Preterm labor occurs when regular contractions result in the opening of your cervix after week 20 and before week 37 of pregnancy. Preterm labor can result in premature birth. The earlier premature birth happens, the greater the health risks for your baby. Many premature babies (preemies) need special care in the neonatal intensive care unit. Preemies can also have long-term mental and physical disabilities. The specific cause of preterm labor often isn't clear. Certain risk factors might increase the chance of preterm labor, but preterm labor can also occur in pregnant women with no known risk factors.
Symptoms
Signs and symptoms of preterm labor include:
- Regular or frequent sensations of abdominal tightening (contractions)
- Constant low, dull backache
- A sensation of pelvic or lower abdominal pressure
- Mild abdominal cramps
- Vaginal spotting or light bleeding
- Preterm rupture of membranes — in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears
- A change in type of vaginal discharge — watery, mucus-like or bloody
Treatment
Medications
Once you're in labor, there are no medications or surgical procedures to stop labor, other than temporarily. However, your doctor might recommend the following medications:
- Corticosteroids. Corticosteroids can help promote your baby's lung maturity. If you are between 23 and 34 weeks, your doctor will likely recommend corticosteroids if you are thought to be at increased risk of delivery in the next one to seven days. Your doctor may also recommend steroids if you are at risk of delivery between 34 weeks and 37 weeks.
You might be given a repeat course of corticosteroids if you're less than 34 weeks pregnant, at risk of delivering within seven days, and you had a prior course of corticosteroids more than 14 days previously.
- Magnesium sulfate. Your doctor might offer magnesium sulfate if you have a high risk of delivering between weeks 24 and 32 of pregnancy. Some research has shown that it might reduce the risk of a specific type of damage to the brain (cerebral palsy) for babies born before 32 weeks of gestation.
- Tocolytics. Your health care provider might give you a medication called a tocolytic to temporarily slow your contractions. Tocolytics may be used for 48 hours to delay preterm labor to allow corticosteroids to provide the maximum benefit or, if necessary, for you to be transported to a hospital that can provide specialized care for your premature baby.
Tocolytics don't address the underlying cause of preterm labor and overall have not been shown to improve babies' outcomes. Your health care provider won't recommend a tocolytic if you have certain conditions, such as pregnancy-induced high blood pressure (preeclampsia).
If you're not hospitalized, you might need to schedule weekly or more-frequent visits with your health care provider so that he or she can monitor signs and symptoms of preterm labor.
Surgical procedures
If you are at risk of preterm labor because of a short cervix, your doctor may suggest a surgical procedure known as cervical cerclage. During this procedure, the cervix is stitched closed with strong sutures. Typically, the sutures are removed after 36 completed weeks of pregnancy. If necessary, the sutures can be removed earlier.
Cervical cerclage might be recommended if you're less than 24 weeks pregnant, you have a history of early premature birth, and an ultrasound shows your cervix is opening or your cervical length is less than 25 millimeters.
Preventive medication
If you have a history of premature birth, your health care provider might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate, starting during your second trimester and continuing until week 37 of pregnancy.
In addition, your health care provider might offer progesterone, which is inserted in the vagina, as a preventive measure against preterm birth. If you are diagnosed with a short cervix before week 24 of pregnancy, your health care provider might also recommend use of progesterone until week 37 of pregnancy.
Recent research suggests that vaginal progesterone is as effective as cervical cerclage in preventing preterm birth for some women who are at risk. The medication has the advantage of not requiring surgery or anesthesia. Your doctor may offer you medication as an alternative to cervical cerclage.
If you have a history of preterm labor or premature birth, you're at risk of a subsequent preterm labor. Work with your health care provider to manage any risk factors and respond to early warning signs and symptoms.
