Pregnancy is undoubtedly one of the most cherished phases of a woman’s life. However, it can also be a daunting journey, especially when one is faced with the risk of a premature birth.

Preterm birth can have severe consequences for both the newborn and the mother, making it a significant concern for healthcare providers and expecting parents alike.

What is Preterm Labor?

Preterm labor refers to the onset of contractions and cervical changes before completing 37 weeks of pregnancy. It is a leading cause of neonatal morbidity and mortality, accounting for almost 17% of deaths of newborns under five worldwide.

Infants born prematurely may experience a range of developmental delays, including neurocognitive deficits, cerebral palsy, visual and auditory impairment, and chronic lung disease. Hence, it is essential to identify women who are at risk of preterm labor and take preventative measures.

What are the Risk Factors for Preterm Labor?

Several factors can contribute to an increased risk of preterm birth:.

Prior preterm birth
Multiple gestations
Cervical incompetence or cerclage placement
Uterine anomalies
Chronic medical conditions, such as hypertension, diabetes, and autoimmune disorders
Placenta previa or abruption
Substance abuse
Low socioeconomic status, stress, or inadequate prenatal care
Fetal anomalies or growth restriction

How can Preterm Labor be Prevented?

Preventing preterm labor requires a multi-faceted approach involving timely identification of at-risk women and management with appropriate interventions. Some measures that may help prevent preterm labor include:.

Cervical length screening: Transvaginal ultrasound assessment of cervical length can predict the risk of preterm birth in asymptomatic women, allowing for close monitoring and early intervention.
Progesterone supplementation: Progesterone has been shown to reduce the incidence of preterm birth in women with a history of preterm birth and those with short cervix.
Cerclage placement: In women with cervical incompetence, placement of a suture around the cervix can help maintain cervical length and reduce the risk of preterm birth.
Antenatal corticosteroids: Administration of corticosteroids to women at risk of preterm birth can hasten fetal lung maturation and reduce the incidence of respiratory distress syndrome and intraventricular hemorrhage in neonates.
Magnesium sulfate: Magnesium sulfate has been shown to reduce the risk of cerebral palsy in preterm infants born to women at risk of preterm birth.
Education and lifestyle modifications: Appropriate prenatal care, adequate nutrition, smoking cessation, stress reduction, and avoidance of substance abuse can all help reduce the risk of preterm birth.

The Miracle Exam

In some cases, preventing preterm birth can be as simple as getting the right test at the right time. Such was the case with Jane, a 26-year-old woman with no prior pregnancy complications and an uncomplicated obstetric history.

Jane presented to her obstetrician at 22 weeks gestation for a routine prenatal visit. During the visit, the obstetrician performed a routine transvaginal ultrasound, which showed a short cervix measuring less than 1.5 cm.

Although Jane had no symptoms of preterm labor, her ultrasound results indicated an increased risk of preterm delivery.

Her obstetrician referred her to a high-risk obstetrical specialist who recommended cervical cerclage placement to maintain cervical length and prevent preterm labor. Jane underwent the procedure without complications and continued with close monitoring and prophylactic progesterone supplementation.

At 37 weeks, Jane delivered a healthy baby girl weighing 6 lbs 2 oz by uncomplicated vaginal delivery.

Without the timely identification of her short cervix, Jane may have gone into premature labor and delivered a premature infant with a higher risk of neonatal morbidity and mortality.

Conclusion

Preterm labor is a significant concern for expecting parents and healthcare providers.

While several risk factors can contribute to preterm birth, appropriate prenatal care, early identification of at-risk women, and timely interventions can help prevent preterm labor and improve neonatal outcomes. The routine transvaginal ultrasound cervical length screening is a valuable tool to identify women at increased risk of preterm labor, allowing for timely intervention and prevention of preterm birth.