Premature Childbirth

Athina Shelby
Block A
January 13,1999

"This occurrence is commonly considered an idiopathic condition, however spontaneous pre-term labor always has a cause when defined as a clinical event." Says Emanuuel P. Gaziano, MD. The failure to recognize this prevents understanding of the symptom and delays effective diagnosis, prevention, and treatment. The following information focuses on the risk factors that point towards the possibility of pre-term labor. With careful pre-natal care some potential causes can be detected and the early delivery often prevented.
Labor that occurs between 20 and 36 weeks of development is considered pre-term. Other indications could consist of :
*Uterine contractions of 4 per 20 minutes or 8 per 60
minutes.
*Intact membranes and documented cervical change.
* Cervical effacement of 80%.
* Cervical dilation of 2 cm or more.

A premature membrane rupture (at 20 to 36 weeks of development) is also considered pre-term labor when corresponding with uterine activity. There is often confusion with the diagnosis of pre-term labor. Contractions without documented cervical change should be called pre-term contraction, not pre-term labor. A birth weight of less than 2,500 g is considered low and between 501 and 1,500 very low. Low-birth-weight newborns are not necessarily delivered pre-term and vice versa.
Costs of pre-term labor
The costs of pre-term labor in 1994 was 48% ($55 million) of the overall hospital charges of newborn care. That is only from infants delivered at hospitals in the Twin Cities metropolitan area. Regardless of this expense, developmental outcomes were compromised for the earlier developed age groups. Between 1990 and 1992, moderate or severe developmental abnormalities were seen on the follow-up exams of 34% surviving very-low-birth-weight infants (born from 23 to 26 weeks of development).
Risk factors
A maternal history of a previous pre-term delivery, is the single most significant historical risk factor for a repeat event. Another pre-term is likely in 17% of women who already experienced this and in 28% of those who experienced it twice. At the first visit the physician should review the patient\'s reproductive history to determine the risk of pre-mature delivery.


Maternal Lifestyle Factors
Maternal stress is linked to pre-term delivery, particularly among teenagers and women in lower social and economical groups. These women may be in "survival mode", with their lives chaotic and disorganized, leaving little time for rest and self-care. Other factors that are significant with early delivery are age (especially adolescence), low income, smoking more than 10 cigarettes per day, and alcohol or cocaine abuse. This stress initiates pre-term labor through a set of complex physiological event including the release of adrenal and hypothalamic hormones, which trigger local expression of corticortropin- releasing hormone in the uterus. This increases uterine contractions.
A Nurturing environment after the birth
New treatments and technology, essential to the survival of pre-mature babies, is no substitute for the comforting environment of the womb or loving touch of a parent. That\'s why the neonatal intensive care program works hard to create a more nurturing environment for pre-mature babies.
"Whenever possible, we try to replicate the environment for pre-mature infant is used to- darkness and quite," says Nancy Claussen, a neonatal nurse practitioner at Fairview Health Services. "As the baby\'s condition improves, we like to encourage parents to hold their baby skin to skin for up to an hour a day. The infants really respond to that."
Continuity of care is also beneficial. From the time pre-term infants are delivered, specially trained neonatal nurse practitioners are part of a team that provides consistent care for the infants and a familiar face for their concerned parents.
In conclusion
It may be possible to reduce the number of pre-term deliveries by focusing on responsible risk factors or identifiable causes and then designing and using preventive strategies. The most effective treatments for the mothers are regular checkups during the pregnancy, proper nutrition, and adequate rest. Also being familiar with the risks and trying to reform behaviors in those categories should help.