All births occurring after the 20th week and before the 37th week of pregnancy are considered preterm. Approximately 10-15% of all pregnancies result in preterm birth. Preterm birth is responsible for 75% of mortality and morbidity in newborns without congenital anomalies. A baby is considered premature if their weight is between 1000-2500 grams and immature if it is below 1000 grams.

In half of the cases, the factor causing preterm birth cannot be identified. Additionally, preterm rupture of the amniotic sac, placental insufficiency, and previous preterm births may lead to preterm labour. The risk of preterm birth increases if the intervals between pregnancies are less than 3 months, there is a serious previous tear in the cervix, the mother is under 18 or over 40 years old, has serious medical problems, or is a heavy smoker. Preterm births can also occur in cases of multiple pregnancies when there is too little or too much amniotic fluid, severe signs of anaemia in the mother, alcohol and drug users, and those exposed to trauma.

Frequent uterine contractions occurring twice an hour in the mother, detection of a 2-3 cm dilation in the cervix during examination, and/or leakage of amniotic fluid are significant signs. Patients presenting with these complaints are immediately admitted to the hospital. The condition is assessed through ultrasound examination and vaginal examination. If the cervix is dilated 4 cm or more, there is severe vaginal bleeding, the mother has serious medical problems (hypertension, severe cardiac and pulmonary disease, etc.), preterm birth is being carried out due to fetal distress, severe growth retardation, and intrauterine infection, attempts are not made to stop the birth.

To prevent preterm birth, hydration is administered to the mother urgently. If childbirth occurs between the 24th and 34th weeks, 2 doses of betamethasone are administered every 12 hours to accelerate the baby’s lung development. The beneficial effect of this treatment appears within 24 hours. Since the maximum beneficial effect of the administered cortisone will be achieved 48 hours later, efforts are made to gain at least this time. If possible and not contraindicated, tocolytic treatment should be applied to delay childbirth until the farthest possible date, and the mother should be put on bed rest.

For tocolysis treatment, one of the beta mimetic drug groups, magnesium sulfate, indomethacin, nifedipine, or a combination of these drugs is applied in a controlled manner. Antibiotics are started to protect the newborn from infection. Vaginal delivery between 1500-2000 grams and cesarean section for premature babies with foot presentation will be appropriate. Birth should always be performed in hospitals with neonatal intensive care units.

It can be difficult to generalise and categorise the future of the newborn. This is because neonatal intensive care conditions can vary greatly. In ideal conditions, babies weighing over 2000 grams have a 90% chance of survival. For those weighing between 1000-1500 grams, the rate drops to the 65% range. Throughout your pregnancy, staying in touch with your doctor and keeping your pregnancy under control will not only protect you from preterm birth but also from other potential risks.

Preterm birth accounts for 75% of newborn deaths. Premature babies tend to have slow growth and development. Problems can arise in hearing, vision, respiratory, and central nervous system development, leading to difficulties at school age.

Factors That May Increase the Risk of Preterm Birth

• Having experienced threatened preterm birth in this or a previous pregnancy
• Having previously given birth prematurely
• Multiple pregnancies (two or more fetuses)
• Previous procedures on the cervix
• The presence of a septum or fibroids in the womb
• Experiencing infection during pregnancy, especially kidney inflammation
• Undergoing abdominal surgery during pregnancy (appendicitis, gallbladder, ovarian surgeries)
• Smoking and drug use
• Bleeding in the first or second trimester of pregnancy
• Unmonitored pregnancy
• Getting pregnant while having an intrauterine device
• Fetal demise
• Incorrect calculation of gestational age

Signs of Threatened Preterm Birth

• Increase in vaginal bleeding or discharge
• Groin or abdominal pain
• Significant lower back pain
• Pain resembling menstrual cramps and continuing daily
• Feeling of tension in the uterus
• Feeling 5-6 or more contractions within an hour
• Sudden gushing of a large amount of fluid from the vagina
  

How is the Diagnosis of Threatened Preterm Birth Made?

The diagnosis of preterm birth is made by examining changes in the cervix. If your cervix has softened, turned forward, and started to shorten, it is determined that you are experiencing threatened preterm birth. Preterm birth is not diagnosed solely based on a feeling of contraction.

Fetal Fibronectin Test

Fetal fibronectin is a protein that can be detected in vaginal discharge between the 24th and 34th weeks of pregnancy. It indicates whether childbirth will occur within 2 weeks if there is a threat of preterm birth. It is obtained by taking a vaginal swab sample from areas near the cervix. If fetal fibronectin is detected, your doctor may prescribe bed rest and start treatment with necessary medications to prevent preterm birth. Medication treatment is also given to mature the baby’s lungs.

Treatment of Threatened Preterm Birth

The main goal of treatment is to restrict activity and increase fluid intake. In case of threatened preterm birth, you need to be hospitalised and stay in bed unless necessary. Initially, a serum is given intravenously. If necessary, tocolytic drugs, which are drugs that relieve uterine contractions, may be added to this serum.

