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| Preterm Birth and Prom Testing |
Preterm birth, which is the birth of a baby before 37 weeks of
pregnancy, is a major public health issue worldwide. It is one of the leading
causes of infant deaths. Although medical care has advanced significantly, the
rates of preterm births have risen steadily over the past few decades.
Causes of Preterm Birth
The exact causes behind most preterm births are still unknown. However, some
potential factors that can increase the risk include:
- Infections: Bacterial infections like bacterial vaginosis and urinary tract
infections in the mother are linked to preterm deliveries.
- Multiple pregnancies: Women carrying twins, triplets or more are at a higher
risk of preterm labor due to the additional stress on the uterus.
- Cervical issues: Shortened cervical length or weak cervix may lead to early
dilation and premature birth.
- Previous preterm birth: Mothers who have previously delivered a baby Preterm
Birth and Prom Testing have an
increased likelihood of another preterm delivery.
- Medical conditions: Conditions like diabetes, high blood pressure, kidney
disease in the mother are associated with preterm births.
- Lifestyle factors: Smoking, drinking alcohol, drug use during pregnancy are
considered risk factors. Stress and physical strains on the job may also play a
role.
PROM Testing For Predicting Preterm Labor
Rupture of membranes, commonly known as water breaking, before the onset of
labor is called PROM (Premature Rupture of Membranes). It occurs in 3-4% of all
pregnancies and is a predictor of potential preterm birth. To assess the status
of membranes and predict preterm delivery risk, various PROM tests are
conducted.
Fern test
One of the simple tests used is the Fern test. In this test, a sample of
vaginal fluid is examined under a microscope for the presence of
"ferning" patterns. These ferning patterns indicate that the Amniotic
fluid has mixed with the vaginal fluid due to the rupture of membranes.
However, the test has a high chance of false positive results.
AmniSure test
The AmniSure test is an advanced diagnostic method approved by the FDA for
detecting ruptured fetal membranes. It is based on the detection of a specific
placental protein called placental alpha macroglobulin-1 (PAMG-1) present in
amniotic fluid but not in vaginal secretions. A positive AmniSure test is
highly predictive of ruptured membranes.
Nitrazine test
The Nitrazine test checks the pH level of vaginal fluid. Amniotic fluid is
alkaline while vaginal fluid is acidic. A drop of Nitrazine paper placed in the
vagina turns blue in the presence of alkaline amniotic fluid, indicating
ruptured membranes. But pH changes associated with menstruation, douching, or
presence of semen/blood can cause incorrect results.
Ultrasound testing
Ultrasound is also sometimes used to examine cervical length and check for
fluid pocketing behind the internal cervical opening, which may signify PROM.
3D/4D ultrasound provides better visualization of the membranes. However,
ultrasound has limited accuracy as tissues can regrow rapidly to cover membrane
ruptures.
Screening For Preterm Birth Risk
Women considered at higher risk based on their history, examination, or
previous preterm births should undergo additional screening tests.
- Cervical length screening using transvaginal ultrasound is an effective
method to identify short cervix which has high predictive value for preterm
delivery.
- Fetal fibronectin (fFN) testing checks for the presence of a protein in the
vagina that may indicate impending preterm labor. A positive fFN test at or
less than 22 weeks predicts a high likelihood of preterm birth.
- At 16-24 weeks, the combination of a cervical length check and fFN testing
called the cervical assessment provides robust detection of preterm delivery
risk before 28 weeks.
Prevention Strategies
With early and accurate prediction of premature labor risk factors, doctors can
counsel patients on lifestyle modifications and medical interventions like
progesterone treatment and cerclage procedure. Nutrition and hydration,
limiting physical exertion and infections, timely treatment of reproductive
tract infections are some low-tech prevention methods.
For women at high risk, vaginal progesterone suppository or capsule is an
effective preventive approach. A cervical cerclage procedure stitches the
cervix tightly shut in early pregnancy to avoid cervical insufficiency in later
stages. Strict bedrest under medical guidance is also prescribed for women with
short cervix or other high-risk symptoms. Early risk detection through
screening followed by timely prevention enhances the chances of full-term
healthy deliveries.
While advances are being made, preterm birth continues posing challenges
globally. Improved screening, risk prediction models, and preventive measures
are helping lower rates. Further research on root causes and new pharmacological
interventions can pave the way for safer pregnancies and optimum neonatal
outcomes by reducing prematurity. Steady progress through collaborative efforts
will be crucial to address this perinatal healthcare priority.
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