Premature Delivery : Meaning, Causes and Support

Every year, many mothers experience a premature birth. This type of birth is on the rise and is characterised by the arrival of the baby before 37 weeks of amenorrhoea, i.e. before 8 and a half months of pregnancy. To understand this phenomenon and the care given to premature babies, find out more about the causes and course of a premature delivery.

Premature delivery

At what point is a birth considered premature?

Categorization of preterm births

The phenomenon of premature delivery can be divided into three main categories. Average prematurity for a delivery between the 32nd and 36th week of amenorrhea, i.e., between the 7th and 8th month of pregnancy. This is the majority of preterm births.The very premature babies.

This refers to deliveries that take place between the 28th and 32nd week of amenorrhea, or between the 6th and 7th month of pregnancy. On average, fetuses born at the 28th week of amenorrhea weigh about 1.1 kg and are 37 cm tall. And children born at 32 weeks of amenorrhea can weigh an average of 1.8 kg.

The last category includes very premature babies born before the 28th week of amenorrhea, which is before the 6th month of pregnancy. For a birth before the 23rd week of amenorrhea, i.e. before the 5th month of pregnancy, fetal survival remains highly uncertain and is not yet made possible by advances in modern medicine.

How to anticipate a potential preterm birth?

During pregnancy, medical monitoring of the mother allows the identification of certain high-risk pathologies or a possible delay in the development of the foetus, which could lead to premature delivery. If there is a risk of premature delivery or if a premature birth must be scheduled, corticosteroids may be prescribed about 10 days before the expected date of delivery in order to reduce the mortality rate and complications in newborns. Similarly, mothers at high risk of preterm birth are preferably referred to a type III maternity ward for appropriate neonatal resuscitation.

What are the causes of premature delivery?

Spontaneous premature deliveries

About half of preterm births are unprovoked. Childbirth can then take place as a result of early labour with contractions and water loss or be linked to infections.

Premature deliveries for medical reasons

The remaining 50% of premature deliveries are induced and decided by the medical profession. This choice is not insignificant, since it responds to a critical situation for the mother or the child. Premature delivery is thus the solution to a risk of death for the mother or the foetus during pregnancy.

It is often a caesarean delivery due to maternal haemorrhage, high blood pressure in the mother, or severe stunting of the baby. Placental malformations are studied very carefully during pregnancy by the medical profession. This type of pathology can lead to fetal growth retardation and premature delivery. Among the premature deliveries that occur, 20% are cases of maternal hypertension.

This pathology can lead to a severe outcome for the mother such as pre-eclampsia with kidney problems. Maternal hypertension can also cause eclampsia and cerebral disorders, as well as liver dysfunction or a decrease in red blood cells. In its study on prematurity, INSERM has identified other pathologies that may be the causes of premature births such as genitourinary infections, gestational diabetes, placental hematoma, multiple pregnancies or uterine abnormalities.

The lifestyle and age of mothers also play a role in the rate of preterm births. Smoking, stress, economic and professional situation are all factors that can influence the premature arrival of the baby.

What kind of care is provided to premature infants?

Controlling the development of vital organs

A premature child needs special care to accompany the development of certain organs to maturity. Medical advances now meet this need. For very and very premature infants, that is, children born before the 32nd week of amenorrhea, care is given to organs such as the brain, lungs, digestive tract and arterial canal. These newborns are admitted to the neonatal intensive care unit as soon as they are born. Then, as soon as their state of health permits, they are transferred to intensive care and neonatology.

Before the 32nd week of amenorrhea, the brain has not fully developed. Medical follow-up, including imaging, is carried out from birth to monitor and identify any abnormalities. A premature child may need a ventilatory support system, especially for birth before 28 weeks of amenorrhea. It helps to compensate for the immaturity of the lungs and also for the lack of surfactant, a substance secreted by the lungs that keeps them functioning. Exogenous surfactant is therefore administered to newborns by intubation.

Cardiorespiratory and digestive immaturity can also be detected in premature infants, especially if born before the 32nd week of amenorrhea. Medical treatments are available to correct this abnormality and enhance organ maturation. Before the 34th week of amenorrhea, newborns can be fed through a gastric tube to help them absorb breast milk or reconstituted milk for premature infants.

During feeding, a premature newborn is not yet able to coordinate breathing, sucking and swallowing. The feeding tube therefore allows the baby to feed without great difficulty. Jaundice (due to the immaturity of the liver), the kidneys or the immune system are checked in premature newborns so that specific medical treatment can be given if necessary. However, it is important to note that births of very premature babies, i.e. from the 29th week of amenorrhea, have a lower rate of infections than births in the previous weeks.

The immune system of children born after the 32nd week of amenorrhea functions in the same way as for children born at term.

Promote a cocoon effect

Premature infants are cared for and placed in an incubator. A bubble of tranquility must settle around them. In the incubator, the newborn baby finds the temperatures felt in its mother's womb, around 35°. The atmosphere around the baby must be calm and with a subdued light, to remind him of his intrauterine life and to avoid a too brutal rupture.The contribution of the parents is strongly recommended. It is advisable to adopt a skin-to-skin approach as much as possible.

A contact that greatly favours the physiological development of the child and brings him the necessary comfort.His hearing, smell and touch are senses developed from 24 weeks of amenorrhea. Through skin-to-skin contact and listening to the voice of his parents, the newborn feels safe. This repeated contact with his parents also promotes sleep.Thanks to medical progress, the survival rate of premature babies is now in the order of 96 to 98%, for deliveries from the 28th week of amenorrhea.As soon as the child reaches 2 kg and does not present any major respiratory or digestive difficulties, an outing from the incubator is then considered.

Thanks to medical treatment, the development of vital organs and the strengthening of the immune system can easily be contained. Prematurity after 30 weeks of amenorrhea leads to developmental deficits in only 2 to 3% of children.The paediatrician will take into account the child's prematurity and the corrected age for medical follow-up. In other words, a child born at 7 months of pregnancy is 2 months earlier than if it had been born at term. Thus, a premature child who is 12 months old is actually 10 months old in corrected age. The paediatrician watches over the child's weight gain and advises the parents on his or her diet, including the addition of vitamins and nutrients.

Being accompanied

Faced with a premature delivery, parents often find themselves at a loss. The joy of a future birth can give way to fear, anxiety and guilt. It is important for parents to fully understand the medical reasons for the birth, and to be accompanied during the pregnancy and after the birth. Medical teams, discussion groups, the maternity psychologist can help parents and answer their questions.

Feeling less alone in the face of this situation, understanding the causes and sharing one's anguish, help to remove one's fears and feelings of guilt, for a more peaceful maternity.


References

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