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Preterm labor

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What is preterm labor?

Preterm labor is labor that occurs before 37 weeks of pregnancy have passed. It is a concern because babies born prematurely are at higher risk of serious health complications.

If there are indications that preterm labor might occur, your doctor will use a range of medications to delay delivery for as long as possible, as every week that delivery can be delayed greatly reduces the risk of complications and increases the chances of survival for your baby.

This page focuses on the events leading up to a preterm birth. For more information about the birth process and what follows, see our premature birth and premature babies pages.

Causes

Causes of preterm labor include:

Risk factors

Risk factors for preterm labor include:

  • Preterm birth in the past;
  • Preterm rupture of the fetal membranes;
  • Surgery on the cervix;
  • A short cervical length;
  • Cervical incompetence;
  • Placental abruption - where your placenta detaches from the wall of the uterus;
  • Smoking and drug use;
  • Vaginal bleeding, and;
  • Polyhydramnios - having too much amniotic fluid in the uterus.

Signs and symptoms

Signs and symptoms of preterm labor include:

Symptoms of preterm labor can include waters breaking and regular contractions. 

Methods for diagnosis

If contractions are frequent and intense enough to cause the dilation of the cervix between 24-37 weeks' pregnancy, it is a sign of preterm labor. A test called the vaginal fetal fibronectin test is performed on a swab of secretions near your cervix. The test detects fibronectin, which is a protein attached to the amniotic sac that surrounds your baby within the uterus. A positive result indicates an increased risk of preterm labor.

Sometimes a transvaginal ultrasound will also be performed to check your cervical length, since a short cervical length increases your risk of preterm labor.

The length of the cervix can indicate a risk of preterm labor. 

Types of treatment

Labor can be delayed or stopped using medications known as tocolytic therapy. However, this is not used if labor is too advanced, or if your pregnancy is past 34 weeks. Tocolytic medications are intended to delay delivery for 48 hours. If by this time labor has stopped, you will be monitored until labor recommences.

Corticosteroids are given to reduce complications for your baby by helping the lungs mature faster. They are given between 24-34 weeks of pregnancy, often in conjunction with tocolytic medications.

Potential complications

For the baby, potential complications of preterm labor include:

Prognosis

If no complications occur, the prognosis is good for preterm birth beyond 34 weeks' pregnancy. The earlier you give birth, the greater the risk of complications. Even an extra week can make a big difference in reducing the risk of complications.

Prevention

You can reduce the risk of preterm labor by not smoking, not using recreational drugs and maintaining low stress levels. If you have a history of preterm labor, you might be given progesterone in the form of an injection or vaginal gel to help prevent it. This preventative treatment has not been proven to be effective for pregnant women who do not have a history of preterm labor.

9 Most frequently asked questions (FAQs)

What is preterm labor?
Preterm labor is labor that occurs in a pregnancy before 37 weeks gestation.
What are the symptoms of preterm labor?
Signs and symptoms of preterm labor include: pelvic pressure; lower abdominal cramping and back pain; your waters breaking; changes in cervical discharge such that it is watery, bloody or mucus-like; dilation of the cervix; vaginal spotting, and; regular uterine contractions.
What causes preterm labor?
Causes of preterm labor include: placental abnormalities, such as placenta previa or placental abruption; infection and inflammation; physical or psychological stress, and; stretching of the uterus - often as a result of a multiple pregnancy.
How is preterm labor diagnosed?
If your waters have broken, you are experiencing frequent and intense contractions and your cervix has dilated, preterm labor is most probably occurring. A test of your cervical secretions can be performed to look for a protein called fibronectin which indicates preterm labor is likely.
How is preterm labor treated?
If preterm labor is suspected, a range of medications comprising tocolytic therapy (to slow down contractions) will be used to delay delivery. Corticosteroids are also used to help your baby mature faster if early delivery is going to happen.
Can preterm labor be prevented?
If you have experienced preterm labor in the past, you will likely be given progesterone in the form of an injection or vaginal gel to help reduce the risk of it happening again. You can also help reduce your risk by not smoking or taking drugs.
What is the outlook for preterm labor?
The outlook for preterm labor depends on how early your baby is delivered in the course of your pregnancy, with complications decreasing and survival increasing dramatically between 24-34 weeks-gestation. The longer that delivery can be delayed, the better the outcome for your baby.
Is preterm labor serious?
If delivery is at 24 weeks, the chances of the baby's survival are lower than 50%. Every week that delivery can be delayed greatly lowers the risk of complications and increases the chances of the baby's survival.
What increases the chances of developing preterm labor?
Preterm labor is more likely if you have experienced it before, had surgery on your cervix, have too much amniotic fluid in your uterus, if your membranes have ruptured, or if you smoke or use recreational drugs.

Related topics

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Labor

Labor is the process through which a baby is delivered from a woman’s womb to the outside world. Stages of labor that pregnant women commonly experience include uterine contractions, dilation of the cervix and the rupturing of fetal membranes to release amniotic fluid, or ‘water breaking’.

Morning sickness

Morning sickness is nausea and vomiting during pregnancy. Despite its name, it can strike at any time of the day. Up to around 85% of pregnant women experience morning sickness. Fortunately, it tends to settle down by the 20th week of pregnancy.

Vaginal tears during labor

During childbirth, the skin and muscles around the vagina can tear as the baby passes through the birth canal. In most cases, the tear is relatively mild and soon heals, but more extensive tears need to be repaired to avoid any complications. Causes. During labour, hormones are released to help soften the tissues of the vagina and the perineum, which is the area between the vagina and the rectum.

About this article

Title: Preterm labor

Author: Dr Idan Ben-Barak PhD, MSc, BSc (Med)

First Published: 13 Jul 2015

Last reviewed: 17 Jan 2022

Category: Information on Preterm labor

Average rating: 4.5 out of 5 (1425 votes)

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