Preterm labor

Preterm labor is labor that begins before 37 weeks of pregnancy and may include one or more of the following:

• Uterine contractions accompanied by cervical changes
• Rupture of the amniotic sac (breaking your water)
• Cervical dilation (opening of the cervix)

Preterm birth is the greatest problem associated with preterm labor. Although most babies are born after 37 weeks, those born preterm are at increased risk for many complications.

Premature babies are born before their bodies and organ systems have completely matured. These babies are often small, with low birth weight (less than 5.5 pounds), and they may need help breathing, eating, fighting infection and staying warm. Very premature babies, those born before 28 weeks, are especially vulnerable. Many of their organs may not be ready for life outside the uterus, which is why our maternal fetal medicine specialists and NICU team are here with around-the-clock care for your child.

Northwell Health has a robust Division of Maternal Fetal Medicine (MFM). The physicians in the MFM division completed additional years of training beyond an OB/GYN residency and are intimately familiar with cutting edge research in the field of preterm labor. Our specialists work tirelessly to offer the most current, evidence-based management and prevention of preterm labor. You can be sure our experts will explore all options to give you the clearest path to starting or growing a healthy family.

The following are the most common symptoms of preterm labor. However, everyone experiences symptoms differently.

Symptoms may include:

• Uterine contractions, especially more than four in one hour
• Menstrual-type cramps
• Pelvic pressure
• Backache
• Intestinal upset
• Vaginal bleeding, mucus or watery discharge

If you notice any symptoms of preterm labor, you should call your doctor as soon as possible. The symptoms of preterm labor may resemble other medical conditions, which is why you should consult a doctor for a diagnosis.

Many factors can contribute to preterm labor or premature rupture of membranes (breaking of the amniotic sac).

Maternal factors include:

• Infection (such as urinary tract infections, vaginal infections, infections of the fetal/placental tissues)
• Drug abuse (such as cocaine or tobacco)
• Abnormal shape of the uterus
• Cervical insufficiency (inability of the cervix to stay closed during pregnancy)
• Previous preterm birth

Factors involving the pregnancy:

• Abnormal or decreased function of the placenta
• Vaginal bleeding
• Placenta previa (low lying position of the placenta)
• Placental abruption (early detachment from the uterus)
• Premature rupture of membranes (amniotic sac)
• Polyhydramnios (too much amniotic fluid)

Factors involving the fetus:

Multiple gestation (twins, triplets or more)

If preterm labor is suspected, most women are evaluated in the labor and delivery area of the hospital. Usually, an electronic monitor is used to check the frequency and duration of contractions. This monitor has a transducer that is placed over your abdomen with a soft belt. The contractions are transmitted and recorded by the monitor. The fetal heart rate may also be monitored at this time.

Other ways of assessing preterm labor may include the following:

• Cervical examination by a specialist to determine if the cervix has softened, shortened, thinned, or dilated (opened)
• Ultrasound
• Testing for premature rupture of membranes
• Testing for fetal fibronectin (FFN)—a protein found between the fetal membranes and uterine lining which can distinguish preterm labor from Braxton Hicks contractions, or false labor

If your baby is coming into the world earlier than expected, our team of specialists will make sure he or she is as ready and developed as possible.

Your physician will likely suggest a set of steroid injections, which can help prepare your baby’s lungs, brain and internal organs. If your baby is delivered early, these steroids are a safe way to minimize the risks of prematurity.

To allow the steroids to take effect, you may also be given medications to stall your labor to give your baby more time to grow.

No matter what treatment plan is chosen, your physician will work closely with you to make sure you understand your situation, the treatment plan and why it is the recommended course of action.