Preterm Labor

Preterm labor is when the regular contractions cause the opening of the cervix and delivery after the 20th week and before the 37th week of pregnancy.

This condition can lead to premature delivery. It can affect the newborn health due to underdevelopment or incomplete development of organs. Premature babies need special care in the neonatal intensive care unit.

The cause of preterm labor is not known; the condition can occur to any pregnant woman.

Symptoms

Regular or frequent uterine contractions
Constant lower back pain
Pelvic or lower abdominal cramps
Vaginal spotting or bleeding
Premature rupture of membranes
Change of vaginal discharge

When to see a doctor
If you have the symptoms or feel worried, please seek medical care. Do not feel embarrassed if it turns out to be just false labor.

Risk Factors

Age of mother, either too young or too old.
The interval from the previous pregnancy is less than 6 months or more than 59 months.
History of preterm labor.
Twin or higher-order multiple pregnancies.
Short cervix.
Polyhydramnios.
Uterine tumor or low-lying placenta with bleeding.
Infection of amniotic fluid or genital tract.
Underlying health conditions, e.g., diabetes, hypertension, autoimmune disease, or depression.
A recent physical or mental stressor event such as loss of loved ones.
Smoking or substance abuse.

Complications

Preterm labor can lead to premature birth, resulting in newborns with health issues such as low birth weight, respiratory distress, and vision defect due to underdeveloped organs. Premature babies are prone to develop cerebral palsy, learning disability, and behavioral problems.

Prevention

Preterm labor is not preventable. However, promoting good maternal health can contribute to a healthy pregnancy.

Keep every doctor's appointment. Seek medical consultation if you have a symptom that evokes anxiety.
Eat healthily.
Avoid the use of addictive substances or tobacco.
Notify your doctor if you have underlying medical conditions.
Avoid a duration of fewer than 6 months or more than 59 months from the last pregnancy.
Keep your underlying medical conditions under control.

Diagnosis

Your doctor will take your medical history and assess the risk factors of preterm labor.

Pelvic exam: Your doctor will assess the uterine health and the size and location of the fetus. The cervix opening may be measured if there is no premature rupture of membranes or placenta previa. Your doctor may examine for evidence of uterine bleeding.
Transvaginal ultrasound: This is to measure the length of the cervix, determine the location and weight of the fetus, and assess the amount of amniotic fluid.
Lab tests: A vaginal swab for bacterial culture to check for infections and fetal fibronectin, which acts like a glue between the amniotic sac and uterine wall, may be considered.

Treatment

There are no medications or definitive treatments that can stop labor. However, your doctor may prescribe the following drugs to you.

Corticosteroids to accelerate the development of fetal lungs for pregnant women at 23-34 weeks of pregnancy who are at risk of preterm birth in the next 1-7 days or those at risk of preterm birth between 34th – 37th weeks of pregnancy.
Magnesium sulfate can lower the risk of cerebral palsy, particularly in babies born before 32 weeks of pregnancy.
Tocolytics can decrease the contractions for at least 48 hours so that the fetal lungs gain time to respond to corticosteroids given through the mother. However, one should avoid tocolytics in women with pregnancy-induced hypertension.

Surgery

Your doctor may perform a cervical cerclage if you are at risk of preterm birth due to the previous history, a short cervix less than 25 millimeters, especially when the pregnancy is less than 24 weeks, or effacement of the cervix. The suture will be removed once the pregnancy reaches the 36th week or sooner if necessary.

Medications

If you have a history of preterm birth, your doctor may prescribe an injectable progesterone hormone known as hydroxyprogesterone caproate at the start of the second trimester until the 37th week. If you have a short cervix before the 24th week of pregnancy, a progesterone vaginal suppository may be prescribed. The use of the vaginal hormone suppository is as effective as cervical cerclage.

Lifestyle modification and home remedies

The false labor contractions or Braxton Hicks contractions are usual. However, if you have suspicious symptoms, you may try walking, resting, or shifting position to see if symptoms improve. If the contractions persist, you may develop preterm labor.

Bed rest cannot lower risk of preterm labor in a woman without other risk factors. On the contrary, it may weaken the muscles, cause blood clots, and make you feel depressed.

Preparation before the doctor's appointment

Bring a partner, family member, or friend to take note of the doctor's advice.
List the questions you would like to ask your doctor.

Questions you may want to ask your doctor

Are these symptoms of labor?
Am I at risk of preterm delivery?
Is there anything I should do or should not do to keep this gestation safe?
What are the DOs and DON'Ts to sustain this pregnancy to term?
What symptoms signify that I need immediate medical care?

Questions your doctor may ask you

When did the symptoms begin?
How often are your contractions in one hour?
Do you notice any vaginal spotting?
Do you have a fever, or are you exposed to anyone who is sick?
When was your last pregnancy? Have you had a miscarriage or uterine surgery?
Do you smoke?
How far is your place from the hospital? How long does it take to reach the hospital?

Preterm labor and birth are detrimental to the newborns. You should discuss it with a doctor to understand the condition and know what you can do to maintain self-care conducive to robust fetal health.