The following signs and symptoms confirms the occurrence of preterm labor:
- Spotting or early bleeding due to the early effacement of the cervix.
- Progressive and frequent uterine contractions. usually 5 or more contractions per hour.
- Low back pain secondary to the impinging head of the baby in the birth canal.
- Fluid leak or gush primarily due to the premature rupture of membranes.
- Bloody mucous discharge suggests that the cervix is starting to open.
Entire Body System
- Problems at School
They may have learning or reading problems in school. The earlier a baby is born, the more likely they are to have problems. Those born after 7 months usually need a short stay in the hospital’s neonatal intensive care unit (NICU.) [webmd.com]
- Chest Discomfort
During the initial period of infusion of beta-adrenergic drugs, auscultate the patient’s lungs for rales and rhonchi; observe for dyspnea and chest discomfort; determine the fetal heart rate, maternal pulse, blood pressure, and respiratory rate; and monitor [medical-dictionary.thefreedictionary.com]
discomfort, pulmonary edema, hypokalemia, and hyperglycemia Fetal tachycardia Tachycardia-sensitive cardiac disease and poorly controlled diabetes mellitus Magnesium sulfate 21, 42 6-g bolus intravenously over 20 minutes, then 2 g per hour as continuous [aafp.org]
Recognition of the early signs of pulmonary edema enable swift clinical diagnosis and steps to be taken to prevent disasterous condition due to progressive hypoxemia. [ncbi.nlm.nih.gov]
- Abdominal Pain
METHODS: Prospectively collected data of pregnant women presenting with symptoms of preterm labor (abdominal pain or tightening) at 24-34 weeks' gestation were retrieved from the research databases of the EQUIPP and PETRA studies for subanalysis. [ncbi.nlm.nih.gov]
Wellbeing of Women ELS Jane Currie (A David primary supervisor) “Do women presenting with abdominal pain and negative urine dipstick tests in pregnancy have subclinical urinary tract infection?” [ucl.ac.uk]
The most common include: pain or swelling in the skin at the injection site a skin reaction at the injection site nausea vomiting Some experience other side effects such as: mood swings headaches abdominal pain or bloating diarrhea constipation changes [healthline.com]
These symptoms include an increase in the amount of vaginal discharge, vaginal bleeding/spotting, a change in the type of discharge (eg. more watery or mucous-like), abdominal pain /cramping similar to period pains, and more than four contractions in [myvmc.com]
- Epigastric Pain
Hypertension and epigastric pain could not be controlled after the operation. [ncbi.nlm.nih.gov]
- Back Pain
Lower backache If you’re nearing the home stretch of your pregnancy, back pain may be all too familiar. [monbaby.com]
Symptoms of preterm labor include contractions, cramps, back pain, or leaking of fluid from the vagina. Preterm labor may result in preterm birth. Babies born too early are at risk for many serious health problems. [stlouischildrens.org]
The signs of premature labor include regular contractions that increase in intensity, back pain, pressure in your vagina, vaginal discharge or bleeding, and decreased fetal movement. [livestrong.com]
If you have any symptoms of preterm labor, including contractions, cramps, back pain, or leaking of fluid from your vagina, contact your healthcare provider right away. [urmc.rochester.edu]
- Thigh Pain
The critical signs include contractions greater than 4 per hour, rhythmic back or thigh pain, increasing pelvic pressure, unusual discharge, vaginal spotting/bleeding, or rupture of membranes, tenesmus, and urgency. [www1.cgmh.org.tw]
The critical signs of recurrent preterm labor include contractions greater than 4 per hour, rhythmic back or thigh pain, increasing pelvic pressure, unusual discharge, vaginal spotting/bleeding, or rupture of membranes. [emedicine.medscape.com]
- Vaginal Discharge
If you have any of these signs or symptoms before your 37th week of pregnancy, you may be experiencing preterm labor: Change in your vaginal discharge (watery, mucus or bloody) or more vaginal discharge than usual Pressure in your pelvis or lower belly [marchofdimes.org]
The results of vaginal discharge tests and maternal serum C-reactive protein (CRP) level at admission, placental biopsy, and perinatal outcomes were searched. The prevalence of abnormal vaginal flora was calculated. [ncbi.nlm.nih.gov]
