Preterm birth and risk factors
Preterm birth is refers to birth of premature infants the birth of a baby which is less than 37 weeks gestational. Premature birth is among the main cause of mortality in many countries. It is estimated that preterm birth rates range from 5% in developed countries and up to 25% in developing countries. In the US, for the year 2006, the preterm birth rate is 12.8% which is 36% increase since 1980s. Specifically, it is responsible for 85% of all neonatal illness and death. The complications of preterm birth can be either short or long term. Prematurity is complex and it is not straightforward issues. In this part, the discussion will concentrate on prematurity. The complications of prematurity will be discussed later in the next article.
When dealing with premature birth, the major concern is about saving the child’s life. Upon delivery, we would not think about the possible long term complications unless the baby shows sign of life or good outcome. Just for the sake of this discussion, I have two questions to ask all of us here. First, do the life is worth to be saved? Second, will the child has a good future ahead, or will the child live cripple and cause burden to care takers and society? Financially, it cause so much to save one 500 grammar but it has no value if the child end up with severe cerebral palsy and need ventilator support at home. Won’t it be better to spend the many on someone that has better future in front of them?
There are various causes contribute to prematurity. The importance of knowing the causes of premature is to arrange a strategy to reduce the premature birth. This is a very challenging proposition while the patients still at the health care setting. Low rates of preterm deliveries are mainly associated with successful education to the patient to identify regular and frequent uterine contraction so they can alert the medical staff to do early intervention. Treatment can be initiated if cervical changes can be identified.
I like to divide causes of prematurity into 3 main factors; (i) maternal causes (ii) fetal causes and (iii) placental causes. Maternal causes include maternal chronic medical illness, history of preterm delivery, preeclampsia, abnormal anatomy of uterus, cervical incompetence or polyhydramnios. Some modifiable risk factors include drug use or infection such as group B streptococcus, urinary tract infections, vaginal infections. Then, fetal causes are referring to abnormality of the fetus or fetal behavior indicates that the intrauterine environment is not healthy. Multiple gestations like twins or triplets also can increase the risk of premature delivery. Finally, placental causes include placenta praevia, abruptio placenta, premature rupture of membranes and abnormal or decreased function of uterus.
By using above information, we can identify some modifiable causes like infection control and avoidance of alcohol. Smoking cessation is an effective way to prevent preterm birth. As for chronic medical illness or pre eclampsia, by controlling the illness at early stage, it may reduce the risk of preterm birth. This is one important management at health care setting where the doctors can handle the problems at the very beginning especially during antenatal follow up. This can reduce the incidence of preterm birth, hence the complications it may cause. Even though to reduce the premature birth is a demanding task, the most affordable effort is trying to delay it from happening. This is because the prognosis of premature infants improve by prolonged the gestation. As a general idea, the earlier the baby is born the shorter the gestational age, the more problem the baby will face and less likely he/she will develop normally. The spectrum of prematurity falls into 3 categories based on the gestational age and birth weight:
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Categories |
Gestational age and birth weight |
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a |
Mild prematurity |
Mild prematurity is the babies who are born between 33 to 36 weeks completed weeks and weigh between 1500g to 2500 grams. |
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b |
Moderate prematurity |
Moderate premature refers to the babies who are born between 28 to 32 completed gestational weeks and weigh between 1000 to 1500 grams. |
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c |
Severe prematurity |
Severe prematurity is refers to the babies born before 28 completed weeks and weigh less than 1000 grams. |
As the conclusion, it is important for the public to be aware of the risk factors of preterm birth so they can be avoided. Some risk factors are not modifiable, in this case, they have to be extra caution with their pregnancy. Early and frequent antenatal check-up will help to identify the possible problems and lead to a better outcome.
REFERENCES:
1. Steer, P. The epidemiology of preterm labor. BJOG: An International Journal of Obstetrics and Gynaecology, 2005, 112,1-3.
2. Births: Final data for 2006,” National Vital Statistics Reports; 2006.Vol. 57, No. 7.
3. McPhee, S.J. and Papadakis, M. A. Current Medial Diagnosis & Treatment. Forty Eight Edition. 2009. McGraw Hill.
4. Mattison, D.R., Wilson, S., Coussens,C. and Gilbert,D. (2003). The role of Environmental Hazards in Premature Birth, Institute of Medicine of the National Academics, The National Academic Press, Washington, D.C.
5. Oats, J. and Abraham, S. Fundamentals of Obstrectics and Gynaecology . Eight edition. Spain. Elsevier Mosby; 2005.
6. Beckmann, C.R.B., Ling, W.F., Smith, R.P., Barzansky,B.M., Herbert, W.N.P. and Laube, D.W.Obstetrics and Gynecology. Fifth edition. Philadelphia Lippincott Williams & Wilkins; 2002.
7. Dambro., M.R. Griffith’s 5-minutes clinical consult. Philadelphia. Lippincott Williams & Wilkins; 2005.
Tags: birth weight, gestational age, mortality, prematurity, preterm birth, preterm infant, risk factors, smoking cessation
Technorati Tags: birth weight, gestational age, mortality, prematurity, preterm birth, preterm infant, risk factors, smoking cessation
Interesting article. Great site as well. – keep up the good work!
My opinion is that every life is valuable and preterm birth isn’t the ‘death sentence’ it would’ve been many years ago before the medical advances we have today, prematurely born children can certainly grow up to be valuable to society.
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I agree with you, preterm birth is not a ‘death sentence’, however, we should know how to prevent it because preterm birth carries a lot of risk. In certain cases, we do deliver the baby earlier than date, or even before 37 weeks for the sake of both mother and the baby. In other words, there are times when preterm birth is unavoidable, at that time, we need to have enough knowledge to deal with the situation and have enough facility to support the baby till the baby is ready to continue living on his/her own.