Birmingham Parent June 2008 : Page 33
The reason that a woman goes into preterm labor is often not known. However, many factors can increase the risk for preterm labor. First among them is a history of preterm labor. “Let your provider know if you have a history of preterm labor or preterm birth,” Christie says. “For women with a history, weekly progesterone injections may help prevent another preterm labor or preterm birth.” Other risk factors that increase the chances that a woman may experience preterm labor are uterine or cervical abnormalities, multiple fetuses (twins, triplets, etc.), the woman’s age (under 17 or over 35), and untreated or severe vaginal, urinary tract or kidney infections, doctors say. When Should You Call Your Doctor? The easy answer to this question is to call your doctor any time you think that something just isn’t right. “Patient awareness is key in identifying early preterm labor and allowing Signs and Symptoms of Preterm Labor— When to Call the Doctor (always consult your doctor if in doubt) • Four contractions in one hour – a contraction every 15 minutes or more often (each doctor may set different guidelines; check with your doctor); a contraction occurs when the entire uterus tightens and the whole lower belly is tight to the touch • Change in vaginal discharge or leaking of fluid • Bleeding or spotting • Pelvic pressure • Low, dull backache • Period-like cramps • Anything different or out of the ordinary; call your doctor Source: Amy Kester, OB/GYN nurse specialist, St. Vincent’s Health System for an appropriate [treatment] intervention,” Christie says. The earlier that preterm labor is identified and treated, the better the chances that preterm birth can be avoided. If the momentum of labor begins and cervical changes are advanced, stopping the labor becomes more difficult. Some signs and symptoms should not be ignored and should not wait to be addressed the next morning or at your next appointment. “A woman should never wait to contact her doctor if she experiences more than four contractions in an hour, vaginal pressure, spotting or bleeding, or a change in vaginal discharge (mucus, pink, or bloody),” Christie says. What Happens at the Hospital? Prathima Ryali-Hancock, working mother of two from Tuscaloosa, experienced preterm labor during both her pregnancies. “With my first child, I was working full time as a college student, and went into a regular prenatal checkup when they noticed dilation at 26 weeks into my pregnancy. I was not in my own hometown; in fact, I was about 700 miles away from home, working as an intern. My husband and I made the difficult decision to temporarily separate while I was put on bed rest.” Ryali-Hancock went to her parents’ home in Montgomery. Her doctors reassured her that she could still carry her baby to full term, but she must take care of herself and take medication. When a woman arrives at the hospital and preterm labor is suspected, she is put on intravenous fluids and bed rest to see if the contractions stop. “She will also be put on a fetal heart rate and contraction monitor, and a non-stress test will be performed on the baby to ensure that the baby is healthy,” Kester says. Often, the woman’s cervix is also checked for changes. However, if early in the pregnancy, the woman’s cervix may not be checked. If the forced fluids and rest do not stop the contractions, medication will be given. The first medicine given is Brethine (terbutaline), Kester says. Brethine, a drug used to treat asthma, relaxes smooth muscles. It can help stop contractions and can be given through an IV or through injections. Once a woman is allowed to go home, it also can be administered in pill form. If Brethine fails to stop the contractions, another drug is used – magnesium sulfate, Kester says. Magnesium sulfate’s use must be monitored closely because it can build up to toxic levels. When on magnesium sulfate, a woman’s blood will be checked frequently to ensure that the woman can continue to receive the drug. If the contractions continue after Brethine and magnesium sulfate, two other medications may also be given: Procardia and Indocin, which also relax smooth muscles. Procardia’s use is increasing because its side effects can be less severe than Brethine. Indocin, one of the last medications used, is not used after 32 weeks because it can decrease the amount of amniotic fluid in the uterus. When used, daily ultrasounds are required to ensure adequate amounts of amniotic fluid, according to Kester. After a woman is considered stable and goes home, she will likely be on bed rest and possibly taking medication, usually Brethine. Why bed rest? “A woman being on her feet puts stress and pressure on her cervix and uterus,” Kester says. “Bed rest is a non- conservative measure that can be taken…it doesn’t hurt, and it may help.” Another measure often taken is steroid injections to enhance fetal lung maturity. At 24 to 34 weeks gestation, beta methasone or celestone injections can be given to the woman in case the baby is born early, giving him/her the best chance for survival, Kester says. Unfortunately, babies are born early, and as Christie says, sometimes the labor cannot be stopped. But being aware of what to look for and when to call your doctor and catching the labor early is a first step in preventing preterm birth. When in doubt, call your doctor. Lori K. Ditoro is a freelance writer living in Alabaster. Contact her at lditoro@sundoro.com. birminghamparent.com | 33
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