Premature (pre-term) labour
preterm; premature; labour;
Most pregnancies go to full term of about 40 weeks. However, about 8.5% of babies will be born before 37 completed weeks of pregnancy.
Going into labour before 37 weeks of pregnancy is called preterm labour.
Having preterm labour may not mean you are about to give birth. Only about 50% of women with preterm labour will actually go on to give birth within 7-10 days.
If preterm labour is identified and treated early, it may be possible to prevent a preterm birth. If you think that you have gone into labour early, it is important to seek care as soon as possible. We know that a woman’s view about being in preterm labour is often correct.
Why is preterm birth a concern?
Preterm babies have not finished developing and some are very small.
Some very premature babies may need the intensive care and artificial support systems of a special hospital nursery - often for a long time - until they can breathe and feed on their own, and regulate their own body temperature.
Even with this intensive care, complications of preterm birth are the most serious threat to the life and health of a newborn baby.
However most premature babies born after 26 weeks, and almost all babies born after 28 weeks of pregnancy, will survive with special care. Some very small babies may have ongoing problems with development.
Preventing preterm labour
There is no way to prevent preterm labour from starting. However, early treatment may:
- stop labour completely and allow the baby to grow to maturity before birth
- stop labour for a short time. This allows time (usually 48 hours) for steroids to be given to help mature the baby’s lungs for breathing.
Who is at risk?
Any woman can have preterm labour. The risk is higher if you have:
- had preterm births before – the likelihood increases with each birth
- stress, poor diet, poor living conditions
- poor dental health - teeth decay and gum disease
- had infections, eg urinary tract infections
- smoked or used drugs or alcohol during pregnancy
- a multiple pregnancy (twins or more).
Signs and symptoms
Preterm labour can be difficult to identify as many of the signs occur normally throughout pregnancy. They include:
- Contractions in preterm labour can be similar to those at full term. However, for many women they may be less painful and experienced as pain or ‘cramps’ in the sides or back.
- Preterm contractions are usually regular and consistent in length. They may happen every 5, 10, 15, 20 or 30 minutes, last 40 to 60 seconds, and continue over a period of time.
- Contractions for some women in preterm labour however have no regular pattern.
- Preterm labour contractions can be confused with Braxton Hicks contractions which have no regular pattern.
Leakage of fluid from the vagina
- For some women there may be no contractions but the waters may break.
- This could be an unmistakable large gush of fluid, or a harder to identify ‘slow leak’ or ‘watery vaginal discharge’. Your underwear may be constantly wet.
- You may have cramps that are either rhythmic or constant. You may feel an ache in your lower abdomen just above the pubic bone, or in your back.
- You may have cramps with or without diarrhoea. They may feel like ‘gas pains’.
Increasing lower backache
- You may have lower backache, which may radiate to your sides or the front. It may be rhythmic or constant, and may not be relieved by change of position.
- You may feel pressure or fullness in your pelvic area, back passage, or thighs. It may feel as though the baby is pushing down or is going to ‘fall out’.
Increase or change in vaginal discharge
- You may have an increase in vaginal discharge, or the consistency may change to mucousy or watery. It may be tinged with pink or brown blood.
Care and treatment
If you are experiencing symptoms of preterm labour, care and treatment for you and your baby may involve:
Admission to hospital
- You will need to be admitted to hospital so that your contractions and your baby’s heart rate can be monitored. You may need to stay for a few hours or a day or two until contractions settle down.
Assessing the cervix
- A doctor or midwife will assess your cervix by internal examination. This will show whether your cervix is preparing for delivery by becoming thinner and opening (dilating). You may be examined every 4 hours while your contractions are happening.
- You may have an ultrasound to assess your baby’s size and growth, the fluid around your baby, and blood flow through the cord. Your placenta and cervix will also be assessed.
- If your baby is less than 34 weeks, you will be given steroids to help mature your baby’s lungs for breathing.
What happens next?
Doctors or midwives will discuss your test results with you, and what action will be best for your and your baby’s health. If your baby is going to be born early you will have a chance, if there is time, to talk with staff of the unit that your baby will be cared in.
Very premature babies may need care in a hospital with special care or intensive care nurseries. If needed it may be recommended that you transfer to a hospital with this 'Tertiary' care facility. It is best for the baby if a mother is transferred to that hospital before delivery, however in Australia a special team of doctors, midwives and nurses would be able to provide expert care when needed to transfer a premature infant to a tertiary care hospital.
Women's and Children's Hospital (South Australia) fact sheet 'Prevention of preterm labour'
Topic on this website Premature babies
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