By Eulalee Thompson, Staff Reporter 
Premature births make up about
10 per cent of the 50,000 babies born each year in Jamaica but nearly 70 per cent of them will die before leaving hospital.
MORE THAN 30 years of scientific enquiry into the issue of premature birth and the medical community is still no closer to an answer in respect of any single cause of the condition in a particular woman.
However, Dr. Santosh Kulkarni, consultant obstetrician and gynaecologist, said that they are working with several ideas:
a woman who gives birth to a premature baby has a high risk of doing it again and so this woman should take extra precautions
Infections such as vaginal infections and infections in related parts of the body such as the urinary tract play a role.
Premature birth is also associated with sexually transmitted diseases
Certain types of physical activities extremely strenuous, repetitive activities such as carrying heavy loads, heavy factory work have been linked to premature births. However, most of the traditional office and household work performed by women are not expected to have a negative impact on pregnancy.
Women carrying twins are at risk for premature births.
"Since we don't have a precise idea of the causes, then the studies in progress are looking at the kinds of physiological or chemical conditions in the body which might predispose a woman to what nature is not supposed to do until the right time. So the science is looking at what causes the womb to begin to contract and the womb mouth to dilate at the wrong time. Knowledge will help to predict who is at risk and prevent premature births," said Dr. Kulkarni, who is also a senior lecturer in the University of the West Indies' Department of Obstetrics and Gynaecology.
While concrete information is not yet forthcoming, it is still a vibrant area of scientific enquiry and many of these topics were discussed here recently at the third annual perinatal audit and symposium held at the University of the West Indies. Interest in this research area is kept alive because of the tremendous complications associated with being born too soon.
SOME BABIES DIE
Dr. Kulkarni points out, for instance, that although premature births make up 8 between eight to 10 per cent of all births in Jamaica (about 5,000 premature births per year), nearly 70 per cent of them die before leaving hospital. The small babies, those weighing less than two pounds (being born less than 28 weeks) are especially at risk for complications. Those weighing more than two pounds tend to greater survival rates and fewer complications.
Complications associated with premature births, Dr. Kulkarni explained, can occur in the mother but especially in the baby.
"Sometimes the baby is deliberately delivered early because of kidney problems or high blood pressure in the mother but most times the premature birth is spontaneous. Few women have problems with cervix which may be slack as a result of a previous abortion, miscarriage or operation, these cases are often recognised and they will have an insertion of a stitch material, 'cervical suture', done early on in the pregnancy. This can help to prevent premature births," he said.
The complications to the baby born too soon are many. The organs in the premature baby would not have had the chance to develop as well as those of a baby allowed to stay in the uterus for the full term of nine months. The organs will be immature, depending on how far the pregnancy had reached at the time of birth. Dr. Kulkarni explained for example, that malfunctioning in the vital organs especially the lungs, is a major area of concern. They cannot adequately breathe for themselves because the lungs are not yet fully developed.
"There is a chemical called surfactant, produced by the lining of the lung... which maintains the lungs, keeping it open after breathing instead of in a collapsed state, and this is what happens in a premature baby, the lungs do not stay open but remain collapsed and instead of being filled with air, they are filled with fluids. Therefore the baby struggles to breathe because it is lacking in this chemical called surfactant and develops respiratory distress," he explained.
MORE VENTILATORS NEEDED
This is where the artificial breathing machine, the ventilator, becomes important. However, this is a very expensive machine, the demand for it in Jamaica is much greater than supply and it requires a lot of trained staff.
There are other options, though equally expensive, such as the administration of the surfactant to the premature baby or the stimulation of the mother's own production of surfactant before the baby is born.
"So, if it could be possible to predict cases of premature labour and encourage those mothers to be in the hospital while she is under observation, the policy now is to give the mother steroid drugs, a brief course usually for 48 hours which cross over through the placenta (the afterbirth) to the baby and stimulate the production of surfactant naturally," Dr. Kulkarni said.
There are other complications associated with premature babies apart from breathing problems, for example, their skin is thinner and therefore more susceptible to bruising, infection and dehydration; there is also the psychological aspect as the premature baby spends time in the hospital and is robbed of the bonding and nursing from mother; they require oxygen while in intensive care and this may affect their vision; their speech may be affected and there is risk for long-term physical and mental disability. Parents of premature babies may also require counselling as Dr. Kulkarni says that it can be a traumatic to see the baby hooked up to all kinds of fancy equipment.
Signs of prematurity
A WOMAN may be at risk for premature labour and should seek medical attention if she is experiencing the following signs:
Excessive bearing down pressure on the rectum or vagina
More vaginal discharge than normally expected during pregnancy
Contractions of womb at a stage when she is still early in her pregnancy.
If the water bag breaks early, that is a special situation called premature rupture of the membranes. This is responsible for about one-third of all causes of premature labour.
Dr. Santosh Kulkarni, consultant obstetrician and gynaecologist, says that studies have been done and are still in progress to understand the reason for the breaking of the bag. It could be a case of the membrane being too thin or easily damaged in some women or infection from the vagina might migrate to the womb and cause the lining to become thinned out.
