Preterm Birth
All births occurring after the 20th week and before the 37th week of pregnancy are considered preterm. Approximately 10-15% of all pregnancies result in preterm birth. Preterm birth is responsible for 75% of mortality and morbidity in newborns without congenital anomalies. A baby is considered premature if their weight is between 1000-2500 grams and immature if it is below 1000 grams.
In half of the cases, the factor causing preterm birth cannot be identified. Additionally, preterm rupture of the amniotic sac, placental insufficiency, and previous preterm births may lead to preterm labour. The risk of preterm birth increases if the intervals between pregnancies are less than 3 months, there is a serious previous tear in the cervix, the mother is under 18 or over 40 years old, has serious medical problems, or is a heavy smoker. Preterm births can also occur in cases of multiple pregnancies when there is too little or too much amniotic fluid, severe signs of anaemia in the mother, alcohol and drug users, and those exposed to trauma.
Frequent uterine contractions occurring twice an hour in the mother, detection of a 2-3 cm dilation in the cervix during examination, and/or leakage of amniotic fluid are significant signs. Patients presenting with these complaints are immediately admitted to the hospital. The condition is assessed through ultrasound examination and vaginal examination. If the cervix is dilated 4 cm or more, there is severe vaginal bleeding, the mother has serious medical problems (hypertension, severe cardiac and pulmonary disease, etc.), preterm birth is being carried out due to fetal distress, severe growth retardation, and intrauterine infection, attempts are not made to stop the birth.
To prevent preterm birth, hydration is administered to the mother urgently. If childbirth occurs between the 24th and 34th weeks, 2 doses of betamethasone are administered every 12 hours to accelerate the baby’s lung development. The beneficial effect of this treatment appears within 24 hours. Since the maximum beneficial effect of the administered cortisone will be achieved 48 hours later, efforts are made to gain at least this time. If possible and not contraindicated, tocolytic treatment should be applied to delay childbirth until the farthest possible date, and the mother should be put on bed rest.
For tocolysis treatment, one of the beta mimetic drug groups, magnesium sulfate, indomethacin, nifedipine, or a combination of these drugs is applied in a controlled manner. Antibiotics are started to protect the newborn from infection. Vaginal delivery between 1500-2000 grams and cesarean section for premature babies with foot presentation will be appropriate. Birth should always be performed in hospitals with neonatal intensive care units.
It can be difficult to generalise and categorise the future of the newborn. This is because neonatal intensive care conditions can vary greatly. In ideal conditions, babies weighing over 2000 grams have a 90% chance of survival. For those weighing between 1000-1500 grams, the rate drops to the 65% range. Throughout your pregnancy, staying in touch with your doctor and keeping your pregnancy under control will not only protect you from preterm birth but also from other potential risks.
