preterm

Preterm labor is labor that starts before 37 completed weeks of pregnancy. It can lead to premature birth. Premature babies may face serious health risks.

Symptoms of preterm labor include:

• Contractions every 10 minutes or more often
• Leaking fluid or bleeding from the vagina
• Feeling of pressure in the pelvis
• Low, dull backache
• Cramps that feel like menstrual cramps
• Abdominal cramps with or without diarrhea

If you think you might be having preterm labor, contact your health care provider.

NIH: National Institute of Child Health and Human Development

Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.

Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include:

• Breathing problems
• Feeding difficulties
• Cerebral palsy
• Developmental delay
• Vision problems
• Hearing problems

Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Centers for Disease Control and Prevention

Childbirth is the process of giving birth to a baby. It includes labor and delivery. Usually everything goes well, but problems can happen. They may cause a risk to the mother, baby, or both. Some of the more common childbirth problems include:

• Preterm (premature) labor, when your labor starts before 37 completed weeks of pregnancy
• Premature rupture of membranes (PROM), when your water breaks too early. If labor does not start soon afterwards, this can raise the risk of infection.
• Problems with the placenta, such as the placenta covering the cervix, separating from the uterus before birth, or being attached too firmly to the uterus
• Labor that does not progress, meaning that labor is stalled. This can happen when
  • Your contractions weaken
  • Your cervix does not dilate (open) enough or is taking too long to dilate
  • The baby is not in the right position
  • The baby is too big or your pelvis is too small for the baby to move through the birth canal
• Abnormal heart rate of the baby. Often, an abnormal heart rate is not a problem. But if the heart rate gets very fast or very slow, it can be a sign that your baby is not getting enough oxygen or that there are other problems.
• Problems with the umbilical cord, such as the cord getting caught on the baby's arm, leg, or neck. It's also a problem if cord comes out before the baby does.
• Problems with the position of the baby, such as breech, in which the baby is going to come out feet first
• Shoulder dystocia, when the baby's head comes out, but the shoulder gets stuck
• Perinatal asphyxia, which happens when the baby does not get enough oxygen in the uterus, during labor or delivery, or just after birth
• Perineal tears, tearing of your vagina and the surrounding tissues
• Excessive bleeding, which can happen when the delivery causes tears to the uterus or if you are not able to deliver the placenta after you give birth to the baby
• Post-term pregnancy, when your pregnancy lasts more than 42 weeks

If you have problems in childbirth, your health care provider may need to give you medicines to induce or speed up labor, use tools to help guide the baby out of the birth canal, or deliver the baby by Cesarean section.

NIH: National Institute of Child Health and Human Development

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
• Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.

The cause of preeclampsia is unknown.

You are at higher risk of preeclampsia if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of preeclampsia
• Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises your risk of blood clots)
• Used in vitro fertilization, egg donation, or donor insemination

Preeclampsia can cause:

• Placental abruption, where the placenta separates from the uterus
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• A low birth weight baby
• Stillbirth
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you
• Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
• HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.

Possible symptoms of preeclampsia include:

• High blood pressure
• Too much protein in your urine (called proteinuria)
• Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• Headache that does not go away
• Vision problems, including blurred vision or seeing spots
• Pain in your upper right abdomen
• Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby's growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby's lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

Vaginitis, also called vulvovaginitis, is an inflammation or infection of the vagina. It can also affect the vulva, which is the external part of a woman's genitals. Vaginitis can cause itching, pain, discharge, and odor.

Vaginitis is common, especially in women in their reproductive years. It usually happens when there is a change in the balance of bacteria or yeast that are normally found in your vagina. There are different types of vaginitis, and they have different causes, symptoms, and treatments.

Bacterial vaginosis (BV) is the most common vaginal infection in women ages 15-44. It happens when there is an imbalance between the "good" and "harmful" bacteria that are normally found in a woman's vagina. Many things can change the balance of bacteria, including:

• Taking antibiotics
• Douching
• Using an intrauterine device (IUD)
• Having unprotected sex with a new partner
• Having many sexual partners

Yeast infections (candidiasis) happen when too much candida grows in the vagina. Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. You may have too much growing in the vagina because of:

• Antibiotics
• Pregnancy
• Diabetes, especially if it is not well-controlled
• Corticosteroid medicines

Trichomoniasis can also cause vaginitis. Trichomoniasis is a common sexually transmitted disease. It is caused by a parasite.

