Pre-term delivery a huge challenge

Can be tackled with proper knowledge to women Preterm deliveries are a huge burden on the society and the family .This is because a lot of resources are necessary to help the baby survive and then rehabilitate to be able to reach the standard outcomes . Such deliveries have multi-factorial causes and some treatments not essentially effective . A lot of respite can be sort if all are aware of the causes and are able to take care of their own self through this awareness . With the purpose of education of women have penned this article .In addition I must mention that I have been through a preterm delivery myself and have been successful in managing it 21 years back despite not so effective resources then as they are today . Birth before the stipulated duration of 37 weeks and after the completion of viability at 20 weeks is preterm delivery /labour / birth .Such a delivery is associated with serious complications and sometimes inability to survive in the neonate as it is not capable of an independent existence . Within the spectrum of preterm births if they occur at or after 34weeks and the baby birth weight is more than 1200 to 1500 g the babies have a better chance of survival and less possibility of residual diseases . The various reasons responsible for such a birth are certain maternal abnormalities such as anaemia ( HB less than 9 g/dl ) , low maternal BMI ( less than 18 ) or high BMI ( > 26), Poor nutritional intake leading to protein , calcium and micronutrient deficiencies , certain infections such as generalised , oral , urinary tract and genital tract infections . Other abnormalities such as raised blood pressure , diabetes , chronic asthma or respiratory infections can cause preterm deliveries . Many a times poor hygienic practices such as oral health , intimate hygiene , etc can be contributory . In addition the cause is classified as either unknown when nothing obvious is identified or multifactorial as many reasons can be contributing . During pregnancy proper nutritional practices ,compliance to the medications subscribed by the doctor are important . There are certain warning signs which when occur immediate help can be taken . Preterm delivery can be prevented to some extent by observing precautions as mentioned and seeking help early .There are no effective medicines to prevent preterm delivery once it sets in .These medications may help if started early . Also in situations where the foetus is extremely premature these medications may not help . Nutritional corrections go a long way in delivering a healthy baby of a healthy mother and it matters in the context of premature delivery as the outcome of the baby depends on the birthweight considerably . Diet should be replete with correct calories , calcium ,protein and iron content should be appropriate . Situations such as PPROM ( Preterm Premature Rupture of Membranes ) that is water break, conservation of pregnancy is unlikely. So also if the baby is distressed or

the placenta is separated ( abruptio placentae ) the pregnancy is terminated and not conserved . Therefore care has to be taken throughout pregnancy such as noting the change in the vaginal discharge to sticky or watery , lower backache , cramps pain in the womb, excessive movements of the the baby , vaginal bleeding ,pain in the tummy etc: It is worth while to embark on a pregnancy with proper planning and pre-pregnancy assessment of health . Checking once hygiene practices , correction of weight , inculcation of proper positive attitude and some physical activity and healthy eating habits help in reducing these occurrences considerably . Anemia if found in the first thee months of conception has been identified to be an important risk factor for preterm delivery . Some women may have inherently weak womb which can make them go in labour very early during pregnancy and this can be cured by taking a stitch on the cervix .Sometimes some medications may be prescribed for uterine quiescence . Regular screening for metabolic syndrome ( obesity and related disorders ) ,diabetes , hypertension ,infections and hypothyroidism is done during pregnancy likewise assessment of the cervical parameters are done by sonography which can guide the doctor to offer the right treatments . Preterm babies are at risk of developing illnesses in adulthood and therefore all measures should be taken to ensure that every pregnancy reached term . It has been observed that many women are not immunised adequately before embarking on pregnancy and this is a very simple preventive measure that can be taken .Immunisation against rubella , hepatitis B and HPV are advocated before marriage or pregnancy . When a couple plans a pregnancy it is important that assessment of woman health , understanding of the fertile period and corrections in existing diseases are done . Its a dream to make women realise that healthy mother will deliver a healthy baby and a healthy generation will be born . We owe it to the society as women to deliver healthy offsprings and this little drop in the ocean can go a long way in creating a healthy society devoid of diseases .

Gynaecologist, Obstetrician,

IVF Specialist

Cloudnine Hosptial

Axon Building, Survey No 28/1, Bhamburda, Shivajinagar, Pune, Maharashtra 411005

Bharati Hospital

Satara Rd, Bharati Vidyapeeth Campus, Dhankawadi, Pune, Maharashtra 411043