Premature Birth – Understanding to Protect Mother and Baby

Premature birth, also known as preterm birth, occurs when a baby is born before 37 weeks of pregnancy, calculated from the first day of the woman’s last menstrual period. Premature babies often have low birth weight, their organ systems are not fully developed, and they are more susceptible to serious health problems, impacting their health and development in the future.

1. Causes of Premature Birth:

Maternal factors:

• Infections: Vaginal infections, cervical infections, urinary tract infections, hepatitis B, meningitis…
• Cardiovascular diseases: High blood pressure, heart disease, anemia…
• Endocrine disorders: Diabetes, hypothyroidism, hyperthyroidism…
• Uterine abnormalities: Uterine malformations, uterine fibroids, incompetent cervix…
• Multiple pregnancies: Premature birth is more likely to occur in women who have had premature births before.
• Maternal age: Women under 18 or over 35 have a higher risk of premature birth.
• Unhealthy lifestyle: Smoking, drug use, alcohol consumption, poor nutrition…

Fetal factors:

• Multiple births: Twins, triplets…
• Fetal malformations: Congenital birth defects…
• Placental disorders: Placental abruption, placenta previa…

Other causes:

• Premature rupture of membranes: Rupture of membranes before the 37th week of pregnancy.
• Environmental factors: Environmental pollution, exposure to harmful chemicals…

2. Symptoms of Premature Birth:

Symptoms of threatened preterm labor:

• Mild, intermittent abdominal pain, more frequent than usual.
• Short, soft, thinned, and dilated cervix.
• Feeling of chest tightness, shortness of breath.
• Vaginal bleeding, usually light pink or dark brown.
• Leakage or rupture of amniotic fluid.

Symptoms of preterm labor:

• Intermittent abdominal pain, increasingly intense and continuous.
• Thinned and dilated cervix >4cm.
• Leakage or rupture of amniotic fluid.
• Decreased or no fetal movement.
• May be accompanied by symptoms such as nausea, vomiting, diarrhea…

3. Prevention of Premature Birth:

• Regular prenatal care: The most important thing is to have regular prenatal checkups to detect early health problems in the mother and fetus.
• Follow the doctor’s instructions: Maintain a healthy diet, supplement with adequate nutrients, get adequate rest, avoid strenuous activity, reduce stress…
• Control existing medical conditions: Effectively manage chronic illnesses like diabetes and high blood pressure…
• Avoid smoking, alcohol consumption, and drug use: These substances can harm the fetus and lead to premature birth.
• Educate and promote knowledge about preterm birth prevention: Raise awareness of preterm birth, its prevention methods, and how to manage it when symptoms arise.

4. Management of Premature Birth:

Management of threatened preterm labor:

• Bed rest, limit activity.
• Use of anti-contraction medications.
• Use of hormones, progesterone supplementation.
• Manage any accompanying medical conditions.

Management of preterm labor:

• Monitor fetal and maternal health.
• Use of anti-contraction medications.
• Perform a cesarean section or vaginal delivery depending on the fetal condition and maternal health.

Note:

• Do not self-treat premature birth at home.
• Seek medical attention for timely examination and treatment.
• Managing preterm birth is a complex process that requires close coordination between the doctor and the patient.

Additional information for the questions:

