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Warning Signs of Preterm Labor
Most of us can’t wait to meet our baby. We eagerly await the onset of labor, which usually starts 38 to 42 weeks after the last menstrual period. If labor begins before 37 weeks, it is called “preterm labor.”

It is normal to feel occasional uterine contractions when you do physical activities such as walking, exercise or sex. However, if contractions become frequent and regular, they can cause the cervix to dilate early, increasing the chances for a premature delivery.

Preterm delivery occurs in 10% of pregnancies, often without obvious cause. Babies born prematurely are at risk for problems with their breathing, vision, hearing, learning and behaviour, and have higher rates of newborn death. If preterm labor is identified early, it can often be treated, allowing the pregnancy to continue longer and decreasing the chances for preterm birth.

A number of factors increase your risk for preterm labor:
  • Carrying more than one baby

  • A history of preterm labor in a prior pregnancy

  • Prior cervical surgery such as a cone biopsy or LEEP procedure

  • Being underweight or undernourished

  • Cigarette smoking or using cocaine or other street drugs

  • Urinary tract or vaginal infections during pregnancy

  • Prior second trimester abortions

  • Having little or no prenatal care

  • Being younger than 18 or older than 40

  • Having uterine fibroids or an unusual uterine shape

  • Bleeding in the second or third trimester of pregnancy

  • Cervical incompetence (when the cervix is weak and opens early)
Preterm labor is most successfully treated if it is detected early. It is important to call your health provider immediately if you experience any of the following signs:

  • Regular, rhythmic contractions of your uterus, either painful or painless. (The uterus will tighten like a ball, and be hard to indent with your fingers.)
  • Menstrual-like cramps

  • Low back pain (constant or rhythmic in nature)

  • Abdominal cramping, petrol or diarrhea

  • Watery vaginal discharge, or unusual gush of fluid or leakage

  • Pelvic or low abdominal pressure

  • Vaginal bleeding
It is difficult to know if you are truly in preterm labor without having an exam by a qualified provider. If you are leaking fluid, your provider will check you to determine if it is amniotic fluid. You may be monitored to detect the frequency of uterine contractions, and have a vaginal exam to check the length (effacement) and opening (dilation) of your cervix. An ultrasound can also be used to determine the length of your cervix. Your urine will be examined to see if you have an infection. A swab of the cervical-vaginal secretions can be tested for “fetal fibronectin” which can help your doctor estimate your chances of having preterm delivery.

If you are found to have preterm labor, you will be advised to rest on your side and relax. Dehydration can exacerbate preterm contractions. You will be given fluids by mouth or an intravenous line to relieve contractions that may be related to dehydration. Urinary and vaginal infections will be treated. If your amniotic fluid is leaking you may be given antibiotics. Several medications are effective at halting contractions; some of these can be taken at home, while others require hospitalization for administration. If labor can be postponed, a steroid medication may be given to accelerate your baby’s lung development.

In some cases, it may be wiser for your baby to be delivered early. This is especially true if your baby is showings signs of distress, if your own health is at risk, or if you have an intra-uterine infection. Sometimes medication is used to induce labor; other times cesarean sections are advisable.

The most important thing you can do to have a healthy baby is to get regular prenatal care, and inform your health care provider of any risk factors you may have for having a premature delivery. Drink plenty of fluids and rest when you are fatigued. Learn the warning signs of preterm labor, and do not hesitate to seek immediate medical attention if you develop any of these symptoms.
Laura E. Stachel M.D. Obstetrician & Gynecologist