Premature Birth: Signs, Causes, Complications and Treatment

When a baby is born premature, numerous health problems can arise. So, it's crucial to understand the reasons for premature birth and how to spot the warning signs.

In this blog, let's explore the key symptoms of premature birth, its causes, how doctors diagnose it, and the available treatments. We will also discuss the risks of premature birth, ways to prevent it, and when you should see a doctor. 

What is Premature Birth?

A premature birth occurs when the delivery happens before 37 weeks of pregnancy. A full-term pregnancy usually lasts around 40 weeks. Prematurity is the leading cause of death in children under five years old. Many premature babies who survive face lifelong disabilities, including learning difficulties and vision and hearing problems. Premature births are divided into categories based on the gestational age:

• Extremely preterm: Born before 28 weeks
• Very preterm: Born between 28 to less than 32 weeks
• Moderate to late preterm: Born between 32 to 37 weeks

Babies can be born prematurely due to spontaneous preterm labour or because of a medical need to induce labour or perform a cesarean delivery early.

Signs and Symptoms of Premature Birth

You should call your doctor immediately if you experience any of the following signs before 37 weeks of pregnancy:

• Regular Contractions:
  • Tightenings or period-like cramps that come at regular intervals
  • Sharp backache that comes and goes, which could be labour contractions
  • Persistent pelvic pressure or cramps
• Fluid Leakage:
  • Gushing or trickling of fluid from the vagina, which may indicate that your waters have broken
  • If the fluid has an unusual colour (green, brown, or black), it could signal an infection.
  • Vaginal bleeding during any stage of pregnancy is a cause for concern 
• Decreased Foetal Movement
  • A noticeable change or reduction in your baby's movements 
  • Even if the symptoms seem mild, contact your doctor promptly. Early detection and treatment can prevent complications of premature birth and improve outcomes for both you and your baby.

Causes of Premature Birth

Premature birth can happen spontaneously or be medically induced. Most of the time, the exact cause is unknown. However, certain factors can contribute:
If you've had a premature birth before, you're more likely to experience it again. The earlier the previous preterm birth, the higher the risk.

• Problems with the placenta, such as placental abruption (the placenta separates from the uterine membrane) or placenta previa (the placenta covers the cervix)
• Excessive or less than normal amniotic fluid (polyhydramnios or oligohydramnios) 
• Preterm premature rupture of membranes (PPROM), where water breaks before 37 weeks
• Uterine abnormalities or a short cervix 
• Carrying multiple (twins, triplets) pregnancies
• Chronic maternal health conditions like high blood pressure, diabetes, or autoimmune disorders like antiphospholipid syndrome 
• Pregnancy-related conditions like preeclampsia (high blood pressure and protein in urine) or gestational diabetes 
• Infections like UTIs, intrauterine infections, or sexually transmitted infections can trigger premature labour.
• Foetal growth restriction, where the baby is smaller than expected, may require early delivery.

Risk Factors

• Being very young (under 18) or older (over 40) at the time of pregnancy 
• Black women have a higher incidence of premature births than other ethnicities.
• Being underweight or overweight before pregnancy 
• Smoking, alcohol use, or illicit drug abuse during pregnancy 
• High levels of stress or depression 

Diagnosis

The doctor will take an in-depth personal & medical history and will discuss risk factors for preterm labour. They will also evaluate your signs and symptoms. Doctors will perform:

• Pelvic Assessment: Your doctor may conduct a pelvic exam to check if your cervix has started dilating and evaluate the firmness and tenderness of your uterus, the baby's size, and position. 
• Ultrasound: A transvaginal ultrasound can measure cervical length and issues with the foetus or placenta, confirm the baby's position, and assess the amniotic fluid volume.
• Uterine Monitoring: Your doctor may perform a uterine monitoring investigation to measure the duration & spacing of your contractions.
• Urine Test: Your doctor may conduct urine analysis to determine the presence of certain bacteria.

Premature Birth Treatment

If you experience preterm labour or are at risk of premature birth, there are preterm birth treatments available to help protect your preterm baby. These include:

• Antenatal Steroids: Doctors may give you steroid injections to help your baby's lungs mature faster. The injections can reduce breathing difficulties and other complications after birth.
• Tocolytic Medications: The use of these medicines can temporarily delay preterm labour so that steroids can take effect or patients can reach a hospital with a neonatal intensive care unit (NICU).
• Antibiotics: If your water breaks early (preterm premature rupture of membranes or PPROM), antibiotics may be prescribed to prevent infections. 

After birth, your premature baby will likely need specialised care in the NICU. Common treatments include:

• Incubator Care: Premature newborns will be placed in an incubator, a warm, enclosed bassinet, to maintain body temperature.
• Respiratory Support: Premature babies often need help breathing. Doctors may use a ventilator or a continuous positive airway pressure (CPAP) machine. Surfactant medication can also help immature lungs function better.
• Feeding Assistance: Initially, your baby may receive nutrients through an IV or feeding tube. As they grow stronger, breastfeeding or bottle-feeding can be introduced.
• Phototherapy: If your baby develops jaundice (high bilirubin levels), they may be placed under special lights to help break down the excess bilirubin.
• In severe cases, surgery may be necessary to treat complications like heart defects or intestinal issues. Your NICU team will closely monitor your baby's progress and provide the appropriate care.

