Most pregnancies last forty weeks but preterm labour may result in the birth of an immature infant and is one of the main problems of obstetric care in many countries including Anguilla. Preterm labour can cause many problems for the newborn and the care of such babies can be a financial strain on parents and the community as well.

What is preterm labour?
The conventional definition of preterm labour includes women delivering before 37 completed weeks of gestation, but in practice most of the problems associated with preterm births occur mostly with births before 34 weeks. Many problems arise in looking after babies weighing less than 1500 grams (3.5 lbs).

What are the causes of preterm labour?
Often, the specific cause of preterm labour, or premature birth, isn’t clear. The mother’s age, parity, socio-economic issues are associated with preterm labour.

Many factors may increase the risk of early labour and premature birth. The most common risk factors include:
 Having a previous preterm labour or premature birth
 Pregnancy with twins, triplets or other multiples
 Problems with the uterus, cervix or placenta (afterbirth)
 Smoking cigarettes, drinking alcohol or using illicit drugs
 Some infections, particularly of the amniotic fluid and lower genital tract
 Some chronic conditions, such as high blood pressure and diabetes
 Being underweight or overweight before pregnancy
 Stressful life events, such as the death of a loved one or domestic violence
 Multiple miscarriages or abortions
For unknown reasons, black women are more than twice as likely to experience preterm labour and premature birth than are women of other races. But preterm labour and premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.

How do you know that preterm labour is starting?
Many pregnant women do not know the signs that might indicate that preterm labour is about to start, while other women refuse to seek medical advice and often do so when it is too late.
Prompt recognition of preterm labour may help you prevent premature birth. Things to look for include the following:
 Contractions that occur more than six times each hour (You’ll feel a tightening sensation in your abdomen, often reminiscent of menstrual cramps.)
 Low, dull backache
 Pelvic pressure or pain
 Diarrhoea
 Vaginal spotting or bleeding
 Watery vaginal discharge (This may be amniotic fluid, which surrounds your baby in the uterus.)
If you’re concerned about what you’re feeling, contact your health care provider. Don’t worry about mistaking false labour for the real thing.

Prevention
The recognition of some of the triggers of preterm labour has led a few obstetricians to take action to prevent labour. Bed rest and the use of prophylactic tocolytic agents are not very helpful, although a doctor might use either of these managements to satisfy a mother who has previously undergone preterm labour and has faith in them. Efforts to modify lifestyle and socio-economic conditions might achieve some success in some patients.
All pregnant women are encouraged to do the following that in addition to help preventing preterm labour will also help to reduce other complications of pregnancy. Pregnant women should:
 Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Mention any signs or symptoms that concern you, even if they seem unimportant.
 Eat healthy foods. During pregnancy, you’ll need more folic acid, calcium, iron, protein and other essential nutrients. A daily prenatal vitamin that contains at least 1 milligram of folic acid — ideally starting a few months before conception — can help fill any gaps.
 Manage chronic conditions. Diseases such as diabetes and high blood pressure increase the risk of preterm labour. Work with your health care provider to keep any chronic conditions under control.
 Follow your health care provider’s guidelines for activity. If you develop signs or symptoms of preterm labour, your health care provider may suggest working fewer hours or spending less time on your feet. Sometimes it makes sense to scale back other physical activities, too.
 Avoid risky substances. If you smoke, quit. Smoking may trigger preterm labour. Alcohol and recreational drugs are off-limits. Even over-the-counter supplements and medications deserve caution. Get your health care provider’s OK before taking any medications or supplements.

 Ask your health care provider about sex. It’s not a concern for women who have healthy pregnancies. But sex may be off-limits if you have certain complications such as vaginal bleeding or problems with your cervix or placenta.

 Limit stress. Set reasonable limits — and stick to them. Set aside some quiet time every day. Ask for help when you need it.

 Take care of your teeth. Brush and floss daily, and visit your dentist for regular cleanings and dental care. Some studies suggest that gum disease may be associated with preterm labour and premature birth.

