Premature or preterm birth: the most frequent causes

The longer a (well) baby remains in the womb, the better the health outlook at birth and the lower the need for neonatal medical care.

Preterm or preterm birth is defined as such when it occurs between the 22nd and 37th complete week.

It happens in about 10% of all pregnancies.

Many mothers complain about the numerous checks to be done during pregnancy (if only the recommended ones are performed, there aren’t even many): why are they required?

With these visits it is possible not only to monitor the health of the mother and the fetus but also to evaluate who is at risk of a possible preterm birth.

The primary aim of prenatal care is to keep the pregnancy as long as possible .

In general, the longer a (well) baby remains in the womb, the better the health outlook at birth and the lower the need for neonatal medical care.

A baby born very early, for example at 23 weeks, has a very high risk of permanent disability, approximately 99%.

If born at 26 weeks this risk drops dramatically to 25%. At 30 weeks this risk is drastically reduced.

However, given that only 1.5% of pregnancies end in premature birth before 32 weeks, the overall risk of problems for the baby is very low.

The causes of premature birth

What determines a premature birth is still unclear, however there are some common causes:

• In some women, the cervix shortens during pregnancy and this is implicated in more than half of premature births.
• smoking during pregnancy increases the risk of premature birth by about 25%. Abuse of alcohol or drugs also increases the risk
• Certain medical conditions such as diabetes can increase the risk of preterm birth
• Women suffering from gingivitis appear to be at a high risk of preterm birth. This is because harmful bacteria can affect the placenta and amniotic fluid. Smoking also lowers the immune system against bacteria present in the mouth
• Problems with the placenta (especially if it doesn’t feed the baby adequately) can cause the baby to release hormones that induce labor
• Vaginal infections are a frequent cause of preterm birth. About 20%-40% of premature births are attributed to the presence of infections in the vaginal tract.
• If you have had a premature birth statistically speaking it is more likely that it will happen again
• Preterm birth can be induced by doctors when the mother suffers from pre-eclampsia, high blood pressure, diabetes, placental insufficiency, placenta previa, or abruptio placenta

The most frequent problems with a premature baby

One of the main problems in a premature baby is related to the immaturity of the lungs.

The lungs have not had time to fully mature and are not elastic enough for the baby to breathe on its own. Surfactant (which prevents the smaller sockets from collapsing and the larger ones from overexpansion) is not produced before 26 weeks of pregnancy and must be given artificially to the baby.

Even at 35 weeks when there should be enough surfactant naturally produced by the baby to breathe, he or she may still need to have oxygen added via the nasal tubes.

That’s why in photos of babies born prematurely you almost always see that they have those little tubes that help them breathe.

If the baby is likely to be born or needs to be delivered before 35 weeks, when possible, mothers are injected with steroids to help the baby produce as much surfactant as quickly as possible.

These steroids also aid in the deposition of subcutaneous fat in the child. However, these steroids need 24-28 hours to produce results and therefore, if possible, doctors try to delay delivery at least until they have taken effect.

They struggle to eat

Premature babies have difficulty feeding . The sucking reflex is not yet fully developed before 35 weeks and their digestive system cannot handle large amounts of fluid intake.

For this reason, premature babies are fed milk through a tube, small amounts at frequent intervals.

Warning signs

If you are having abdominal pain, bleeding or your water has broken go to the hospital immediately.

If you are having contractions go to the hospital, doctors may give you medicines to relax the uterus and thus stop the contractions. You will remain in strict rest and under surveillance.

If the contractions stop and everything stabilizes you can go home but even in this case bed rest is recommended and intercourse is prohibited.

In case labor cannot be stopped doctors will try to delay delivery for at least 48 hours to get the baby to produce surfactant through steroid injection.

Although natural delivery of a preterm baby is faster than natural delivery at full term, doctors prefer to resort to a cesarean section if signs of fetal distress are noticed.

A caesarean section can also be chosen to protect the baby’s head : the skull bones of a premature baby are in fact much softer than those of a full-term baby.