Is India vulnerable to premature births?

Women experience preterm labour when their body gets ready to give birth to a baby before 37 weeks of pregnancy. Today, preterm deliveries constitute 10 per cent of all the deliveries. Out of 15 million babies born early, more than one million die due to preterm birth complications. 

There are various predisposing factors linked to premature birth: 

• Smoking: Cigarette contains chemicals which impact the growth of the foetus. It narrows down the supply of nutrients and causes complications during pregnancy and child birth. 

• Weight: It is essential for women to have balanced weight before pregnancy. Being overweight or underweight can cause complications 

• Frequent check-ups: Lack of good prenatal care leads to premature birth 

• Alcohol: Consuming alcohol or any form of drugs during pregnancy is not good 

• Poor health condition: If the expecting mother has bad health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, infections or decreased haemoglobin, it can cause complications 

• If the baby has certain birth defects 

• Being pregnant through vitro fertilisation: Factors in the mother (hormonal imbalance) and the IVF factors (multiple embryo) can increase the risk of having a premature baby 

• Pregnant with twins or other multiples: Can cause complications to both mother and infant leading to preterm birth 

• A family or personal history of premature labour 

• Getting pregnant too soon after having a baby

There are many maternal characteristics associated with preterm birth. In most of the cases the actual aetiology is not clear, although, for the earliest cases, the role of intra uterine infection is assuming greater importance. Infection in the context of a pregnancy means infection in membrane that surrounds the baby, the umbilical cord and/or the amniotic fluid. Usually, natural bacteria which women carry in their vagina or skin are harmless but if the bacteria migrate through the vagina, cervix and later infect the entire womb, it can badly affect the pregnancy. In many cases, efforts made to prevent preterm labour have not proven to be effective. Doctors use various components of management aimed at preventing neonatal complications through the use of corticosteroids and antibiotics to prevent group B streptococcal neonatal infection, and avoiding traumatic deliveries. After a preterm birth, the expert prioritises their efforts on the survival of the baby. Some babies don’t even make it past their first day. 

For a healthy baby, it is essential to start the care in the early stage of pregnancy which will help in avoiding complications during the final stage of pregnancy. There are various symptoms that can help in detecting premature birth: 

• Leaking of a watery fluid from the vagina indicating that the water sac has broken 

• Frequent backaches, specifically in the lower back 

• Experiencing contractions every 10 minutes 

• Increased vaginal discharge and bleeding

• Cramps in your lower abdomen which may come with diarrhea It is essential to identify women at risk of preterm labour and help them to give birth in a healthy facility and support for adequate feeding with breast milk, continuous skin-to -skin contact, antibiotics and proper care. Advances in foetal medicine have made prediction and prevention of preterm births possible. To avoid future complications there should be timely ante natal visits to the obstetrician, maintenance of personal hygiene, good nutrition, timely diagnosis and management of the underlying causes to reduce the risks of premature delivery.

Case study 

“A young mother Mrs. X, in her final trimester having completed 30 weeks complained of pain in the abdomen and urinary tract infection. As it is premature, we tried to manage conservatively. After one day she presented with leaking vagina and a drop in the fetal heart rate. Parents were counselled about the risk of prematurity like respiratory distress, respiratory tract infections, gut infections, development delay, risk of cerebral palsy and other long-term effects. In view of fetal distress, we delivered her by cesarean, a female baby with birth weight 940 gm was born and because of lung immaturity and low birth weight, baby was admitted in NICU. Surfactant injections were given, on third day baby had distension of abdomen, fever and dropping of platelet count. Antibiotics and platelet transfusion were given and on the 15th day, baby started showing signs of improvement. 

The infant started sucking gradually and also began to gain weight.  End of the month the baby was discharged with the weight of 1.08 kg.”  It is important to take the right treatment and go for regular prenatal care check-ups as soon as you think you’re pregnant. Prenatal care helps your provider make sure you and your baby are healthy.  Effective care of the preterm neonates in case of prematurity would lead to a better outcome.