Preterm Labor

What is preterm labor?

If you have regular, painful uterine contractions and changes in your cervix between your 20th and 37th weeks of pregnancy, you may be having preterm labor. It is also called premature labor.

Preterm labor can lead to an early, premature delivery of your baby. A baby that is born early may have some health problems. A premature baby may need special treatment in an intensive care nursery. The baby may have lung disease or other serious, life-threatening problems.

How does it occur?

Preterm labor seldom has a clear cause. Your risk of preterm labor may be higher if:

• You do not see your healthcare provider regularly while you are pregnant.
• You have problems during your pregnancy, such as high blood pressure or too much or too little fluid in the sac surrounding the baby.
• You have a sexually transmitted infection during the pregnancy.
• You had a previous preterm labor or delivery.
• You are pregnant with more than 1 baby.
• You have an abnormally shaped uterus or fibroids in your uterus.
• You are less than age 18 or older than 35 years old.
• You smoke or use drugs or alcohol during your pregnancy.
• You were underweight before getting pregnant.

What are the symptoms?

Preterm labor contractions may not feel like normal labor contractions. They may be weaker. Many times, preterm labor contractions may feel the same as movements of the baby or the normal aches and pains of pregnancy. It is important to know the signs and symptoms of preterm labor, how to feel the uterus for contractions, and when to call your healthcare provider about contractions.

Some of the signs and symptoms of preterm labor are:

• an increase or change in vaginal discharge; for example, a slow, ongoing leaking of fluid from the vagina
• feelings of pressure in your pelvis
• cramps like you have during your period that come and go (contractions)
• backache with a hardening feeling of your uterus in your abdomen

If you have any unusual feelings or pains, tell your healthcare provider right away.

How is it diagnosed?

Your healthcare provider reviews your symptoms and does a pelvic exam to see how much your cervix has thinned or opened. A number of tests may be done.

• You may have tests of blood, urine, or cells from the cervix to check for infection.
• Your healthcare provider may use a uterine monitor to measure and time uterine contractions. Your provider may have you wear the uterine monitor at home if you have a high risk for preterm labor.
• You may have an ultrasound scan to check the placenta, check the baby's age, look for birth defects, see the position of the baby, and measure the cervix and the amount of fluid in the amniotic sac.
• You may have a test for a protein called fetal fibronectin. This protein may be found in the vagina or amniotic fluid. (This test is done only when you are pregnant with just 1 baby.) The test is done by collecting fluid from the vagina with a special Q-tip and sending the Q-tip to the lab for testing. If the fetal fibronectin protein is found, then you may be more at risk for a preterm delivery and need more treatments to try to avoid early delivery.

How is it treated?

Your healthcare provider may or may not try to stop the labor and early delivery of your baby. The decision is based on:

• how long you have been pregnant
• your health
• the baby's health
• the availability of an intensive care nursery
• changes in your cervix
• whether or not your bag of water has broken.

The longer the pregnancy continues, the better the chances are that the baby will live and be healthy. It also usually reduces the amount of time your baby will need to be in the intensive care nursery.

Treatment for stopping preterm labor may include:

• staying in the hospital
• medicines to stop the contractions
• bed rest (lying on the left side is best for uterine relaxation and blood flow)
• treatment for infection if lab tests show infection

Medicines to stop preterm labor may be given orally or into a vein (IV). Your healthcare provider will probably not use medicine to stop premature birth if:

• You have a lot of vaginal bleeding.
• You have very high blood pressure.
• You have an infection in your uterus.
• The cervix is very open.
• You have a baby with fatal birth defects or who has died already.
• There are problems with the placenta.
• You have any condition in which the pregnancy should not go on.

If it looks like your preterm labor may become full labor and delivery, your healthcare provider may give you medicine to help the baby's lungs develop more fully before birth. The medicine will help your baby breathe better after delivery. The medicine is usually given only if you are between the 24th and 34th weeks of pregnancy and you are going into full labor. You may need to go to a hospital with an intensive care nursery if your hospital does not have one.

How can I take care of myself and help prevent preterm labor?

If you have a high risk for preterm labor:

• Visit your healthcare provider as soon as you think you are pregnant.
• Visit your healthcare provider according to the schedule you are given and follow all of your provider's advice.
• Talk to your healthcare provider about the possible effects of your work schedule.
• Rest as much as possible.
• Don't skip meals. Eat healthy meals and snacks every day.
• Learn how to know when you are having contractions by feeling your uterus with your hand on your belly.
• Get treatment for any kidney, bladder, or vaginal infections.
• Call your healthcare provider if you have any signs or symptoms of preterm labor or any unusual feelings.
• Avoid stimulation of your nipples, which can cause contractions.
• Avoid intercourse if it causes contractions.
• Don’t smoke and don’t use alcohol or illegal drugs.

If you are being treated for preterm labor, carefully follow all of your healthcare provider's instructions.