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Wednesday, November 17, 2021

World prematurity day - Awareness about preterm labour, delivery, and birth

By

Dr. Varshali Mali

Gynecologist & pregnancy doctor
The World Prematurity Day is observed on 17th November every year. The preterm birth and complication arising due to preterm delivery are critical problems around pregnancy and childbirth. We have been thinking of participating in this global awareness initiative for some time now. So, this year, we took a few initiatives to create awareness about this topic. This article is one of the efforts to explain the severity of preterm birth, complications related to preterm delivery, and prevent preterm labour.

What is world prematurity day?

World prematurity day is a global initiative to raise awareness about preterm birth and encourage the improvement in the treatment and care of all premature babies. The world prematurity day is observed globally on 17th November every year. This day was initiated by EFCNI (European Foundation for the Care of Newborn Infants) and partnering European parent organizations in 2008. The date 17 November was chosen at the first EFCNI Parent Organizations Meeting in Rome, Italy. That day, one of the founding members of EFCNI became a proud father of a daughter after having lost his triplets due to preterm birth. A new awareness day was born. In 2010, the US organization March of Dimes, the African organization LittleBigSouls, the Australian National Premmie Foundation, and EFCNI joined together across continents to observe this special day.
The world prematurity day is an opportunity to talk about the solutions for the death, disability, pain, suffering caused by preterm birth, preterm labour, and preterm delivery.

What is preterm birth?

A pregnancy lasts typically for about 40 weeks. Preterm birth is when a baby is born more than three weeks before the baby's estimated due date. If preterm labour happens and the baby arrives before the 37th week of pregnancy, it is referred to as preterm birth. Preterm birth is sub-divided into different categories depending on how early the baby is born or the gestational age.
Late preterm: Babies born between 34 to 36 weeks of pregnancy
Moderately preterm: Babies born between 32 to 34 weeks of pregnancy
Very preterm: Babies born between 28 to 32 weeks of pregnancy
Extremely preterm: Babies born before 28 weeks of pregnancy
Preterm birth often causes medical complications for the baby. The complications and seriousness depend on the completed weeks of pregnancy. Still, the earlier the baby is born, the higher the risk of complications.

Preterm birth statistics

According to WHO, an estimated 15 million babies are born preterm every year due to preterm labour and preterm delivery. More than 1 in 10 babies come to the world three weeks before their estimated due date. Every year, approximately 1 million babies do not survive due to complications arising from preterm birth. Many of those who survive faces lifetime disabilities, including learning disabilities, visual and hearing problems. Globally, preterm birth is a leading cause of death in children under the age of 5 years.
Across 184 countries, preterm birth rates range from 5% to 18% of babies born. According to data provided on the National Health Portal of India, out of 27 million babies born every year in India (2010 data), 3.5 million babies born are premature. Though preterm birth is a global problem, more than 60% of preterm births occur in Africa and South Asia. On average, in the lower-income countries, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk. The survival of premature babies also depends on where they are born. Almost 9 out of every 10 preterm babies survive in high-income countries because of enhanced primary care and awareness. This is about 1 out of 10 in low-income countries.
According to WHO fact sheet on preterm birth (updated in November 2014), following are the 10 countries with greatest number of preterm births:
Country Preterm births
India 35,19,100
China 11,72,300
Nigeria 7,73,600
Pakistan 7,48,100
Indonesia 6,75,700
United States of America 5,17,400
Bangladesh 4,24,100
Philippines 3,48,900
Democratic Republic of the Congo 3,41,400
Brazil 2,79,300
Of 65 countries with reliable trend data, all three show an increase in preterm birth rates over the past 20 years. Possible reasons for this include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies.

