Braxton-Hicks or Preterm Labor
What are Braxton Hicks Contractions? These irregular contractions were first described by a Doctor J. Braxton Hicks in 1872. He first detected the irregular contractions in the second trimester during a bimanual examination. Overtime, these contractions can become stronger and more clinically apparent.
Statistically, preterm birth occurs in 12 percent of all live births in the United States. Half of those patients experienced preterm labor prior to the live birth. Preterm birth is described as delivery of an infant between the gestational ages 20 weeks and 0 days and 36 weeks and 6 days. Term is 37 weeks or later. Preterm labor is defined as 1) Regular and Painful contractions with documented change in cervical dilation, cervical thinning, or fetal position or 2) Painful and regular contractions with a cervical dilation of 2cm or more.
The exact cause of preterm labor is not well understood and is likely multifactorial.
What can you expect if you are in preterm labor?
If you are between 22-23 and 32 weeks you will receive:
· Antibiotics for Group B Strep Prophylaxis
· Magnesium Sulfate (Has many benefits including reducing the risk of cerebral palsy, neonatal stroke and necrotizing enterocolitis-NEC)
· Corticosteroids (improves lung maturity among other benefits)
· Tocolytic (contraction stopping medicine is given for neonates who would benefit from a 48-hour delay. They are not recommended beyond the initial 48-hour window.). These include terbutaline, nifedipine or indomethacin.
If you are between 32 and 34 weeks you will receive:
· Antibiotics for Group B Strep Prophylaxis
· Corticosteroids (improves lung maturity among other benefits)
· Tocolytic (contraction stopping medicine is given for neonates who would benefit from a 48-hour delay. They are not recommended beyond the initial 48-hour window.). These include terbutaline, nifedipine or indomethacin.
If you are between 34 and 37 weeks you will receive:
· Antibiotics for Group B Strep Prophylaxis
· Corticosteroids (improves lung maturity among other benefits) if they have not been previously given
Fortunately, less than 10 percent of women will deliver within 7 days of presenting in preterm labor. 30 percent of preterm labor will resolve without intervention. Approximately 1/2 of women who experience preterm labor will go on to deliver at term (after 37 weeks).
If you are experiencing regular and painful contractions every few minutes, having vaginal bleeding (aside from mild spotting after intercourse or vaginal examination), or you are leaking fluid go to your nearest hospital or call 911.
Fetal Viability
· In 1960s
o Neonatal survival between 32 and 35 weeks was 90 percent
o Neonatal survival between 28 and 32 weeks was 40 percent
o Neonatal survival less than 28 weeks was under 20 percent
o JFK’s newborn Patrick passed away due to complications of a premature birth at 34 weeks
· 1970s
o Viability was considered 28 weeks
· 1980s
o Viability extended to 26 weeks
· 1990s
o Viability extended to 24 weeks
· Currently
o Viability generally considered 22 weeks although, there is a trend towards the term of peri-viability which includes gestational ages 20 to 26 weeks
o Everyday of pregnancy between 23 and 24 weeks improves infant survival by 3 to 4 percent
o Everyday of pregnancy between 24 and 26 weeks improves infant survival by 2 to 3 percent
o Fetal survival (defined as living long enough to be discharged) at 22 weeks is 30%, by 24 weeks 70% and by 28 weeks 95% (although continuous improvement changes these numbers frequently and they vary by institution). If you are at risk of delivering during the periviable window, you should request to discuss specifics with the neonatologist at your hospital.