Complications - high risk

Premature Labor

The more dangerous kind of preterm labor is the kind that doesn’t respond to treatment. This is especially true when the contractions (cramping) begin to soften and dilate (open) the cervix. This puts you at risk for having the baby before it is ready to be born. Women at most risk for a pregnancy with preterm labor and early delivery, include those who:

• are younger than 20 and older than 35 years
• smoke
• have poor nutrition
• have had a previous pre-term delivery
• have had a previous abortion
• have had a previous surgical procedures of the cervix such as cone biopsy
• have a defect of the uterus such as fibroids
• have infections like a urinary tract infections or STD, etc.
• have multiple gestations (twins or more)
• have early rupture of membranes (water bag break or leak)

Delivery before 36 weeks probably means that the baby will have to be supported with some special medical treatments. For example, the lungs may not be ready for breathing outside the mother, and this may cause breathing difficulties. A breathing tube and oxygen may be needed to help the baby until the lungs are mature enough to breathe on their own. The baby may need support in regulating body temperature because his or her “thermostat” doesn’t work well – an incubator may be necessary. Whatever the needs of the baby, most can be taken care of in a special care nursery. If the hospital doesn’t have a special or “intensive” care nursery, a transfer (by special ambulance or helicopter) will be made to a medical facility that can support all the baby’s medical needs.

The signs of pre-term labor include:

• Abdominal cramps (like menstrual cramps)
• Pressure in the pelvis
• Regular contractions or tightening, more than four in an hour, with OR without pain
• Vaginal discharge, an increase in the amount or change in the type, watery to bloody
• Change in the dilation of the cervix or thinning of the cervix
• Loose stool or diarrhea

Treatment for preterm labor may initially include hospitalization. The frequency and strength of your contractions will be monitored. Your cervix will also be checked to see if it is softening or opening in response to the contractions. Hospital treatment may include:

• intravenous fluids to hydrate you (boost your fluid stores)
• medication to relax the uterus
• reduced activity or bed rest
• steroids (prednisone-like medication) may be given to help mature the fetal lungs; this is usually done when a pre-mature birth is expected.

When you are discharged from the hospital, your activity at home will likely be limited. The following tips may help you prepare for going home after hospitalization for preterm labor:

• Rest is very important.
  Be sure to follow your clinician’s direction regarding activity restrictions. If you are allowed some activity and find that you are experiencing symptoms:

  Make sure you get enough to drink, 8 glasses of water a day will keep you well hydrated. Too little fluid decreases the blood flow to the uterus, as well as increasing prostaglandins, hormones that stimulate contractions. Adequate hydration also helps prevent urinary tract infection (UTI is a common cause of preterm labor).

• Medication
  Drugs(like terbutaline) may be prescribed to help the uterus stay relaxed.

• Traveler’s Advisory
  Long trips can bring on pre-term labor symptoms. Your clinician may advise you not to travel long distances. If you must travel a long distance, stop for breaks; get out of the car and walk and stretch for a bit.

• Sexual Activity
  This is usually just fine, and will not interfere with the health of your pregnancy. Female arousal and orgasm may stimulate the uterus but this is rarely enough to start contractions (unless labor is about to start anyway). If the cervix is very soft or dilated or there is a break in the water, there may be restrictions placed on penetration and intercourse. Your physician will give you the necessary guidance regarding what is safe for you. If you have pain, pressure or cramping related to certain types of sexual activity – avoid it – and consult your physician for further advice.

• Nutritious Diet
  Be certain to enjoy a healthy, well-balanced diet and gain appropriate amounts of weight. There is a correlation between poor weight gain and pre-term labor.

• Know the warning signs
  If you feel cramping, follow your physician’s instructions – depending on your situation you may be told to call the doctor or go directly to the hospital. If you have any trouble getting through to the doctor – and there is cramping or bleeding or decreased fetal movements or a break in your water – go directly to the hospital!

  If mild cramping is your only symptom (no decreased movements, no bleeding, no break in your water, etc.); your physician may allow a small observation period at home instead of referring you directly to the hospital. Usually they recommend something along these lines: