Premature labor--risks of and tests for--
What are some symptoms of premature labor? Can you tell if you might go
into labor early?
Premature labor is one of the most costly complications of pregnancy--in
the way of money, loss of work, and most of all, emotions. Although we still don't know all of the reasons
patients may experience preterm labor, there are nevertheless many things
that we do know can provoke it:
1) Infection
of the uterus or pregnancy (amnionitis), frequently with group B
beta-strep.
2) Multiple gestations--twins,
triplets,
etc., which cause the uterus to reach "critical mass" earlier, at which
time it tries to expel the contents like it would a term single pregnancy.
3) Incompetent
cervix--in which the structural integrity of the cervix cannot maintain
it in a tightly closed condition. Dilation may invoke several neurological
and chemical reflexes which may cause labor to continue the process.
4) Bleeding within the uterus, usually caused
by abruption of the placenta (premature separation of the afterbirth).
5) Vaginal infections
(still not conclusively proven) like yeast,
bacterial
vaginosis, etc.--infections usually fairly inconsequential otherwise.
6) Urinary tract infections--bladder
or kidney.
7) Other systemic infections, like pneumonia,
peritonitis (appendicitis, etc.)
8) Previous history of preterm labor with prior
pregnancy.
9) The largest category--Unknown reasons.
How can one tell whether they're at risk for preterm
labor? Certainly any of the risk factors above can raise the possibility.
When treatable, preterm labor might be avoided. Three services by
private companies may also aid in predicting, and these services are used
sporadically in private practice.
1) Tocometry--equipment is worn in a
belt around the abdomen and recordings for an hour are modem'd in to a
central station where nurses notify your doctor if there are troubling
runs of contractions or irritabilities.
2) Fetal fibronectin--a test from a vaginal exam
that may indicate those at risk.
SalEst--salivary
estriol read in, of all things, the mother's saliva, under the theory that
fetal estriol is released prior to the onset of active pre-term labor.
It presents in the mother's saliva and her saliva can be tested every two
weeks.
Also, ultrasound to check for the length of the
cervix should be part of the evaluation.
