CWC Article - Exercise In Pregnancy

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Premature Labor

By: Bradley G. Goldberg, M.D.

Premature labor is defined as labor that begins more than 3 weeks before a woman’s anticipated due date. It can affect up to 10% of all pregnancies. Conventionally, the due date is set at 40 weeks from the first day of a woman’s last menstrual period. Therefore, labor before the 37th week of pregnancy is considered to be premature and should be treated.

The definition of labor itself is another important point in this discussion. Labor means that a woman is experiencing both contractions and dilatation of her cervix. In other words, contractions alone do not always mean labor unless the woman’s cervix is dilating as well. Contractions alone without dilatation of the cervix is sometimes referred to as “false labor” and is very common.

Many causes have been identified as being responsible for premature labor and delivery. These include abnormalities of the placenta (the “after-birth”), infection, autoimmune disorders, cervical incompetence (a condition where the cervix is weak), abnormalities of the uterus, and abnormalities of the baby. However, in many cases of premature labor the cause may not ever be identified.

Once a pregnant woman is diagnosed with premature labor, an attempt should be made to stop the labor especially when the pregnancy is earlier than 36 weeks. How aggressive the physician should be depends upon how premature the baby is, and what type of nursery services are available at the treating hospital.

Neonatal intensive care is a highly specialized hospital service. It is available only at large tertiary care institutions which in our area include those in Savannah, Macon, Albany or Jacksonville. These larger hospitals have Level III nurseries which are capable of caring for the most premature babies.

Since these neonatal services are not available locally at the hospitals here in Douglas, Tifton or even Valdosta, obstetricians are usually very aggressive in treating patients in premature labor at these hospitals. If labor is very premature, 34 weeks or less, an attempt will be made to transport the pregnant mother to a tertiary care center (usually to Savannah’s Memorial Medical Center) before she delivers. This is so the baby will be born in an environment where the special medical care needed for premature babies will be available.

The treatment of premature labor, even in the 21st century, still leaves something to be desired. Medications used to stop a woman’s early labor are referred to as tocolytics. Tocolytics include medicines such as magnesium sulfate (often referred to as “mag”), brethine, nifedipine, and indocin among others. Unfortunately, none of these medications have been proven to be very effective.

The tocolytic medications are important however, since they can help postpone premature labor long enough for the obstetrician to administer intravenous antibiotics and steroid injections to the pregnant woman. The steroids are particularly useful until the 34th week of pregnancy since they have been proven to help the premature baby’s lungs to develop before he is born.

Overall, premature labor is stressful to all involved. This includes the baby, mother, family and doctor. With aggressive treatment using tocolytics, antibiotics, steroids, and transport to tertiary hospitals when needed, outcomes for the newborn can be maximized.