For any mother, giving birth to a premature baby is a terrifying time. In fact, medics say mothers can be affected physically and emotionally. Such babies could be delivered without any problem, however, the earlier they are born, the more likely they are to have problems later. As weight is easier to determine than gestational age, the World Health Organization tracks rates of low birth weight. Preterm birth complicates the births of infants worldwide affecting 5 to 18 per cent of births, while in many developing countries; the preterm birth rate is generally 5 to 9 per cent. However, in Rwanda, 35,000 babies are born too soon each year and 2,070 children under five years die due to direct preterm complications. Moreover, among the eight causes of deaths among children in Rwanda, premature births lead with 13 per cent, according to data from the Ministry of Health (MoH). HOW DOES IT COME ABOUT? Dr Yves Bandora Iraguha works in the pediatric department at King Faisal Hospital in Kigali; he says this is a baby who is delivered before the 37th completed week of gestation. This, he explains, in some cases happens when the cervix dilates prenatally without pain or perceived contractions. He notes that the mother may not have warning signs until very late in the birthing process. “When the membrane has raptured, this may not be followed by labour; usually delivery is indicated as infection which is a serious threat to both the baby and the mother,” he says. For one to identify this, Iraguha says there are different signs and symptoms that can help a mother seek medical attention immediately in case they happen to experience them. For instance, he says, watery discharge from the vagina may indicate premature rapture of the membrane that surrounds the baby. Another sign pregnant women should be aware of is vaginal bleeding; especially in the third trimester. “Heavy pressure in the pelvis or abdominal/back pain could be a sign that a preterm birth is about to occur. When it comes to back pain, one can experience lower back pain that is constant, or it may come and go,” he says. Additionally, Iraguha says that if the mother experiences four or more uterine contractions in one hour, it is also a sign of preterm labour. All these, however, can be detected earlier if mothers seek help from an obstetrician. He explains that the physician may carry out an obstetric ultra sound, which will aid in the assessment of the cervix in women at risk of premature delivery; this makes it vital for expectant women who may experience these signs to see a gynaecologist or obstetrician to avoid complications after. WHAT ARE THE RISK FACTORS? Dr Iba Mayale, a gynaecologist Clinic Galien in Remera, Gasabo District, says that preterm labour and premature birth happens too early, before 37 weeks of pregnancy. He says that babies who are born prematurely are at high risk of having health problems in the future, compared to those born normally. Although the causes of preterm labour are not known, Mayale says that there are a number of risk factors that could make one have a premature birth. He points out that uterine abnormalities can lead to preterm labour as there is trauma to the cervix. Also, chronic or acute maternal illness is another risk factor. On the other hand, Mayale says that intrauterine infections can cause the labour to start, and this is implicated as a major factor for preterm labour. “Mothers should be aware that anything that causes increased stretching of the uterine muscles can initiate preterm labour, particularly multiple pregnancy or excess production of amniotic fluid,” he says. Substance abuse such as smoking cigarettes, drinking alcohol and doing drugs are also major risk factors that can lead to an infant being delivered prematurely, says Mayale. COMPLICATIONS Dr Emmanuel Semwanga, a gynaecologist/obstetrician at La Croix Du Sud at Kisement, Kigali, says it’s easier for babies born premature to develop respiratory distress syndrome. He further explains that this is due to lack of endogenous surfactant, which leads to respiratory difficulties, oxygen requirement and poor compliance of the lungs. He adds that due to immaturity of the brain of the baby born prematurely, it can lead to cessation of breathing, chronic lung diseases, long term damage to the alveoli caused by cutting forces of mechanical ventilation oxygen toxicity in the preterm neonate, among others. Low blood pressure due to poorly contractive heart and low blood volume could be another complication. Semwanga also points out that such babies can as well have retinopathy of prematurity; which is the abnormal growth of blood vessels in the retina of the eyes. Another condition that may be likely to occur is periventricular Leukomalacia, a brain condition affecting foetus and new-borns in which there is softening, dysfunction, and death of the white matter of the brain. Lastly, he says, intraventricular haemorrhage, which is the bleeding into the germinal matrix of the immature brain ventricles, can extend into the parenchyma. “Due to more pathogens, the infant many also develop different infections. This is more common in the preterm neonate because of the reduced defences,” he adds. PREVENTION AND TREATMENT When it comes to prevention, Dr John Muganda, a gynaecologist in Kigali, says it’s hard to predict preterm birth, but adapting to some healthy pregnancy habits can help prevent the condition. For instance, he says, pregnant women should be in a position to ensure that they attend all the antennal care sessions from the time of conceiving until they give birth. Also, he advises that getting enough folic acid is vital for each and every pregnant woman as it may help prevent preterm labour. “This is important because it can help reduce the cases of babies being born before their time, and stop them from developing complications which sometimes are long-term,” he says. Muganda says that research indicates that if one had preterm labour previously, the risk of having it again is high. Therefore, a physician should be in a position to give progesterone shots to women at high risk of this, especially during their second and third trimester. For treatment, he says bed rest can help as well as cervical stitches in case of cervical incompetence. A doctor can as well prescribe some drugs to the patient, which can help relax the uterine muscle. PARENTS NEED CARE TOO Iraguha says both the parents undergo emotional and physical distress when their baby is placed in the intensive care unit. These parents, he says, should consult experienced nurses or any other physician who can help them cope with the situation, and figure out how best to take care of the child in that condition. He notes that even after being discharged, they should be helped with how to handle the baby. “It’s important that such parents are given the support needed, schooling and any services needed to ensure they are in the position to take care of the baby without any problem,” he says. He adds that failure to do that, for some parents, can lead to issues related to psychological distress, stemming from caring for a premature baby. *************************************** PREMATURE BABIES ARE Premature babies are fragile unlike full term babies who are born after 38 weeks. Their nutritional requirement is complicated, therefore, they need close monitoring and the right balance of fluids. Raymond Awazi, Paediatrician *************************** Although premature babies have problems when it comes to breastfeeding or feeding from the bottle, mothers should ensure they provide breast milk for them because of its nutrients that provide natural immunity which is essential for babies. Joseph Uwiragiye, Nutritionist *************************** A sterile environment should be maintained when it comes to handling these babies to prevent infections. After being discharged from hospital, in case of any alarming signs, parents should immediately see a paediatric to avoid complications. Christian Bahati, Nurse *************************** While pregnant, mothers should avoid anything that can lead to complications, before and during delivery. And, maintaining a balanced diet throughout the entire pregnancy is important. Claudine Uwajeneza, Nurse editorial@newtimes.co.rw
