Preterm Labor – Diagnosis and Treatment
Diagnosis
Healthcare providers identify preterm labor by considering several key factors. First, they talk to the patient about their medical history and any past or current risk factors that may increase the likelihood of delivering early.
| Symptom/Test | What It Shows |
|---|---|
| Regular contractions | Uterus is tightening often |
| Changes in vaginal discharge | Possible early labor |
| Cervical changes | Cervix is opening, thinning, or softening |
| Fetal fibronectin detection | Early labor may be happening |
| Ultrasound | Short cervix, fetal health, fluid |
Symptoms such as regular abdominal tightening, back pain, or changes in vaginal discharge are important signs to discuss.
A pelvic exam often helps determine if the cervix has started to dilate (open) or if it is thinning or softening earlier than expected. During this exam, the healthcare professional may also check for any vaginal bleeding.
If the placenta covers the cervix or if the patient’s water has already broken, providers may skip this exam for safety reasons.
Providers usually perform an ultrasound—often through the vagina—to measure the length of the cervix. A shorter cervix may mean a higher chance of preterm labor.
Ultrasound can also provide details about the fetus’s size and location, check the placenta for problems, and assess the amount of amniotic fluid.
Another tool, uterine monitoring, records how often and how long contractions last, helping determine if they are regular and possibly leading to labor.
Lab tests may involve checking a swab from the vagina or a urine sample. Providers look for infections or the presence of fetal fibronectin, a substance that acts like glue during pregnancy.
Finding fetal fibronectin before 37 weeks may suggest that labor could start soon.
Treatment
Stitching the Cervix Closed
Doctors sometimes use a medical procedure called cervical cerclage to help prevent early labor. In this procedure, a doctor uses strong stitches to keep the cervix closed.
This is usually recommended for women before 24 weeks of pregnancy who have had very early births in the past or have a cervix that is opening or measures shorter than 25 mm.
The stitches are generally removed after 36 weeks but can be taken out sooner if labor begins or if needed for other reasons.
Key points about cervical cerclage:
| Reason for Use | Timing | Removal |
|---|---|---|
| Short cervix (<25 mm), early birth history | <24 weeks pregnant | After 36 weeks or earlier if needed |
Progesterone Given Through the Vagina
Providers may recommend vaginal progesterone to reduce the risk of preterm labor for those who have a short cervix found before 24 weeks of pregnancy. This medicine is inserted into the vagina, usually as a gel or suppository.
It works by supporting the pregnancy and helping the cervix stay firm and closed.
How vaginal progesterone is used:
- Inserted daily as a gel, capsule, or suppository.
- Often recommended for women with a short cervix found on ultrasound.
- Used only until a certain point in pregnancy, as advised by a healthcare provider.
Medicines and Care During Early Labor
Once labor starts, providers cannot usually stop it completely, but certain treatments can help improve health outcomes for the baby and provide more time for preparation.
Types of medical care when labor starts early:
- Steroid Medications (Corticosteroids): Providers give these to help the baby’s lungs and other organs mature more quickly, especially if labor is likely within one week and the pregnancy is less than 37 weeks along. Steroids reduce the risk of breathing problems, brain bleeding, and serious infection.
- Magnesium Sulfate: This medicine protects the baby’s brain and lowers the chances of cerebral palsy if birth is expected before 32 or 33 weeks. Doctors may offer it between 24 and 32 weeks if there is a high risk of delivery.
-
Medicines to Slow Contractions (Tocolytics): Providers may use drugs like nifedipine and terbutaline sulfate to delay birth for up to 48 hours. This short delay allows steroids more time to work or gives time to transfer the patient to a hospital with special care for early babies.
- Providers do not use tocolytics to treat the reasons labor starts early and avoid them if certain health risks are present, such as preeclampsia.
Providers monitor patients closely, sometimes needing frequent visits and checkups for those at continued risk.
Everyday Choices and Remedies at Home
People can make some changes at home that may help lower the risk of early labor. Avoiding smoking and alcohol is important, as both can raise the chances of problems.
Eating nutritious foods helps the body and unborn baby stay strong. Staying hydrated is also helpful. Gentle activities, like changing positions or resting, may stop mild contractions.
Bed rest is not always needed and might cause other problems, such as muscle loss or feeling down.
Healthy Habits Table
| Habit | Benefit |
|---|---|
| No smoking | Less risk of early birth. |
| No alcohol | Safer for baby and mother. |
| Good nutrition | Supports a healthy pregnancy. |
| Staying hydrated | Helps prevent early labor. |
Emotional Wellness and Finding Help
Dealing with stress related to preterm labor risk can be hard. Speaking with the healthcare team and asking questions may help lower anxiety.
Some people find it helpful to use relaxation strategies or join support groups.
- Take time to rest.
- Practice deep breathing.
- Reach out to trusted friends or family.
Getting Ready for Your Medical Visit
Steps You Can Take Ahead of Time
Preparing for your visit with your healthcare provider is important. Keep these tips in mind to help the appointment go smoothly:
- Check for instructions before going. Sometimes, the healthcare team may want you to limit your activity while waiting for your appointment.
- Bring a support person. Having a family member or friend with you can help you listen and remember details during the visit.
- Make a list of questions. Writing questions ahead of time ensures that you won’t forget to ask anything important.
You might consider asking questions such as:
| Question | Purpose |
|---|---|
| Am I having real labor? | To understand if labor has started. |
| Can I lower the chance of an early birth? | To know if there are steps to prevent it. |
| Are treatments available for my baby? | To learn about possible care for your baby. |
| What symptoms need urgent attention? | To recognize urgent warning signs. |
| When should I come to the hospital? | To know the right time to seek hospital care. |
| What could happen if my baby arrives now? | To understand the risks of early delivery. |
It can also be helpful to create a note on your phone or a sheet of paper with these questions.
How the Healthcare Team Will Advise and Ask
During your visit, the healthcare provider will need information to give the best care. Expect to answer these types of questions:
- When did the symptoms start?
- Are there contractions, and if so, how often?
- Has there been a change in discharge or any bleeding?
- Have you been around illness or had a fever recently?
- Is there a history of other pregnancies, loss, or any operations on the cervix or uterus?
- Do you use tobacco products or have you in the past?
- How far is your home from the hospital?
- How would you get to the hospital quickly during an emergency?
If you bring this information and prepare ahead of time, you help the provider decide the next steps in your care.
