Preterm labor
Pregnancy complications - preterm
One of the first signs of labor starting is the appearance of a mucus plug, or what is sometimes called a bloody show. The bloody show is the discharge of a small amount of pinkish mucus that formed the barrier between the uterus and vagina during pregnancy. Shortly after the bloody show, another important event occurs: the amniotic sac ruptures and amniotic fluid begins to trickle out of the uterus and vagina. For some women, it can actually gush out in a stream. The rupturing of the amniotic sac, which surrounds and protects the baby, is commonly referred to as the water breaking. The combination of contractions, the bloody show, and water breaking indicates the first phase of labor starting.
What are the Signs and Symptoms of Preterm Labor?
You need to see a health care provider right away if you have:
- Spotting or cramps in your abdomen
- Contractions with lower back pain or pressure in your groin or thighs
- Fluid that leaks from your vagina in a trickle or a gush
- Bright red bleeding from your vagina
- A thick, mucous-filled discharge from your vagina with blood in it
- Your water breaks (ruptured membranes)
- More than 5 contractions per hour, or contractions that are regular and painful
- Contractions that get longer, stronger, and closer together
What Causes Preterm Labor?
Researchers do not know what actually causes preterm labor in most women. However, we do know that certain conditions can increase the risk of preterm labor, including:
- A previous preterm delivery
- A history of cervical surgery, such as a LEEP or cone biopsy
- Being pregnant with twins
- Infection in the mother or in the membranes around the baby
- Certain birth defects in the baby
- High blood pressure in the mother
- The bag of water breaks early
- Too much amniotic fluid
- First trimester bleeding
The mother's health problems or lifestyle choices that can lead to preterm labor include:
- Cigarette smoking
- Illegal drug use, often cocaine and amphetamines
- Physical or severe psychological stress
- Poor weight gain during pregnancy
- Obesity
Problems with the placenta, uterus, or cervix that can lead to preterm labor include:
- When the cervix does not stay closed on its own (cervical incompetence)
- When the shape of the uterus is not normal
- Poor function of the placenta, placental abruption, and placenta previa
Lower Your Risk of Preterm Labor
To reduce your risk of preterm labor, follow your provider's advice. Call as soon as you can if you think you are having preterm labor. Early treatment is the best way to prevent preterm delivery.
Prenatal care lowers the risk of having your baby too early. See your provider as soon as you think you are pregnant. You should also:
- Get routine checkups throughout your pregnancy.
- Eat healthy foods.
- Not smoke.
- Not use alcohol and drugs.
- Get a moderate amount of physical activity. Ask your provider before starting a new exercise program.
- Try to get 8 to 10 hour of sleep each night. Take daytime naps if needed.
It is even better to start seeing your provider if you are planning to have a baby but are not yet pregnant. Be as healthy as you can be before getting pregnant:
- Tell you provider if you think you have a vaginal infection.
- Keep your teeth and gums clean before and during pregnancy.
- Make sure to get prenatal care and keep up with recommended visits and tests.
- Reduce stress during your pregnancy.
- Talk to your provider or midwife about other ways to stay healthy.
Women with a history of preterm delivery may need weekly injections of the hormone progesterone. Be sure to tell your provider if you have had a previous premature birth.
When to Call the Doctor
Contact your provider right away if you notice any of these signs before your 37th week of pregnancy:
- Cramps, pain, or pressure in your abdomen
- Spotting, bleeding, mucous, or watery fluid leaking from your vagina
- Sudden increase in vaginal discharge
Your provider can do an exam to see if you are having preterm labor.
- An exam will check to see if your cervix has shortened (reduction in cervical length ), dilated (opened), or if your water has broken.
- Besides the vaginal exam by the provider, a transvaginal ultrasound is often done to assess the length of the cervix. Early preterm labor can often be diagnosed when the cervix shortens. The cervix typically shortens before it dilates.
- Your provider may use a monitor to check your contractions.
- If you have a fluid discharge, it will be tested. The test may help show if your membranes are leaking amniotic fluid, and if you will deliver early or not.
If you have preterm labor, you will need to be in the hospital. You may receive medicines to stop your contractions and mature your baby's lungs.
References
American Academy of Family Physicians. Sleep and pregnancy: tips for better rest.
Mercer BM, Gibson KS. Premature (prelabor) rupture of the membranes. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 39.
Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188. PMID: 32217980
Rose J, Eiting E. Labor and delivery. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 176.
Simhan HN, Romero R. Preterm labor and birth. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 36.
Version Info
Last reviewed on: 5/14/2024
Reviewed by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