You can also have vaginitis if you are allergic or sensitive to certain products that you use. Examples include vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. They can cause burning, itching, and discharge.

Hormonal changes can also cause vaginal irritation. Examples are when you are pregnant or breastfeeding, or when you have gone through menopause.

Sometimes you can have more than one cause of vaginitis at the same time.

The symptoms of vaginitis depend on which type you have.

With BV, you may not have symptoms. You could have a thin white or gray vaginal discharge. There may be an odor, such as a strong fish-like odor, especially after sex.

Yeast infections produce a thick, white discharge from the vagina that can look like cottage cheese. The discharge can be watery and often has no smell. Yeast infections usually cause the vagina and vulva to become itchy and red.

You may not have symptoms when you have trichomoniasis. If you do have them, they include itching, burning, and soreness of the vagina and vulva. You may have burning during urination. You could also have gray-green discharge, which may smell bad.

To find out the cause of your symptoms, your health care provider may:

• Ask you about your medical history
• Do a pelvic exam
• Look for vaginal discharge, noting its color, qualities, and any odor
• Study a sample of your vaginal fluid under a microscope

In some cases, you may need more tests.

The treatment depends on which type of vaginitis you have.

BV is treatable with antibiotics. You may get pills to swallow, or cream or gel that you put in your vagina. During treatment, you should use a condom during sex or not have sex at all.

Yeast infections are usually treated with a cream or with medicine that you put inside your vagina. You can buy over-the-counter treatments for yeast infections, but you need to be sure that you do have a yeast infection and not another type of vaginitis. See your health care provider if this is the first time you have had symptoms. Even if you have had yeast infections before, it is a good idea to call your health care provider before using an over-the-counter treatment.

The treatment for trichomoniasis is usually a single-dose antibiotic. Both you and your partner(s) should be treated, to prevent spreading the infection to others and to keep from getting it again.

If your vaginitis is due to an allergy or sensitivity to a product, you need to figure out which product is causing the problem. It could be a product that you started using recently. Once you figure it out, you should stop using the product.

If the cause of your vaginitis is a hormonal change, your health care provider may give you estrogen cream to help with your symptoms.

It is important to treat BV and trichomoniasis, because having either of them can increase your risk for getting HIV or another sexually transmitted disease. If you are pregnant, BV or trichomoniasis can increase your risk for preterm labor and preterm birth.

To help prevent vaginitis:

• Do not douche or use vaginal sprays
• Use a latex condom when having sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
• Avoid clothes that hold in heat and moisture
• Wear cotton underwear

When you are ready to have your baby, you'll go through labor. Labor is the process of giving birth. Signs that you might be going into labor include:

• Contractions that are regular then start to come closer together
• Leaking fluid or bleeding from the vagina
• Low, dull backache
• Abdominal cramps

Call your health care provider if you have any of these signs, even if it is before your due date. Preterm labor can start before 37 completed weeks of pregnancy.

Labor happens in three stages. The first stage begins with contractions. It continues until your cervix has become thinner and dilated (stretched) to about 4 inches wide. The second stage is the active stage, in which you begin to push downward. Crowning is when your baby's scalp comes into view. Shortly afterward, your baby is born. In the third stage, you deliver the placenta. The placenta is the organ that supplied food and oxygen to your baby during pregnancy.

Mothers and babies are monitored closely during labor. Most women are able to have a baby through normal vaginal delivery. If there are complications, the baby may need to be delivered surgically by a Cesarean section.

NIH: National Institute of Child Health and Human Development

Vaccines are injections (shots), liquids, pills, or nasal sprays that you take to teach the immune system to recognize and defend against harmful germs. The germs could be viruses or bacteria.

Some types of vaccines contain germs that cause disease. But the germs have been killed or weakened enough that they won't make your child sick. Some vaccines only contain a part of a germ. Other types of vaccines include instructions for your cells to make a protein of the germ.

These different vaccine types all spark an immune response, which helps the body fight off the germs. Your child's immune system will also remember the germ and attack it if that germ ever invades again. This protection against a certain disease is called immunity.

Babies are born with immune systems that can fight most germs, but there are some serious diseases they can't handle. That's why they need vaccines to strengthen their immune system.

