Preterm Labor

What are the Signs and Symptoms of Preterm Labor?

You need to see a health care provider right away if you have:

• Spotting and cramps in your abdomen
• Contractions with lower back pain or pressure in your groin or thighs
• Fluid that leaks from your vagina in a trickle or a gush
• Bright red bleeding from your vagina
• A thick, mucous-filled discharge from your vagina with blood in it
• Your water breaks (ruptured membranes)
• More than 5 contractions per hour, or contractions that are regular and painful
• Contractions that get longer, stronger, and closer together

What Causes Preterm Labor?

Researchers do not know what actually causes preterm labor in most women. However, we do know that certain conditions can increase the risk of preterm labor, including:

• A previous preterm delivery
• A history of cervical surgery, such as a LEEP or cone biopsy. Being pregnant with twins
• Infection in the mother or in the membranes around the baby
• Certain birth defects in the baby
• High blood pressure in the mother
• The bag of water breaks early
• Too much amniotic fluid
• First trimester bleeding

The mother's health problems or lifestyle choices that can lead to preterm labor include:

• Cigarette smoking
• Illegal drug use, often cocaine and amphetamines
• Physical or severe psychological stress
• Poor weight gain during pregnancy
• Obesity

Problems with the placenta, uterus, or cervix that can lead to preterm labor include:

• When the cervix does not stay closed on its own (cervical incompetence)
• When the shape of the uterus is not normal
• Poor function of the placenta, placental abruption, and placenta previa

Lower Your Risk of Preterm Labor

To reduce your risk of preterm labor, follow your provider's advice. Call as soon as you can if you think you are having preterm labor. Early treatment is the best way to prevent preterm delivery.

Prenatal care lowers the risk of having your baby too early. See your provider as soon as you think you are pregnant. You should also:

• Get routine checkups throughout your pregnancy
• Eat healthy foods
• Not smoke
• Not use alcohol and drugs

It is even better to start seeing your provider if you are planning to have a baby but are not yet pregnant. Be as healthy as you can be before getting pregnant:

• Tell you provider if you think you have a vaginal infection.
• Keep your teeth and gums clean before and during pregnancy.
• Make sure to get prenatal care, and keep up with recommended visits and tests.
• Reduce stress during your pregnancy.
• Talk to your provider or midwife about other ways to stay healthy.

Women with a history of preterm delivery may need weekly injections of the hormone progesterone. Be sure to tell your provider if you had a previous premature birth.

When to Call the Doctor

Call your provider right away if you notice any of these signs before your 37th week of pregnancy:

• Cramps, pain, or pressure in your abdomen
• Spotting, bleeding, mucous, or watery fluid leaking from your vagina
• Sudden increase in vaginal discharge

Your provider can do an exam to see if you are having preterm labor.

• An exam will check to see if your cervix has dilated (opened) or if your water has broken.
• A test called fetal fibronectin is often done if you are less than 32 weeks pregnant. This is a vaginal swab that helps assess the possibility of your preterm contractions resulting in a preterm delivery.
• A transvaginal ultrasound is often done to assess the length of the cervix. Early preterm labor can often be diagnosed when the cervix shortens. The cervix typically shortens before it dilates.
• Your provider may use a monitor to check your contractions.
• If you have a fluid discharge, it will be tested. The test may help show if you will deliver early or not.

If you have preterm labor, you will need to be in the hospital. You may receive medicines to stop your contractions and make your baby's lungs more mature.

References

Simhan HN, Iams JD, Romero R. Preterm labor and birth. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 29.

Sumhan HN, Berghella V, Iams JD. Preterm labor and birth. In: Creasy RK, Resnick R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 40.