Premature Birth: Causes, Signs & Preventive Tips

Premature labor or premature labor means the onset of spontaneous labor after gestation of viability (24-28 weeks, in India) and before the completion of 37 weeks of the labor cycle. According to the WHO estimate, 15 million babies are born prematurely each year. That’s more than 1 in 10 babies. Also, about 1 million children die each year due to complications from premature delivery. And for survivors, it’s a lifetime of disabilities, including cognitive, visual and hearing problems.

Given the situation, November 17 is known to be observed as World Prematurity Day to raise awareness about the disease, its tumultuous consequences on maternal and newborn health, and its impact on the family. A purple ribbon is the official symbol to represent sensitivity and exception. Besides that, the line of socks has become a popular symbol of World Prematurity Day. The little pair of purple socks, framed by nine full-size baby socks, symbolizes the 1 in 10 babies who are born prematurely. In this blog, we are discussing the factors that lead to premature birth, it’s indicative signs and steps to prevent premature delivery.

Before we get to its roots, let’s understand the two categories of premature birth. Classification is made on the basis of presumed lung maturity. The period of 28 to 34 weeks is called early prematurity when the lungs are not mature, while births that occur between 24 and 37 weeks are late prematurity when the lungs are presumed to be nearly mature. Late prematurity has a better prognosis than early prematurity and fortunately most premature births occur in the late prematurity stage.

Causes of premature birth

There are many factors that can lead to premature birth and we have listed almost all of them for you. However, please note that according to Holland and Brew’s Manual of Obstetrics, no plausible cause is found in approximately 30-50% of the total number of preterm births, making it an enigmatic complication.

1. Pregnancy factors

a. Urinary tract infections

Nearly 30% of all preterm births are the result of maternal genital infection. Urinary tract infection and asymptomatic bacteriuria can cause preterm labor and therefore urine is routinely sent for culture and sensitivity to many centers. It also means that disadvantaged women of lower socioeconomic status are at a higher risk of delivering premature babies.

b. Antepartum hemorrhage

Antepartum hemorrhage (APH) is generally defined as bleeding from the birth canal after the 24th week of pregnancy. It can occur anytime up to the end of the second trimester; bleeding after the baby is born is postpartum hemorrhage.

(To understand this, remember how we refer to clock time, AM and PM where Prime is Ante Meridian and PM is Post Meridian)

There are three convenient options for management:

• Pregnant: in the hope that the pregnancy will continue
• Immediate Cesarean
• Rupture membranes and aim for vaginal delivery

However, all of these options must be weighed against a number of other factors of concern and only then should the decision be made.

vs. Cervical inefficiency

Cervical inefficiency, also called incompetent cervix, occurs when weak cervical tissue causes or contributes to premature birth. Structural weakness of the cervix causes the cervix to open prematurely and increases the risk of premature labor in women.

D. Uterine abnormalities

The risk of premature birth varies with the type of abnormality and the outcome is worse in unicorn or bicornuate uterus compared to separated uterus. According to Cleveland Clinic“A unicornuate uterus is a rare condition in which a person has only half a uterus. A woman with a unicornuate uterus has one functioning fallopian tube (instead of two) and a smaller uterine cavity. is a congenital uterine anomaly, that is, one is born with it. In the case of a bicornuate uterus, it is the shape that is the problem. A bicornuate uterus is described as heart-shaped, appearing to have two sides instead of a hollow cavity.This too being a congenital condition is a major contributor to premature births. to research, the risk of preterm birth associated with uterine abnormality is high, especially with a history of preterm birth or second-trimester loss. The risk remains high even in women who have given birth at term.

e. RPROM

Premature rupture of membranes (PROM) is a rupture of the membranes (amniotic sac) before the onset of labor. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PRMP). PROM occurs in about 8-10% of all pregnancies. Improper prenatal care, vaginal bleeding, STDs, history of preterm birth, and smoking are factors that increase the incidence of PPROM.

