What causes a premature birth?

A premature baby is one who is born too early, before 37 weeks of pregnancy. This may present with signs such as back pain, regular contractions, and change in vaginal discharge and increased pelvic pressure just as normal labour.

According to Irene Nyaketcho, a midwife at Mulago Hospital, some of the possible causes include women who consume alcohol during pregnancy.  She says substances in the alcohol affect baby’s growth and development and can cause uterine contractions when consumed in high quantities.

Self-medication is another cause for preterm births. In Uganda, for instance, some pregnant women use over the counter medicine if they get any strange feeling and since they do not get the right diagnosis, when things fail. “By the time they go to hospital, it is too late and the situation is out of control hence a preterm delivery,” she says.

High blood pressure

Nyaketcho adds that women with a history of high blood pressure usually give birth prematurely. When the pressure is not controlled, a woman will develop pre-eclampsia- a condition that is characterised by high blood pressure that leads to serious and fatal, complications for both mother and baby. “Also, when a mother has uncontrolled diabetes, the baby tends to increase in size whereby some parts of the body have not fully developed,” she adds.

She explains that babies with birth defects are usually born prematurely. Such conditions can be detected in the first trimester if mothers starts the antenatal care as soon as they conceive.

Cervical incompetence- a condition where the cervix remains open and cannot accommodate a growing foetus is another cause of premature delivery. Professionals say once detected early enough, the mother can be stitched and have the cervix closed.

However, many mothers cannot afford the bills that come with the cervical cerclage which is usually above Shs1m depending on where you get the services from.

Conceiving too soon

When a woman conceives too soon after giving birth, Nyaketcho says, “the risk of giving birth prematurely increases. When a woman gives birth, the uterus undergoes involution- a process where the uterus shrinks and undergoes changes to regain preconception shape and functionality.”

She says conceiving immediately after delivering increases the risk of a premature baby because the uterine muscles are incompetent and cannot carry the baby at the time.

Nyaketcho appeals to mothers to attend antenatal care as soon as they conceive in order to detect such abnormalities early enough and find a solution before the mother gets serious birthing problems.

What can be done?

Once a woman exhibits signs of premature labour, the doctor assesses to identify any dilation according to Dr Joseph Kafuuma, a gynaecologist at Women’s Hospital International and Fertility Centre. An ultrasound scan determines the amount of amniotic fluid and confirms the gestation age of the baby.

 “The longer the baby stays in the womb, the higher the chances of survival. So the doctor will try to hold off labour. If the condition is not life-threatening, a woman is advised to take a bedrest, treat any infection, take medication to stop the contractions. She is also given corticosteroids that help in maturing the lungs of the baby.”

Complications

According to Dr Sabrina Kitaka, a paediatrician at Mulago Hospital, babies that are born prematurely are prone to more health complications than babies born at term. The common ones are brain, lungs, heart, eyes and other organ defects .

“Immediately after they are born, preemies often have to spend time in a newborn intensive care unit to get special medical care and monitoring by specialists. They stay in this unit until their organs develop enough to stay without medical support, can feed by mouth, are able to maintain their body temperature and have some weight gain. Even after leaving hospital, prematures need regular hospital reviews to monitor their growth and development,”Dr Kitaka says.

Development disabilities

“The earlier in pregnancy a baby is born, the more the health complications they are exposed to,” Kitaka adds.

Neonatal jaundice -baby’s skin and the white parts of his eye turn yellowish. This is caused by a build-up of bilirubin in the baby’s blood. Jaundice happens when a baby’s liver is not fully developed.

Anemia is one of the commonest complications that befall a preemie. “Such a baby cannot make new blood cells quick enough to replace those which they lose during blood tests to check on their health,” Kitaka remarks.