Preterm (premature) labour

What is preterm labour?

Preterm or premature labour refers to going into labour before 37 weeks of pregnancy. This can result in preterm or premature births. Premature babies can have problems with their brains, lungs, hearts, eyes and other organs. They can also have long-term health issues including intellectual and development delays.

Why does preterm labour happen?

In some cases, an exact cause cannot be found. Risk factors of preterm labour include:

• History of preterm labour in previous pregnancy
• Anything that increases uterine distension: big baby, having twins, excessive amniotic fluid (polyhydramnios) 
• Abnormal uterine shape
• Short cervix e.g. history of previous cervical operations
• Smoking
• Infections
• Short pregnancy gap 
• Younger or older mothers
• Low-lying placenta/ placenta previa
• Medical conditions e.g. lupus

What are the symptoms of preterm labour?

These may include:

• Abdominal tightenings or contractions
• Lower backache 
• Pelvic pressure
• Vaginal bleeding 
• Preterm premature rupture of membranes (PPROM)

If you experience any of the above or think you may be going into preterm labour, contact your gynaecologist immediately.

What tests do I need to diagnose preterm labour?

Your gynaecologist will need to take a detailed history and perform a vaginal examination to check for cervical dilation. Vaginal swabs may need to be taken e.g. Actim Partus to check for the possibility of going into preterm labour in the next 48 hours. Both vaginal swabs and urine samples will be taken to screen for infections. Your baby’s position (head up or down) will be checked. An electronic monitor (cardiotocography/CTG) will be used to monitor your baby’s well-being by checking his/her heartbeat and the frequency of your contractions.

How is preterm labour treated?

You will need to be hospitalised. Depending on how many weeks pregnant you are, you may require:

• Steroid injections: these help mature your baby’s lungs faster to reduce the risk of breathing difficulties at birth
• Antibiotics: these reduce the risk of infection 
• Tocolytics: these are medications to relax your uterus and stop premature labour
• Intravenous magnesium sulphate: to reduce risk of preterm brain injury
• Regular temperature, blood pressure, pulse rate, oxygen saturation monitoring: as some tocolytics may cause side effects such as fast heart rate or breathlessness
• Regular checks on your baby’s heartbeat and uterine contractions 

If your preterm labour continues despite treatment and you are deemed at high risk of having a preterm birth, your gynaecologist will discuss the appropriate mode of delivery with you (vaginal delivery versus caesarean section). If your preterm labour is successfully treated and your contractions subside, you may be allowed to go home with close outpatient clinic visits. 

I’ve had preterm labour/birth in my previous pregnancy. Will it happen again in my next pregnancy?

You do have an increased risk of having premature labour and birth in your subsequent pregnancies, but there are things that can be done to reduce this risk – do speak with your gynaecologist for advice.