Preterm Labor

Preterm labor is defined as strong contractions that dilate or open the cervix before 37 weeks gestation. About half of the time this results in a preterm or premature delivery.

WHAT COULD HAPPEN IF MY BABY IS PREMATURE?

Preterm birth can cause serious health problems or even be fatal for a baby, particularly if it happens very early, before 24 weeks. In general, the more mature a baby is at birth, the better the chances of surviving and being healthy.

Some preterm babies may have problems breathing. Prematurity also puts a baby at a greater risk for cerebral hemorrhage. The nervous system, gastrointestinal tract, and other organs may be affected too. Preterm babies are more prone to infection and jaundice and may have difficulty feeding as well as trouble maintaining their body temperature.

Survivors sometimes suffer long-term health consequences, including chronic lung disease, vision and hearing impairment, cerebral palsy, and developmental problems.

The majority of premature babies are born between 34 and 37 weeks. If these “late preterm infants” have no other health problems, they generally do significantly better than those born earlier; although, they still face a higher risk of problems than babies who are born later in pregnancy.

If you go into labor before 34 weeks and there is no medical reason for an immediate delivery, your medical team may be able to delay your labor. This means your baby can be given corticosteroids to help his or her lungs develop faster, which boosts the chance of survival.

Many technological advances have been made to help treat preterm infants. To take advantage of these, a preterm infant is best cared for at a hospital with a neonatal intensive care unit (NICU).

WHAT ARE THE SIGNS OF PRETERM LABOR?

Call our office if you are having any of the following symptoms before 37 weeks:

  • Increased vaginal discharge from usual
  • A change in the type of discharge, i.e, if you are leaking watery fluid or your discharge becomes watery, mucus-like, or bloody (even if it is pink or tinged with blood)
  • Vaginal bleeding or spotting
  • Abdominal pain, menstrual-like cramping, or more than four contractions in one hour (even if they do not hurt)
  • Increased pressure in the pelvic area (a feeling that your baby is pushing down
  • Low back pain, especially if you did not previously have back pain or it is dull or rhythmic

These symptoms can be confusing because some of them, such as pelvic pressure or low back pain, are common during pregnancy. Likewise, sporadic early contractions may be Braxton Hicks contractions. However, it is always better to be safe than sorry. Call us if you are experiencing anything unusual at any time during your pregnancy.

WHAT CAUSES PRETERM LABOR?

  • Genital tract infections- from urinary tract infections to sexually transmitted diseases
  • Certain non-uterine infections, such as a kidney infection, pneumonia, and appendicitis
  • Problems with the placenta, such as placenta previa or placental abruption
  • An excessively large uterus, which may be due to a multiple gestation or too much amniotic fluid
  • Structural abnormalities of the uterus or cervix such as uterine fibroids, a uterine septum, a bicornuate uterus, or cervical insufficiency.
  • Abdominal surgery during pregnancy, such as removal of the appendix, the gallbladder, or an ovarian cysts.

WHAT ARE RISK FACTORS FOR SPONTANEOUS PRETERM LABOR?

Over half of spontaneous preterm births happen in pregnancies without an identifiable risk factor. Risk factors for preterm labor include:

  • Previous preterm delivery (the earlier in gestation your baby was born and the more spontaneous preterm births you have had, the higher your risk)
  • Twins or other multiples
  • Age less than 17 or greater than 35
  • African American ethnicity
  • Underweight before pregnancy or do not gain enough weight during your pregnancy
  • Vaginal bleeding in the first or second trimester- Vaginal bleeding in more than one trimester means the risk is even higher.
  • Moderate to severe anemia early in your pregnancy.
  • Smoke, abuse alcohol, or use drugs (especially cocaine) during pregnancy.
  • Have given birth in the last 18 months (particularly if you became pregnant within six months of giving birth)
  • Were born to a mother who took the drug DES. (Note: DES was taken off the market in the United States in 1971 but remained available in some other countries. If you are in your late thirties or older or your mother lived in another country when she carried you, ask her whether or not she took DES.)
  • Lack of prenatal care or got a late start on prenatal care
  • Infertility treatment
  • Chronic stress
  • Abusive relationship- Whether your partner is emotionally abusive or if you endure physical violence, you have an increased risk. As to be expected, the risk is even higher if there is trauma to the abdomen.
  • Work night shift or stand for more than 40 hours a week.

IS THERE ANYTHING I CAN DO IF I AM AT HIGH RISK?

Take care of yourself. If you eat well, get plenty of rest, start your prenatal care early and see your physician regularly, stop unhealthy habits (such as smoking), and manage your stress level, you are already doing a lot to ensure a healthy, full-term baby. Depending upon your situation, your doctor may recommend that you see a high-risk specialist (Maternal Fetal Medicine) for your care. If you have had preterm premature rupture of the membranes (PPROM) or spontaneous preterm labor resulting in a preterm birth before 34 weeks and are currently carrying only one baby, your physician may recommend injections with a progesterone compound called 17 alpha-hydroxyprogesterone caproate or 17P for short. This injection is typically given from 16-36 weeks.