- Regular Uterine Contractions
This communication describes a case of a pregnant woman who had an allergic reaction and regular uterine contractions after the ingestion of lobster meat, to which she was known to be allergic. [ncbi.nlm.nih.gov]
Definition Preterm labor : Regular uterine contractions with cervical effacement, dilation, or both before 37 weeks gestation. [amboss.com]
Signs & Symptoms of Preterm Labor The most common signs that you may give birth to a preemie include regular uterine contractions. Some women describe these symptoms as severe menstrual-type cramps in the lower part of the abdomen (tummy area). [healthcare.utah.edu]
This study aimed to evaluate the effectiveness of nifedipine versus a placebo for inhibiting uterine contraction in threatened preterm labor. [dovepress.com]
The effective dose was maintained for at least six hours after the cessation of regular uterine contractions; the dose was then progressively decreased until the infusion was ended. [nejm.org]
- Pelvic Pain
If you are entering labor, you may notice symptoms such as a heavy feeling in the pelvis, cramping, spotting or bleeding, backache, and intermittent pelvic pain that lasts 30 to 90 seconds. [nyulangone.org]
Vaginal bleeding Vaginal discharge that is unusual Severe, persistent, frequent headaches Pain or burning upon urination, or decrease in urination Persistent nausea or vomiting Leakage of fluid from the vagina Sharp pelvic pain or severe cramping Frequent [sidelines.org]
Back pain: A constant low, dull back pain may be a sign of labor. Increased pelvic pressure: If you feel a significant increase in pressure in your pelvic area, call your doctor. [whattoexpect.com]
The diagnosis of preterm labor precludes with the accurate determination of fetal gestational age that falls beyond 20 weeks and lower than 37 weeks, with concurrent regular contractions and vaginal spotting.
The following tests and procedures may be utilized to help in the diagnosis of preterm labor:
- Pelvic Examination will give the obstetrician an idea of how the baby may present during delivery, estimate the firmness of the uterus, and determine whether the cervix has started to open.
- Ultrasound: A pelvic sonogram can determine the accurate age of the fetus, its relative presentation, amniotic fluid volume, length of cervix and baby’s size.
- Uterine monitor will determine the actual spacing of the uterine contractions.
- Fetal monitoring is used to monitor the fetal heart rate during the course of the labor to determine the child’s well-being.
- Laboratory test: Vaginal swabs may be taken to determine the presence of fibronectin and the possible presence of infectious organisms.
- Maturity amniocentesis: This laboratory study involves the extraction of amniotic fluid when the age of gestation is beyond 32 weeks to determine the fetal lung age and determine the presence of amniotic fluid infections .
The following treatment modalities are done to prevent the progression of preterm labor to preterm delivery:
- Cervical cerclage: This surgical procedure is done to reinforce the cervix and prevent preterm birth in an incompetent cervix condition.
- Corticosteroids: Patients in preterm labor between 24 to 34 weeks of gestation may benefit from betamethasone or dexamethasone injections to hasten the lung maturity of the neonate before preterm birth .
- Tocolytics: This group of medications may be given to patients in preterm labor to halt the uterine contractions and its progression. Tocolytics are not routinely given to preterm labor cases beyond 34 weeks, deliveries are postponed till the 37th weeks to significantly lower neonatal mortality and morbidity . The use of magnesium sulfate as a tocolytic agent has been found to decrease the incidence of cerebral palsy and low birth weight infants .
Patients with less frequent contraction without bleeding may still be able to tocolyze the preterm labor till term pregnancy. However, patients presenting with rapid contractions with eminent bleeding may have an increased chance to progress to preterm delivery.
The relative prognosis of neonates born through preterm labor varies directly with age of gestation, and varies inversely with the number of congenital defects seen. This prognostic relationship is also true with maternal and neonatal morbidity and mortality ratings respectively.
