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. Your arteries are blood vessels that carry blood from your heart to other parts of your body. High blood pressure, or hypertension, is blood pressure that is higher than normal. Having high blood pressure can put you at risk for other health problems, such as heart disease, heart attack, and stroke.

During pregnancy, high blood pressure can cause problems for you and your baby. To keep you and your baby healthy, it's important to get treatment for high blood pressure before, during, and after pregnancy.

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. If it becomes severe, it can lead to a preterm birth or your baby having a low birth weight. Some women with gestational hypertension do go on to develop preeclampsia, a more serious type of high blood pressure in pregnancy.
• Chronic hypertension is high blood pressure that starts before the 20th week of pregnancy or before you became pregnant. Some people 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. Preeclampsia also often includes signs of damage to some of your organs, such as your liver or kidneys. The signs may include protein in the urine (pee) and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.
  • If preeclampsia becomes severe enough to affect your brain function and causes seizures or a coma, it is called eclampsia.
  • In rare cases, preeclampsia symptoms may not start until after delivery. This is called postpartum preeclampsia. If this type of preeclampsia becomes more severe and causes a seizure, it is known as postpartum eclampsia.
  • When a person with preeclampsia or eclampsia has damage to the liver and blood cells, it's called HELLP syndrome. It is rare, but very serious.

You are more likely to develop high blood pressure in pregnancy 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 under age 20 or over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of high blood pressure in pregnancy
• Have certain health conditions, such as diabetes or lupus

High blood pressure usually has no symptoms. People usually find out they have high blood pressure when their health care provider measures their blood pressure.

Preeclampsia can cause other symptoms, including:

• Too much protein in your urine (called proteinuria).
• Swelling (edema) 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.
• A headache that does not go away.
• Vision problems, including blurred vision or seeing spots.
• Pain in your upper right abdomen (belly).
• 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.

High blood pressure in pregnancy can lead to complications such as:

• Placental abruption, where the placenta (the organ that brings oxygen and nutrients to the baby) separates from the uterus (the place where a baby grows during pregnancy)
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• Your baby having a low birth weight
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you

Your 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 order some tests. These may include blood tests and other lab tests, such as a test to look for extra protein in your urine.

If you have high blood pressure, you and your baby will be closely monitored to lower the chance of complications. You may need to:

• Check your blood pressure at home.
• Keep track of how many times you feel the baby kicking each day.
• Adjust your physical activity. Talk to your provider about what level of physical activity is right for you.
• Take medicine to control your blood pressure. Talk to your provider about which medicines are safe for your baby.
• Take aspirin in the second trimester, if you are at risk of preeclampsia and your provider recommends aspirin.
• Visit your provider more often to monitor your condition and your baby's growth rate and heart rate.

If you have eclampsia, HELLP syndrome, or a severe case of preeclampsia, you will most likely need to go to the hospital. Treatment often includes medicines. Your provider may also recommend delivering the baby early. They will make the decision based on:

• How severe the condition is
• The possible risks to you and your baby
• How far along the pregnancy is

The goal is to lower the risks to you while giving your baby as much time as possible to mature before delivery.

The symptoms of preeclampsia can last after delivery, but they usually go away within 6 weeks.

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 infection (STI). 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 STI. 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.

Cerebral palsy (CP) is a group of neurologic disorders that cause problems with movement, balance, and posture. The first part of the name, cerebral, means having to do with the brain. The second part, palsy, means weakness or problems with using the muscles.

CP can range from mild to severe. The brain damage and the disabilities it causes are permanent. But treatments can improve the lives of people who have the condition. For example, treatments can help to improve their motor skills and ability to communicate.

There are different types of CP:

• Spastic cerebral palsy, which is the most common type. It causes increased muscle tone, stiff muscles, and awkward movements. Sometimes it only affects one part of the body. In other cases, it can affect both arms and legs, the trunk, and the face.
• Dyskinetic cerebral palsy, which causes problems controlling the movement of the hands, arms, feet, and legs. This can make it hard to sit and walk.
• Ataxic cerebral palsy, which causes problems with balance and coordination.
• Mixed cerebral palsy, which means that you have symptoms of more than one type.

CP is caused by abnormal development or damage to the developing brain. When this development or damage happens before birth, it is called congenital CP. Most CP is congenital, and its causes may include:

• Gene changes (variants)
• Brain malformations
• Infections or fevers in the pregnant parent
• An injury to the developing baby

CP can also happen during or after birth. CP that happens more than 28 days after birth is called acquired CP. Its causes can include:

• Brain damage in the first few months or years of life
• Infections, such as meningitis or encephalitis
• Problems with blood flow to the brain, for example from a stroke or abnormal blood vessels
• Head injuries, for example from a car accident, a fall, or child abuse

In some cases, the cause of congenital or acquired CP is unknown.

Certain medical conditions or events that can happen during pregnancy and delivery may increase a baby's risk of congenital cerebral palsy. These may include:

• Being born too small
• Being born too early
• Being born a twin or other multiple birth
• Being conceived by in vitro fertilization (IVF) or other assisted reproductive technology (ART)
• Infections
• Health problems in the pregnant parent, such as thyroid problems and seizures
• Severe newborn jaundice
• Having complications during birth
• Rh incompatibility
• Exposure to toxic chemicals during pregnancy

There are many different types and levels of disability with CP. So the signs can be different in each child. These signs usually appear in the early months of life. They may include:

• Developmental delays. Your child may be slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk.
• Abnormal muscle tone. Your child may seem floppy, or they may be stiff or rigid.
• An unusual posture or favoring one side of the body when reaching, crawling, or moving.
• Stiff or tight muscles and exaggerated reflexes (spasticity).
• Shaking (tremor) of arms, legs, hands, or feet.
• Sudden, uncontrolled movements.

It's important to know that children without CP can also have these signs. Contact your child's health care provider if your child has any of these signs, so you can get a correct diagnosis.

Diagnosing CP involves several steps:

• Developmental monitoring (or surveillance) means tracking a child's growth and development over time. If there are any concerns about your child's development, they should have a developmental screening test as soon as possible.
• Developmental screening involves giving your child a short test to check for motor, movement, or other developmental delays. If the screenings are not normal, the provider will recommend more evaluations.
• Developmental and medical evaluations are done to diagnose which disorder your child has. To make the diagnosis, your provider:
  • Will check your child's motor skills, muscle tone, reflexes, and posture
  • Will ask about their medical history
  • May order lab tests, genetic tests, and/or imaging tests

There is no cure for CP, but treatment can improve the lives of those who have it. It is important to begin a treatment program as early as possible.

A team of health professionals will work with you and your child to develop a treatment plan. Common treatments include:

• Medicines
• Surgery
• Assistive devices such as braces and walkers
• Physical, occupational, recreational, and speech therapy

You cannot prevent the genetic problems that can cause CP. But it may be possible to manage or avoid some of the risk factors for CP. For example:

• If you are pregnant, make sure that you are vaccinated against infections that could cause CP in your developing baby.
• Get regular prenatal care, which can reduce the risk of preterm birth or having a low birthweight baby. It can also help you manage any health conditions that could raise the risk of CP.
• Use car seats for your baby to prevent head injuries that could cause CP.

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 infections (STIs)
• 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.
• Talk to your health care provider about vaccinations.
• If you have sex during pregnancy, use a condom every time.

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.