F. Fetal growth restrictions

Fetal growth restriction (FCR) is a condition in which a fetus (unborn child) is smaller than the standard size for its corresponding gestational age. With this condition, a baby weighs less than 90% of other babies at the same gestational age. Causes of FGR include high blood pressure in the mother, infections, smoking or alcohol abuse, and problems with the placenta or umbilical cord. The placenta is the tissue that brings nutrients and oxygen to the developing baby blood flow through the umbilical cord, which connects the baby to the placenta.

g. Fetal abnormalities

Fetal abnormalities refer to malformations during the gestation period. There are two general categories of fetal abnormalities:

• Structural abnormalities affect parts of the baby’s developing body, such as their heart, lungs, kidneys, limbs, or facial features. Heart defects, missing toes, cleft lip, and spina bifida are examples of structural birth defects.
• Functional abnormalities affect the functioning of a body part or body system, such as the brain, nervous system, or sensory perception. Examples of functional birth defects include seizures, blindness, developmental disabilities, muscular dystrophy, and Down syndrome.

Some fetal abnormalities can affect both structure and function of the baby.

2. Maternal age

Advanced maternal age presents a higher risk of immaturity and fetal malformations. In older women, the eggs, which have been present in an immature state since birth, may have been affected by aging or exposure to chemicals, drugs, and other harmful agents. Thus, advanced age is associated with an increased risk of preterm birth. Conversely, in young women (those under the age of 18), the reproductive system may not be fully developed and therefore face similar problems.

3. Maternal nutrition

The mother is the only source of nutrition for the unborn child and therefore a diet that includes all five components of a balanced meal – protein, fibre, carbohydrates, vitamins and minerals and plenty of water is of the utmost importance . Maternal nutritional deprivation has a direct relationship with premature birth as it is one of the main determinants of maternal weight. It has been found that when the maternal weight is below 45 kg, the rate of preterm labor is three times higher than when the maternal weight is above 55 kg.

4. Maternal medical condition

Measles or German rubella and cytomegalovirus diseases are among the most dangerous diseases for pregnant women. These diseases also infect the child and thus cause significant developmental problems. If the rubella virus crosses the placenta, it can lead to devastating results like premature birth. Women who suffer from blood poisoning during pregnancy most often give birth to premature babies or babies that are smaller than the average baby. Finally, preterm labor is common in pregnancies complicated by chronic hypertension, heart disease, anemia, kidney failure, etc.

5. Drug and chemical use

It is absolutely necessary to avoid any type of drugs or chemicals unless prescribed by a licensed physician. Drugs and alcohol cause fetal abnormalities, as mentioned above, which eventually lead to premature delivery. Smoking is also very closely associated with prematurity and low birth weight.

6. Chronic stress

Women who are stressed or depressed seem to be more at risk of giving birth prematurely. And while scientists have yet to establish a conclusive link between the two, there are a number of possible links. Chronic stress causes long-term changes in the body’s vascular system and hormone levels, and thus affects the body’s immunity which triggers a different set of complications. Complications can potentially influence the onset of labor (before 37 weeks of gestation). Another reason may be that stressed mothers are less likely to lead healthy lives. Mental well-being is difficult to assess – not least because we all have different stress thresholds – but certain factors linked to psychological distress have also been linked to premature birth.

7. History of preterm labor

A history of preterm birth is a good predictor of a similar outcome. This risk increases with the number of past preterm deliveries and decreases with the occurrence of a term delivery. The risk is also increased when there have been one or more spontaneous or induced abortions during the second trimester. The risk with premature delivery is 17 to 40%.

8. Coitus

Frequent sexual intercourse during pregnancy is commonly thought to trigger contractions and, therefore, induce labor. However, in low-risk pregnancies, there is neither association with preterm birth, premature rupture of membranes, or low birth weight, nor with spontaneous onset of labor at term.

Now that we understand the causes of premature birth, it will be easier to understand preventive measures.

Steps to Prevent Premature Birth

Although preventing premature births is not always guaranteed, there are a number of simple ways to support a healthy full-term pregnancy that ensures the holistic development of the child.

