. Correction of structural disorders in the uterus, smoking cessation, correction of anaemia and thyroid dysfunction, if any, and determination and treatment of vaginal infections will mean to go a long way in preventive medicine. However, it is of course not possible to reduce the risk factors to zero.
Ensuring that the woman is informed correctly and awake about the findings during pregnancy and especially in risky pregnancies 20-26. Measuring cervical length by vaginal ultrasonography in weeks will be important in determining risk.
Complaints and Findings of Preterm Labour
The most important findings that makes the threat of preterm birth noticed or suspected by the woman is:
* a feeling of contraction or pain (not necessarily !!!). Especially if the contractions do not pass at rest and if 4 contractions and above are felt within an hour, hitting the lower part of the waist, creating a feeling of pressure towards the vagina.
* If there is a suspicion of mucus discharge, water or vaginal bleeding, it should be consulted.
The only way to ensure successful treatment in the threat of preterm delivery is to be able to be diagnosed early. This is about the admission time.
Diagnosis in Threat of Preterm Labour
Diagnosing preterm Labour may not always be very easy. In cases where the diagnosis is clear, the absolute condition is the state of the cervix. If the cervix opens and thinks, the diagnosis is very clear.
If the opening in the cervix is 4 cm or more during diagnosis, it is almost impossible to prevent the risk of preterm birth and the process should be left to its own by taking precautions for the mother and the baby.
If the cervical opening is below 4 cm, the process becomes more likely to be prevented. Rapid fetal well-being and contractions are evaluated with non-stress test. In the meantime, a sterile speculum should be performed with a vaginal examination, and it should be understood whether the water of the woman comes by performing a pH test. In terms of infection, vaginal cultures and urine cultures should be taken.
The group that is most difficult to diagnose is the group whose contractions are not very regular or strong and that the opening of the cervix is insufficient in the vaginal examination every 2 hours. This group should preferably be monitored in the hospital. If the cervix opens as a result of contractions during follow-up, preterm delivery is started immediately. However, it is decided that if the opening is insufficient, the process is stable and if the woman is relieved, there is no threat of preterm Labour.
Perhaps the threat of preterm birth is put a little too much in many cases because of the great cost of premature birth to babies. However, it will not always be very easy to set limits.
Risk of Early Birth for the Baby
Although the risks brought by the preterm birth to the fetus vary depending on the week of gestation, the smaller the week, the harder the conditions will be. If we list the risks related to the baby:
1) difficulty breathing
2) difficulty feeding
3) the possibility of bleeding in the intestines
4) intracranial bleeding
5) retinal disorder of the eye
6) hearing problems
7) patent ductus arteriosis
While some of these problems can be tackled and completely resolved, some may leave serious sequelae that may affect the life of the baby. Therefore, when the diagnosis of preterm birth is diagnosed; If it can be achieved, it will bring profit regardless of the time gained by treatment.
Treatment in Threat of Preterm Labour
After the diagnosis is made, treatment should be dynamically started. Treatment of preterm Labour is started and continued by hospitalization. After the situation stabilizes, if the woman’s medical and social conditions allow it, then it can be monitored at home with oral treatment.
The first step in treatment is restriction of activity and bed rest. Serious fluid support must be provided. This support is preferably made through the vascular access. Meanwhile, the blood and urine values of the mother are checked and the necessary treatments are arranged.
In the treatment, agents that will prevent uterine contractions are preferred. Although ritodrin is the oldest known agent, its effectiveness in treatment is now controversial. Its use in the clinic has decreased considerably. We no longer use ritodrin in our own applications.
The first of two preferred agents in evidence-based medical practice is magnesium sulfate treatment. This treatment is administered intravenously, doses and follow-up are very well followed. Clinical and Labouratory findings of magnesium toxicity should be closely followed. When the severity of contractions is reduced and the situation is under control; the dose is reduced and the most effective is followed at the lowest dose. Oral forms of magnesium sulfate are also available and can be tried in maintenance therapy.
Another effective treatment is calcium channel blockers. In the hospital follow-up, besides the proper fluid treatment, the vicious cycle of contractions with high doses is eliminated with high-dose calcium channel blockers and then it is regulated by oral treatment. Here, if it is ensured that the situation is stable and the conditions of the woman are appropriate, home treatment can be continued with long-acting calcium channel blockers.
While trying to prevent contractions in terms of preventing preterm Labour, dexamethasone, which is administered in two doses at 12-hour intervals, should be administered to the mother simultaneously to accelerate the lung development of the baby. Being able to delay delivery for at least 48 hours will help cortisone application to achieve its purpose.
Saving time in treatment with these treatments is closely related to how early the diagnosis of preterm birth is made. However, response to treatment is not standard. From time to time, a very good treatment response can be obtained, but from time to time, the Labour is progressing very decisively. This process is mostly related to the reason. In any case, it would be ideal to perform the treatment in a full-fledged center with intensive care of the baby and to be ready for the birth of the premature baby.