In identifying the woman at risk for prematurity, the following factors are very important:
1. Lower economic status. In many cases these women do not receive good prenatal care or proper nutrition. 2. Poor nutrition. In order to have an adequate weight gain, pregnant women must consider both the quantity and quality of foods eaten. The mother should gain at least 10 pounds by the 20th week. A woman who has suffered from extreme morning sickness must be monitored carefully. I am convinced that some babies come out early because they are hungry! 3. Previous preterm labors or births. Try to establish the reason for previous outcomes. 4. Multiple gestations. I insist, however, that twins can come to term when the mother is "super-nourished." 5. Smoking, alcohol or drug abuse. 6. Urinary tract infections. It is not unusual for a woman to feel like she is in labor when she has a UTI. When a woman calls with symptoms of early labor, always get a clean catch urine specimen for laboratory diagnosis. If there is a high bacterial count, she should be treated with antibiotics as an infection can cause premature labor. 7. Anemia or low platelet count. A low hemoglobin may contribute to placental insufficiency and preterm labor. Take in consideration the woman's general health and her country of origin. Remember that women of Mediterranean descent generally have lower hemoglobins. A woman who has always had a hemoglobin of 10 and feels well is not at risk. A more significant factor is when a normal hemoglobin of 14 drops considerably during pregnancy, and the mother feels weak and tired, and so on. 8. Maternal trauma or extreme stress. 9. Premature rupture of membranes. Because bacteria can be a culprit in initiating PROM, it is important that any suspicious vaginal discharge be investigated. 10. Maternal illness, particularly with high fever. 11. Uterine anomalies or incompetent cervix. Find out if your client had explorations of or surgeries upon the cervix or uterus. Was a previous labor "forced" through manual or oxytoxic methods? Is this woman a DES daughter? 12. A history of "late" second trimester abortions or any abdominal surgery during pregnancy. The surgery may not be the problem as much as the anesthesia involved.
-Valerie El Halta, "Too Small, Too Soon," Midwifery Today Issue 36
A few other factors can come into play during pregnancy that put a woman at risk for premature delivery. The most common are: 1. Placental abruption 2. Placenta previa 3. Abnormal amount of amniotic fluid. Too much amniotic fluid puts extra pressure on the uterus and may cause premature labor. This happens more frequently in multiple pregnancies and in those complicated by diabetes, or when there is an abnormality in the fetus. Too little amniotic fluid can inhibit normal fetal growth. 4. Uterine fibroids: commonly found in women in their 30s or 40s. They can cause placental abruption, intrauterine growth retardation, and premature birth. 5. Toxemia/preeclampsia: This can cause a reduction in the amount of blood flow through the placenta, which slows down the delivery of vital nutrients. 6. Two or more abortions. 7. A history of kidney disease. 8. Pregnancy before age 16 or after age 34. Many young girls do not get proper, ongoing prenatal care. Their growing bodies may compete with the fetus for necessary nutrients. Older women may deliver prematurely because they are more prone to diseases that can negatively affect a pregnancy such as hypertension, diabetes, and heart and kidney disease.
-Frank P. Manginello, MD & Theresa f. DiGeronimo, MEd, Your Premature baby, John Wiley & sons, 1991
Reprinted from Midwifery Today E-News (Vol 1 Issue 32, Aug 6, 1999)
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