Worldwide, premature birth stands as the primary cause of death among children below 5 years old. Differences in survival rates globally are apparent. In countries with limited financial resources, approximately half of infants born at or before 32 weeks (two months premature) perish due to the absence of accessible, affordable care like warmth provision, support for breastfeeding, and fundamental treatment for infections and respiratory issues. According to a 2022 study issued in the journal PloS One, India has approximately 18 per cent of preterm births which is estimated at around 3.5 million cases.

 

We see you! Get exclusive access to the best parenting advice from experts. Sign up today.

 

What is Premature Birth?

Preterm and premature are synonymous terms, both indicating an early occurrence of pregnancy. According to a 2022 report by Cleveland Clinic, preterm labour occurs before the typical 37-week mark during pregnancy. Such premature labour can result in the birth of the baby before reaching the full 37 weeks of gestation, known as premature birth.

 

Babies born prematurely, prior to the 37-week threshold, face heightened health risks both during birth and throughout their lives. These premature infants may encounter significant health challenges at birth and may experience ongoing health issues later in life.

 

How to Know If You’re Experiencing Preterm Labour?

Knowing the signs of preterm labour is crucial for timely intervention. If you experience any of the following symptoms and they persist for an hour, or if the pain becomes severe and persistent, it's essential to go to your healthcare provider immediately:

1. Four or more contractions in an hour: These contractions, the tightening and relaxing of uterine muscles which persist even after changing positions or attempting to relax.
2. Regular back pain: Consistent or intermittent low, dull back pain that isn't alleviated by changing positions or employing comfort measures.
3. Lower abdominal cramping: Cramps resembling gas pain, with or without accompanying diarrhoea.
4. Increased pressure in the pelvis or vagina: A sensation of heightened pressure in the pelvic area or vaginal region.
5. Menstrual-like cramps: Persistent cramping similar to menstrual discomfort.
6. Changes in vaginal discharge: An increase in discharge volume, a mucus-like consistency, or a pinkish tinge.
7. Leaking fluid from the vagina: This could indicate amniotic fluid leakage.
8. Vaginal bleeding: Any amount of bleeding during pregnancy warrants immediate attention.
9. Flu-like symptoms: Nausea, vomiting, or other flu-like symptoms.
10. Decreased foetal movements: If you notice a significant decrease in your baby's movements (less than six movements in an hour).

 

Understanding the prevalence and associated risk factors becomes imperative in effectively managing this condition. Delving into the prevalence rates and various risk factors offers crucial insights into identifying and addressing ICP's impact on both maternal well-being and foetal health. By understanding the significance of ICP in pregnancy, we can navigate its complexities and better advocate for proactive care strategies to safeguard both mother and child.

 

Risk Factors of ICP in Pregnancy

As per 2023 research by the World Health Organisation, the prominent risk factors that elevates the likelihood of premature labour are:

• If you've previously delivered a baby prematurely, it increases the chances of experiencing preterm labour in subsequent pregnancies. 
• Carrying twins, triplets, or a higher-order multiple pregnancy can heighten the risk of preterm labour due to the increased strain on the uterus and cervix. 
• Conditions or complications affecting the uterus, cervix, or vagina—either currently or historically—can pose a risk for preterm labour. 

These issues might involve structural problems or past surgical interventions in these areas, influencing the stability of the cervix or the integrity of the uterus during pregnancy.

 

Preterm labour can be triggered by a variety of factors, and it's often a complex interplay of various elements within your medical history, prior pregnancies, and lifestyle choices. Surprisingly, some individuals experiencing preterm labour may have no identifiable risk factors. This condition, characterised by disrupted bile flow in the liver during pregnancy, goes beyond mere discomfort, warranting attention for several reasons:

• Maternal Health Risks: ICP poses risks to the pregnant woman, manifesting in distressing symptoms such as severe itching, particularly on the hands and feet. However, beyond the discomfort, elevated levels of bile acids in the bloodstream can lead to potential complications for the mother, including increased risks of developing gestational diabetes, vitamin K deficiency, and even an increased susceptibility to haemorrhage post-delivery.
• Foetal Health Impact: Elevated bile acids due to ICP may pose risks of preterm birth, intrauterine foetal demise (stillbirth), and foetal distress. Moreover, this condition has been associated with an increased likelihood of meconium staining (passing of stool by the baby in the womb), which can potentially lead to respiratory issues upon birth.
• Risk of Premature Birth: ICP is intricately linked to preterm birth, raising the urgency to address and manage this condition promptly. Studies suggest that mothers diagnosed with ICP have a higher likelihood of delivering prematurely, necessitating vigilance in monitoring and managing the condition to mitigate the risks associated with premature birth.
• Psychological Impact: Beyond the physical health concerns, the distress caused by incessant itching and the looming risks for the baby can take a toll on the mental health and emotional well-being of expectant mothers. Addressing the psychological aspects of coping with ICP becomes a crucial aspect of comprehensive care.