• Question 815: Answer B is incorrect. A baby born weighing 500g to 900g is considered extremely preterm, not premature.
• Question 817: Treatment and advice for pregnant women with signs of threatened preterm labor is hospitalization for monitoring and treatment (answer B). It is absolutely not recommended to self-treat at home or continue normal work activities.
• Question 819: The lack of creases on the sole of the foot is a characteristic of a premature baby. Question 819 is incorrect.
• Question 822: Limiting exercise during pregnancy is incorrect advice. Gentle, moderate exercise, appropriate for the pregnant woman’s health condition, is essential.
• Question 827: The nervous system is not fully developed in premature babies. The answer is “True”.
• Question 829: Threatened preterm labor, with a closed cervix, requires rest and not just anti-contraction medication (answer B).
• Question 835: Preterm birth is labor that occurs before **37 weeks** of pregnancy (calculated from the first day of the last menstrual period).
• Question 836: Benefits of ultrasound in preterm birth:
  • Estimate fetal weight.
  • Detect uterine and fetal malformations.
  • Determine the position of the placenta and amniotic fluid.
  • Ultrasound measurement of cervical length to assess the risk of preterm birth.
• Question 837: Essential laboratory tests in suspected cases of maternal fever:
  • Urine culture.
  • Cervical swab for bacteria.
  • Blood tests for malaria parasites, CRP, and blood culture.
  • Ultrasound to check fetal and amniotic fluid status.
• Question 838: One of the most well-known causes of preterm birth, even before pregnancy, especially in women with a history of preterm birth, is **incompetent cervix.**
• Question 839: **Anencephaly** typically does not pose a risk of preterm birth.
• Question 841: If a baby is born before 32 weeks, the risk of neurological complications is **1/3.**
• Question 842: **Nuchal cord** is not a cause of preterm birth due to fetal adnexa.
• Question 843: Preterm labor has symptoms like intermittent abdominal pain, cervical effacement >80%, and ruptured membranes. Dizziness is not a common symptom.
• Question 844: **It is crucial to actively manage threatened preterm labor even when the cervix is dilated >2cm** is an incorrect statement.
• Question 845: **Hypotension** is not a side effect of Salbutamol.
• Question 846: **Loss of tendon reflexes is a symptom of drug toxicity** is a correct statement about Magnesium sulfate.
• Question 847: **Ovarian cysts** are usually not a cause of preterm birth.
• Question 849: **Sucking reflex begins around 36 weeks of gestation.**
• Question 850: **High gastric acidity** is not a typical physiological characteristic of premature babies.
• Question 851: **Premature babies should not be overheated as they have difficulty losing heat** is a false statement. Premature babies are very susceptible to heat loss and need to be kept warm carefully.
• Question 853: **Premature rupture of membranes, early rupture** is the most common cause of preterm birth.
• Question 854: **Diagnosis of ruptured membranes** is a cause of preterm birth that cannot be diagnosed by ultrasound.
• Question 855: **Multiple vaginal examinations** are not necessary in the management of threatened preterm labor.
• Question 856: In a case of a pregnant woman with a history of two late miscarriages in the second trimester with the following characteristics: sudden rupture of membranes, rapid labor, cervical cerclage at 14 weeks.
• Question 857: **With current treatment options, the number of preterm births under 37 weeks has significantly decreased** is an incorrect statement.
• Question 858: **A neonatal resuscitator should be present at delivery** is the right thing to do in a preterm birth.
• Question 859: The rate of preterm birth among all births is **5-15%.**
• Question 860: Corticosteroid use in mothers reduces the risk of respiratory distress syndrome in newborns by **40-60%.**
• Question 861: Ritodin has a side effect of **hypokalemia.**
• Question 862: In the case of a 28-week pregnancy with ruptured chorioamnionitis, antibiotics and monitoring are required.
• Question 863: The most suitable incubator temperature for a premature baby weighing 1.500 – 2.000g is **330 – 340**.
• Question 864: **Placenta previa** is not a cause of difficult delivery due to fetal adnexa.
• Question 865: Treatment of threatened preterm labor and preterm birth should only be done at primary healthcare facilities for cases of **long, closed cervix.**
• Question 866: **Delivering a preterm baby does not require an episiotomy when the baby is small** is an incorrect statement.

Additional information:

• Early diagnosis: Ultrasound, laboratory tests, and regular prenatal checkups are crucial tools for the early diagnosis of preterm birth.
• Support for preterm babies: Preterm babies need special care in an incubator, appropriate breastfeeding or formula feeding, and complete immunizations.
• Role of the family: Family’s love, care, and attention play a significant role in supporting the healthy development of preterm babies.

Conclusion:

Premature birth is a serious health issue that impacts the health and development of babies. Raising awareness of preterm birth, its prevention methods, and timely treatment are the best ways to protect mothers and babies.

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