November 16, 2018 by John Fernandez
Born Before Their Time
From the moment most women find out they’re pregnant, they eagerly anticipate the arrival of their baby. They look forward to holding, caring for and getting to know their bundle of joy.
For some, that period of hopeful anticipation ends too soon, when labor starts well before the 40-week mark of carrying a full-term baby is met. This pre-term labor places the mother and baby at risk for complications. But advances in medical interventions and hospital-based special care units are improving survival for babies born before their time.
At South Miami Hospital, which recently became the sixth hospital in the country to earn The Joint Commission’s Gold Seal certification for the management of pre-term labor, a special unit of doctors and nurses cares for women experiencing pregnancy complications, including pre-term labor.
According to Jorge Gomez, M.D., a perinatologist who cares for patients with high-risk pregnancies and medical director of the Maternal-Fetal Special Care Unit at South Miami Hospital, the known risks that increase a woman’s chance of experiencing pre-term labor include:
• Previously delivering a premature baby
• Pregnancy with multiples, such as twins or triplets
• Pregnancy resulting from in vitro fertilization (IVF), since these usually involve multiples
• Little or no prenatal care
• Smoking or drug use
• Being younger than 17 or older than 35 years old
• African-American descent
• Insufficient or excessive weight gain during the pregnancy
Dr. Gomez points out that having the above risk factors put women in a high-risk category, but pre-term labor can result from the mother having or developing the following conditions, which may not be known ahead of time:
• Cervical insufficiency caused by abnormal anatomy, such as a shorter cervix
• Excessive stretching of the uterus from prior pregnancies or too much amniotic fluid (polyhydramnios)
• Infections, like bacterial vaginosis, within the uterine cavity
• Urinary tract infections
• Pneumonia, which decreases oxygenation to the uterus
The following signs before 37 weeks of pregnancy, Dr. Gomez says, may mean you’re experiencing pre-term labor. He advises to immediately call your doctor or healthcare provider if you have any of these symptoms:
• Sudden onset of pelvic pressure
• Dull pain or ache in your lower back
• Vaginal discharge, including blood, or a feeling of leaking fluid
• Contractions or menstrual-like cramps
“Women should understand that pre-term labor can be managed, if they seek the proper care right away,” Dr. Gomez said. “We have medications that can slow down or stop the progression of labor, allowing enough time for the baby to further develop.”
• Tocolytics are medications given to slow down or stop contractions, usually only for a few days.
• Steroids help the unborn baby’s lungs develop quickly, reducing respiratory complications that may arise in underdeveloped lungs.
• Magnesium sulfate is given to protect the neurological system of the unborn baby and has been shown to reduce the risk of cerebral palsy in premature babies.
Dr. Gomez warns that there are no effective treatments for pre-term labor past 48 hours, but that delay in the birth of the baby allows time to improve the chance of survival and reduce long-term disabilities. He also says that these treatments are not given to women who enter pre-term labor after 34 weeks of pregnancy.
“Those babies born after 34 weeks are developed enough that these treatments don’t improve their health,” he said. “For all of these premature babies, having a neonatal intensive care unit ensures the best chance at survival.”