08:41am Sunday 23 February 2020

Fight Prematurity with Awareness, Longer Pregnancies Ob-Gyns Say

While many preterm births are spontaneous, some babies that could be born at full-term are delivered early. During National Prematurity Awareness Month in November, The American College of Obstetricians and Gynecologists (The College) encourages women to become familiar with the signs of preterm labor and reminds women and ob-gyns to aim for delivery at or after 39 weeks of gestation for the best health outcomes for newborns.

A pregnancy is considered full term at 40 weeks. In most pregnancies, spontaneous labor begins between 37 and 42 weeks gestation. Deliveries before 37 weeks are considered premature. Premature birth is the cause of most newborn deaths, and infants who survive may face serious illness, such as problems with vision, hearing, respiration, and nervous system development. Later in life, premature infants may have learning and behavioral problems.

According to the March of Dimes’ 2011 “Premature Birth Report Card”, preterm birth rates in most states have declined. However, there is still work to be done. “Preterm birth is very common in the US. About 12% of all babies—roughly 500,000 each year—are delivered before 37 weeks,” said George A. Macones, MD, chair of The College’s Committee on Obstetric Practice. “We’re doing everything we can here at The College to educate physicians, providers, and patients about the issue of prematurity and are advocating to try to reduce the rate of preterm birth.”

Most preterm births are the result of labor that starts early. Others occur when there is a clear medical indication for early delivery because of serious maternal or fetal problems. “If the baby is growing very poorly in utero, delivering the baby may be safer. On the maternal side, women may get very sick during pregnancy with preeclampsia or diabetes, making an early delivery necessary,” Dr. Macones added. In addition to preexisting maternal health conditions, risk factors may include preterm labor or delivery in a previous pregnancy, smoking, illegal drug use, multiple pregnancy, a shortened or abnormal cervix, an abnormal uterus, problems with the placenta, bleeding in the second or third trimester of pregnancy, and little or no prenatal care.

Raising women’s awareness of the symptoms of preterm labor is a crucial step. “While we can’t always treat preterm labor or prevent preterm births, there are things we can do to improve outcomes in the nursery if we have an idea that early delivery is imminent,” said Laurie S. Swaim, MD, a member of The College’s Committee on Practice Bulletins-Obstetrics.

Uterine contractions—an often painless tightening or hardening of the uterus—should be noted. “Any woman who is not full term should not be experiencing regular contractions,” Dr. Swaim said. “If you are having contractions that start coming every 10 minutes or so, you should tell your doctor.” Preterm labor may also be marked by unusual changes in vaginal discharge, leaking amniotic fluid, vaginal bleeding, pelvic or lower abdominal pressure, mild abdominal cramps, or constant, low, dull backache. Women with a history of preterm birth may be prescribed medication to delay the onset of labor.

Healthy Babies Need 39 Weeks
“After 37 weeks of pregnancy, there’s still significant fetal development occurring until a woman’s due date. The remaining weeks are the time when the lungs and brain mature and the fetus gains body fat,” said Sindhu K. Srinivas, MD, a member of the Committee on Practice Bulletins-Obstetrics. Despite research demonstrating the developmental importance of these last few weeks, there has been an increase in deliveries scheduled before a woman’s due date. “We know that healthy babies need 39 weeks to have the best start in life. Therefore, The College recommends against labor inductions or cesarean delivery for non-medically indicated deliveries at less than 39 weeks.”

Click the links below to see Prematurity Awareness Month messages from ACOG Fellows:

Prematurity in the US — George A. Macones, MD
Symptoms of Preterm Labor — Laurie S. Swaim, MD
The Importance of 39 Weeks — Sindhu K. Srinivas, MD

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The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

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