Psychological factors in preterm labor and psychotherapeutic intervention

Prematurity is the leading cause of perinatal mortality in developing countries and nearly 50% have no identifiable clinical risk factor. A few studies have enlightened the role of psychological factors in its causation and psychotherapeutic interventions in the form of hypnosis, relaxation exercises and anxiety reducing exercises [1]. The following study was conducted to assess the psychological factors in subjects with preterm labor of unknown cause and to compare the effect of psychotherapeutic intervention along with tocolysis to tocolysis alone. Fifty subjects with preterm labor satisfying the inclusion and exclusion criteria were assessed of psychological stress using modified life inventory [2] and abbreviated psychosocial scale [3]. They were randomly assigned to control group (25) who received tocolysis with nifedipine and study group (25) who received nifedipine along with psychotherapeutic intervention in the form of Luthe's relaxation technique and transcendental meditation. The endpoints studied were cessation of uterine contractions, prolongation of pregnancy and neonatal outcome. Statistical analysis was done using Graphad Instat employing correlation analysis, Students' ‘t’ test and Fischer's exact test. Gestational age at presentation showed a negative correlation with stressful life events (r − 0.9894) and a negative correlation with abbreviated psychosocial score (r − 0.9549) which means that the patients with more stressful life events and with poor psychosocial status experienced preterm labor at an early gestational age. Table 1 shows the effect of psychotherapeutic intervention on various parameters studied. Psychotherapeutic intervention and tocolysis administered together was more effective at early effacement (p ≤ 0.01) and when cervix is dilated from 1 to 2 cm (p ≤ 0.0261). Mean prolongation of pregnancy was 19.65 days in study group and 6.92 days in control group (p = 0.003). Although, the association of increased stressful experiences in subjects with preterm labor was brought to lime light in 1963 by Gunter [4], it was Newton and Hunt [2] who assessed objectively to find increased number of stressful events. His findings are in agreement with the present study. Among the Psychotherapeutic interventions, Omer and colleagues found hypnosis with tocolytic therapy to be better in inhibiting preterm labor [1]. Mamelle and colleagues found significant (p < 0.01) reduction in preterm delivery rate when psychological support was given [5]. In the present study, transcendental meditation and sequential muscle relaxation along with tocolytics was found to be more effective. Psychotherapeutic intervention in the form of progressive muscle relaxation revealed higher rates of pregnancy prolongation in 107 subjects studied by Janke [6]. Subjects with more stressful life events and poor psychosocial status had preterm labor at an early gestational age. Tocolysis along with psychotherapeutic intervention is more effective than tocolysis alone in inhibiting preterm labor and prolonging pregnancy. This helps to achieve a neonate who is delivered at a later gestational age with less requirements of neonatal intensive care facilities and hence these interventions may be useful, especially for developing countries.