Treatment
As with labour at term, diagnosing the onset of preterm labour is much easier retrospectively than at the time. You can look back and say labour started at a certain time, but to do so prospectively is much harder. Strong Braxton Hicks contractions can be confused for true labour. The measurement of the strength and timing of contractions can help to make the diagnosis of preterm labour. Once a diagnosis is made the options of treatment will be discussed with the patient.

Treatment depends on the stage of pregnancy and how far labour has progressed. The patient and her doctor usually discuss the risks and benefits of trying to stop labour. Sometimes your doctor might allow labour to progress while other times your health care provider may recommend medication. Some medications stop contractions by relaxing smooth muscles, including those of the uterus. Others block the production of substances that stimulate uterine contractions. These drugs may be given intravenously or by injection. Unfortunately, these medications typically stop labour only briefly — perhaps long enough to accomplish other goals, such as transferring you to a facility better equipped to care for a premature baby.

If the pregnancy is between weeks 23 and 34, your doctor may recommend an injection of potent steroids to speed your baby’s lung maturity. After week 34, steroids may not be needed because fetal lung development is more advanced.
Preterm labour and premature birth may have various complications:

For mothers
Aside from starting too early, preterm labour typically resembles normal labour. Treatments used to delay delivery may carry risks, however. Medications that halt uterine contractions may cause fluid to collect in your lungs which can make it difficult to breathe. Other side effects depend on the medication used to stop labour, Some medications can lead to fatigue and muscle weakness. Others may cause a rapid heartbeat, blood sugar abnormalities, headaches, dizziness or nausea.

Your health care provider will weigh the potential risks from medications used to stop labour against the risks for your baby if he or she is born too soon.

For babies
The risks of premature birth vary depending on how soon a baby is born. Although survival is possible for babies born as early as 24 to 26 weeks, the risks are greatest for the youngest babies.
There are numerous complications associated with preterm labour. Complications for the newborn include the following:
 Difficulty breathing
 Episodes of stopped breathing (apnoea)
 Bleeding in the brain (intracranial haemorrhage)
 Fluid accumulation in the brain (hydrocephalus)
 Cerebral palsy and other neurological problems
 Vision problems
 Developmental delays
 Learning difficulties
Less serious complications may include:
 Yellowing of the skin and whites of the eyes (jaundice)
 Lack of red blood cells (anaemia)
 Low blood pressure
For some premature babies, difficulties may not appear until later in childhood or even adulthood. Not performing well in school is often a prime concern. Some studies suggest that premature babies may face an increased risk of type 2 diabetes and cardiovascular disease in adulthood.
But not all preemies have medical or developmental problems. By 28 to 30 weeks, the risk of serious complications is much lower. The medical problems related to premature birth for babies born between 32 and 36 weeks are short term. In the vast majority of babies born after 34 weeks there are few medical problems.

Caring for a preterm baby
Caring for a premature baby can be physically and emotionally exhausting. You may be anxious about your baby’s health and the long-term effects of premature birth. You may feel angry, guilty or overwhelmed. Some of these suggestions may help during this difficult time:
 Learn everything you can about your baby’s condition. In addition to talking to your baby’s doctor and other caregivers, read books on premature birth and look for information online.
 Take care of yourself. Get as much rest as you can and eat healthy foods. You’ll feel stronger and better able to care for your baby.
 Establish your milk supply. Use a breast pump until your baby is able to breast-feed. Ask the hospital staff for help, if needed.
 Accept help from others. Allow friends and family to help you. They can care for your other children, prepare food, clean the house or run errands. This helps you save your energy for your baby.
Remember, caring for a premature baby is a great challenge. Take it one day at a time.

Conclusion
Preterm labour has been a challenge for obstetricians for many years and continues to occur despite the many advances in the care of pregnant women worldwide. Many more babies are surviving at earlier gestations, thanks to improved technology, but preterm births continue to occur in many countries including Anguilla. Efforts to prevent preterm labour must continue as research continues to determine the exact cause of preterm labour.

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