What You Need To Know About Preterm Labour

What can cause preterm labour? What are the signs of preterm labour? Can a baby survive preterm labour? What is the difference between preterm labour and preterm delivery?

All pregnancies have a due date. It is reassuring for the mother-to-be to know when she will give birth and finally meet her new son or daughter. But things do not always go as planned.

Sometimes, pregnancies have a surprise (or more) for the expectant mum, like when labour begins early, and the baby seems to want to come out way before the ideal 40-week period. This is called premature or preterm labour.

“Preterm labour is having labour pains or uterine contractions that lead to the opening up of the cervix between 20 weeks and less than 37 completed weeks of pregnancy,” said Dr. Katleen del Prado, an obstetrician-gynaecologist from the Philippines, whose subspecialties are maternal-foetal medicine (perinatology) and high-risk pregnancies.

Early labour could result in delivery and a premature baby.

What Is Preterm Labour

Preterm labour is a condition in which contractions occur before 37 weeks of gestation.

A woman is considered to be in early labour if she experiences regular 37 weeks of gestation.

Early labour can range from mild to severe and may cause the baby to be born too early. The more severe the condition, the more likely the baby will not survive or be born with complications.

It is important to note that some women may experience early contractions that do not indicate early labour. If they persist for more than 24 hours, however, they should consult their doctor immediately because they could be an indication of infection in the uterus or placenta.

What Is the Difference Between Preterm Labor and Preterm Delivery?

Preterm labour and preterm delivery are distinct stages in the process of giving birth prematurely. Preterm labour refers to the onset of contractions and other signs of labour before 37 weeks of pregnancy. It is a warning sign that premature birth may occur.

Preterm delivery, on the other hand, is when a baby is born before completing 37 weeks of gestation. While preterm labour may be successfully halted or delayed with medical intervention, preterm delivery signifies that the baby is born early, often necessitating care in a neonatal unit to support their health and development.

Preterm Labour Symptoms

What are the signs of preterm labour?

These can be different for everyone, but there are some common symptoms that you’ll want to look out for.

Some of the most common preterm labour symptoms include:

• Cramping
• Water breaking (or leaking)
• Bloody show
• Pelvic pressure or pain in your lower back or abdomen

Recognising the signs is crucial for taking prompt action. If you have any of these symptoms, contact your doctor immediately!

Image Source: iStock

Causes of Preterm Labour

What causes preterm labour?

Preterm labour, occurring before 37 weeks of pregnancy, can be triggered by various factors. Here are some of the most common causes:

• Infection

According to Dr. del Prado,

“The most common causes are urinary tract infection (UTI) and cervicovaginal infections, but infections elsewhere, like in the lungs for pneumonia or in the mouth for periodontal disease, can trigger preterm labour as well.”

Other causes of preterm labour are:

• • Uterine stretch or conditions that stretch the uterus, like when there is too much fluid or the baby is too big. Uncontrolled diabetes mellitus, for instance, can increase the amniotic fluid.
  • Cervical incompetence or the opening up of the cervix, even if without uterine contractions. “This is not under the classification of preterm labour but is a significant cause of preterm delivery,” explained Dr. del Prado.
  • Spontaneous preterm birth, which causes about two-thirds of all premature births, is when labour happens on its own and/or the pregnant woman’s water breaks early.

“There are many causes of preterm labour,” said Dr. del Prado.

“We must understand how labour works. Labour happens because of uterine contractions and the opening up of the cervix. The basic mechanisms are inflammation, muscle stretch, and cervix opening spontaneously or secondary to contractions.”

Image source: iStock

• Stress

Stressful situations like a death in the family or losing your job can cause stress hormones to increase and cause contractions, which can lead to early labour.

• Age

Women younger than 20 or older than 35 are more likely to experience premature birth than those who fall between 20 and 35 years old.

Women in their 40s have a higher risk of delivering a baby prematurely than women in their 20s or 30s. This is because older women are more likely to have medical conditions that contribute to early labour, such as diabetes or high blood pressure (hypertension).

• Smoking

Smoking increases your risk of contracting preterm labour as it reduces the amount of oxygen that enters the placenta. This means that less blood will be available for you and your baby once you give birth.

