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 are 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. Even with intensive treatment, the premature baby may die or may have chronic lung disease, mental or other serious problems.

Preterm labor can sometimes be controlled with bed rest or medicine so that the baby is born closer to your due date. Follow all of your healthcare provider's instructions very carefully so that your baby can be born in the best condition possible.

How does it occur?

Preterm labor seldom has a clear cause. However, you have a greater risk of preterm labor if:

• You do not see your healthcare provider regularly while you are pregnant.
• You have problems during your pregnancy, such as high blood pressure, too much or too little fluid in the sac surrounding the baby, bleeding, or early separation of the placenta from the wall of the uterus.
• 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 inside your uterus.
• You are less than age 18 or older than 35 years.
• You smoke or use drugs or alcohol during your pregnancy.
• You are 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, continuous leaking of fluid from the vagina
• pelvic pressure
• cramps like you have during your period, which come and go (contractions)
• abdominal cramps with or without diarrhea
• backache with a tightening of the abdomen

If you are at risk for preterm labor and you have any unusual feelings or pains, call 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. Your provider may also test your vagina and cervix for an infection. Your provider may use a uterine monitor to measure and time uterine contractions. Your healthcare provider may have you wear the uterine monitor at home if you have a high risk for preterm labor. Ultrasound may be done to measure the length of the cervix to see if it is shortening. Your healthcare provider may check for a protein (fetal fibronectin found in the vagina or amniotic fluid) to check for the chances of preterm labor. This test is only used when you are pregnant with only one baby.

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 and the baby's health, the availability of an intensive care nursery, changes in your cervix, and whether or not your bag of water has ruptured.

The longer your 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 spend in the intensive care nursery.

Treatment for stopping preterm labor may include:

• wearing a monitor when you go home from the hospital
• staying in the hospital
• continuous uterine monitoring
• medicines to stop the contractions
• bed rest (lying on the left side is best for uterine relaxation and blood flow)
• amniocentesis to look for infection or to see if the baby's lungs are mature
• treatment for infection if lab tests of blood, urine, or cells from the cervix show infection
• ultrasound scan to check the condition of the placenta, check the baby's age, look for any birth defects, see the position of the baby in your uterus, and measure the cervix and the amount of fluid in the amniotic sac.

Sometimes medicines may be given to stop preterm labor. They can be given orally or into a vein (IV). Usually one medicine is started with an IV. Later you may switch to pills. Your healthcare provider will probably not use a drug 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 provider may give you medicine to help the baby's lungs mature 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 also be sent 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 are at increased 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.
• Discuss with your healthcare provider 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 recognize contractions by feeling your uterus with your hand on your abdomen.
• Get treatment for any kidney, bladder, or vaginal infections.
• Learn about other signs and symptoms of premature labor. 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.
• Do not smoke or use alcohol or illegal drugs.

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