Preterm Birth Prevention

Across the world preterm birth is the leading cause of pregnancy loss and long-term disability. An estimated 15million babies in the world are born less than 37 weeks. In Australia over 26000 babies (9% of pregnancies) are born preterm. If the birth occurs before viability (23-24 weeks), it will be a pregnancy loss.

Premature babies may have more short-term and long-term health problems and may need to stay in the hospital longer in a hospital’s neonatal intensive care unit (also called NICU). This is the part of a hospital that takes care of sick newborns. But thanks to advances in medical care, even babies born very prematurely are more likely to survive today than ever before. Those born at the earliest gestational ages may suffer from severe problems such as cerebral palsy, developmental delay, chronic lung disease, diabetes or blindness. For those born at a later gestation, even approaching full-term, there may be behavioural and learning problems.

Every pregnancy is at risk of a preterm birth.

There are a group of women who are at a higher risk of preterm birth and a planned program of risk assessment, monitoring and evidence based care pathway can lead to a reduced risk of preterm birth. If you are in this category, our tailored preterm birth prevention services will be beneficial to achieve a better outcome during your pregnancy. Certain events can stimulate the onset of premature labour including placental abruption, incompetent cervix, hormonal changes or infection. There are multiple risk factors for premature birth including having a previous premature birth, pregnancy with multiple babies, drug or alcohol use, smoking, slow maternal weight gain, stressful work habits, low pre-pregnancy weight, prior multiple uterine surgery and extremes of maternal age.

If you had a previous premature labour, your chance of having another premature labour increases two and a half times. That rate jumps to 10 times if your previous premature labour occurred before the 28th week of pregnancy. It is important for you and your health care provider to keep this in mind, so that they can provide you with appropriate care throughout your pregnancy.

Another major risk factor for premature labour and delivery is being pregnant with twins or multiple babies. The rate of twins and multiple babies has increased over the past few years, mostly because of the use of fertility drugs and other assisted reproduction techniques. About half of all twins deliver at 36 weeks or less. Half of triplets deliver before 32 weeks. Many mothers of twins and multiple babies go into premature labour spontaneously. Others may need to have premature labour induced because of complications during pregnancy.

One important risk factor is infection. Some types of infection such as untreated bladder infection and vaginal bacterial vaginosis can result in premature birth. We have the availability to screen for an treat these infections.

IVF pregnancy and ovulation induction to achieve a pregnancy also increases the risk of preterm birth.

Knowing these risks can help you and your health care provider determine whether you will need special care to prevent premature labour. If you are at high risk of going into premature labour, your health care provider can refer to our centre for a risk assessment and management program.

Early referral to this service, ideally, for a pre-pregnancy or early pregnancy consultation will allow time for risk assessment and a preventative plan to be set-up.

Appropriate cervical screening during low risk pregnancies can identify pregnancies at risk of preterm birth, giving an opportunity to prevent this outcome.

The Preterm Birth Prevention Services at Centre for Women’s Ultrasound and maternal Fetal medicine Services offer comprehensive specialised ultrasound and consultation services ideally placed to offer expert advice and diagnostic ultrasound for patients at risk of preterm birth.

Our high-quality ultrasound during routine pregnancy scans detect changes in the cervix of low risk women, giving an opportunity to commence management pathways to prevent preterm birth.

For high risk women, we offer pre-pregnancy and pregnancy consultations by Maternal Fetal Medicine Specialists, highly trained in preventing and managing preterm birth.

We perform preterm birth risk assessment, combining background risk factors and cervical length measurement by sonographers who have completed training for ultrasound cervix measurement through the Fetal Medicine Foundation, London.

Treatment with progesterone pessaries can be prescribed and our trained maternal fetal medicine specialists are available for cervical suture insertion if required.

Preterm birth preventive strategies are developed for each patient, targeted for their risk profile.

We provide management advice in collaboration with the primary obstetric carer. Complete assessment, monitoring, pregnancy management and delivery packages can also be provided for pregnancies at risk of preterm delivery by Maternal Fetal Medicine specialists.

Health problems that may affect premature babies include:

• Apnoea. This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnoea. It may happen together with a slow heart rate.
• Respiratory distress syndrome (RDS). This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing.
• Intraventricular haemorrhage (IVH). This is bleeding in the brain. It usually happens near the ventricles in the centre of the brain. A ventricle is a space in the brain that’s filled with fluid.
• Patent ductus arteriosus (PDA). This is a heart problem that happens in the connection (called the ductus arteriosus) between two major blood vessels near the heart. If the ductus doesn’t close properly after birth, a baby can have breathing problems or heart failure. Heart failure is when the heart can’t pump enough blood.
• Necrotizing enterocolitis (NEC). This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth.
• Retinopathy of prematurity (ROP). This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss.
• Jaundice. This is when a baby’s eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isn’t working well.
• Anaemia. This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
• Bronchopulmonary dysplasia (BPD). This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage.

Infections. Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and spinal cord.