Pregnancy is a wonderful stage of life. Most mothers to be, however, don’t think of having problems during their pregnancy, and premature birth is not an eventuality that is planned for when making baby preparations. But premature birth occurs in about 1 out of every 10 infants in the United States. These babies are born prior to 37 weeks of gestation, and many face complications such as cerebral palsy, developmental delays, hearing impairments and vision problems.
Prematurity Awareness Month and World Prematurity Day, which is November 17 are two campaigns that seek to bring knowledge and awareness to the issue of premature birth. Although the rate of premature birth has declined in recent years, 9.6 percent of babies are born prematurely and face enormous challenges.
Decreasing the rate of premature birth is an important public health initiative. Learning more about preterm labor, especially if you are pregnant, is key to prevention.
PROM and pPROM
Preterm labor occurs with the premature rupture of membranes, or PROM. Amniotic fluid surrounds your baby, and membranes hold this fluid in until the baby is ready to be born. These membranes typically rupture during labor, which is when the ”water” breaks. PROM occurs when the membranes break easily but the mother is not in labor. Once this occurs, a woman will usually go into labor within 24 hours.
PROM may be caused by infections in the uterus, vagina or cervix, or when too much stretching of the amniotic sack occurs. Sometimes smoking can cause this membrane to rupture. Biopsies or surgeries in the uterine area can also be a cause. Mothers who experience PROM during a prior pregnancy are prone to subsequent membrane ruptures.
PPROM is often an unexpected event. PPROM occurs when PROM happens prior to 37 weeks of gestation. When pPROM happens before 37 weeks of gestation, it normally leads to preterm birth. Most women who experience a water break of this nature do not have any risk factors. Women will typically experience slow leaking fluid, which sometimes can be mistaken for urine, although amniotic fluid is odorless.
After birth, the primary short-term complications for preterm birth include:
- Temperature control problems
- Heart issues
- Brain problems
- Issues with breathing
- Blood problems that can lead to jaundice
- Metabolism and immune system problems
The long-term complications associated with preterm birth include:
- Cognitive impairment
- Dental and hearing problems
- Vision problems
- Chronic health issues
- Cerebral palsy
Sometimes pPROM-induced labor can lead to fetal death.
PROM and pPROM are treated differently from a clinical perspective. PROM is not as serious since the baby is typically at full term. Usually a mother who experiences PROM will go into labor without the need for medicinal assistance.
PPROM occurs in about 3 percent of the population and is much more serious. There are a variety of medications that are used to treat pPROM:
- Corticosteroids are recommend after PROM and can help reduce certain risks, including respiratory distress, inflamed bowels or bleeding.
- Antibiotics help to reduce the chances for infection.
- Tocolytic therapy is sometimes used to delay delivery, although only in certain patients for a certain length of time.
Sometime simple observation serves as the best medicine, and a physician may opt out of any medication regime.
New Clinical Guidelines
As evidence is developed, treatments for PROM and pPROM have changed as well. New clinical guidelines suggest the use of progesterone and using cervical length as a measure of determining whether or not a women is at risk for PROM were recently introduced.
“When progesterone is used it is important to restrict its use to only women with a documented history of a previous spontaneous birth at less than 37 weeks gestation because unresolved issues remain, such as optimal route of drug delivery and long-term safety of the drug,” writes ACOG’s Committee on Obstetric Practice.
Treating pregnant women who have shorter cervix lengths and therefore are at increased risk for PROM with progesterone will help decrease their chances of premature birth.
PROM is obviously no dance a women wants to do while pregnant. Both PROM and pPROM can cause negative outcomes for both mother and baby. Knowing any risks you may have is the first step in handling PROM if it happens to you. Your doctors can help in both identifying and treating your risks for PROM.