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As many as ten per cent of babies in the UK are born prematurely (usually defined as before 37 weeks of pregnancy). In the years 2001/2002 around 7% of all babies born in the UK were born prematurely. This means that of 650,000 births per year in the UK, there are about 45,000 premature births each year. Or, there are about 125 babies born too soon each day in the UK. Despite improvements in antenatal and neonatal care, the number of premature babies born each year has not significantly decreased since the 1960s. There is little risk for the mother but the implications for the baby can be enormous. Over the last few decades there have been great strides in our ability to care for premature babies and for those born after 34 weeks there are only marginal long-term risks compared to those delivered at term.
Figure 1 Neonatal Mortality according to birthweight and gesational age. (After Steer, P and Flint, C -BMJ. 1999 April 17; 318(7190): 1059–1062.) By 2000, survival rates of more than 90% were being achieved for those born at 28 weeks gestation (Figure 2).
Figure 2 Survival Rates in Extreme Prematurity Mortality rates from 32 weeks of gestation are similar to those at term and therefore it is the very early premature deliveries at greatest risk of neonatal death and serious morbidity (Figures 2 and 3), which are most likely to benefit from treatment. This accounts for 1–2% of pregnancies.9901
Figure 3. Impairment including one or more of the following: mental retardation, cerebral palsy, blindness and deafness. Survival is now feasible even for babies born as early as 22-23 weeks. However, these infants face a huge battle at the start of life, with a risk of many significant long-term problems. The risks for premature babies include:- Risks to the baby
The risk factors for premature birth include:
Premature labour can develop in any woman but especially very young, single or unsupported mothers, and those who are underweight or smoke. The challenge with premature labour is to spot it before it gets going. The only absolute proof of labour is dilation of the cervix, and by then it's usually too late to stop the baby being born. Contractions of the uterus can be confusing as many women experience contractions that may be painful, known as Braxton Hicks contractions, from 24 weeks of pregnancy. Two-thirds of women diagnosed as being in labour will not have delivered within 48 hours, and one in three continue their pregnancy to full term. If a woman's membranes rupture, and she loses amniotic fluid, then labour becomes more likely especially as there is then a risk of infection. But urine may be mistaken for amniotic fluid and even special testing sticks can give incorrect answers. Some research has examined chemicals that might give a clue that labour is about to start - one such is called foetal fibronectin, which is found in the secretions in the vagina. The exact place for the test is still to be determined. It may be considered in those with a previous preterm birth. Drugs have been tried to halt premature labour, including drugs to stop the contractions of the uterus, but nothing is very effective and the medications may have side effects. Drugs that stop contractions, called tocolytics help in about a quarter of cases but rarely work for more than 48 hours and may have some risks, especially if the membranes have ruptured. These drugs are mostly used to postpone delivery until the woman can get to a hospital with a special care baby unit. Steroids may be prescribed to help mature the lungs. These may reduce the risk of the complications of prematurity, halving the severity of respiratory distress syndrome.
DISCLAIMER The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
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