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How to Prevent Preterm Birth in the Second Pregnancy

HIGHLIGHTS:

  • Mothers whose first pregnancy ended in a preterm birth have an increased risk of preterm birth in the second pregnancy by up to 15%.
  • Preterm birth carries with it the risk that the birth will affect the development of various organs in the baby, thus more easily resulting in complications and even putting the baby at risk of death.
  • Screening for risk of preterm birth in a second pregnancy can be carried out at the 16th week of gestation. This is a modern and effective prevention method.

How to Prevent Preterm Birth in the Second Pregnancy

A pregnancy is regarded as being full-term between 37 and 40 weeks of pregnancy. If a baby is born before the 37th week of pregnancy it is considered a “preterm” or “premature” birth. This is one of the main issues that most pregnant mothers are concerned about, as it can affect both the mother and the newborn baby. Preterm birth may be caused by a variety of factors, such as maternal smoking during pregnancy or regular exposure to secondhand smoke, alcohol consumption, certain types of medications, poor maternal nutrition, a strenuous workload during pregnancy, and infection during pregnancy.

Additionally, mothers who have a history of preterm birth with their first pregnancy have up to a 15% higher risk of preterm birth in the second pregnancy, and this risk increases gradually according to the number of preterm births a mother has experienced.

How to Prevent Preterm Birth (for Second Pregnancies)

Preterm birth from a first pregnancy is a key factor for an increased risk of preterm birth in the second pregnancy, and causes many mothers to become anxious or fearful about becoming pregnant again. However, if mothers can learn what steps to take to prevent it, the risk of preterm birth in the second pregnancy can be reduced through the following methods:

 

  • Quit smoking and stop drinking alcohol. It’s best if this can be done even before the pregnancy, as this will further reduce the risk of a second pregnancy preterm birth.
  • Control chronic diseases such as diabetes, high blood pressure, by following your doctor’s advice.
  • Properly treat any infections as inflammation and infection increase the risk of preterm birth.
  • Eat a healthy and balanced diet, including the 5 food groups or as per a doctor’s recommendations in order to reduce issues arising from a lack of essential nutrients.
  • Get sufficient rest. Pregnant mothers should sleep at least 8 hours a night to improve blood flow to the uterus.
  • Abstain from strenuous work and refrain from lifting heavy objects or doing activities that require intense effort. If you want to exercise, do so under the supervision of a doctor or specialist.
  • Exercise caution in sexual activity. A doctor should be consulted in order to assess any possible risk and to receive advice regarding sexual activity during pregnancy.
  • Avoid stress. Mothers who are concerned about the possibility of preterm birth in their second pregnancy should talk with their doctor about any problems or concerns and should be sure to attend regular checkups and doctor’s appointments.

Preterm Birth Risk Assessment and Screening

Preterm birth risk assessment and screening for second pregnancies is another contemporary and effective prevention method. This can be carried out using a variety of methods including:

  • Ultrasound examination via the cervix can be done after 16 weeks of gestation.
  • Blood test and fetal fibronectin (fFN) test using a swab of cervical or vaginal fluid.
  • Genetic testing, which, in addition to screening for preterm birth, can also provide information regarding the potential risks of developing genetic complications and/or preeclampsia early enough to allow for the most effective prevention methods to be carried out.

Genetic Testing

Preconception genetic testing is a “precision medicine” health check-up that helps to identify genetic risks in an individual including those influenced by family history, genetics, environment or lifestyle. It utilizes modern technology to detect preterm birth risks and to provide a treatment plan. The process begins with a detailed review of the patient’s medical history. If it is found that a patient has a history of preterm birth, she will immediately be placed in the at-risk group.

There is also a screening test to measure cervical length via transvaginal ultrasound. A cervical length shorter than 25 mm is considered a warning sign that the mother is at risk of preterm labor. This test can be carried out starting at 16 weeks of gestation.

If inflammation is found inside the uterus, the doctor can provide medication to prevent and reduce inflammation and therefore reduce the risk of preterm birth. The doctor may also carry out a fetal fibronectin test to search for the fibronectin protein in the area between the fetal sac and the uterine lining in order to identify any possible tendencies toward preterm birth.

Treatments for Prevention of Preterm Birth

In case a risk of preterm birth is detected, the doctor may carry out preventative measures as follows:

  • Natural progesterone therapy in order to prevent uterine contractions.
  • Use of a cervical pessary to help strengthen the cervix in cases where natural progesterone therapy is ineffective and the cervix is still found to be short.
  • In cases where both methods above are unsuccessful and the mother continues to experience symptoms of preterm labor, the doctor can administer tocolytic agents to suppress uterine contractions, delaying preterm birth for at least 48 hours, after which drugs in the steroid group known as corticosteroids can be given to help stimulate the baby’s lung functions and prevent brain bleeding. Finally, the baby will be delivered and efficient neonatal care will be provided for the newborn.

Babies born prematurely are at risk of a variety of medical issues affecting organ development and may also experience other complications including difficulty breathing, very high or low body temperature, jaundice, anemia, choking or gagging on milk, bloating, and developing infections easily, among others. Premature infants are also at increased risk of death, and they may experience a variety of issues such as congenital heart defect leading to heart attack, brain disorders, seizures, deafness, blindness, abnormal body movements, lower IQ, and more.

Therefore, when risk factors for preterm birth are detected, mothers should strictly follow their doctor’s advice. Mothers who have a history of preterm birth from their first pregnancy should not allow themselves to become overly anxious or to develop antenatal stress, particularly not from the very beginning of the pregnancy. These steps, when taken along with proper health care, sufficient sleep and relaxation, stress control, and regular doctor’s appointments, can help to reduce the risk of preterm birth.


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Assoc. Prof. Boonsri Chanrachakul, M.D. Summary: Obstetrics And Gynaecology Maternal And Fetal Medicine