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Women's Health

Early Arrivals Why prenatal care matters. By Dr. Julianne TooheyPublished: October, 2006

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Why prenatal care matters It may surprise you that despite tremendous medical advances, the incidence of preterm birth has remained essentially the same for the last 50 years.  Great improvements have been made in the difficult care of the tiny newborn with increased survival; however, the preterm delivery rate in the United States continues to be at about 12%. At least 75% of neonatal deaths are due to babies being born prematurely, and many of these deaths are after long, difficult stays in the neonatal intensive care nursery. Costs to the baby, the baby’s family and to society are tremendous. A full-term pregnancy lasts 40 weeks. Any delivery before 37 weeks is considered to be preterm. These infants are at increased risk for many complications, and of course those born earliest (before 28 weeks) have the highest risk. Common complications can include lung, visual and gastrointestinal problems, mental retardation and cerebral palsy. Complications can lead to death. In some cases, a preterm birth occurs when a woman’s doctor induces her labor early because of serious maternal health problems. However, most preterm births are due to spontaneous preterm labor or early rupture of membranes and often involve infections. Unfortunately, in more than half of early deliveries, no actual cause can be found. Know the facts Risk factors include a history of preterm delivery, multiple gestation  (twins or more) and some uterine or cervical abnormalities. Other documented risk factors include low socioeconomic status, non-white race, maternal age of less than 18 or greater than 40 years, low pre-pregnancy weight, urinary tract infections, illicit drug use (especially cocaine and methamphetamines) and smoking. Women who do not seek prenatal care also deliver earlier. Orange County is unique in that we have an overwhelmingly high number of twins, triplets and quadruplets, compared to national figures. This is due to the increased number of couples using fertility drugs and assisted reproductive techniques.  Up to 25% of premature births are these multi-fetal pregnancies. Orange County’s overall incidence of preterm birth is approximately 10.5%, which is encouraging in light of the high number of multiples. Our large Latina population has a low incidence of preterm births and this likely balances other factors in the county. What can one do to decrease the chance of delivering your baby or babies too early?  Obviously, early prenatal care is a must, not only to accurately date your pregnancy but also to diagnose twins or other factors, such as diabetes or high blood pressure, that can impact your pregnancy. Eating well, taking your vitamins, discontinuing smoking and treating any urinary tract infections are a must. Recognizing the signs and symptoms of preterm labor are important so that early treatment and bed rest can be started. Often, busy women ignore the nagging backache or mild cramping that can be a sign that trouble is brewing. Early signs of preterm labor include uterine contractions in which your abdomen tightens with or without pain, change in vaginal discharge (leakage or bleeding), menstrual-like cramps, a low, dull backache and pelvic pressure. If you are experiencing any of these symptoms, contact your healthcare provider immediately. Consult a specialist Women who are known to be at increased risk for preterm delivery should seek care from a perinatologist (specialist in high-risk obstetrics or maternal-fetal medicine) as early in their pregnancy as possible to maximize their chances for a healthy baby. Patients are often placed on bed rest or decreased activity.  In addition, they may be followed closely with transvaginal ultrasound to assess the length of the cervix. A fairly recent tool that your doctor may use is the fetal fibronectin (Adeza) vaginal swab that may assist in identifying who should be treated more aggressively. In addition, there is evidence that some patients at increased risk for delivering early may benefit from weekly 17-hydroxyprogesterone injections. Various medications are also used to decrease contractions once they have begun. There are risks and benefits associated with all of these medications and their use may not be appropriate for all. Discuss these options with your doctor. Premature delivery continues to be one of the most important healthcare problems that this nation is facing. The March of Dimes is leading the fight against premature birth with research, education and services. Join me in the effort to prevent premature deliveries by seeing your healthcare provider early, educating yourself about the signs and symptoms and supporting the March of Dimes. Information:  marchofdimes.com. Dr. Julianne Toohey is an OB/GYN and specialist in maternal-fetal medicine at UCI Medical Center, Orange County’s only university hospital, which has  been named one of the nation’s best hospitals for gynecology by U.S. News & World  Report. Information: www.ucihealth.com or call 714.456.2911.

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