Preterm Labor is a condition that almost every first-time mother worries about and wants to prepare for to ensure the safest possible pregnancy each time. Here is advice from Dr. Tharinee Lamleuk, Obstetrician and Gynecologist specializing in Maternal and Fetal Medicine, Phyathai 2 Hospital on how to observe yourself to be ready to handle warning signs from your body that may indicate a risk of preterm labor.
What is considered… Preterm Labor?
Preterm Labor is a condition where the cervix dilates as a result of uterine contractions and expansion before the pregnancy reaches 37 weeks. Normally, a full-term pregnancy is counted from 37 to 40 weeks and no more than 42 weeks. Preterm labor affects both the mother and may cause complications for the baby.
Causes of Preterm Labor
1. Causes related to the mother’s health
- Chronic diseases Pregnant mothers with chronic diseases directly affect the pregnancy, such as hypertension, diabetes, heart disease, lung disease, or other chronic conditions, which are major causes of preterm labor.
- Maternal stress Pregnant mothers are generally more prone to stress than non-pregnant women due to hormonal levels and discomfort from pregnancy affecting their mood directly, especially in the third trimester. This causes discomfort, fatigue, and hormonal fluctuations, increasing stress levels. High stress can stimulate more uterine contractions, leading to preterm labor.
- Mother’s pregnancy history Having a history of preterm labor in the first pregnancy increases the chance of preterm labor in subsequent pregnancies.
- Infections and inflammation Infections and inflammation in pregnant mothers directly affect pregnancy. Common infections include urinary tract infections and respiratory infections such as cystitis, influenza, or fever caused by other infections.
- Triggering behaviors Factors that trigger preterm labor may come from the mother’s daily lifestyle or unexpected accidents causing early labor. Risky behaviors include excessive walking, heavy activities, fast walking, or doing things carelessly, which may cause accidents. However, many mistakenly believe pregnant women cannot exercise. Doctors recommend exercising from early pregnancy until the second trimester or no more than 28 weeks, with light exercises such as swimming, yoga, or light walking under expert supervision to avoid harm and excessive uterine contractions.
2. Causes related to uterine abnormalities
- Short cervix The cervix functions like a uterine sphincter. A longer cervix means tighter sphincter control, but a short cervix means weaker control, increasing the risk of preterm labor. If shorter than 2-2.5 centimeters, there is a risk of preterm labor and close monitoring is necessary. Usually, mothers learn this during prenatal visits and ultrasound in the second trimester. If treatable, doctors may prescribe additional hormones or use devices to help prevent preterm labor.
- Uterine fibroids Normally, the uterus expands well, but fibroids can limit expansion, causing abnormal uterine contractions, which can lead to preterm labor.
- Abnormal uterine shape Congenital uterine abnormalities are hidden risks. Some have a double uterus or congenital malformations, which can cause preterm labor.
- Infection or inflammation of the amniotic sac This condition involves inflammation of the fetal membranes or amniotic sac due to bacterial infection, mostly from bacteria ascending from the vagina to the uterus.
3. Causes related to the fetus
- Fetal death refers to the death of the fetus before birth, regardless of gestational age. It may result from maternal health problems or accidents during pregnancy.
- Fetal abnormalities or disabilities Normally, the fetus stays in the womb for 37-40 weeks, but if abnormalities arise that affect the fetus’s health or growth, doctors may need to perform a preterm cesarean to save the baby and care for it in an incubator until it can breathe independently at room temperature.
- Twin pregnancy Over 50% of twin pregnancies result in preterm labor because the uterus tends to contract earlier than in singleton pregnancies.
Prevention and self-care to reduce the risk of preterm labor
- The first step for pregnant mothers is to ‘register for prenatal care’ to plan self-care early and prepare for any risk of preterm labor. Prenatal care includes physical exams, ultrasounds, blood tests, and screening for chronic diseases to identify risks that may affect pregnancy. If abnormalities are found, treatment plans can be made from the start.
- After the physical exam, mothers should take good care of both physical and mental health because pregnant women are prone to stress, hormonal fluctuations, and mood changes. They also have lower immunity than others, making them more susceptible to infections. They should stay in well-ventilated areas, eat cooked food, and regularly monitor their body’s changes.
What symptoms are warning signs of preterm labor that require urgent medical attention?
- Increasingly frequent and stronger uterine contractions Normally, after 30 weeks of gestation, some uterine contractions occur but are infrequent, irregular, and mild. If you notice more frequent contractions than usual, seek medical attention immediately.
- Clear fluid leaking from the vagina, also known as ‘water breaking’
- Mucus mixed with blood from the vagina, which is mucus that plugs the cervix, indicating the cervix is likely opening and signaling imminent labor.
- Decreased fetal movement, such as from oxygen deprivation, which can trigger preterm labor.
Risks to mother and fetus if preterm labor occurs
- Risks to the baby Babies born prematurely often have underdeveloped bodies, especially their lungs and cardiovascular systems. After birth, they need to stay in a temperature-controlled incubator depending on how early they were born to help them breathe and adapt until they can breathe normally at room temperature.
- Risks to the mother Usually, there are no serious dangers if there are no complications, but mothers may experience delayed or low milk production because their bodies are not fully ready. Postpartum care should be similar to that of full-term deliveries.
