Q&A: What Does the Doctor Mean?April C. Sanchez, M.D.
Q My daughter is in her 34th. week of pragnancy (due date 6/20/00). She was having some contractions, and her doctor checked her. He said that she is 1+,and 50%, and high. What does all this mean? Is it possible she'll be having her baby early? And if she does, what are the chances for a healthy baby?
A It sounds like your daughter is having pre-term labor, which is defined as uterine contractions that cause cervical change before 37 weeks of gestation. When her doctor said that she was 1+, he was referring to the dilatation of her cervix. This is a measurement in centimeters of how much the cervix has opened in preparation for childbirth. 1+ would mean greater than 1cm, but not quite 2 cm. Active, irreversible labor usually occurs at 4-5cm of dilatation. 50% refers to the effacement, or thinning, of the cervix. In preparation for labor, and throughout labor, the cervix becomes progressively thinner. 50% effacement simply means that the cervix is about 1/2 the thickness of a normal, non-laboring cervix. "High" is a term used to designate the position, or station, of the fetal head within the pelvis. If the doctor said the head was high, he meant that the head was not yet engaged in the pelvis. Although these terms indicate that there has been some change in the status of your daughter's cervix, this does not necessarily mean that she will deliver prior to 37 weeks.
In most cases, no one knows what causes pre-term labor. The biggest risk factor for pre-term labor is a history of pre-term labor in a previous pregnancy. Other things that are associated with pre-term labor include multiple gestation (twins or more), fetal abnormalities, and maternal infections or other conditions. In the absence of an obvious cause of the pre-term labor, there are several measures which could be taken. Bed rest is the simplest measure which is known to decrease uterine activity. Dehydration can lead to contractions, so every pregnant woman should drink lots of water--at least 2 liters per day, more when outside in the heat. There are several medications which are safe in pregnancy and decrease contractions. These include brethine, procardia, and magnesium. Steroids are often given prior to 34 weeks to aid in fetal lung maturity, but would not be indicated for your daughter. Studies have shown no benefits from steroid use after 34 weeks gestation. Home uterine monitoring can be helpful. This is when a pregnant woman wears a monitor twice a day, then sends the transmission over the phone lines to be interpreted by a nurse. The patient's doctor orders limits of the number of contractions that are acceptable for a particular gestational age. At 34 weeks of gestation, the threshold is usually 5-6 contractions in an hour. The doctor is called when the threshold is exceeded. Unfortunately, not every insurance company allows for home uterine monitoring and it is a costly procedure.
It is impossible to predict whether or not your daughter will deliver early. Often, we struggle and struggle to control pre-term contractions, only to have to induce the patient after her due date. Fetal lung maturity usually occurs between 36 and 37 weeks. If the baby is born before the lungs are mature, a stay in the neonatal intensive care unit will be required. The baby may need oxygen or to be on a ventilator. Over 90% of babies born at or beyond 34 weeks will do fine in the long run, with no permanent problems or developmental delays.
I wish the best of luck to your daughter.
April C. Sanchez, M.D.
Click here to Ask Dr. Sanchez your pregnancy questions.
Dr Sanchez lives with her husband and two boys ages 6 and 2 in Mandeville, Louisinana. She is a Board Certified OBGYN with a dregree from Louisiana State University Medical School. She completed her residency through the Tulane University Medical School Residency Program. She also received a Surgical Excellence Award.
Total Woman Care
She is now practicing Obstetrics and Gynecology at Total Woman Care, in Manderville, Louisiana. The Total Woman Care website, (http://www.totalwomancare.com) is an "Advanced" Obstetrics and Gynecology Practice that cares and provides for the needs of women with total Compassion, Empathy, and Understanding. Dedicated to Provide Obstetrics and Gynecology Related Information for the Women of West St Tammany Parish.
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