Premature birth is a birth that occurs before the 37th week or earlier than the expected day of birth. This condition occurs when uterine contractions cause the cervix to open (cervix), thus making the fetus enter the birth canal.
The last week of pregnancy is an important period in the formation of the final stages of various vital organs, including the brain and lungs, as well as the process of increasing fetal weight. Therefore, babies born prematurely are at risk of health problems because the condition of their organs is not perfect, so they need intensive care.
Causes of Premature Birth
The cause of premature birth is sometimes unknown, but premature rupture of the membranes is one of the main causes of premature birth. Several factors can trigger premature birth, namely:
- maternal health factors, including:
- Preeclampsia.
- Chronic diseases, such as kidney or heart disease.
- Infectious diseases, such as urinary tract infections, amniotic fluid infections, and vaginal infections.
- Uterine deformity.
- Inability of the cervix to close during pregnancy (cervical incompetence).
- Stress.
- Smoking habits before and during pregnancy.
- Drug abuse.
- Have had a preterm birth before.
- pregnancy factor, as:
- Abnormalities or decreased function of the placenta.
- Abnormal position of the placenta.
- The placenta that comes off prematurely.
- Too much amniotic fluid (polyhydramnios).
- Premature rupture of membranes.
- Factors involving the fetus, that is:
- Twin pregnancy.
- Blood disorders in the fetus.
Symptoms of Premature Birth
Symptoms of preterm birth are almost the same as symptoms or signs of wanting to give birth. To ensure that these symptoms do not harm the pregnant woman and the fetus, it is recommended that pregnant women immediately consult a doctor or visit the nearest hospital. The symptoms are as follows:
- Lower back pain.
- Contractions every 10 minutes.
- Cramps in the lower abdomen.
- More and more fluid and mucus from the vagina.
- Vaginal bleeding.
- Pressure in the pelvis and vagina.
- Nausea, vomiting, to diarrhea.
Premature Birth Diagnosis
As a first step in responding to signs of premature birth, the doctor will check the health history of the pregnant woman, as well as examine the current physical condition of the pregnant woman and fetus. The obstetrician will also perform an internal vaginal examination to check the condition of the cervix and detect the possibility that the cervix has opened.
Next, the doctor will measure the frequency, duration, and strength of contractions using a CTG (cardiotocography). Through this tool, the doctor can also monitor the fetal heart rate.
The doctor will also advise the patient to undergo further examinations, namely:
- ultrasound of the vagina, to measure the length of the cervix and the condition of the uterus.
- cervical mucus examination, to examine a protein called fetal fibronectin, which is a protein that is released when there is an infection or disruption of the uterine tissue.
- Vaginal swab test (vaginal swab), to check and detect the presence of infection-causing bacteria, if an infection is suspected.
Management of Premature Birth
The steps for handling premature birth are determined based on the condition of the pregnancy and the patient's overall health. Some of the early treatment measures for premature birth, namely:
- Patients are recommended to be hospitalized so that doctors can monitor the condition of pregnant women and fetuses in the womb. The doctor or nurse will put an IV tube to deliver fluids and drugs.
- Drug.Several types of drugs will be given by the doctor, including:
- tocolytic drugs, which is a type of drug used to reduce or stop contractions, such as: blinded and isoxsuprine.
- Corticosteroids, is a drug used to accelerate the development of fetal lung organs.
- magnesium sulfate, to reduce the risk of disruption or damage to the brain.
- Antibiotics, if the preterm birth is caused by an infection.
- Cervical ligation procedure, which is a procedure performed by sewing the opening of the cervix. This procedure is performed on pregnant women with a weak cervix and a risk of opening during pregnancy.
- Labor. If preterm birth cannot be delayed with early treatment, or if both the fetus and mother are in a life-threatening condition, then labor will begin. If possible, delivery can be carried out normally. However, premature babies have a higher risk of being breech. If this is the case, the obstetrician may advise pregnant women to give birth by Caesarean section.
