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Preterm Labor

GENERAL INFORMATION:

What is preterm labor? Preterm (premature) labor occurs when the uterus (womb) contracts and the cervix opens earlier than normal. The cervix is the opening of your uterus. Labor brings changes to prepare the baby to move from the uterus through the vagina (birth canal). This includes tightening and relaxing of your uterus, which causes the cervix to get thinner and open. Preterm labor happens after the 20th week of pregnancy but before the 37th week of pregnancy. An early labor could cause you to have your baby before he is ready to be born.

What causes preterm labor? No one knows for sure what causes preterm labor. The following are some factors that may cause early labor:

• Abnormal uterus: The shape of your uterus may cause preterm labor. A large uterus or a short cervix can cause you to go into labor early.
  
  
• Chronic illness: Illnesses such as high blood pressure, diabetes, or obesity can cause early labor.
  
  
• Infection: Infections, such as urinary tract infections or bacterial vaginosis, can weaken the membranes (linings) that surround the amniotic sac your baby lies within. The amniotic sac contains the fluid around your baby. This could lead to premature rupture of the membranes and preterm labor.
  
  
• Problems with the placenta: Problems with the placenta, such as placenta previa or placental separation, may cause preterm labor. The placenta is the tissue (like skin) that joins you to your baby.
  
  
• Trauma: Injury to your abdomen (stomach) or uterus may also cause some cases of preterm labor.

What are my risks of having preterm labor? You may be at an increased risk if:

• You are pregnant with two or more babies.
  
  
• You are under 17 or over 35 years of age.
  
  
• You get pregnant again in less than 6 months.
  
  
• You had a preterm labor or preterm birth in the past.
  
  
• You have no prenatal check-up with your caregiver.
  
  
• You smoke, drink alcohol, or use street drugs during pregnancy.
  
  
• You weigh less than what your caregiver recommends before getting pregnant. Poor weight gain during pregnancy may also increase your risk of having early labor.

What are the signs and symptoms of preterm labor? You may not know that you are having preterm labor. It is common for some women to have preterm contractions (tightening and relaxing of the uterus) and not notice them. The following are signs and symptoms that suggest a preterm labor:

• Abdominal pain or menstrual-like (period-like) cramping.
  
  
• Change in vaginal discharge, such as increase in amount or the discharge becomes watery or bloody.
  
  
• Low back pain.
  
  
• Pressure in the lower abdomen.
  
  
• Vaginal spotting or bleeding.

How is preterm labor diagnosed? You may have one or more of the following tests to check if you are having a preterm labor:

• Fetal fibronectin test: This test checks for a protein called fetal fibronectin in the cervix or vagina. Normally, there is no protein in cervical and vaginal secretions from the 20th week of pregnancy until near term.
  
  
• Pelvic exam: This is also called an internal or vaginal exam. During a pelvic exam, feel free to ask for a woman to be present if one is not. Your caregiver gently puts a warmed speculum into your vagina. A speculum is a tool that opens your vagina. This lets your caregiver see your cervix (bottom part of your uterus). With gloved hands, your caregiver will check the size and shape of your uterus and ovaries.
  
  
• Vaginal ultrasound: This simple test uses sound waves to show pictures of the inside of your uterus (womb) and ovaries. A small tube is placed into your vagina. Pictures of your uterus and ovaries are seen on a TV-like screen.

How is preterm labor treated?

• Bed rest: You may need to drink lots of fluids and rest in bed on your left side, which improves circulation to the uterus. Your caregiver will tell you when it is OK to get out of bed.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Corticosteroids: These medicines may be given if your preterm labor cannot be stopped and your caregiver thinks you may deliver the baby early. These medicines help your child's lungs to mature and prevent breathing problems after your baby is born.
    
    
  • Tocolytics: Tocolytics are given to stop contractions if your baby is not ready to be born. Contractions are when the muscles of your uterus tighten and loosen.

Where can I find more information? Having preterm labor may be life-changing for you and your family. Accepting that you have preterm labor may be hard. You may feel afraid, sad, or scared. Talk about your feelings with your caregiver or someone close to you. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington, DC 20090
  Phone: 1-202-638-5577
  Web Address: http://www.acog.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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