Overview
Preterm labor occurs when regular contractions cause the cervix to open before week 37 of pregnancy, which is before the baby is full term. It can lead to premature birth, which poses health risks for the baby, including long-term mental and physical disabilities. The specific cause of preterm labor is often unknown, but certain risk factors can increase the chance of experiencing it. Risk factors include a history of previous preterm labor or premature birth, pregnancy with multiples, problems with the uterus or placenta, smoking, certain infections, chronic conditions, stressful life events, and certain intervals between pregnancies. Symptoms of preterm labor include regular or frequent abdominal tightening, backache, pelvic or lower abdominal pressure, mild abdominal cramps, vaginal spotting or bleeding, and a sudden gush or continuous trickle of fluid. If you experience these symptoms, contact your health care provider right away.
Understanding the disease
Symptoms
The 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, and vaginal spotting or light bleeding. Other signs may include preterm rupture of membranes (fluid gushing or leaking), a change in vaginal discharge (watery, mucus-like, or bloody), and decreased movement or activity from the baby. If you experience any of these symptoms or are concerned about your pregnancy, it is essential to contact your healthcare provider immediately.
Risk Factors
Risk factors for developing preterm labor include:
- Pregnancy with multiples (twins, triplets, etc.)
- Shortened cervix
- Problems with the uterus or placenta
- Smoking cigarettes or using illicit drugs
- Certain infections, particularly of the amniotic fluid and lower genital tract
- Certain chronic conditions, such as high blood pressure, diabetes, autoimmune disease, and depression
- Stressful life events, such as the death of a loved one
- Too much amniotic fluid (polyhydramnios)
- Vaginal bleeding during pregnancy
- Presence of a fetal birth defect
- An interval of less than 12 months or more than 59 months between pregnancies
- Advanced maternal age (both young and older)
- Black, non-Hispanic race and ethnicity It is important to consult your healthcare provider if you experience any symptoms of preterm labor or have concerns about your pregnancy.
Development
Preterm labor can develop due to a variety of factors, including:
- Shortened cervix: A cervix that is shorter than normal can lead to preterm labor. This might be caused by weak cervical tissues, hormonal changes, or previous surgeries.
- Problems with the uterus or placenta: Issues with the structure or function of the uterus or placenta can contribute to preterm labor. These issues can include uterine abnormalities, inadequate blood flow to the placenta, or placental abruption.
- Smoking cigarettes or using illicit drugs: Both smoking and illicit drug use can increase the risk of preterm labor. Smoking can cause cervical weakness, while illicit drugs can lead to premature contractions.
- Certain infections: Infections in the amniotic fluid or lower genital tract can trigger preterm labor. These infections can include bacterial vaginosis, urinary tract infections, and sexually transmitted infections.
- Chronic conditions: Maternal conditions like high blood pressure, diabetes, autoimmune diseases, and depression can increase the risk of preterm labor.
- Stressful life events: Emotional stress, such as the death of a loved one, can contribute to preterm labor.
- Too much amniotic fluid (polyhydramnios): An excessive amount of amniotic fluid can place pressure on the uterus and trigger preterm labor.
- Vaginal bleeding during pregnancy: Any form of vaginal bleeding during pregnancy can be a sign of preterm labor.
- Fetal birth defects: Certain fetal birth defects might cause preterm labor.
- Inadequate pregnancy spacing: Pregnancies that are too close together or too far apart can increase the risk of preterm labor. It's important to note that the specific cause of preterm labor is often not clear, even when there are identified risk factors. If you have concerns about preterm labor, please consult your healthcare provider.
Assessment and Diagnosis
Triage
If you experience symptoms of preterm labor, such as regular contractions, abdominal tightening, constant low backache, pelvic or lower abdominal pressure, mild abdominal cramps, or vaginal spotting or light bleeding, you should contact your healthcare provider right away. It's better to err on the side of caution, as preterm labor can lead to premature birth, which may result in health risks for your baby.
Diagnosis
To diagnose preterm labor, healthcare providers typically review a patient's medical history, risk factors, and evaluate symptoms such as regular uterine contractions and cervical changes. Tests and procedures may include pelvic exams, ultrasounds, uterine monitoring, lab tests to check for infections and fetal fibronectin, and urine tests to detect bacteria. If you suspect preterm labor, consult with your healthcare provider who can determine the best course of action.
Management and Treatment
Complications
Potential complications of preterm labor include delivering a preterm baby, which can pose health concerns for the baby such as low birth weight, breathing difficulties, underdeveloped organs, and vision problems. Preemies also have a higher risk of cerebral palsy, learning disabilities, and behavioral problems. Other complications of preterm labor may include infections in the mother or baby, placental abruption, and premature rupture of membranes.
Prevention
Preterm labor, or labor that occurs before 37 weeks of pregnancy, can be challenging to prevent completely. However, there are steps you can take to promote a healthy, full-term pregnancy. These include:
- Seeking regular prenatal care: This allows your healthcare provider to monitor your health and your baby's health, and address any concerns.
- Eating a healthy diet: Consuming a nutritious diet rich in polyunsaturated fatty acids (PUFAs), found in nuts, seeds, fish, and seed oils, may help lower the risk of premature birth.
- Avoiding risky substances: Quit smoking and avoid illicit drugs.
- Cervical cerclage: If you have a history of preterm birth and a short cervix, your healthcare provider may suggest this procedure during pregnancy to provide extra uterine support.
- Pregnancy spacing: Consider discussing pregnancy spacing with your healthcare provider, as some research suggests a link between certain pregnancy intervals and an increased risk of premature birth.
- Managing chronic conditions: Work with your healthcare provider to keep any chronic conditions like diabetes, high blood pressure, or obesity under control.
- Avoiding assisted reproductive technology (ART) risks: Discuss with your healthcare provider the number of embryos to be transferred during ART to minimize the risk of multiple pregnancies. Remember, while these steps may help lower the risk of preterm labor, it may not be possible to prevent it entirely. Always consult your healthcare provider for personalized advice.
Treatment
Treatments for preterm labor depend on the specific situation and the stage of the pregnancy. In some cases, medical interventions can help stop or slow down preterm labor.
Preparing for medical consultation
To prepare for an appointment for preterm labor, you can take the following steps:
- Write down any symptoms you're experiencing, including when they first started and how they've changed over time.
- Make a list of key personal information, including any previous pregnancies, miscarriages, or cervical or uterine surgeries you've had.
- Include all medications, vitamins, herbs, or supplements you're currently taking and their dosages.
- Bring a family member or close friend with you to the appointment for support and to help recall important information.
- Prepare a list of questions to ask your health care provider, such as:
- What are the possible causes of my preterm labor?
- Are there any treatments that could help prolong my pregnancy?
- What signs or symptoms should prompt me to call you or go to the hospital?
- What are the risks if my baby is born prematurely?
- Take notes during the appointment to help remember important information discussed. By being well-prepared, you can make the most of your appointment and ensure you receive the best possible care for you and your baby.