A- What is prematurity?
• Prematurity describes births that occur before 37 weeks of pregnancy.
• Any birth which occurs before complete maturity is considered premature birth.
• A premature baby is usually not fully developed, meaning some vital organs might not be functioning as they should.
• extremely preterm: less than 28 weeks
• very preterm: from 28 to < 32 weeks
• Moderate to late preterm: from 32 to < 37 weeks. (While they tend to appear healthy at birth but may have more difficulties adapting than full-term babies)
• Babies born before 32 weeks face the greatest risk of death and long-term disabilities such as mental retardation, cerebral palsy, lung and gastrointestinal problems, and vision and hearing loss.
B- Basic statistics you should be aware of
• Around12 percent of all babies are born premature. Thatis roughly 1 in every 8births.
• The rate of preterm births has increased over the last 20 years.
• Around 15 million babies are born preterm every year and this number is rising
• Prematurity is the biggest killer of young children, with more than 1 million children dying each year due to the complications of preterm birth
• Nigeria has the highest rate of newborn deaths caused by prematurity in Africa and second highest in the world.
• Around 900, 000 premature births are recorded in Nigeria every year, around 10% of these die within few month of birth
• Prematurity causes around 33% of newborn deaths in Nigeria.
• Many premature babies weigh less than 2.5 kg and may be referred to as low birth weight (LBW).
C- What causes premature birth?
These can be grouped into three:
1- Maternal factors
• Preeclampsia – high blood pressure of pregnancy, also gestational hypertension
• Chronic medical illness, such as heart or kidney disease
• Infection, such as group B streptococcus, urinary tract infections, vaginal infections, infections of the fetal/placental tissues
• Drug use, such as cocaine
• Abnormal structure of the uterus
• Cervical incompetence – inability of the cervix to stay closed during pregnancy
• Previous preterm birth
2. Factors involving the pregnancy
• Abnormal or decreased function of the placenta
• Placenta previa – low-lying position of the placenta
• Placental abruption – early detachment from the uterus
• Premature rupture of membranes, amniotic sac
• Polyhydramnios – too much amniotic fluid
3. Factors involving the fetus
• When fetal behavior indicates the intrauterine environment is not healthy
• Multiple gestation – twins, triplets or more
Risk factors include
• Prior early delivery;
• smoking or illegal drug use;
• high blood pressure or diabetes;
• carrying multiple fetuses, such as twins;
• a uterine infection during pregnancy;
• being age of 35 or older;
• pregnancy complications such as preeclampsia
• being over- or underweight
It should be known that half of all women who deliver early have no known risk factors.
D- Can it be prevented?
Unfortunately, the mechanisms of preterm birth are not known adequately to enable scientists come up with safe, effective ways to prevent it. The following are however some of the steps that can be taken to reduce the chance of premature birth
1) Early Prenatal Care
Start prenatal care immediately you know you are pregnant.
Folic acid lowers the risk of placental abruption and preeclampsia;two conditions that are responsible for about 20 percent of premature birth
2) Know the risk Factors.
Certain pregnant women,with one or more of the risk factors earlier listed, are more likely to deliver early. Doctors can suggest ways to minimise them, such as improving lifestyle through diet and exercise or treating a uterine infection.
3) Uterine Infections
Research suggests that uterine infections may be responsible for up to half of all preterm births, particularly those that occur before 30 weeks’ gestation.Sexually transmitted diseases such as gonorrhoea and chlamydia increase preterm birth risk. Women with Bacterialvaginosis (BV) also have higher rates of preterm birth.
Getting tested and treated is therefore recommended
4) Dental infections
Some dental problems increases the chance of preterm birth.
Dental check-ups are still a smart idea, as is brushing and flossing after meals.
Excessive weight gain will put up the odds of complications like gestational diabetes and preeclampsia, which increase preterm labour risk.
Underweight is a risk factor too. Women eitha body mass index (BMI) lower than 20 are less likely to carry their baby to term. A healthy BMI is 20 to 25.
Your doctor can therefore recommend losing or gaining weight depending on where you currently are.
6) Diet and Exercise
Walking often during the first 20 weeks of pregnancy can lowerthe risk of preeclampsia by a third.
Exercisealso helps you relax. Severe chronic stress may kick-start labour.
Swimming, walking and yoga are good and generally it’s better to avoid contact exercises and lifting.
Eat well, exercise well.
7) Know the signs of early labour.
Although little can be done to reverse the course of preterm labour once it’s started, delivery can usually be delayed for a few days to a week using tocolytics, drugs that suppress contractions.
During this critical window, corticosteroids, can be administered which can improve fetal health by speeding up lung maturation.
Signs of preterm labour include contractions that occur every ten minutes or more, fluid leaking from your vagina, pelvic pressure, lower back pain, menstrual-like cramps and abdominal cramps that begin in the back and move to the front.
E- Taking care of a preemie and the mother
F- While some are lucky enough to be relatively healthy at birth, many others battle many serious problems, such as heart conditions, bleeding in the brain, compromised kidney function, jaundice, and anemia.
• TEMPERATURE CONTROL: Hypothetmia (low temperature) is one of the causes of death in preemies. because the preemie’s internal temperature control mechanism isn’t mature, they rely on others to help. The KANGAROO MOTHERCARE is a great way to regulate a preemie’s temperature while fostering the bod between mother and child.
• INFECTIONCONTROL: Due to their immature immune systems, preemies are especially susceptible to infection. Hence, care should be taken to ensure preemies are kept in environment that are clean, safe and sterilized. Hygiene should be taken very seriously.
• NUTRITION: Preemies require optimal nutrition to help them grow. Breast milk is proven to be safer and cheaper than formula. Where a preemie is required to take formula for any reason, the health care provider should recommend the best.
• Because preterm babies have special needs and require special care, most preemies spend some times in the Neonatal Intensive Care Unit where they are helped to survive.
• It is best to look for an hospital with a great NICU for your preemies.
• The result- Nothing could be sweeter than watching a baby who once battled to breathe develop into a happy, active kid.
G- How society and you can help preemies and their parents
Some preemies are born very early and sickly too. They therefore do not have the healthy, bubbly appearance of newborns. They should not be stigmatized against either through looks or words. Preemies and their parents go through a rough road to recovery, they need our empathy at the very least.
Support groups are required to help preemie parents discuss ideas and just share.
Counseling should be available in case of depression.
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