Premature Birth

Preterm Labor and Birth

Good Evening. I'm Dr. Lata Bhat. I'm a Neonatology and I take care of the developmental problems of children. So today I want to talk a bit about pre-term babies who're born before 36 weeks. Normal babies are born from 37-40 weeks of gestation after the mother becomes pregnant and babies who're born before 36 weeks have some problems. Babies who're born from 34-36 weeks donot have that much problem but those who're born before 34 weeks, especially those born below 28 weeks have lot of problems and especially babies who're less than 1.5kg or less than 1kg. But in good centers in India, like my center also, we do save babies, about 600 or 700 or 800gm babies and also thos born in about 25-26 weeks of gestation and there is a success rate of about 90%.

Now, globally about 15 million babies are born pre-term and out of this 25% are born in India. So imagine the burden of pre-term babies in India and the facilities that exist in India are abysmal as compared to the number of babies who're born pre-term, and we've to remember out of all the number of deliveries about 12.5% are born pre-term which is a huge number. About 27 million babies are born annually and out of this about 3.6 million babies are born pre-term.

So now considering the problem all the prospective parents and everybody should know what causes prematurity. Because however much educated a gynecologist maybe or a pediatrician maybe there is no full proof method to predict or prevent it but there are certain factors which contributes more to prematurity. So early recognition and timely transfer to higher center with better facilities is very important. Now in India it happens due to complex factors, it happens in poor people as well as rich people. Pregnancy in adoloscent people, whose womb is no yet ready to take babies or if the mother is underweight, there are recurrent infections in the mother, under-nutrition or impropoer nutrition, then substance abuse by the mother, in vitro fertilisation, if the mother has diabetes during pregnancy, mother has uncontrolled blood pressure during pregnancy, infections during pregnancy, especially urinary tract infection or genital infection, Sexually Transmitted Diseases.

These are the conditions where we can definitely predict that baby can be born pre-term, and also in case of multiple pregnancies, especially if the mother has twins or triplets then risk of pre-term birth is more. Now stress also leads to pre-term birth. In the current lifestyle there is stress, everybody is career oriented so we're facing a lot of infertility, people are taking treatment for infertility, having in vitro fertilisation that is also leading to pre-term birth. Now, once we know there are a lot of factors how do we prevent it. First is prevention then comes treatment. For prevention, as I told you before conception we've to think that mother's nutrition should be good, she should be well nourished, mother's age should be appropiate, she should not be a teenager or an adolescent, that is more than 22-23yrs of age. Then pregnancy planning, birth spacing, then we've to think about preventing sexually transmitted diseases, we've to give vaccines which are recommended for adoloscents, then genetic counselling, screening for diabetes, if there is substance abuse you've to stop it, stop smoking, prevent stress and all these things. And also proper ante-natal care by a proper gynecologist where they screen for everything and do regular ultrasound examination of the mother and they train the mother to handle the pregnancy well

Now, despite doing everything if we're not able to avoid pre-term labour then one has to plan to deliver at a center where there are facilities, there is trained new born consultant who'll be attending the delivery and they have all the facilities to take care of the baby after birth. And supposing if sill the baby is born in a center where there are no facilities then a proper transport should be arranged. We should not just pick up the baby and shift to a center because temperature mainatainance is very important, we've to take care the baby is getting continuous glucose, baby is receiving oxygen and is properly transported. Even during transport if these things are not taken care of the baby's brain development can be affected. If transient dip of oxygen, even for a few seconds or for few minutes if the baby is not receiving any glucose or if there is very rigorous transport the baby can suffer haemorrahage in the brain.

So new born babies, especially a pre-term babies can be very very delicate and so transport should be done in a proper manner and then once you've gone to a center where they're saving babies, you've to first maintain the temperature, take care of the breathimg, if require breathing support, if require oxygen then maintanance of blood sugar, prevention of infections, hen regular screening to lok for the eye problems, brain problems and once the baby survives at the time of discharge these babies may stay in a hospital for a long time and after discharge you should listen carefully to what the doctor is telling because a proper follow up is what will give a quality outcome in the long run. Because we just don't want to save lives and give them long term problems like hearing, speech, vision or physical disability.

All these are preventable and to a certain extent correctable. If you follow properly the pediatrician and if possible the developmental pediatrician. So that's very important. So the take home message is try to prevent pre-term birth by knowing the factors which cause it and if its inevitable get your delivery done in a center that has facilities to take care of the pre-term babies and after the baby survives follow up all the instructions given by your doctor and pediatrician.

So, if you've any further doubts related to a pre-term baby or any baby you can consult me through librate.com where we can chat or telephonic conversation or you can contact me at Child Developmental Clinic which is at Poorvanchal Plaza, Shop No-106, Mayur Vihar, Phase-2.