• Diabetes

If you are diabetic, there’s an increased chance that your blood sugar levels will rise too high during pregnancy which can cause complications such as high blood pressure and heart disease, which could lead to preterm labour.

• Being overweight

When you’re overweight or obese during pregnancy, there’s an increased risk of developing gestational diabetes (diabetes during pregnancy) which can also lead to complications like preterm labour.

• High blood pressure (hypertension)

Gestational hypertension or high blood pressure during pregnancy puts you at risk for developing preeclampsia (a type of pregnancy-related high blood pressure) which may lead to preterm labour if left untreated.

Image Source: iStock

Preterm Labour Complications

The complications of preterm labour are numerous and include:

• Uterine infection
• Placental abruption
• Respiratory distress syndrome (RDS)
• Low birth weight babies (especially if the pregnancy lasts for less than 24 weeks)

What Is Threatened Preterm Labour

Threatened preterm labour is when a woman experiences regular contractions and dilate. Still, the cervix has not fully opened, and the baby has not descended into the birth canal.

The most common cause of threatened preterm labour is a bacterial infection or inflammation of the uterus (endometritis), though other causes exist.

Most often, it not result in an actual birth before 37 weeks (gestational age). However, about 20 per cent of women who experience this condition go on to deliver their babies prematurely.

The main symptom of threatened preterm labour is contractions that occur regularly at least 6 to 8 minutes apart and last 30 seconds or longer. They may be painful or mild, depending on your pregnancy’s length.

If you think you might be having threatened preterm labour, call your doctor immediately.

How to Avoid Preterm Labour From Happening

If you have experienced preterm labour, there are several things you can do to reduce the chance of it happening again:

• Do not smoke or drink alcohol during pregnancy. Both of these things can increase your risk of preterm labour.
• Stay active as much as possible. This helps keep your blood pressure and stress levels down, which can also help prevent preterm labour.
• Avoid stressful situations whenever possible. If you have an upcoming exam or interview scheduled during your pregnancy, try to reschedule it until after the baby is born so you don’t put yourself under unnecessary stress (which can increase your risk for preterm labour).

Can a Baby Survive Preterm Labour?

Advances in medical care have significantly improved the chances of survival for babies born prematurely. The likelihood of a baby surviving preterm labour depends on various factors, including how early the birth occurs and the level of medical intervention available.

Babies born at around 24 to 28 weeks may have a good chance of survival, although they may face health challenges and require specialised care in the neonatal intensive care unit (NICU).

The chances of survival and long-term health outcomes improve with each passing week of gestation, making it crucial to delay preterm labour when possible through medical intervention and lifestyle choices.

Other Noteworthy Facts About Preterm Labour

1. Preterm labour is not life-threatening to the mother

Image source: iStock

However, the premature birth that usually results from it is the leading cause of death for neonates or newborns worldwide, shared Dr. del Prado. According to the World Health Organization (WHO), an estimated 15 million babies are born too early every year, and about one million die annually due to preterm birth complications. WHO also reported that prematurity is the leading cause of death in children under five.

2. Being pregnant with twins, triplets or more increases the risk of preterm labour

This is because carrying more than one baby can overstretch the uterus.

Other risk factors are:

• having medical conditions like anaemia, and blood clotting disorders
• having a premature baby in the past
• being pregnant after in vitro fertilization (IVF)
• having a baby with birth defects
• having problems with your uterus, cervix or placenta
• getting pregnant too soon (less than six months) after giving birth
• lack of or no prenatal care
• chronic stress

According to the American Pregnancy Association, premature labour occurs in about 12 per cent of all pregnancies. But mothers-to-be are at the greatest risk for it if they have these three simultaneously:

• multiple babies (carrying triplets or more)
• a previous premature birth
• specific uterine or cervical abnormalities

3. Pregnant women with no known risk factors can experience preterm labour. Conversely, having one or several risk factors does not automatically mean you will go into early labour

4. The warning signs of preterm labour are very similar to labour that occurs at term

These are:

• regular or frequent contractions (five or more in an hour) that feel like menstrual cramps or could be painless
• a dull, low backache that is constant or may come and go
• watery fluid leaking from your vagina (a gush or a trickle) to show that your bag of water or amniotic sac has broken
• pelvic or lower abdominal pressure
• vaginal spotting or bleeding
• increase or change in vaginal discharge (it may be watery, bloody or include mucus)
• nausea, diarrhoea or intestinal upset

The woman will feel labour pains, said Dr. del Prado, like any other labouring woman.

