Preterm Birth! How Early Is Too Early?

Preterm Birth! How Early Is Too Early?

Pregnancy is a period in which very intense and complex emotions are experienced together. Immediately after confirming the pregnancy with a blood beta-hCG test and ultrasound following a missed period, a unique and indescribable happiness arises—accompanied at the same time by thoughts and concerns about how the pregnancy will turn out. In fact, pregnancy is often perceived as a source of joy that cannot be fully enjoyed due to underlying fears. The shadow of stress about whether everything will go well begins to fall over that joy.

Indeed, pregnancies turn into a marathon, progressing step by step through stages such as miscarriages, screening tests (especially those for Down syndrome), and detailed ultrasounds in the mid-pregnancy period. Just when one begins to breathe a sigh of relief after passing these stages and starts looking at baby rooms and clothes, the possibility of preterm birth comes up. It seems that complete peace of mind will not be possible until delivery.

Yes, preterm birth occurs in approximately 10% of pregnancies and remains a major challenge in obstetrics.

To clarify the issue of the 40-week duration: only a small percentage of pregnancies actually reach 40 weeks, and the number of births occurring exactly at 40 weeks is much lower than commonly believed. Obstetricians generally define births occurring after 37 weeks and before 41 weeks as “term” or “on-time” deliveries. This is also expressed by the terms “miad” (from Ottoman Turkish/Arabic) and “term” (Latin for boundary). Therefore, births before 37 weeks are considered preterm, while those after 37 weeks are considered term births.

In society, it is commonly believed that babies born before 37 weeks will require incubation (NICU care).

Perhaps the most important message of this article is that preterm birth itself has different stages and degrees. With advances in neonatal intensive care experience and facilities, two subcategories have emerged: births before 32 weeks are considered “very preterm,” while those after 32 weeks are classified as “preterm.” The baby’s lungs, heart, and circulatory system are the most critical determinants. After 32 weeks, the baby’s lungs respond much better to respiratory support such as mechanical ventilation in the NICU. Therefore, births after this week generally have better outcomes, with a much higher likelihood of recovery without long-term complications and returning to the family.

Thus, when we define preterm birth as delivery occurring after 24 weeks but before 37 weeks, it becomes clear that the closer the pregnancy progresses toward 37 weeks, the better the outcome. The survival chances of the baby (or babies in twin pregnancies) increase, and the duration of neonatal intensive care decreases.

With this understanding, obstetricians and perinatologists have developed various treatments and approaches aimed at prolonging pregnancy as much as possible to reach 37 weeks, or at least to surpass 32 weeks and ideally reach 34–35 weeks. Common interventions include progesterone therapy, cerclage (suturing the cervix), tocolysis (medications given orally or intravenously to suppress contractions), rest recommendations, and hospitalization when necessary.

This naturally raises the question: can preterm birth be prevented? While some risk factors are predictable and preventable, unfortunately others are neither predictable nor preventable.

To summarize the main predictable risk factors:

Unfortunately, preterm birth is still largely not a fully predictable or preventable condition. It can occur even in women with no identifiable risk factors and despite preventive measures.

The good news is that advances in medical technology and experience are improving outcomes every day. Through comprehensive risk assessment during both first-trimester screening (11–14 weeks) and detailed ultrasound examinations, high-risk pregnancies for preterm birth can be identified and appropriate preventive strategies can be implemented successfully at our Irenbe IVF Center and Perinatology Unit.

By taking a detailed medical history and performing focused examinations, many risk factors for preterm birth can be identified, allowing opportunities for treatments and precautions aimed at reaching as close as possible to 37 weeks.

Smoking, an important risk factor for preterm birth, should be addressed with professional support if necessary, and must be completely stopped during pregnancy.

Twin pregnancies should be closely monitored at two-week intervals, with attention to cervical length changes. If critical shortening is detected, cerclage (cervical stitching) may be considered when appropriate.

Regular follow-up with a trusted physician and adherence to a consistent prenatal care schedule significantly improve pregnancy outcomes. When deemed necessary by the physician, progesterone supplementation, urine culture and sensitivity testing for infections, and timely and appropriate antibiotic treatments are also effective and preventive. Frequently changing doctors during pregnancy may disrupt continuity of care and lead to missed essential tests. Therefore, a structured and consistent follow-up plan is just as important as all other preventive measures.