PREMATURE LABOR

This whole area of "premature labor" is steeped in controversy! The questions that are involved are: when is labor premature?, How do you detect it?, and What can be done about it? Traditionally, full term is 37 weeks and beyond (about eight and a half months). This is from the days when infants born any earlier had a significantly increased mortality. The primary risk to the baby was immaturity of the lungs and inability to breath. Some risks to the baby and maternal complications are still waited out until late in pregnancy because of this respiratory risk. There are those that are now suggesting that these standards be reevaluated. Neonatal I.C.U.s, modern ventilation techniques, antibiotics and medical treatments for the baby's lungs have made the birth of a 35 week infant very unlikely to have any long term detrimental effects on the child. Now waiting until "full term", if other medical jeopardy exists, may not be worth the risks to mother and child. It is a judgment call.

Assuming one does use 37 weeks as full term, there are many reasons that labor can occur earlier. Female infections, placental injuries, cervical weakness, abdominal injuries, urinary tract infections and birth defects of the mother's uterus can all cause early labor. Multiple pregnancies also usually deliver before teen. Preterm labor can be watched for at home with devices that detect contractions. These devices are placed on the abdomen two or three times a day and with a telephone hook-up the number of contractions an hour is evaluated by nurses at a central monitoring site. The cost for this is over $100 a day. If started at six months a bill of six or seven thousand dollars can be accumulated for this service. The effectiveness of doing this has not been proven to prevent premature birth any more than good communication between the patient and here doctors office.

There is also now a test called fetal fibronectin (FFN). This substance is within the layers of the baby’s membranes and leaks out if the contractions are strong enough. The test is done with a speculum if the patient thinks she is having contractions and may be in premature labor. If the test is negative, it tells us delivery is unlikely that week. If the test is positive it is less useful, 50% are actually at risk and 50% it is really just a false positive.

If you are at risk for premature delivery the labor can be often stopped with magnesium (a common blood salt), terbutaline (an artificial adrenaline) and bed rest. There are medicines that can mature the baby’s lungs, bowel and blood vessels. They are given over a 48 hour period if labor is earlier than 34 weeks. Antibiotics are also given with premature labor. The antibiotics go through the mothers system and into the baby, the child is then born with protection from bacteria. Premature infants are not as capable of fighting of infection as well as full term babies.

FRED CREUTZMANN, M.D. – CARROLLTON

972-394-7277 or www.DrCmd.com