“The contractions usually happen hourly, then the interval between shortens, until it becomes every two to three minutes. The pain is like the pain we feel during menses in the lower belly and radiates to the lower back.

There is a watery or bloody-mucoid type of vaginal discharge. There are contractions of the uterus and opening up of the cervix upon digital internal examination by the doctor.”

Contact your doctor immediately if you experience these signs and symptoms.

6. Doctors can stop or slow down early labour

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Medications can be given, for example, to stop contractions and delay delivery or keep the baby in the womb as long as possible.

“Choice of medications is highly individualised because these are not without side effects, and hence, cannot be overly prolonged. Response to these medications also depends on the patient, who may or may not be admitted depending on the case,” said Dr. del Prado.

7. Sometimes, preterm labour stops on its own

This happens in three out of 10 pregnant women, according to the American College of Obstetrics and Gynecology (ACOG). The Centers for Disease Control and Prevention (CDC) likewise reported that up to 50 per cent of women who experience preterm labour go on to have their babies at 37 weeks or later.

8. Preterm labour can be scheduled

Yes, this type of labour is not always surprising or unexpected. According to the National Health Service (NHS), certain cases call for planned and induced premature labour because it is safer for the baby to be born earlier. An example is when the expectant mother has a high blood pressure disorder like preeclampsia.

9. A pelvic exam is done by the doctor to confirm preterm labour

Your doctor will check your cervix for changes and monitor your contractions. These changes include effacement (the cervix thins out) and dilation (the cervix opens so the fetus can enter the birth canal).

Your doctor may need to examine you repeatedly as your labour progresses in the next few hours. He/she could do other tests, like a transvaginal ultrasound, to check the length of the cervix and determine if specialised care or hospitalisation is needed.

10. Management of preterm labour is highly individualised

Women have different histories, risk factors, and pregnancy experiences. Not all who go into early labour, for example, will need a cervical cerclage or a cervical stitch. This is a treatment for cervical weakness (when the cervix starts to shorten and open too early during pregnancy) and could help prevent a late miscarriage or premature birth.

You might receive one or more treatments and medications from your doctor to stop or delay early labour, hasten your baby’s development, or help you feel better.

It is important to have professional medical care throughout your pregnancy.

“Those with previous preterm births must be managed by obstetricians and deliver their babies in the hospital,” stressed Dr. del Prado.

11. You can reduce the risk of preterm labour by dealing with treatable risk factors

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Start by getting very early prenatal care with a perinatologist or a high-risk pregnancy expert, even if you have yet to conceive, as Dr. del Prado recommended. This way, you can plan your pregnancy, control chronic conditions effectively, and make the necessary lifestyle changes to improve your health.

For those already pregnant, consult with an obstetrician regularly and at the earliest stage of pregnancy as possible.

Here are other steps you can take to reduce the risk of preterm labour and have a healthier pregnancy:

• Eat a well-balanced diet and take supplements if needed.
• Strive to reach your ideal weight before getting pregnant, especially if you need to lose or gain several pounds.
• Avoid all products and substances that could harm you and your baby, like tobacco, illegal drugs, and alcohol.
• Work with your doctor to manage medical conditions such as high blood pressure and diabetes.
• Seek treatment for all infections. Ideally, this should be done before pregnancy.
• Get enough rest and sleep.
• Minimise stressful situations, strenuous activities, and long periods of standing.
• Discuss pregnancy spacing and birth control options with your doctor.

Obstetrician-gynecologist Katleen del Prado, MD, FPOGS, FPSMFM, is a perinatologist and high-risk pregnancy specialist who practices in Lucena City, Quezon, Philippines. You can find her on Facebook: Katleen Del Prado, MD-ObGyn

Updated by Pheona Ilagan

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