These diseases once killed or harmed many infants, children, and adults. But now with vaccines, your child can get immunity from these diseases without having to get sick. And for a few vaccines, getting vaccinated can actually give you a better immune response than getting the disease would.

Vaccinating your child also protects others. Normally, germs can travel quickly through a community and make a lot of people sick. If enough people get sick, it can lead to an outbreak. But when enough people are vaccinated against a certain disease, it's harder for that disease to spread to others. The entire community is less likely to get the disease. This is called "community immunity."

Community immunity is especially important for the people who can't get certain vaccines. For example, they may not be able to get a vaccine because they have weakened immune systems. Others may be allergic to certain vaccine ingredients. And newborn babies are too young to get some vaccines. Community immunity can help to protect them all.

Vaccines are safe. They must go through extensive safety testing and evaluation before they are approved in the United States.

Some people worry that childhood vaccines could cause autism spectrum disorder (ASD). But many scientific studies have looked at this and have found no link between vaccines and autism.

No, vaccines do not overload the immune system. Every day, a healthy child's immune system successfully fights off thousands of germs. When your child gets vaccines, they are getting weakened or dead germs. So even if they get several vaccines in one day, they are being exposed to a tiny amount of germs compared to what they encounter every day in their environment.

Your child will get vaccines during well-child visits. They will be given according to the vaccine schedule. This schedule lists which vaccines are recommended for children. It includes who should get the vaccines, how many doses they need, and at what age they should get them. In the United States, the Centers for Disease Control and Prevention (CDC) publishes the vaccine schedule.

Following the vaccine schedule allows your child to get protection from the diseases at exactly the right time. It gives their body the chance to build up immunity before being exposed to these very serious diseases.

Developmental disabilities are severe, long-term problems. They may be physical, such as blindness. They may affect mental ability, such as learning disabilities. Or the problem can be both physical and mental, such as Down syndrome. The problems are usually life-long, and can affect everyday living.

There are many causes of developmental disabilities, including:

• Genetic or chromosome abnormalities. These cause conditions such as Down syndrome and Rett syndrome.
• Prenatal exposure to substances. For example, drinking alcohol when pregnant can cause fetal alcohol spectrum disorders.
• Certain infections in pregnancy
• Preterm birth

Often there is no cure, but treatment can help the symptoms. Treatments include physical, speech, and occupational therapy. Special education classes and psychological counseling can also help.

NIH: National Institute of Child Health and Human Development

During pregnancy, some common infections like the common cold or a skin infection do not usually cause serious problems. But other infections can be dangerous to you, your baby, or both. Some infections may lead to preterm birth and low birth weight babies. Others can cause serious illness, birth defects, and lifelong disabilities, such as hearing loss or learning problems.

Some of the infections that can be dangerous during pregnancy include:

• Bacterial vaginosis (BV)
• Group B strep (GBS)
• Hepatitis
• Sexually transmitted diseases
• Toxoplasmosis
• Urinary tract infections
• Yeast infections
• Zika virus

To try to prevent infections,:

• Don't eat raw or undercooked meat
• Don't share food or drinks with other people
• Wash your hands frequently
• Don't empty cat litter. Cats can transmit toxoplasmosis.

If you do get an infection during pregnancy, contact your health care provider about how best to protect you and your baby. Only some medicines are safe during pregnancy.

You may need to take medicines while you are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking your opioid medicines in greater amounts or more often than you are supposed to, using them to get high, or taking someone else's opioids.

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include:

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms such as irritability, seizures, vomiting, diarrhea, fever, and poor feeding in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 completed weeks of pregnancy
• Stunted growth, leading to low birthweight
• Problems with the placenta (the organ that brings oxygen and nutrients to the baby)

If your provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include:

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If you have been taking opioids and you become pregnant, contact your provider. But don't stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

If you regularly take opioid medicines, you may be able to breastfeed. It depends on which medicine you are taking. But you should not breastfeed if you have HIV or take illegal drugs. Check with your provider before breastfeeding.

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your provider so you can get help. The treatment for opioid use disorder (OUD) is called medication for opioid use disorder (MOUD). For MOUD during pregnancy, providers prescribe either buprenorphine or methadone. These medicines can reduce your cravings and help prevent withdrawal.

Counseling, including behavioral therapies, can also help you to change your attitudes and behaviors related to drug use and build healthy life skills.