Preterm Birth and Baby Health

The health of the baby is linked to how early the preterm birth occurs. Babies born after the 35th week usually go home with their mothers within a few days. The closer to the expected delivery date a baby is born prematurely, the longer they will stay in the hospital, approximately the same amount of time left until the expected delivery date. Premature babies cannot survive outside the incubator. These babies need neonatal intensive care. 

Premature babies may experience difficulties in maintaining body temperature. They are kept under heaters to prevent hypothermia. Since they may have problems regulating blood sugar, calcium, and magnesium levels, these are supplemented intravenously. Umbilical cords are usually preferred for intravenous access. Since these babies may also have problems related to sucking, swallowing, and chewing, they can be fed through tubes inserted through the nose or mouth. If premature babies are fed too early, they may develop necrotising enterocolitis, a potentially fatal intestinal disease.

Since the liver function of premature babies is not fully developed, jaundice often occurs. This yellow appearance of the skin will disappear over time. Ultraviolet light therapy may be required to prevent the accumulation of bilirubin.

Potential Long-Term Problems in Premature Babies

Thanks to the significant advancement in neonatal intensive care units, many small babies can now be saved. The smaller a baby is born, the more problems they may face in the long term. These problems include chronic respiratory problems, hearing difficulties, vision problems, neurological and developmental problems, and learning difficulties. These are generally unavoidable problems. However, due to the excellent treatment methods implemented today, many premature babies recover without experiencing these difficulties. Throughout your pregnancy, staying in touch with your doctor and keeping your pregnancy under control will not only protect you from preterm birth but also from other potential risks.

A normal pregnancy is described to be within 38-42 weeks. Babies born at 37 weeks and before are premature babies and are in need of special care. Especially the severely premature babies born before 32 weeks constitute the actual risk group. Nowadays it is of value to have a conscious pregnancy as with the rise of assisted reproductive techniques there is a rise in multiple births and in parallel to that in premature babies.

How Should First Care be for Premature Babies?

The baby lives in the mother’s womb in a stable temperature, sterile, less noisy compared to the outside world, a dark, safe environment. With birth, the baby comes in a much different temperature, not sterile, noisy, very bright and unsafe environment. The babies that are born on time are provided a safe and warm environment by being dried, dressed up and handed to their mothers’ chests. The baby adapts to this new environment quickly. But the babies that are born before their due date are exposed to many procedures and thus are distanced from their mother’s safe environment. They struggle to adapt to the new environment as some of their systems are underdeveloped due to premature birth. These babies are taken care of in incubators which is an environment similar to a mother’s womb. The incubator is heated in ideal temperatures for the baby, the moisture is provided in the required levels to prevent temperature loss. The baby is provided a more sterile environment by being kept away from the outer environment and being ventilated with air processed through special filters. In the incubator, the amount of oxygen adjusted to the baby’s needs can be given to the baby. An isolated environment where the noise is minimised is provided for the baby. A dark environment is provided when needed by covering the incubator. Thus, in this environment which resembles the mother’s womb, all of the care and treatment is provided to the baby in the least harmful way.

In their time in intensive care units, respiratory distress due to underdeveloped lungs, respiratory arrest, problems in preserving the temperature, infections, nutritional issues, hypoglycaemia, jaundice, cerebral haemorrhage, anaemia, bowel gangrene, issues called premature retinopathy which can even lead to blindness can be seen in babies. Their treatments are done for these problems. The babies that stay in intensive care units for a long time, get over their success issues, can be breastfed, and that do not need respiratory support are discharged. Premature babies’ discharge from the hospital does not mean that all of their problems are over. Care is needed after they are sent home as well. Special care is needed for both the baby has stayed in intensive care and lacks factors regarding the immune system. The immune system is passed to the baby from the mother during the last months of the pregnancy. But because they are born early, these babies fall short of their immune system and they are more vulnerable against infections. Because of that, hand hygiene holds primary importance when handling these babies. These babies shouldn’t be put in too crowded environments. In the meantime, the protection should not be exaggerated. Keeping the baby locked inside the home is not recommended as well. It is especially important to take them out to the sun and fresh air during warm temperatures.

How Long is the Period Needed to Be Careful for Premature Babies?

Premature babies are usually discharged when they are 34-35 weeks old. In premature babies, there can be respiratory arrests which are called apneas as their respiratory system is not fully developed until 40-45 weeks. Because of that, mattresses for apneas at home are recommended for babies with risk. Babies start to form their defence systems usually around 6-7 months. They require special care for the first 6-7 months, up to the first one year regarding infections.

How Should Nutrition Be for Premature Babies?

Getting early and accurate nutritional support after discharge is significant for premature babies’ long-term growth and development. The most ideal nutrition is breast milk. It is preferred to feed the babies with breast milk if it is sufficient. However, since premature babies have more nutritional requirements breast milk is supported with breast milk boosters when necessary, according to the monitoring of the baby’s weight gain. If the breast milk is not enough special formula milks are used for premature babies.