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Managing pre-term labor: Coordinated care for moms and babies

Bookmark and Share "Oh, no, this is it," thought 35-year-old Krista Lamorgese when her water broke just 35 weeks into pregnancy. "I'm going into labor and it's too soon."

Krista's story
Detecting pre-term labor at it earliest stages
Giving babies a healthy start
Krista's story
"Krista was at risk for pre-term labor because she has lupus anticoagulant — a blood-clotting disorder that caused two previous miscarriages; we knew careful monitoring was essential for a successful pregnancy" says Edward Klein, MD, the Virtua Health obstetrician and gynecologist (OB/GYN) who coordinated Lamorgese's care in collaboration with Virtua's nationally renowned maternal-fetal medicine specialists.

Women who have had a previous pre-term birth or who are carrying multiples are at higher risk of pre-term labor. Lifestyle also plays a part. Smoking, poor prenatal care and stress increase a woman's risk. Other factors include uterine or cervical abnormalities, previous cervical surgery and conditions such as diabetes, high blood pressure or infections during pregnancy.

Detecting pre-term labor at it earliest stages
Using vaginal ultrasound technology, doctors can measure the length of a woman's cervix and identify the softening of the cervix that occurs in labor's early stages. An additional test detects the presence of fetal fibronectin, a substance that indicates a higher chance of labor in women experiencing contractions.

"New technologies help identify pre-term labor in its earliest stages when it's easier to stop," says Virtua Health OB/GYN Elizabeth Zadzielski, MD. "We are now saving babies who, 10 years ago, may have been born too early to survive." Women also play an active role in detecting pre-term labor. Dr. Zadzielski encourages patients to look for symptoms such as contractions, abdominal cramping, a low and dull backache, pelvic pressure and a change in vaginal discharge or bleeding. "A woman should call her doctor if she experiences symptoms that persist for more than an hour," advises Dr. Zadzielski. "I called Dr. Klein several times with questions," says Lamorgese. "He was always reassuring, whether it was the middle of the afternoon — or night." When a woman shows evidence of premature labor, doctors work to prolong the pregnancy as long as possible. Some women, like Lamorgese, are put on bed rest. Others may be admitted to the hospital for round-the-clock monitoring. For these moms, Virtua helps ease this time with ice cream socials, scrapbooking classes, special menus and personalized services such as hair care and massage. Women in active labor may be given medications that work to stop the labor's progression or steroids to help mature the baby's lungs.

Giving babies a healthy start
When labor can't be stopped, Virtua obstetricians work with board-certified neonatologists to prepare parents for the intensive care many preemies need. Lamorgese's daughter Francesca, who weighed approximately four pounds at birth, was cared for in Virtua's Neonatal Intensive Care Unit while she developed feeding reflexes and gained weight.

At three months old, Francesca is doing well, a fact Lamorgese credits to the combined efforts of the many Virtua medical professionals who cared for her and her baby. She concludes: "Although my pregnancy was difficult, I felt confident that each step of my care was coordinated through Dr. Klein, a doctor I know and trust."

Read more
What causes pre-term labor?