Causes of preterm birth

Preterm labour, preterm delivery, and preterm birth occur for a variety of reasons. More preterm births happen spontaneously, but some are due to early induction of labor or caesarean birth due to some medical condition of the mother or the baby. The reasons for preterm birth revolve around your pregnancy history, current pregnancy status, medical conditions, age, and habits.
Pregnancy history: If you have given early birth before, it is more likely that you will give premature birth again.
Carrying more than 1 baby: If you are pregnant with twins, triplets, or other multiples, it is more likely to have preterm delivery. Even if you don't go into premature labour, your gynecologist may advise giving birth before your due date to reduce the risk of complications.
Diabetes: Preterm birth is one of the most common problems associated with type 1 and type 2 diabetes. Some women may show an elevated level of glucose in the blood during pregnancy. In women with gestational diabetes, your gynecologist will evaluate the risk to you and your baby and may suggest an early delivery.
Weak cervix: Sometimes cervix (the neck of the womb) is damaged, and the cervix shortens during pregnancy. This is called a weak cervix condition and may lead to premature labour.
Placenta: Some placenta conditions like placenta separating from uterus early, placenta in an abnormal position can increase the risk of preterm birth.
Age and weight: If you become pregnant before 18 or after 35, there is an increased chance of preterm delivery. Women who are under or over-weight are more likely to have a preterm birth.
Stress: It is also observed that women with high stress have more chances of delivering the baby early.
Smoking and alcohol consumption: Smoking and drinking a large amount of alcohol increases the chances of your baby's preterm birth. It may also lead to miscarriage, low birth weight of your baby, learning difficulty, and ectopic pregnancy.
Nutrition and diet: A mother's poor diet around the time of conception can cause preterm birth. A woman who eats a protein-rich diet is at a lower risk of preterm birth.
There are other medical conditions, which may call for preterm birth. It includes low PAAP-A level, placenta praevia, polyhydramnios, antiphospholipid syndrome, pre-eclampsia, and uterine abnormalities, etc. Consult your pregnancy doctor and go through suggested regular checkups to track and evaluate your and your baby's condition.

Complications due to preterm birth

Not all babies born prematurely due to preterm delivery experience complications. The earlier the baby is born, the more likely they are to have medical problems. These babies may have short-term and long-term problems. The severity of the problem depends on factors like the baby's birth weight, how much early the baby is born, etc.

Short term complications

Breathing problems: Women going into preterm labour and delivering a premature baby may have breathing problems due to an immature respiratory system. If the lungs lack surfactant, the baby may develop respiratory distress syndrome. In addition, some premature babies may experience prolonged pauses in their breathing, known as apnea.
Heart problem: Patent ductus arteriosus and low blood pressure are the most common heart problems experienced by premature babies.
Brain problem: Premature babies are at the risk of bleeding inside the brain. The earlier they are born, the more they are at risk of intraventricular hemorrhage. In most babies, this is mild and causes short-term impact, but some may have a permanent brain injury.
Body temperature: Premature babies may have difficulty in maintaining their body temperature. They have low body fat, so they can't generate enough heat to compensate for the heat lost through their body surface. That's why smaller premature infants require additional heat from an incubator until they become larger and generate the heat needed to maintain the body temperature.
Gastrointestinal problem: Due to the immature gastrointestinal system, the premature babies are more likely to have complications like necrotizing enterocolitis (NEC). This is the most common and serious intestinal disease among premature babies. It happens when tissue in the small or large intestine is injured or inflamed. This can lead to the death of intestinal tissue and, in some cases, a hole (perforation) in the intestinal wall.
Blood problems: Premature babies may have the blood problems like anemia and jaundice. Anemia is a condition where the body does not have enough red blood cells. Anemia is a common condition in newborn babies. Still, premature babies may be at higher risk due to a rapid decrease in red blood cells. Newborn jaundice is a yellow discoloration in a baby's skin and eyes. Many babies may get jaundice after birth, but it is more common in preterm babies.
These are some of the short-term complications in preterm babies. Other short-term problems include less activity than average, movement and coordination issues, difficulties with feeding, metabolism, and Immune system problems.

