Preterm birth is the main cause of neonatal mortality and morbidity in developed countries. Preterm birth is also the most common cause of prenatal hospitalization for pregnant women, which is associated with a socio-economic burden for society. Therefore, the diagnosis of the threat of preterm labor, which will lead to preterm birth, and the management of preterm birth are important.
Parents Life works in the market of Assisted Reproductive Technologies (ART) in Ukraine for many years. We have seen many cases related to the negligent attitude of many medical institutions in relation to one of the key issues in gestation of pregnancy, namely the birth of genetically healthy and term children. Cases of the birth of premature babies, especially twins, have become more frequent lately. We would like to comment on our attitude to this situation, making a key emphasis on the impact of prematurity is not only for the index premature infant to be born, its mother and the family, but also for their own offspring.
Diagnosis and Management of Preterm Birth Are Important.
Gestational Weeks Associated with Preterm Birth
Preterm birth is defined according to the gestational age at birth. Gestational age at birth is divided into four categories: abortion, preterm, term, and post-term. Preterm birth is then subdivided into late preterm, early preterm, and extreme preterm.
The duration corresponding to “late preterm” was classically called “near term,” in which we expected that those infants born at 34–36 weeks of gestation are considerably well matured, close to the term infants, from the developmental viewpoint. However, because of the recent recognition that late preterm infants have significantly higher incidences of infant’s short-term and long-term morbidity compared to those of the term infants, the new term “late preterm” has now been widely accepted.
According to the recent definition, “late preterm” is from 34 + 0/7 weeks until 36 + 6/7 weeks and “early preterm” is before 34 completed weeks. In addition, those who are delivered before 28 completed weeks are commonly named as “extreme preterm.”
Definition of Preterm
Preterm labor is diagnosed by clinical manifestations and medical examinations, which include both uterine activity and cervical maturational changes of the uterus. Thus, preterm labor is defined as regular uterine contractions associated with cervical changes that start before 37 weeks of gestation. Uterine activity alone can be misleading because of the presence of false labor, which is spontaneous uterine contractions alone. Some women who deliver preterm have uterine contractions that is attributed to false labor, causing difficulties in differentiating true labor from false labor. Maturational changes in the uterine cervix include effacement and dilatation.
Now in Ukraine, the definition of preterm labor requires both regular uterine contractions and cervical changes. In addition, since preterm birth includes women with cervical incompetence, a woman who has cervical dilatation ≥2 cm at her first visit is also diagnosed as preterm labor.
Identifying women who will give birth preterm infants is an inexact process. The signs and symptoms of preterm labor that pregnant women may have are as follows: changes in vaginal discharge (especially bloody or watery one), pelvic or lower abdominal pressure, dull backache, and regular uterine tightening or contractions. These clinical signs are subjective, nonspecific to preterm labor, and also present in some normal pregnancies, therefore lacking precision.
The diagnosis of threatened preterm birth is an imprecise and problematic process. We conclude that the large majority of women who experience symptoms of preterm labor will not deliver preterm and more than half will deliver term.
In the developed countries, premature infants have medico-social impacts that account for 90% of perinatal deaths and 50-60% of neurological handicap, leading to huge social burden. Thus, preterm labor and delivery is one of the most impending and significant clinical issues to be solved. The impact of pre-maturity is not only for the index premature infant to be born, its mother and the family, but also for their offspring.