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Premature labour

K and her husband looked at me pleadingly: “Can we hold and touch our baby for a while, please? It means so much to us.”

A 31-year-old housewife, K had just delivered a premature stillborn baby. I could not think of a way to console her and gently placed the dead baby boy on her abdomen.

He appeared normal and seemed to be sleeping peacefully. His parents wept silently over their loss.

K was infertile for many years and had three previous miscarriages. When she was into her 25th week of pregnancy, I admitted her to hospital for observation as she had frequent contractions.

Then, one morning – a few days after admission – she felt that her baby was not moving. She prodded her tummy which usually helped but there was no response this time.

She quickly called the midwife.

The baby’s heartbeat could not be heard on a Doppler machine, and an ultrasound scan soon confirmed an intra-uterine death. Devastated, K went into premature labour that night.

The length of human pregnancy is normally 40 weeks from the firth day of the last menstrual period. Premature birth is defined as childbirth occurring earlier than 37 completed weeks of pregnancy.

It is estimated that 7 to 15 per cent of babies are born premature. Among these, about 6 per cent are born at fewer than 28 weeks of gestation. Such babies are deemed extremely premature and their chances of survival after delivery are very low as many organs are too immature to function well.

The cause of premature labour is unknown in about 40 per cent of the cases.

In other cases, causes include maternal illness such as hypertension, diabetes and heart diseases, multiple pregnancy (twins or triplets), cervical incompetence (laxity of the neck of the womb) and foetal abnormalities or death.

Any history of miscarriage, abortion and premature delivery may also increase the risk of premature labour.

Vaginal infections are a potential trigger. A common infection is Group B streptococci. The bacteria cause inflammation in the placenta. Chemicals are released which then stimulate the womb to contract. One can reduce the risk of premature labour by screening for and treating such infections with antibiotics.

There is also growing evidence that stress can induce labour, particularly when it is sudden or severe, as in K’s case.

The precise diagnosis of pre-term labour is not easy. The only proof is progressive opening of the neck of the womb. Once this occurs, it is usually too late to arrest the process.

The painless contractions which K had prior to labour are called Braxton Hicks contractions, which many women experience from the late second trimester of pregnancy onwards. They are not related to premature labour.

Many methods have been used to treat premature labour. However, there is no general consensus regarding their effectiveness.

Drugs that stop contractions (tocolytics) may help in some cases, but rarely work for more than 48 hours. I did not prescribe any medication for K as the foetus was already dead. I allowed nature to take its course.

In a situation when the foetus is alive, steroid injections may be given to the mother to help mature the baby’s lungs. This may reduce the severity of potential lung complications of newborn.

K tried IVF (test-tube baby method) twice subsequently but failed. She and her husband have since moved to another country and adopted a child.

In her last e-mail to me a few years ago, she thanked me for the chance to hold and touch her stillborn, which helped lessen the pain of losing her child. “The grief is less now, as I am feeling like a real mother every day,” she said.

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