 

Understanding the significance of ICP in pregnancy involves recognising its multifaceted impact on both the mother and the unborn child. Managing this condition effectively becomes imperative to safeguard maternal health, ensure optimal foetal development, and reduce the risks associated with complications such as premature birth.

 

Diagnosis and Screening Methods 

Preterm labour diagnosis involves several assessments to determine if the onset of labour is occurring earlier than anticipated. Healthcare providers typically conduct the following examinations and tests:

• Cervical Examination: A pelvic exam is performed to assess the cervix for effacement (thinning) and dilation (opening). These signs can indicate the onset of preterm labour.
• Ultrasound: This imaging technique helps in gauging foetal size, positioning within the uterus, and assessing the condition of the placenta and amniotic fluid for any abnormalities or concerns.
• Contractions Monitoring: Your healthcare provider might utilise a monitoring device to measure the frequency and intensity of contractions.
• Foetal Fibronectin Test: This test involves sampling vaginal fluid to detect the presence of foetal fibronectin, a protein that, if detected, might suggest the initiation of labour.

 

Management and Treatment

The management of preterm labour involves a careful evaluation of the pregnancy's stage, the well-being of the foetus, and the underlying reasons for early labour, ensuring the best possible outcome for both the mother and the baby. If preterm labour is confirmed, the healthcare provider will consider various factors to determine the appropriate course of action:

• Medication to Halt Labor: Depending on the situation, medications may be administered to slow or halt the progress of labour.
• Delivery Consideration: If preterm labour advances and stopping it isn't feasible or safe, early delivery might be necessary. The decision is based on factors such as gestational age, the safety of the foetus, and the underlying reasons for early labour, which could involve medical conditions, placental issues, or infections.
• Medications for Foetal Lung Maturity: In cases where early delivery is inevitable, medications may be given to help enhance the foetal lung and organ maturity, improving the baby's chances of healthier outcomes after birth.

 

How To Care For a Premie

Caring for a premature baby, often referred to as a preemie, is of paramount importance due to the unique challenges they face in their early days of life. 

 

The significance of specialised care for preemies encompasses several crucial aspects:

• Providing Developmental Care To Overcome Fragility: Premature infants are born before they reach full term, making them more vulnerable to health complications. Their underdeveloped organs, particularly the lungs and immune system, require attentive care to support their growth and development.
• Aiding Preemies With Neonatal Intensive Care: Preemies often require specialised care in a Neonatal Intensive Care Unit (NICU) equipped with advanced medical technology and skilled healthcare professionals. These units provide tailored care to address the specific needs of premature infants, including respiratory support, temperature regulation, and feeding assistance.
• Regulating Temperature to Keep Them Comfortable: Premature babies struggle to maintain body temperature. Keep them warm using incubators or warmers and dress them in soft, cosy clothing.
• Monitoring Vital Signs To Ensure Stability: Keep a close watch on your baby's vital signs. Regularly monitor their breathing, heart rate, and temperature to ensure they're stable and thriving.
• Offer Developmental Care to Mitigate Health Issues: Early intervention and developmental care are crucial for preemies to mitigate potential long-term challenges. Developmental delays, neurological issues, and sensory integration problems are common concerns that necessitate close monitoring and early interventions such as physical therapy, occupational therapy, and developmental assessments.
• Providing Complete Feeding Support: Premature infants may face difficulties in feeding due to underdeveloped sucking reflexes or gastrointestinal immaturity. Consult with healthcare providers about specialised feeding techniques, such as tube feeding or fortified breast milk, to ensure adequate nutrition. 
• Initiate Kangaroo Care To Facilitate Bonding: According to  2022 WHO Guidelines, skin-to-skin contact or kangaroo care is highly beneficial for preemies. This practice not only helps in regulating the baby's temperature and improving bonding but also supports overall physiological stability and emotional well-being.
• Encourage Family-Centred Care to The Premie: Involving and supporting the parents and family members in the care process is essential. Educating and empowering families to participate actively in their preemie's care not only enhances bonding but also prepares them for the unique needs and challenges of caring for a premature infant.
• Ensure Long-Term Follow-Up: Care for preemies extends beyond the NICU. Regular follow-up appointments and developmental assessments are crucial to monitor their progress and address any emerging issues or developmental delays as they grow.

 

These preventive measures aim to strengthen the cervix and support the uterus, significantly reducing the risk of early labour and subsequent preterm birth in individuals with a history of such complications during pregnancy. Consulting with an obstetrician to discuss the most appropriate preventive strategies based on individual medical history is crucial for a tailored and effective approach to care.

 

We see you! Get exclusive access to the best parenting advice from experts. Sign up today.