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This blog post is based on a Healthful Woman Podcast episode during which Dr. Nathan Fox interviewed Dr. Jennifer Lam-Rachlin to discuss indicated preterm birth and when it may be necessary in our continuing mini-series on preterm birth.

What is Indicated Preterm Birth?

Preterm birth is defined as a delivery that takes place before the 37^th week of pregnancy. While preterm birth can occur naturally, sometimes it is intentional. In these cases, it is referred to as indicated preterm birth.

Indicated preterm birth may be necessary for a variety of reasons to ensure the health and safety of the mother and baby, including but not limited to the following.

Preeclampsia

Preeclampsia is a serious pregnancy-related condition that typically occurs after 20 weeks of pregnancy.

“The usual presentation would be a sudden spike in the mom’s blood pressure, usually, happening in the third trimester,” said Dr. Lam-Rachlin. “And the more severe forms can put her at risk of stroke, seizures, and then organ damage like heart failure, liver failure, and kidney failure.”

Delivery of the baby and the placenta allows the body to fully recover. Because of the seriousness of this condition, women with this condition should be monitored closely.

In cases where preeclampsia presents with significant symptoms early in pregnancy, indicated preterm birth may be beneficial to the mother’s health. In severe cases, women may be delivered as early as 24 weeks.

Fetal Growth Restriction

Fetal growth restriction (FGR), sometimes called intrauterine growth restriction (IUGR), occurs when the unborn baby is smaller than expected for the gestational age. There are a variety of causes for FGR, including issues with the placenta, genetic or structural anomalies, and/or infections.

For most cases of FGR waiting to delivery until the pregnancy is full term is the best case scenario, however, there are cases where indicated preterm birth is necessary.

“Generally, for fetal growth restriction, we do wait until the baby is full term because it’s usually mild enough that we’re not that worried about the risk of stillbirth,” explained Dr. Fox. “But if there are certain findings that are concerning…the more likely we are to deliver early.”

Placental Abruption

Placental abruption is a serious pregnancy complication in which the placenta partly or completely separates from the inner wall of the uterus before delivery. This is a significant issue, as this can result in a decrease or blockage of the baby’s oxygen and nutrient supply and cause heavy bleeding for the mother. In cases where the abruption is causing significant maternal health risks from excessive bleeding and/or fetal distress then indicated preterm delivery may be required.

PROM

Premature rupture of membranes (PROM) is the rupture of the membranes before labor begins. If PROM occurs before 37 weeks of pregnancy, it is considered preterm premature rupture of the membranes, or PPROM.

Preterm delivery may be recommended if the water is broken to decrease the risk of complications, such as intrauterine infection and/or fetal distress

“The longer she stays pregnant, the higher the chances of intrauterine infection or chorioamnionitis,” Dr. Lam-Rachlin explained. “And in that setting, to already have a preterm baby, and then, on top of that, potentially having an infection complicates that post-delivery course for the baby.”

Surgical and Medical Reasons

There are some situations where a baby may be delivered before 37 weeks because the doctor doesn’t want the mother to go into labor due to surgical reasons. This may include prior surgery on the uterus that may put them at higher risk for uterine rupture. Another reason may be placenta previa and/or placenta accreta, which can cause significant bleeding for the mother.

Overall, these instances are handled on a case-by-case basis. The ultimate goal is to reduce or eliminate risks to the baby and mother.

Unknown Reasons

There is also an array of other, unknown reasons that may call for indicated preterm delivery. These can include things such as a low fetal heart rate.

“The concern would be whether there’s a metabolic reason that the baby is not ‘happy,’” Dr. Lam-Rachlin said.” And then, that might be an ominous sign that if we continue the pregnancy, then there might be a stillbirth that will occur soon. So, to do a preterm delivery in that setting is to avoid the possibility of a potential stillbirth in the future.”

Pregnancy Imaging with Carnegie Imaging for Women

For more information regarding indicated preterm birth, please contact Carnegie Imaging today. Our award-winning team of OB/GYNs and maternal-fetal medicine specialists are dedicated to providing you with professional and compassionate care.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!