Long term complication

Preterm babies may have long-term complications.
Vision and hearing: Premature babies may be potentially affected by the retinopathy of prematurity (ROP) disease. The small a baby is at birth, the more likely that baby is to develop ROP. This is one of the most common causes of visual loss in childhood and may lead to lifelong vision impairment and blindness. Premature babies are also at an increased risk of some degree of hearing loss.
Learning: Premature babies are more likely to have learning disabilities. They are likely to have difficulties with learning than babies born at full-term.
Cerebral palsy: This is a group of conditions that mainly affects movement and coordination. This can be caused by infection, inadequate blood flow, or injury to the developing brain during pregnancy or at the baby's early age. The symptoms may range from mild to severe and include problems in balance, posture, talking, learning, etc.
Chronic health issues: Premature babies are more likely to have chronic health issues like infections, asthma, feeding problems.
Dental problems: Premature babies are at higher risk of dental issues like delayed tooth eruption, tooth discoloration, and teen alignment.
Emotions and behavior: Premature babies may have emotional and behavioral problems like being shy, less active, or hyperactive. They may show more impulsive behaviors and seem to withdraw quickly.
Some of the above problems can be resolved through proper critical care. For the premature baby, it is very vital to perform various tests to identify the problem. These tests will help to identify and reduce the risk of complications. Continuous monitoring and intensive care for the premature baby are very essential. So, if you are having a preterm birth of your baby, consult your pregnancy doctor, the pediatrician. Make sure that you have all necessary facilities available to your baby.

How to prevent preterm birth

There are certain medical conditions you can not avoid. But many of the reasons for preterm labour, preterm birth, and preterm delivery can be avoided with proper prenatal care and good habits during your pregnancy period. Following are a few ways of preventing or reducing the risk of preterm birth.

Lifestyle

Your lifestyle matters a lot when it comes to the health of your baby. Your habits will decide whether you will have preterm labour and your baby will arrive before time or enjoy full growth in your protective womb. Following are a few things you can do to reduce the risk of preterm birth of your baby:
Don't smoke, drink alcohol, or do drugs. It's far too dangerous to your baby now.
Eat nutrition and a balanced diet. Try to include an appropriate amount of iron and folic acid in your diet.
Be active and at least do a moderate exercise of 30 minutes every day.
Make sure that your medical conditions like blood pressure and sugar are under control.
Make sure that your weight or body mass index is appropriate. If you are overweight, lose weight, and if you are underweight, gain weight.
Keep your stress level low. Get involved in activities like yoga, meditation, reading, painting, or anything that helps you relax.
Try to have a happy environment around. Maintain healthy relations with your near ones and avoid conflicts and violence.

Pregnancy care

How you take care of yourself during pregnancy matters a lot for your baby's health and whether you will have preterm delivery or not. Good care reduces the chances of preterm labour and preterm birth. Following are a few things to be followed during pregnancy:
Start your prenatal care as soon as possible. Visit your pregnancy doctor as soon as you come to know that you are pregnant. This is most critical if you have a history of preterm birth before or are aware of some uterus or cervix issues. Make sure to follow the appropriate pregnancy check schedule defined by your pregnancy doctor. This will help to do diagnosis and treatment of problems that may cause preterm birth.
Make sure that you follow the given tests & baby ultrasound scan schedule.
There are some recommended vaccinations to be taken during pregnancy. Make sure that you follow the vaccination schedule.
If your diet does not include the required nutrients, make sure that you take the needed multivitamins containing folic acid, calcium, and iron. Take the advice of your pregnancy doctor for the frequency and quantity of these vitamins.
Get enough sleep. You may feel a little tired during pregnancy. So, take a good nap. Sleeping might be a little discomforting, especially during the final few months of pregnancy. But make and follow the schedule of sleeping for at least 8 to 9 hours a day.
Keep an eye on your baby's movements and signs of premature labour. In case if you feel anything, consult your gynecologist immediately.
It is advisable to keep the appropriate gap between two pregnancies. Especially when your previous baby's birth is premature, at least keep a gap of 12 months. If you have had any preterm birth before, inform your gynecologist. She will be able to analyze the situation and provide appropriate medication and advice.
These are some of the things you can do to reduce the risk of preterm birth. Remember that your good habits and a little discomfort in letting few things go will help your baby be born healthy and enjoy the rest of his healthy life. In case of any query on preterm birth or what you can do to avoid it, feel free to consult me or ask me a question.