Features and Treatment of Premature Babies
Physically, babies born prematurely will look different from babies born normally. Premature babies are smaller in size with a slightly larger head. Other characteristics of premature babies are:
- Covered with fine hair that grows thickly all over the body.
- The eye shape is not as round as a normal baby because of a lack of body fat.
- Low body temperature.
- Difficulty breathing due to immature lung development.
- Have not been able to suck and swallow perfectly, so it is difficult to accept food intake.
Gestational age will determine the health condition of the baby born. The following are health problems that can occur:
- Fetuses born before 23 weeks of gestation may not be able to survive outside the mother's womb.
- Babies born before 25 weeks of gestation have a high risk of suffering from long-term disorders, namely neurological disorders and learning difficulties.
- Babies born before 28 weeks of gestation are at high risk for non-permanent complications, such as respiratory problems.
- Babies born between 28-32 weeks of gestation, their health condition will gradually improve. After 32 weeks of age, the baby's risk of developing the disorder is lower.
After birth, doctors will perform special treatment for premature babies. Premature babies will undergo intensive care in the NICU (neonatal intensive care unit) until the internal organs are fully developed and the baby's condition is stable without being supported by hospitalization. Babies born prematurely with breathing problems also generally need resuscitation. Special forms of treatment carried out by pediatricians include:
- Put the baby in the incubator to keep the baby's body temperature warm.
- Install sensors on the baby's body to monitor the baby's respiratory system, heart rate, blood pressure, and body temperature.
- Feeding breast milk or formula through a feeding tube that is inserted through the baby's nose.
- Babies born with jaundice will undergo light therapy to reduce the yellow color of the body.
- Give a blood transfusion to increase the baby's blood cell count, if needed. This is done because the process of formation of red blood cells is not perfect.
- Perform periodic examination of the baby's heart with cardiac ultrasound or echocardiography.
- Ultrasound examinations are also performed to check for possible bleeding in the brain and other organs, such as the liver and kidneys.
- An eye exam will be done to detect abnormalities that can interfere with vision.
Complications of Premature Birth
Premature birth has an impact on both the mother and the baby being born. Premature babies have a greater risk of disease complications than normal babies. Complications are divided into two types, namely:
- Short term complications. Premature babies are at risk of experiencing a number of disorders of organ function, such as the heart, brain, respiratory tract, digestive tract, as well as immune disorders and difficulty regulating body temperature. Premature babies also have the potential to experience jaundice, because the liver is not yet mature.
- Long term complications. Premature infants are at risk for long-term complications, such as cerebral palsy (cerebral palsy), hearing loss and visual impairment (Retinopathy of Prematurity), decreased intelligence, psychological disorders, until the baby died suddenly. Babies born prematurely are also at higher risk for developing asthma later in life.
Prevention of Premature Birth
The main prevention of premature birth is to maintain health, before and during pregnancy. This effort can be done in several ways, namely:
- Get regular prenatal checkups. Through prenatal care, doctors can monitor the health of pregnant women and the fetus in the womb, as well as detect abnormalities that may occur during pregnancy.
- Follow a healthy diet before getting pregnant. Consumption of a healthy diet rich in protein, fruit, and whole grains before pregnancy can reduce the risk of preterm birth.
- Avoid exposure to harmful chemicals and substances, such as cigarette smoke, canned food, cosmetics, alcohol, and drugs.
- Take calcium supplements. Consumption of calcium supplements 1000 mg or more per day, can reduce the risk of premature birth and preeclampsia.
- Consider the spacing of pregnancies. Pregnancy that is only less than 6 months from the last delivery, can increase preterm birth.
- Using a pessary (cervical pessary). Pregnant women with a short cervix are advised to wear a pessary to support the uterus so it doesn't descend. The shape of this tool resembles a ring that is placed in the cervix.
If pregnant women are at high risk of having a premature birth due to a chronic disease, the doctor can give medicines according to the condition of the pregnant woman to reduce this risk, for example drugs to control blood pressure or blood sugar levels.