1. Eat well

While healthy pregnancy outcomes are generally associated with good nutrition, poor nutrition is known to predispose to preterm labor. Eat a balanced diet with foods high in iron and folic acid, as they keep your hemoglobin levels in check. Women with hemoglobin levels below 9 g/dL are at a higher risk of giving birth prematurely. Overweight and underweight women are more likely to give birth to premature babies. Work with your nutritionist to achieve a healthy weight. Additionally, work with your healthcare provider to keep any chronic conditions under control. Read this article to learn more about the basics of pregnancy diets.

Apart from this, regular consumption of unhealthy foods will increase your stress level and lead to anxiety. However, there are some magic foods that can help relieve stress and keep you and your baby healthy. Here are the 9 best foods to help you manage your stress.

Here are some foods you should include in your diet if you’re looking for ways to relieve stress:

2. stay active

Being physically active throughout pregnancy will improve your overall well-being and reduce your risk of diseases such as gestational diabetes which can lead to premature birth. Unless you’ve been specifically advised otherwise, it’s a good idea to do something that keeps your muscles active every day. It doesn’t have to involve organized exercise or anything very elaborate, a routine nighttime walk can remove the risk to a great extent.

Here is a basic guide to the best exercises for pregnancy.

3. Spacing of pregnancies

According to a BBC News report, mothers should wait at least one year between giving birth and becoming pregnant again to reduce the risks to their health and that of their baby. Small gaps between pregnancies lead to premature births, smaller babies, and infant and maternal mortality. The report is based on a study of nearly 150,000 births in Canada by the University of British Columbia (UBC) and Harvard TH Chan School of Public Health published in JAMA internal medicine. The study revealed that 12 to 18 months was the ideal length of time between childbirth and the new pregnancy. He also suggested that waiting 18 months between pregnancies reduced the risk to 0.5% (five cases per 1,000). Younger women who became pregnant six months after a previous childbirth had an 8.5% risk (85 cases per 1,000) of preterm labor. This percentage drops to 3.7% (37 per 1,000) if they wait 18 months between pregnancies.

4. Avoid taking stress

There are a few things you can do to reduce stress during pregnancy (and these are great ideas if you’re not pregnant, too). More research needs to be done to determine exactly which relaxation strategies will help reduce the risk of preterm birth, but anything that reduces chronic stress could potentially increase your chances of having a full-term baby.

In a small study, researchers found that chronically stressed mothers who received psychological counseling during pregnancy were less likely to give birth early.

Low-impact activities generally recommended during pregnancy include brisk walking, swimming, stationary cycling, and using an elliptical trainer or stair climber. Yoga has been shown to improve pregnancy outcomes and reduce the risk of preterm birth. Talk to your doctor about safe exercises during pregnancy and what to avoid (like lying on your back or on your stomach).

Massage, aromatherapy, acupuncture and hypnotherapy have been shown to help reduce stress. (Note that no studies have shown whether they reduce the risk of preterm labor, specifically.)

Avoid the use of alcohol, tobacco and illicit drugs in any form. Also limit your caffeine intake. Do not take any medicine unless your doctor has prescribed it.

Road signs

• Feeling of abdominal tightening (contractions) every 10 minutes or more often.
• A feeling of pelvic or lower abdominal pressure as if the baby is pushing down.
• Constant low and dull back pain.
• Mild abdominal cramps.
• Any amount of vaginal spotting or bleeding.
• A change in the type of vaginal discharge – watery, mucus or bloody and an increase in their amount.
• Swelling of the face, hands or feet, or double vision, blurred vision or other eye disorders. These are signs of pre-eclampsia, which is a common cause of premature births.

If you observe any of the symptoms mentioned above, contact your doctor as soon as possible. Remember that nothing is more important than your health and that of your baby.

Improving the health of the world for premature babies

Every baby is worth the wait. Be aware of the risks of prematurity and take the necessary precautions to save them. Remember that even the smallest footprints can leave the deepest impressions. From a small spark will spring a mighty flame. Save the little angels and protect them in this day and beyond. Premature birth is a real problem, we can’t afford not to talk about it. Raise awareness of the issues and let’s unite to form a loving cradle for every child that comes into the world.