Neonatal Intensive Care Unit (NICU) and preterm babies

The babies born prematurely may need extra care during the initial few weeks. The earlier the babies are born, the more likely they will have complicated medical problems. Such newborn babies who need intensive medical care are often put in a particular hospital area called the neonatal intensive care unit (NICU). A good NICU will have a specifically trained healthcare professional who will take care of the baby. It includes neonatologists. Pediatric resident, neonatal nurse practitioner, respiratory therapist, dietitian, lactation consultant, etc. So, if you are expecting a preterm delivery, make sure to ask for details about their NICU facility.
I have been working with Surya Mother and Child Super Specialty Hospital, Pune, for quite a long time. I believe that their NICU facility is best in class and provides excellent care for a newborn, especially for preterm babies. They have a state-of-the-art level III Neonatal ICU. The NICU has 24×7 coverage by a Neonatologist and a nurse trained in neonatal care. This level III NICU facility comes fully equipped with monitoring facilities and advanced incubators with features that ensure that your baby is well taken care of. Experienced technicians and blood gas analyzers assist in ventilator management of babies who need assistance to breathe. Baby warmers and phototherapy units are state of the art and come with inbuilt safety features.
To know more about Surya hospital, refer to the below links:

What are we doing on World Prematurity Day?

Preterm labour, preterm delivery, and preterm birth are serious problems. We at Dr. Varshali's Gynecology Clinic really appreciate the initiative by EFCNI to bring the community together on this issue. The event at such a global scale will help bring awareness among people, healthcare providers, and health policymakers about the problem device a solution to reduce the severity.
This year, Dr. Varshali's Gynecology Clinic has decided to contribute its little piece to this initiative. So, we are doing the following:

Go purple

Purple is the color of world prematurity day. So, starting from 17th November, our website is going all purple for the next three days. We have little traffic (not much, but I guess ok) on our website. The website is visited mainly by people looking for pregnancy and gynecology topics. Even creating awareness among those 4 to 5K visitors might make a slight difference. And who knows, they will pass on the messages to others, and we may start a little chain of information.

Awareness

The purpose of writing the articles itself is to create awareness. We included specifics about what, why, and how to avoid preterm birth. The intention is to write and spread awareness about this among the readers. We are also posting this on all our social media handles to understand, act, and support the initiative. We will be putting the World Prematurity Day poster in our clinic. The visiting patients will know about the day and its importance and may help spread awareness.
We know that much more significant, better can be done and should be done. So, we are planning to make this much more prominent the following year. I hope so, we will be able to do that.
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Entrance at Dr. Varshali's Gynecology Clinic
Dr. Varshali's Gynecology Clinic on World Prematurity Day

Written by

Gynecologist & pregnancy doctor

Dr. Varshali Mali is an Obstetrician and Gynecologist. She did her MBBS from Dr. D. Y. Patil Medical College, Pune, DNB (Obstetrics & Gynecology) from Jehangir Hospital, Pune, and Diploma in Gynecological Endoscopy from the University of Schleswig Holstein - Kiel Germany. She has several years of experience working as a gynecologist, pregnancy doctor, and lecturer. Through her clinic located at Life Republic township near Marunji, she provides gynecology and pregnancy care solutions to the women around Hinjewadi, Wakad, and nearby Pune. She is known for her welcoming nature, smiley face, supportive attitude, intelligence, and in-depth knowledge about gynecology and pregnancy in her patient community. Mother of two daughters, she believes that motherhood is the best gift one can get. As her contribution, she puts her best efforts into making the pregnancy journey most enjoyable for her patients.

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