Options Once Premature Labor Has Begun

Early Signs and Treatment Options

USA, Utah, Payson, Man assisting childbirth in hospital
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Premature, or preterm, labor can be very distressing, and most parents are unprepared for this situation. However, there are ways to help prevent preterm labor in women who are at high risk. There are also treatments that may be able to slow or stop preterm labor if contractions begin prematurely, before 37 weeks gestation.

About 12% of all births happen prematurely, according to the American College of Obstetricians and Gynecologists (ACOG). Of those, about half occurred after preterm labor. Preterm labor does not always lead to delivery. Sometimes it stops on its own (about 30% of the time), or responds to treatment to stop labor or at least slow its progress. About 90% of women with preterm labor do not give birth within seven days after labor begins.

Causes of Preterm Labor and Premature Birth

Sometimes doctors just don't know why labor begins prematurely. However, there are several factors that can increase risk, including:

Treatments to Prevent Preterm Labor

Women at risk for preterm labor, particularly those who have had one or more premature births, may be candidates for one or more of the following treatments:

  • Progesterone is often used to prevent miscarriage and preterm birth. Studies have shown it to be effective in women with short cervixes in both twin and singleton pregnancies.
  • Cerclage is a stitch placed in the cervix to hold it closed. While cerclages have been used for over 50 years to prevent preterm birth, research suggests that especially in singleton pregnancies, progesterone may be just as effective as cerclage.
  • Bed rest is typically advised for women experiencing multiple pregnancy, eclampsia, preeclampsia, heavy vaginal bleeding, abnormal cervical changes, fetal development, placental complications, or gestational diabetes.

Healthy pregnancy habits such as good prenatal medical care, staying hydrated, avoiding smoking and alcohol, eating nutritious foods and taking prenatal vitamins may also help lower your risk of preterm labor.

Signs and Symptoms of Preterm Labor

In some cases, it may be possible to prevent premature birth by knowing the early signs of labor. Some of the most telling symptoms include:

  • Five or more contractions within an hour
  • Watery fluid from the vagina (indicating your water may have broken)
  • A dull backache below the waist that may come and go or be constant
  • Menstrual-like cramps in the lower abdomen
  • Pelvic pressure that feels like your baby is pushing down

If you are at risk for preterm labor, your doctor or midwife may perform a fetal fibronectin test, which checks vaginal secretions for a protein that may indicate that labor is imminent.

Treating Preterm Labor

There are a number of treatments doctors turn to during premature labor. Bed rest, pelvic rest, and hydration (sometimes with intravenous fluids) can sometimes slow or stop contractions.

Women who experience preterm rupture of membranes often take antibiotics to prevent uterine infections which can lead to preterm birth. Antibiotics can also prolong pregnancy in women who have previously experienced a preterm rupture.

Medications for Stopping Preterm Labor

It can be difficult to stop preterm labor, especially if the cervix has already started dilating. So the two major goals of treatment are to delay birth long enough to transfer a mother to a hospital which has a neonatal intensive care unit (NICU), and speed up a baby's lung development by providing steroids.

To achieve this delay, doctors usually prescribe drugs called tocolytics, which can slow or stop uterine contractions. Among the most common of these is magnesium sulfate, which has a two-fold effect. It can prevent seizures in women with preeclampsia and reduce the risk of cerebral palsy and other brain disorders in premature babies.

Other tocolytics include drugs used to treat heart and lung problems, such as nifedipine and terbutaline, both of which are effective in inhibiting uterine contractions.

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