What is preterm labour?
Preterm labour refers to when a pregnant woman goes into labour before 37 weeks of pregnancy have been completed. Preterm labour does not mean that a preterm birth will occur, as the birth may be delayed depending on the situation. However, preterm labour does require immediate medical attention.
Preterm babies can also be further classified into:
- Late preterm (34-36 weeks)
- Moderate preterm (32-34 weeks)
- Very preterm (less than 32 weeks)
What are the signs and symptoms of preterm labour?
If you experience any of the following signs and symptoms, do go visit your doctor as soon as possible!
- Tightening of uterus (contractions), more than 4 per hour
- Contractions may not be painful
- Mild abdominal cramps
- Pressure in lower belly
- Constant and dull backache
- Diarrhoea
- Vaginal discharge, spotting
- Abnormal vaginal discharge — mucus-like, bloody or watery
- Water breaking
- A gush or a trickle of fluid
Can I prevent preterm labour?
- Don’t ignore any abnormal symptoms
- Have regular antenatal visits
- Antenatal visits will allow your doctor to assess you and the baby’s condition
- If one has any risk factors, your doctor may also advise you on warning signs and symptoms of preterm labour.
- Aside from that, bed rest and abstinence from sexual intercourse would also be important for those at risk of preterm labour.
- Lead a healthy and active lifestyle
- Avoid drinking and smoking
- Seek help if you are unwell
- Avoid planning a caesarean section unless medically necessary
- Manage existing medical conditions (if any)
- For example, if one has intrauterine infection, it would be good to take antibiotics to manage this condition.
- Vaginal examination and ultrasound can be used to assess the condition of the cervix
- Dilation, length and status
- This can then be used to predict preterm labour in some cases.
What increases my risk of preterm labour?
A mother’s medical history may provide insight to whether she is at increased risk of preterm labour. However, fulfilling a risk factor does not mean one will have preterm labour, and a large portion of women who experience preterm labour do not have these risk factors.
Possible risk factors include (do not that this is not an exhaustive list!):
- History of premature births, can be personal or family history
- Multiple pregnancy
- This refers to being pregnant with more than 1 baby.
- Under 17 or over 35 years old
- Cervical incompetence
- Cervix is shorter than normal or begins to dilate early
- Uterine abnormalities
- The uterus (womb) is where the baby grows
- Uterine abnormalities can include intrauterine infection
- History of premature rupture of the membranes (PPROM)
- Pregnancy complications
- Pre-eclampsia
- Gestational diabetes
- Intrahepatic cholestasis of pregnancy (liver condition)
- Foetal abnormalities
- Smoking, alcohol, drugs
- Body weight and nutrition
- Body Mass Index (BMI) under 19.0
How is preterm labour managed?
Firstly, you may need to undergo some tests so the doctor can monitor you and your baby’s condition. These tests can include:
- Pelvic examination
- Transvaginal ultrasound
- As opposed to an ultrasound examination, this type of ultrasound is carried out inside the vagina to measure the length and thickness of the cervix
- Ultrasound examination
- This is to estimate the gestational age of your baby
- Testing for foetal fibronectin (FFN)
- A swab test of cervical or vaginal fluid will be done, and if this protein is detected, it may be a sign of preterm labour.
If you are indeed going through preterm labour, then treatment may be carried out.
Aims of treatment of preterm labour:
- Achieve uterine quiescence (stop contractions)
- Reduce negative effects on the foetus
To achieve uterine quiescence
Tocolytics are a type of medication which is used to delay delivery. Possible tocolytics that your doctor may use are described below.
Beta agonists: most widely used type of medication to suppress uterine contractions. They are usually administered intravenously (IV) to the bloodstream.
- Examples: salbutamol, ritodrine, terbutaline
- Common side effects: (not an exhaustive list)
- Palpitations
- Nausea and vomiting
- Tremors
- Headaches
- Serious side effects and risks:
- Maternal tachycardia — increase in heart rate over 100 beats per minute
- Pulmonary oedema — excess fluid in lungs, fluid in body must be carefully monitored and managed
- Hyperglycaemia — high blood glucose levels
- Multiple pregnancy — there is higher risk of cardiac failure and pulmonary oedema in women with multiple pregnancies
Other possible tocolytics include: oxytocin antagonists, which may also be useful in preventing preterm labour. Oxytocin antagonists can also lead to fewer side effects as opposed to beta agonists.
To minimise foetal complications
Corticosteroid therapy
This type of medication is used to help the baby’s lungs mature more quickly, and can be helpful in preventing Respiratory Distress Syndrome (RDS). RDS is a condition which affects around 40-50% of babies born before 32 weeks of gestation. It occurs when the baby’s lungs are not fully developed and face difficulty breathing. Corticosteroids can be given to a pregnant woman who is between 24 to 36 weeks of pregnancy and at risk of preterm delivery.
What can I expect if I give birth?
A preterm baby may not be fully developed so there will be some differences and complications which may be faced in such situations. This can include:
| Preterm baby | |
| Appearance | Smaller, head looks very large in comparison to rest of the bodyBirth weight is lower than normal (around 3.17kg)Very little fat, skin may appear translucent |
| Behaviour | Will get cold at room temperaturesMay have difficulty breathing, crying at birth (if at all) will be softer than normal |
| Handling by nurses and doctors | Baby may need to be placed in an incubator to keep he/she warm, this incubator is also known as an isoletteMay also be moved to the Neonatal Intensive Care Unit (NICU) for special care and monitoring |
| Returning home | A longer period of time may be required at the hospital before the baby can return homeFeeding instructions will also be provided by the healthcare team |
If you or anyone you know experiences any of the symptoms of preterm labour, it is important to seek medical attention immediately. Preterm labour can often be managed and a preterm birth delayed if caught early enough. However, left untreated, preterm labour can lead to a premature birth which can be dangerous for both mother and child.
If you are pregnant or know someone who is, be sure to share this information so that they are aware of the signs and symptoms of preterm labor.
References:
https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/diagnosis-treatment/drc-20373842
https://marchofdimes.org/complications/preterm-labor-and-premature-birth-are-you-at-risk.aspx
https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842