Premature birth: prevention

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What is it about ?

It is a question of premature birth when thechildbirth takes place before the end of the 37e week of pregnancy or before 259e day from the first day of the last menstrual period. There are 4 categories of prematurity depending on the duration of the pregnancy:

  • very high prematurity: less than 28 weeks;
  • very prematurity: between 28 weeks and 31 weeks and 6 days;
  • moderate prematurity: between 32 weeks and 33 weeks and 6 days;
  • late prematurity: between 34 weeks and 36 weeks and 6 days.

What is its frequency?

In 2011, 8,842 deliveries in Belgium (slightly less than 7 births out of 100) were premature births.

Causes and risk factors

Premature birth can be medically triggered in the mother or baby. It is thus possible to decide to perform a cesarean section if the life of the mother or the child is in danger.

But, more often than not, a premature birth occurs spontaneously and the contractions begin spontaneously before the expected date. We distinguish between contractions with and without rupture of the water bag:

  • If the pocket of water is broken, childbirth is inevitable: it will take place within 48 hours.
  • If the water bag is intact, the contractions can still be stopped.

A number of risk factors increase the risk ofchildbirth premature:

  • a previous pregnancy that ended in a premature birth;
  • pregnancy with several fetuses (multiple pregnancy);
  • a previous operation on the cervix;
  • an infection ;
  • the smoking ;
  • an underweight or overweight mother;
  • a in vitro fertilization (IVF) ;
  • the age of the mother.

How to recognize it?

The main symptoms are painful and regular contractions, at intervals of 10 minutes or less. These may be accompanied by a bleeding and / or water loss.

Prevention in case of increased risk

Prevention aims to prevent premature birth.

In general, a distinction is made between primary prevention and secondary prevention: primary prevention consists of taking measures to prevent the occurrence of a disease before the onset of a risk, the secondary prevention attempts to prevent the progression of an existing condition in women.

In this case, these are specifically women who already have an increased risk of preterm birth. Primary prevention therefore no longer applies. In the prevention of premature birth, we will rather speak of secondary prevention and tertiary prevention.

Secondary prevention

Secondary prevention targets women who have already had a premature labor or who have had cervical surgery and who are not yet having contractions. This form of prevention may also be useful in women who have a short cervix (measured by means of a ultrasound). The goal is to prevent the early onset of contractions.

  • This can be done by administeringprogesterone hormone intravaginally, from 2e trimester and up to at least 34 weeks of pregnancy. The drug is available in the form of gel or soft capsules.
  • the cervical strapping is a procedure that involves placing a loop around the cervix to prevent it from opening too soon. The technique is applied to women who, during a previous pregnancy, gave birth before 32e week of pregnancy as well as in those who have already experienced several premature deliveries during the 2e trimester of pregnancy. The strapping must be carried out before the 24e week.

Tertiary prevention

Tertiary prevention is intended for pregnant women in whom the contractions have started prematurely. THE’childbirth risk of triggering in the short term. Tertiary prevention therefore aims to stop premature contractions and further delay thechildbirth. It is hoped that this will save enough time for the baby to be viable or to be able to administer drugs (eg cortisone) that improve its viability. Medicines will be used to stop the contractions (medicines tocolytics).

How can the doctor identify situations where tocolytics may still be helpful? Sometimes it is not possible to stop the contractions. To find out, the doctor will measure the length of the cervix using a ultrasound and assess the cervical opening using a vaginal exam.

  • If the length of the cervix is ​​15 mm or less and its opening is less than 3 cm, treatment is started immediately.
  • If the length of the cervix is ​​between 15 and 27 mm and its opening is less than 3 cm, the doctor performs an additional examination: the fetal fibronectin test. This test involves measuring the concentration of a protein in the fluid in the cervix.
    • If the test is normal, no treatment is set up.
    • If the test is abnormal, treatment is started.

The tocolytics are administered for 48 hours. DMARDs are only indicated in a few exceptional situations. Along with tocolytics, other drugs are given to protect the baby. A single dose of cortisone thus has a positive effect on the maturation of the lungs. If tocolytics do not work, we give magnesium sulfate for 24 hours. This product has a positive influence on the formation of the nervous system.

When the doctor decides to start treatment with a tocolytic, it should always be based on a careful clinical examination and an assessment of the expected risks and benefits. These decisions are sometimes very difficult to make from a professional, ethical and emotional point of view. Parents face difficult choices and an uncertain prognosis. It is important that they can benefit from intense follow-up and support in this process.

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Source

www.ebpnet.be