Birth

Premature birth is usually heralded by warning signs. Pregnant women who notice one of the following warning signs should consult their gynaecologist immediately so that an attempt can be made to prevent a premature birth.  Alternatively it is advisable to attend the Emergency Room of your maternity hospital to be assessed.

• Sudden show of blood
• More intense, unpleasant smelling discharge
• Frequent urination (beyond what is normal during pregnancy)
• Severe itching or burning in the vagina
• High Temperature
• Frequent severe diarrhoea
• Premature amniorrhexis (waters breaking)
• Premature contractions

Premature contractions manifest themselves as:

• Severe stomach cramps similar to menstruation pain
• Tightening in the inguinal flexor muscles or back
• Repeated hardening of the lower abdomen at short intervals

If an imminent premature birth is diagnosed, the mother-to-be will be admitted to a perinatal centre with a premature baby unit. Women suffering premature contractions after the 34th week are usually not treated with medication, as the state of maturity of the unborn baby is virtually equivalent to that of a full-term baby and does not represent an increased risk for they child.  If the pregnant woman has not reached the 34 week point of the pregnancy and there are no acute risks for child or mother, an attempt will be made to delay the birth as long as possible, using treatment measures which may involve medical or not.

A primary risk for a premature baby is general immaturity of the organs. The most critical issue is immaturity of the lungs. The birth needs to be delayed about 48 hours to allow the lungs to be matured by treatment with corticosteroids.  As a consequence, an attempt will be made to delay the premature birth using uterine relaxants (tocolytics) until the lungs have matured. The first measure to inhibit contractions is physical rest, but not necessarily strict bed rest. However, the mother-to-be should try to lie down as much as possible on her side with her pelvis slightly elevated to reduce the pressure of the baby on the cervix. In some instances where a woman’s cervix is considered shortened or incompetent, a situation which can result in a premature birth, a stitch or cerclage is inserted in the cervix early in the 2nd trimester and is removed late in the final trimester by the obstetrician.