Prenatal Massage Table
Prenatal Massage Table
In humans, preterm birth refers to the birth of a baby of less than 37 weeks gestational age. Premature birth , commonly used as a synonym for preterm birth, refers to the birth of a premature infant. The child may commonly be referred to throughout their life as being born a "preemie" or "preemie baby". Because it is by far the most common cause of prematurity, preterm birth is the major cause of neonatal mortality in developed countries. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. Significant progress has been made in the care of premature infants, but not in reducing the prevalence of preterm birth. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging proposition.
Classification
In that they continue developing after birth, most animals are not born mature. At birth, a normal human infant is less mature than infants of some other primate species, possibly to allow the disproportionately large head to fit through a pelvis adapted for walking on two legs.
In humans, whereas the usual definition of preterm birth is birth before 37 weeks gestation, a "premature" infant is one that has not yet reached the level of fetal development that generally allows life outside the womb. In the normal human fetus, several organ systems mature between 34 and 37 weeks, and the fetus reaches adequate maturity by the end of this period. One of the main organs greatly affected by premature birth is the lungs. The lungs are one of the last organs to develop in the womb; because of this, premature babies typically spend the first days/weeks of their life on a ventilator. Therefore, a significant overlap exists between preterm birth and prematurity: generally, preterm babies are premature and term babies are mature. Prematurity can be reduced to a small extent by using drugs to accelerate maturation of the fetus, and to a greater extent by preventing preterm birth.
Signs and symptoms
Symptoms of imminent spontaneous preterm birth are signs of premature labor; such signs consists of four or more uterine contractions in one hour before 37 weeks' gestation. In contrast to false labor, true labor is accompanied by cervical shortening and effacement. Also, vaginal bleeding in the third trimester, heavy pressure in the pelvis, or abdominal or back pain could be indicators that a preterm birth is about to occur. A watery discharge from the vagina may indicate premature rupture of the membranes that surround the baby. While the rupture of the membranes may not be followed by labor, usually delivery is indicated as infection (chorioamnionitis) is a real threat to both fetus and mother. In some cases the cervix dilates prematurely without pain or perceived contractions, so that the mother may not have warning signs until very late in the birthing process.
Mortality and morbidity
The shorter the term of pregnancy, the greater the risks of mortality and morbidity for the baby primarily due to the related prematurity. Preterm-premature babies ("preemies" or "premmies") have an increased risk of death in the first year of life (infant mortality), with most of that occurring in the first month of life (neonatal mortality). Worldwide, prematurity accounts for 10% of neonatal mortality, or around 500,000 deaths per year. In the U.S. where many infections and other causes of neonatal death have been markedly reduced, prematurity is the leading cause of neonatal mortality at 25%. Prematurely born infants are also at greater risk for having subsequent serious chronic health problems as discussed below.
The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability. As NICU care has improved over the last 40 years, viability has reduced to approximately 24 weeks, although rare survivors have been documented as early as 21 weeks. This date is controversial as gestation in this case was measured from the date of conception rather than the date of her mother's last menstrual period. Gestation appears 2 weeks less than if calculated by the more common method. As risk of brain damage and developmental delay is significant at that threshold even if the infant survives, there are ethical controversies over the aggressiveness of the care rendered to such infants. The limit of viability has also become a factor in the abortion debate.
Specific risks for the preterm neonate
Preterm infants usually show physical signs of prematurity in reverse proportion to the gestational age. As a result they are at risk for numerous medical problems affecting different organ systems.
- Neurological problems include apnea of prematurity, hypoxic-ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), developmental disability, cerebral palsy and intraventricular hemorrhage, the latter affecting 25 percent of babies born preterm, usually before 32 weeks of pregnancy. Mild brain bleeds usually leave no or few lasting complications, but severe bleeds often result in brain damage or even death.
- Cardiovascular complications may arise from the failure of the ductus arteriosus to close after birth: patent ductus arteriosus (PDA).
- Respiratory problems are common, specifically the respiratory distress syndrome (RDS or IRDS) (previously called hyaline membrane disease). Another problem can be chronic lung disease (previously called bronchopulmonary dysplasia or BPD).
- Gastrointestinal and metabolic issues can arise from hypoglycemia, feeding difficulties, rickets of prematurity, hypocalcemia, inguinal hernia, and necrotizing enterocolitis (NEC).
- Hematologic complications include anemia of prematurity, thrombocytopenia, and hyperbilirubinemia (jaundice) that can lead to kernicterus.
- Infectious include sepsis, pneumonia, and urinary tract infection
Causes
As the cause of labor still remains elusive, the exact cause of preterm birth is also unsolved. Labor is a complex process involving many factors. Four different pathways have been identified that can result in preterm birth and have considerable evidence: precocious fetal endocrine activation, uterine overdistension, decidual bleeding, and intrauterine inflammation/infection. Activation of one or more of these pathways may happen gradually over weeks, even months. From a practical point a number of factors have been identified that are associated with preterm birth, however, an association does not establish causality.
Maternal background
A number of factors have been identified that are linked to a higher risk of a preterm birth: low socio-economic or educational standing and single motherhood, as well as age at the upper and lower end of the reproductive years be it more than 35 or less than 18 years of age. Further, in the US and the UK Afro-American and Afro-Caribbean women have preterm birth rates of 15–18% more than double than that of the white population. This discrepancy is not seen in comparison to Asian or Hispanic immigrants and remains unexplained.
Pregnancy interval makes a difference as women with a 6 months span or less between pregnancies have a two-fold increase in preterm birth. Studies on type of work and physical activity have given conflicting results, but it is opined that stressful conditions, hard labor, and long hours are probably linked to preterm birth. Patients who had undergone previous induced abortions have been shown to have a higher risk of preterm birth only if the termination was performed surgically but not medically. Adequate maternal nutrition is important. Women with a low BMI are at increased risk for preterm birth. Further, women with poor nutritional status may also be deficient in vitamins and minerals. Adequate nutrition is critical for fetal development and a diet low in saturated fat and cholesterol may help reduce the risk of a preterm delivery. Obesity does not directly lead to preterm birth; however, it is associated with diabetes and hypertension which are risk factors by themselves. Women with a previous preterm birth are at higher risk for a recurrence at a rate of 15–50% depending on number of previous events and their timing. To some degree those individuals may have underlying conditions (i.e. uterine malformation, hypertension, diabetes) that persist.
Marital status is associated with risk for preterm birth. A study of 25,373 pregnancies in Finland revealed that unmarried mothers had more preterm deliveries than married mothers (P=0.001). Pregnancy outside of marriage was associated overall with a 20% increase in total adverse outcomes, even at a time when Finland provided free maternity care. A study in Quebec of 720,586 births from 1990-97 revealed less risk of preterm birth for infants with legally married mothers, compared with those with common law wed or unwed parents.
Genetic make-up is a factor in the causality of preterm birth. An intra- and transgenerational increase in the risk of preterm delivery has been demonstrated. No single gene has been identified, and it appears with the complexity of the labor initiation, that numerous polymorphic genetic interactions are possible.
Factors during pregnancy
Multiple
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