Overview: What is a premature birth?
A premature birth is the premature delivery of a living child. The birth takes place before the 37th week of pregnancy. This means that delivery takes place before 37 weeks of pregnancy have been completed.
Depending on the time of delivery, doctors differentiate between an extremely early preterm birth (before 28 weeks’ gestation), an early preterm birth (28 to 32 weeks’ gestation) and a late preterm birth (from 32 to 37 weeks’ gestation).
The birth weight is also often used as a criterion. According to this, babies weighing between 500 and 2,500 grams count as premature births. However, body weight is not the only decisive factor, as children can also have a low birth weight if they are born at the expected time.
Premature birth – frequency and age
According to the Federal Statistical Office, around 7 out of every 100 newborns in Switzerland are born prematurely.
Premature birth: causes and risk factors
The causes of a premature birth can be very different. It depends on whether the birth is medically induced due to premature labor, premature rupture of the amniotic sac (spontaneous rupture of the membranes) or complications. In around 40 percent of cases, the exact causes are unclear. Several factors often play a role in premature delivery.
The reasons for a premature birth can lie with both the mother and the child. Possible causes of premature birth include
- Acute ascending infection of the birth canal
- Pregnancy-related high blood pressure, diabetes mellitus, kidney disease, thyroid dysfunction
- Diseases of the uterus, for example benign tumors (fibroids), malformations or opening and softening of the cervix with simultaneous shortening of the cervix (cervical insufficiency)
- Age of mother under 18 years or over 35 years
- Multiple pregnancies
- Previous miscarriages, premature births or abortions
- Excessive consumption of nicotine, alcohol or drugs
- Psychological stress
- Disturbance of the exchange of substances between mother and child (lack of function of the placenta = placental insufficiency)
- Infections, malformations, genetic changes or developmental disorders in the child
Symptoms: Premature birth
There are several signs that indicate an imminent premature birth:
- Premature labor: The clearest sign of a premature birth is the premature onset of labor. As an expectant mother, you should therefore observe the contractions. Pay attention to whether they last longer than an hour, occur at intervals of five to ten minutes and last longer than 30 seconds each. In this case, you should inform your midwife or doctor and go to hospital. During the examination, your doctor or midwife can also determine whether and to what extent the cervix is already open.
- Rupture of the membranes: In a third of all premature births, the waters break prematurely. If amniotic fluid is released involuntarily – either in droplets or gushes – this is another sign that the birth is imminent.
- Bleeding: Bleeding can also indicate an imminent premature birth. These should therefore be medically clarified immediately.
Premature birth: Diagnosis by the doctor
For a reliable diagnosis, the doctor or midwife will first carry out a thorough physical examination. This can also determine whether and to what extent the cervix has already opened and shortened. In this case, the birth is imminent.
An ultrasound examination provides information about the position, size and weight of the baby, the amount of amniotic fluid and the position of the placenta. The cause of bleeding can also often be determined with the help of an ultrasound scan. A cardiotocography (CTG) is used to monitor the baby’s contractions and heartbeat.
Premature birth: prevention, early detection, prognosis
The causes of a premature birth often remain unclear. The following measures may help you as an expectant mother to reduce the risk of a premature birth:
- As a pregnant woman, take advantage of regular check-ups.
- Avoid nicotine, alcohol and drugs.
- Try to avoid stress and excitement.
Sometimes, however, a premature birth does occur despite all precautionary measures.
Course and prognosis of a premature birth
A premature birth can take very different courses and result in complications for mother and child.
Complications can arise, for example, if the organs of a newborn, where there is often a lack of surfactant, are not yet fully mature. This affects the lungs, among other things. This substance supports breathing after birth. In premature babies, respiratory distress syndrome often occurs due to a surfactant deficiency and the immaturity of the lungs.
Similarly, the central nervous system (CNS) is often not yet fully developed in premature babies. This can lead to shallow breathing and repeated pauses in breathing (apnea), particularly during sleep.
Premature babies also often have problems with nutrition and digestion due to their incompletely developed gastrointestinal tract. The kidneys can also be affected, which can lead to disturbances in the electrolyte balance. Temperature regulation disorders and the risk of hypothermia often mean that premature babies have to spend some time in the incubator.
Premature babies suffer from neonatal jaundice more often than other babies. The yellowing of the skin occurs when a breakdown product of the red blood pigment hemoglobin, bilirubin, is stored in the skin. The liver is less mature in premature babies. They are therefore less able to break down bilirubin.
Premature birth: treatment
With timely treatment, a threatened premature birth can often be delayed, so it is important that you seek hospital treatment at the first sign of a threatened premature birth.
Further treatment depends on the state of health of the mother and child and the week of pregnancy. Doctors therefore always decide on an individual basis whether to induce or allow the birth or whether it can be therapeutically delayed.
Treatment: Inducing and allowing a premature birth
If the baby has a good chance of survival, the birth can be permitted or induced.
Induction of labor is necessary, for example, if the amniotic sac has already broken but the cervix does not open or contractions do not start. The same applies to a detached placenta, severe “pregnancy poisoning” (pre-eclampsia) or a cervix that is already wide open. To stimulate labor, the doctor will administer the hormone oxytocin.
In the case of a premature birth, doctors often perform an episiotomy to reduce the pressure on the premature baby’s still soft head during the birth process.
Treatment: Delaying a premature birth
If, on the other hand, the aim is to delay the birth, you as a pregnant woman must take it easy and stay in bed. If this is unsuccessful, doctors use labor-inhibiting agents such as beta-sympathomimetics or oxytocin antagonists. A cortisone preparation (glucocorticoid) can accelerate the maturation of the child’s lungs.
If the cervix has already opened and the cervix has shortened (cervical insufficiency), doctors can close it with a suture loop, known as a cerclage, up to the 23rd week of pregnancy.
Further treatment
After a premature birth, “the premature baby” is usually placed in an incubator for some time to recover from the stresses and strains of the birth. The incubator ensures a constant temperature and humidity as well as a sufficient supply of oxygen. At the same time, the incubator protects the newborn’s still fragile immune system.
The baby receives breast milk from the very beginning, as it contains important nutrients.
An important part of the treatment is also to strengthen the emotional bond between baby and parents. After all, a premature birth is a great emotional burden for parents and child. For this reason, we offer the option of placing the newborn skin-to-skin on the mother’s or father’s upper body for several hours a day. This so-called kangaroo method not only strengthens the bond between you and your baby, but has also been shown to improve the premature baby’s health.
