Problems during pregnancy

If you face a problem during your pregnancy, you may be concerned, confused and frightened. This section describes some of the problems pregnant women may face and explains how health care providers might manage those conditions.

Preterm labor

A full-term pregnancy is defined as one in which birth occurs between weeks 37 and 42 of pregnancy. Preterm labor refers to contractions that begin opening the cervix before the end of the 37th week.

About 11 percent of births in the United States are preterm. Babies who are born this early often have low birth weight, defined as less than 5 V2 pounds. Their low weight, along with various other problems associated with preterm birth, puts them at risk of several health problems.

Preterm labor sometimes occurs between weeks 20 and 28. It more often occurs between weeks 29 and 37. No one knows exactly what causes preterm labor. In many cases, it occurs among women who have no known risk factors.

Health care providers and scientists have identified factors that seem to increase your risk. These include:

• A previous preterm labor or birth

• A pregnancy with twins, triplets or other multiples

• Previous miscarriages or abortions

• An infection of the amniotic fluid or fetal membranes

• Excess amniotic fluid (hydramnios)

• Abnormalities in your uterus

• Problems with your placenta

• Pre-existing medical conditions, especially serious illness or disease

• Bleeding during your current pregnancy

• A dilated cervix

• Other infections, including urinary tract infections

• Preeclampsia, a condition characterized by high blood pressure after your 20th week of pregnancy

Signs and symptoms

For some women, the clues that labor is starting are unmistakable. For others, they're more subtle. You may have contractions that feel like a tightening in your abdomen. If the contractions aren't painful, you may be able to tell you're having them only by feeling your abdomen with your hand. Some women go into preterm labor without feeling any sensation of uterine contractions.

Women sometimes attribute contractions to gas pain, constipation or movement of the fetus. In many cases, the contractions aren't painful. Other signs of preterm labor may include the following:

• You have pain in the abdomen, pelvis or back.

• It feels as if your baby is pressing down, creating pelvic pressure.

• You're urinating more frequently.

• You're having menstrual-type cramps or abdominal cramps.

• You have light vaginal spotting or bleeding.

• There's a watery discharge from your vagina.

If you have a watery discharge, it may be amniotic fluid, a sign that the membranes surrounding the fetus have ruptured (your water has broken). If you pass the mucous plug — the mucus that builds in the cervix during pregnancy — you may notice this as a thick discharge tinged with blood.

If you have any concerns about what you're feeling — especially if you have vaginal bleeding along with abdominal cramps or pain — call your health care provider or your hospital. Don't be embarrassed about the possibility of mistaking false labor for the real thing.

Treatment

If your health care provider suspects that you may be having early labor, you'll need to be examined. Your health care provider may look to see whether your cervix has begun to dilate and whether your water has broken. A cervical exam may be needed to make these determinations.

In some cases, a uterine monitor may be used to measure the duration and spacing of your contractions. Or ultrasound imaging may be used to monitor your cervix. In addition, a sampling of the cervical canal for the presence of a glue-like tissue lost with labor (fetal fibronectin) may help guide your treatment. A salivary estrogen test may be used to detect preterm labor, although this test is being used less often than previously.

Unless birth seems imminent, your health care provider will probably make every attempt to help you continue your pregnancy, giving your baby an opportunity to mature fully. Factors that might have brought on early labor can be carefully considered, as can your general physical condition.

Your health care provider might begin by reviewing your medical history and doing a physical exam. During your pelvic exam, your health care provider can take a look at your cervix, checking to see if it's opening (dilating) or thinning (effacing).

Tests may be done to evaluate the health of your baby. You may have an ultrasound exam. A prenatal test called amniocentesis may be done to obtain a sample of amniotic fluid. This test can be useful in several ways. One of the biggest problems facing premature infants is underdeveloped lungs. By analyzing a sample of amniotic fluid, experts can predict the maturity of a baby's lungs. Testing can also indicate whether the amniotic fluid is infected, which would indicate the baby might be better served by delivery.

Most women in preterm labor receive fluids through an intravenous (IV) tube and are asked to rest in bed. Sometimes, these measures alone will stop preterm labor. In fact, if contractions decrease and your cervix isn't dilating, you may simply be sent home and may be advised to remain on bed rest to reduce the chances of another episode of preterm labor.

If contractions continue and your cervix dilates, your health care provider will probably recommend a medication called a tocolytic to help stop your preterm labor and an injection with potent steroid medications. This is especially true if you and your baby seem to be healthy and if you're less than 34 weeks along in your pregnancy. Tocolytic medications have been shown to be effective at stopping labor only for a short time. Most commonly, they're used to allow time for the baby to gain the benefits of the steroid injection, which can help a baby's lungs move toward maturity in as little as 48 hours.

In some cases, your health care provider may recommend that your baby be delivered early. This may happen if contractions can't be stopped, your baby's health is threatened before your pregnancy runs its normal course, or you develop a health problem, such as severe high blood pressure (hypertension). Sometimes, the baby is delivered by Caesarean birth, but most often labor is started (induced).

To induce labor, your health care provider will probably give you a medication called oxytocin. With oxytocin you may begin to have contractions within half an hour, but most likely it will take longer. Sometimes a medication is given to soften (ripen) the cervix. This, too, helps imitate the natural onset of labor.

Most premature births follow a course similar to that of a normal birth. It's very beneficial for your preterm baby when a team of pediatric experts is immediately available at the time of birth. These health care providers can assess your baby's condition at birth and give help as needed.

If you've had one premature birth, you have a 25 percent to 50 percent chance of going into premature labor again. Research continues on methods

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