American Medical Association Family Medical Guide - American Medical Association [295]
Diagnosis and Treatment
If you think you are starting labor prematurely, contact your doctor immediately. If your doctor is not available, call the hospital where you plan to deliver your baby, tell the staff what the problem is, and ask for their advice. They will probably tell you to come to the hospital right away. Arrange to have someone drive you if possible. If you don’t think you will be able to make it to your hospital in time, call 911 or your local emergency number and arrange to be taken to the nearest hospital emergency department.
When you arrive at the hospital, you will be examined to see if you have started labor. A doctor may perform amniocentesis (see page 510) to evaluate the fetus’s lung development. If you are having contractions, you may be given medication to control them to allow the pregnancy to continue until the fetus is more mature. If the doctor decides to let the labor proceed, you may have an episiotomy (see page 533) to allow easier passage of the baby’s head, which is more fragile than that of a full-term baby.
Depending on your infant’s health status, he or she will be sent to either the nursery or the neonatal intensive care unit (see page 383), where his or her heartbeat, breathing, and temperature will be monitored and any problems treated promptly.
Retarded Growth of the Fetus
In some pregnancies, the placenta does not supply enough nourishment to the fetus, resulting in stunted development (called intrauterine growth retardation or retarded fetal growth). A fetus’s growth is determined to be retarded if the fetus’s weight falls below the fifth percentile. The inability of the placenta to supply nourishment can result from scarring in areas of the placenta where tissue has died from lack of blood. The obstruction of blood flow can result from preeclampsia (see page 526), high blood pressure (see page 520), vaginal bleeding (see page 523), or placenta previa or placental abruption (see page 527). Retarded fetal growth can also occur when the pregnant woman has a heart disorder (see page 520) or diabetes (see page 521), or when she smokes cigarettes, drinks alcohol or uses other drugs, or is malnourished during pregnancy.
A newborn whose growth is stunted has less body fat (and therefore is less able to resist cold) and is more susceptible to having low blood sugar (hypoglycemia; see page 897) than an infant who is at a normal weight. Low-birth-weight babies have more medical and developmental problems, some of which can be life-threatening. If the infant is preterm (see left), he or she may have complications such as respiratory distress syndrome (see page 381).
To help ensure that your baby is born healthy, go to all of your scheduled prenatal appointments. If you are beyond the 30th week of your pregnancy and think that your fetus is not moving as much as before, your doctor may recommend that you keep a kick chart (see page 523) to record fetal movements. To monitor the fetus’s condition, your doctor may recommend that you have an ultrasound and tests that measure the fetus’s heartbeat.
If your doctor thinks that your fetus’s growth may be stunted, he or she will discuss moving up the delivery date by inducing labor (see page 533) or by performing a cesarean (see page 534). A fetus that is not growing normally inside the uterus may do better in a neonatal intensive care unit. Your doctor will recommend that you deliver in a hospital that has a neonatal intensive care unit so that any problems your baby has can be treated promptly by trained neonatal specialists.
Postterm Pregnancy
Ideally, labor starts when the fetus is fully mature and able to survive outside the uterus. Most women give birth between the 37th and 42nd weeks of pregnancy. A pregnancy that goes beyond the 42nd week is called a postterm pregnancy, or postmaturity. Postterm pregnancies occur most frequently in women who have gestational diabetes (see page 521)