Complications

Premature birth can lead to various short-term and long-term complications for the baby. Generally, the sooner a baby is born, the higher the chance of complications.

• Short-Term Complications: In the first few weeks after birth, premature babies may experience:
  • Breathing Problems: Underdeveloped lungs can cause respiratory distress syndrome, apnea (pauses in breathing), and bronchopulmonary dysplasia, requiring oxygen support.
  • Heart Problems: Common heart issues include patent ductus arteriosus (PDA) and low blood pressure.
  • Brain Problems: Intraventricular haemorrhage, or bleeding in the brain, is a risk, with the potential for permanent brain injury in severe cases.
  • Digestive Problems: Underdeveloped digestive systems can cause gastrointestinal issues like necrotising enterocolitis (NEC).
  • Blood Problems: Anaemia (low red blood cell count) and newborn jaundice (excess bilirubin) are common in premature babies.
  • Metabolism Problems: Premature babies may have low blood sugar levels and difficulty converting stored sugar into usable forms.
  • Immune System Problems: Immature immune systems increase the risk of infections, including life-threatening sepsis.
• Long-Term Complications: Over the long term, premature birth may lead to:
  • Cerebral palsy
  • Learning disabilities
  • Abnormal blood vessel growth in the eye's retina can cause retinopathy of prematurity, which, if untreated, can lead to vision impairment or blindness.
  • Hearing loss
  • Enamel defects and delayed tooth development
  • Increased risk of conditions like autism spectrum disorder, anxiety, depression, ADHD, and sleep disorders
  • Long-term health problems, including asthma, feeding difficulties, and a higher possibility of sudden infant death syndrome (SIDS)

When to See a Doctor

You should contact your doctor immediately if you experience any signs of premature labour before 37 weeks of pregnancy. These signs include:

• Regular contractions or tightenings that come at regular intervals
• Excess fluid leakage from your vagina
• Any vaginal bleeding during pregnancy
• A noticeable change or reduction in your baby's movements
• Persistent pelvic pressure or cramps
• Your mucus plug (a jelly-like discharge) passing

Prevention

You can take several steps to diminish your risk of premature birth. Here are some preventive measures:

• Maintain a Healthy Weight: Being overweight or underweight increases your chances of developing complications that could contribute to premature birth. Manage your weight healthily through a balanced diet and regular exercise.
• Stay Active: Staying physically active throughout pregnancy will improve your overall wellness. It also reduces your risk of conditions such as diabetes and preeclampsia, which can lead to premature birth. 
• Manage Stress and Depression: Women who have stress or depression seem to be more prone to giving birth prematurely. Try to find suitable ways to manage stress and seek help if you're experiencing depression during pregnancy.
• Quit Smoking and Avoid Alcohol: Quitting smoking is one of the most positive steps you can take to reduce the risk of premature birth. Drinking alcohol during pregnancy also is known to be a risk factor for premature birth. It's safest to avoid alcohol altogether.
• Check Medication Safety: Before taking any medication, always ask your doctor to ensure its safety during pregnancy. 
• Prevent Infections: Many types of infections are associated with premature birth. Practice good hygiene. Wash your hands frequently. Hand washing is essential, especially after using the restroom, before eating, and after changing diapers. 
• Remember that premature birth can still occur even with no identifiable risk factors. Regular prenatal monitoring and care are crucial for detecting and managing potential issues.

Conclusion

Premature birth is a complex issue that impacts many families worldwide. Understanding the signs, causes, and potential complications can help expectant parents be better prepared to handle this challenging situation. Early identification and prompt medical attention are crucial to improving outcomes for both mother and baby.

Taking care of a preterm baby can be a challenging journey, but with advances in medical care, many preterm infants go on to live healthy lives. To reduce the risk of premature birth, maintain a healthy lifestyle, manage stress, and attend regular prenatal check-ups. 

FAQs

1. How common is premature birth?

Premature birth is quite common, affecting around 1 in 10 babies worldwide. 

2. What week is preterm birth safe?

There is no definitive "safe" week for preterm birth, as any birth before 37 weeks is considered premature. However, the risks and potential complications increase the earlier a baby is born. 

3. How to stop preterm labour?

If you are experiencing signs of preterm labour, your doctor may recommend treatments to try to stop or delay labour. These can include:

• Tocolytic medications to temporarily halt or slow contractions
• Corticosteroids to help promote your baby's lung maturity
• Antibiotics if your water has broken early (PPROM) to prevent infections
• Progesterone shots or vaginal progesterone if you have a history of premature birth

4. How long can preterm labour be delayed?

Tocolytic medications can often delay labour for 48 hours to 7 days. This window allows time for corticosteroids to help the baby's lungs develop further or for you to be transported to a hospital with a neonatal intensive care unit (NICU) if needed.

5. How to avoid a premature baby?

While premature birth cannot always be prevented, you can take steps to reduce your risk:

• Maintain an optimal weight and healthy diet during pregnancy
• Stay active with regular exercise (as approved by your doctor)
• Manage stress and depression
• Quit smoking & avoid alcohol and illicit drugs
• Practice good hygiene to prevent infections
• Attend all prenatal care appointments to monitor for potential issues