The following medical conditions are common complication of preterm labor:
The progression to preterm labor is influenced by the maternal health, lifestyle and inherent anatomical defects. The following etiologic factors may lead to preterm labor:
- Multiple pregnancy
- Severe congenital defects of the fetus
- Premature rupture of membranes
- First trimester bleeding
- Cigarette smoking
- Illegal drug use
- Severe psychological and physical Stress
- Previous preeclampsia 
- Poor weight gain during pregnancy
- Short cervical length 
- Cervical incompetence
- Abnormal uterine shape
- Abruptio placenta and placenta previa
Preterm labor initiates more than half of preterm deliveries and is considered as the leading cause of neonatal mortality in the United States today . Preterm births accounts for the 70% of neonatal morbidity and mortality .
The relative risk of preterm births due to preterm labor may be averted by the prompt and early identification of risk factors among mothers with less than 37 weeks of gestation. The active reduction of extreme prematurity (less than 32 weeks) will significantly reduce the mortality, morbidity and the inherent expenses during the delivery .
The pathophysiology of preterm labor lies on the nature of the inciting factor that induces labor. Preterm infection like chorioamnionitis or maternal septicemia may trigger uterine labor prematurely. The relative mass of the conceptus pressing against the thinning cervix may be influenced by twining or multiple pregnancies. Consequently, the cervical competence and amniotic fluid volume is also an important contributory factor in the progression of the preterm labor.
Mothers who begin to feel uterine contractions should take a short walk, change position or rest for a few minutes to quell the preterm contractions at home. Frequent false contractions in the preterm period is a risk factor for preterm labor in the late preterm stages (34-36 weeks) .
Persistent contraction despite these remedies must be brought in to the nearest obstetric care facility for proper assessment and monitoring. Adequate rest and fluid intake during intermittent uterine contractions may prove to be beneficial in some cases of preterm labor.
Preterm labor is a clinical condition defined as the premature opening of the cervix due to frequent uterine contractions before 37 weeks of gestation. When such event is unabated, this may result to the delivery of a premature baby that may require special care upon birth and may be at risk to long term complications. Mothers who underwent preterm labor may be at risk to another preterm labor on her next pregnancy.
Preterm labor is defined as the frequent uterine contraction that lead to the opening of the cervix before term pregnancy.
Treatment and follow-up
Cervical cerclage, corticosteroids to enhance fetal lung maturity, and tocolytics to control preterm contractions are the treatment options.
- Lykke JA, Paidas MJ, Langhoff-Roos J. Recurring complications in second pregnancy.Obstet Gynecol. Jun 2009; 113(6):1217-24.
- Durnwald CP, Walker H, Lundy JC, Iams JD. Rates of recurrent preterm birth by obstetrical history and cervical length. Am J Obstet Gynecol. Sep 2005; 193(3 Pt 2):1170-4.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001. (Replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001). Obstet Gynecol. Oct 2001; 98(4):709-16.
- ACOG practice bulletin. Management of preterm labor. Number 43, May 2003. Int J Gynaecol Obstet. Jul 2003; 82(1):127-35.
- Eden RD, Penka A, Britt DW, Landsberger EJ, Evans MI. Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way. J Matern Fetal Neonatal Med. Oct 2005; 18(4):253-8.
- Romero R, Miranda J, Chaiworapongsa T, et al. A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra-amniotic infection in preterm labor with intact membranes. Am J Reprod Immunol. Apr 2014; 71(4):330-58.
- Crowther CA, McKinlay CJ, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev. Jun 15 2011; 6:CD003935.
- Cheng Y, Kaimal A, Bruckner T, Hallaron D, Caughey A. Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation. BJOG. Nov 2011; 118(12):1446-1454.
- Conde-Agudelo A, Romero R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks' gestation: a systematic review and metaanalysis. Am J Obstet Gynecol. Jun 2009; 200(6):595-609.
- Chao TT, Bloom SL, Mitchell JS, McIntire DD, Leveno KJ. The diagnosis and natural history of false preterm labor. Obstet Gynecol. Dec 2011; 118(6):1301-8.