Preterm birth

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks.[1] Very early preterm birth is before 32 weeks, early preterm birth occurs between 32–36 weeks, late preterm birth is between 34–36 weeks' gestation.[8] These babies are also known as premature babies or colloquially preemies (American English)[9] or premmies (Australian English).[10] Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks.[11] Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision.[1] The earlier a baby is born, the greater these risks will be.[1]

Preterm birth
Other namesPremature birth, preemies, premmies
Intubated preterm baby in an incubator
SpecialtyNeonatology, Pediatrics, Obstetrics
SymptomsBirth of a baby at younger than 37 weeks' gestational age[1]
ComplicationsCerebral palsy, delays in development, hearing problems, sight problems[1]
CausesOften unknown[2]
Risk factorsDiabetes, high blood pressure, Multiple gestation, obesity or underweight, a number of vaginal infections, celiac disease, tobacco smoking, psychological stress[2][3][4]
PreventionProgesterone[5]
TreatmentCorticosteroids, keeping the baby warm through skin-to-skin contact, supporting breastfeeding, treating infections, supporting breathing[2][6]
Frequency~15 million a year (12% of deliveries)[2]
Deaths805,800[7]

The cause of spontaneous preterm birth is often not known.[2] Risk factors include diabetes, high blood pressure, multiple gestation (being pregnant with more than one baby), being either obese or underweight, vaginal infections, air pollution exposure, tobacco smoking, and psychological stress.[2][3][12] For a healthy pregnancy, medical induction of labor or cesarean section are not recommended before 39 weeks unless required for other medical reasons.[2] There may be certain medical reasons for early delivery such as preeclampsia.[13]

Preterm birth may be prevented in those at risk if the hormone progesterone is taken during pregnancy.[5] Evidence does not support the usefulness of bed rest.[5][14] It is estimated that at least 75% of preterm infants would survive with appropriate treatment, and the survival rate is highest among the infants born the latest in gestation.[2] In women who might deliver between 24 and 37 weeks, corticosteroid treatment may improve outcomes.[6][15] A number of medications, including nifedipine, may delay delivery so that a mother can be moved to where more medical care is available and the corticosteroids have a greater chance to work.[16] Once the baby is born, care includes keeping the baby warm through skin-to-skin contact or incubation, supporting breastfeeding and/or formula feeding, treating infections, and supporting breathing.[2] Preterm babies sometimes require intubation.[2]

Preterm birth is the most common cause of death among infants worldwide.[1] About 15 million babies are preterm each year (5% to 18% of all deliveries).[2] Late preterm birth accounts for 75% of all preterm births.[17] This rate is inconsistent across countries. In the United Kingdom 7.9% of babies are born pre-term and in the United States 12.3% of all births are before 37 weeks gestation.[18][19] Approximately 0.5% of births are extremely early periviable births (20-25 weeks of gestation), and these account for most of the deaths.[20] In many countries, rates of premature births have increased between the 1990s and 2010s.[2] Complications from preterm births resulted in 0.81 million deaths in 2015, down from 1.57 million in 1990.[7][21] The chance of survival at 22 weeks is about 6%, while at 23 weeks it is 26%, 24 weeks 55% and 25 weeks about 72%.[22] The chances of survival without any long-term difficulties are lower.[23]