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Preterm Labor
Labor that starts
before the 37th week of pregnancy is preterm labor. Most pregnancies
last between 37 and 42 weeks counting from the first day of the
last menstrual period. Delivery before 37 weeks is called preterm
or premature. If preterm labor leads to a preterm delivery, your
baby may be at risk for health problems.
Your uterus
prepares for delivery by tightening and relaxing during your pregnancy.
These are contractions and most women feel them from time to time
during their pregnancy. Occasional contractions that do not cause
the cervix to change are not
preterm labor.
Labor occurs when
contractions are frequent or intense enough to cause cervical changes.
The cervix is the opening to your uterus. When labor begins, uterine
contractions cause the cervix to efface (thin) and dilate (open).
Your cervix should stay closed until you approach your due date.
This keeps your baby safely inside your uterus until it's mature
enough to survive outside your womb.
Signs
of Preterm Labor
The early signs of labor can be subtle and hard to detect. Many
women are unaware of their uterus tightening. It is very important
that you call your provider immediately if you think you are experiencing
any symptoms of labor and you are less than 37 weeks gestational
age. Preterm labor can often be treated and a preterm delivery avoided
if symptoms are detected in time, and steps are taken to stop labor
from progressing. Call your provider immediately
if you experience any of the following signs of preterm labor:
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Warning
Signs
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- Contractions
that are occurring 4 or more times in an hour
- Menstrual
-like cramps
- Backache
- Pelvic
pressure
- Vaginal
discharge that is watery, mucus-like or blood tinged
- Diarrhea
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Risk
Factors for Preterm Labor
Preterm labor occurs in about 8 - 10% of all pregnancies. It
is important to know if you are at higher risk for preterm labor
as early detection can help prevent progression to preterm delivery
in some cases. Some of the risk factors for preterm labor are:
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Higher
Risk For Preterm Labor
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- A multiple
pregnancy (you are expecting twins or more)
- Incompetent
cervix (a condition where the cervix is at risk for opening
too soon)
- Teen
pregnancy
- History
of preterm labor or delivery
- Presence
of uterine fibroids (benign growths) or other uterine abnormalities
- Vaginal
bleeding in the second or third trimester
- Smoking
or other substance use
- Underweight
(weighing less than 50 kg) at start of pregnancy
- Age less
than 20 or over 35
- Infection
or illness
- History
of second or third trimester pregnancy termination
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Some women can
experience preterm labor without
feeling any contractions! A cervical exam by your prenatal care
provider is the only way to rule out or confirm preterm labor.
Diagnosing
Preterm Labor
The presence of uterine contractions accompanied by cervical
changes (effacement or dilation) confirm the diagnosis of preterm
labor. Remember that most women feel uterine contractions during
their pregnancy. However, more than four contractions per hour,
or contractions that are painful or intense, could indicate preterm
labor. You should always call your provider immediately if you have
any reason to suspect you might have preterm labor. Your doctor
has the best chance of preventing a premature delivery the earlier
your preterm labor is detected.
Treatment
for Preterm Labor
Bedrest
and lots of fluid are often the first treatment for preterm labor.
Intravenous fluids can stop contractions in some women. Tocolytic
agents (drugs that stop uterine contractions) are often used. Drug
therapy is effective in stopping preterm labor in many cases if
there is no bleeding or rupture of membranes (leaking from the "bag
of waters" that surrounds your baby in your uterus). Hospitalization
may be necessary. If a preterm delivery is a possibility, your doctor
may give you a medication that will help your baby's lungs mature.
Management of
preterm labor involves treating underlying causes, assessing maternal
and fetal health and trying to delay delivery if it is in the best
interest of mom and baby to do so. If the health of mom or baby
is in imminent danger, sometimes allowing labor to continue is the
only option.
Preventing
Preterm Labor
Preterm labor cannot always be prevented, particularly if you
have risk factors. However, there are a few things you can do to
reduce your risk.
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Reducing
Risk Of Preterm Labor
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- Start
your prenatal care early and consistently keep all your
scheduled appointments.
- Begin
your pregnancy at a healthy weight for you. Discuss weight goals with your primary care physician
before beginning pregnancy.
- Stay
well hydrated throughout your pregnancy.
- Don't
smoke or use drugs.
- Seek
treatment immediately if you have any signs of infection
or illness.
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