Definition

Generally, a fetus needs around 39 weeks in the womb to grow and develop before birth. Babies born before 37 weeks of pregnancy are referred to as preterm or premature. The terms preterm and premature mean the same thing, derived from the word "preemie," which refers to babies born too early or prematurely, about 3 weeks before the estimated due date (EDD).

Preterm labor is labor that occurs before 37 weeks of pregnancy, potentially leading to the birth of a premature baby. Premature babies may experience serious health problems at birth and later in life.

Based on how early labor occurs, the baby can be classified as:

• Late preterm: born between 34 and 36 weeks of gestation
• Moderate preterm: born between 32 and 34 weeks of gestation
• Very preterm: born before 32 weeks of gestation
• Extremely preterm: born before 25 weeks of gestation

Causes

The causes of premature birth can happen suddenly, and the specific cause is often unknown. Some suspected causes include early induction to trigger the labor process.

Several conditions that can lead to preterm labor include:

• Chronic health conditions
• Substance or alcohol abuse
• Multiple pregnancies (twins or more)
• Pre-eclampsia (high blood pressure during pregnancy)
• Problems with the uterus or cervix
• Short interval between pregnancies (less than 18 months)
• Vaginal bleeding or infection during pregnancy

Risk Factor

Several factors can increase the risk of preterm labor, including:

• Previous preterm birth
• History of miscarriage or abortion
• Pregnancy through in vitro fertilization (IVF)
• Lifestyle factors such as substance abuse, smoking and pre-pregnancy weight that is either underweight or overweight
• Maternal age below 20 or over 40
• Infections, particularly in the amniotic fluid and lower urinary tract
• Body condition
• Chronic conditions, such as high blood pressure and diabetes
• Stress
• Physical injury or trauma
• Race. Black women have a higher risk of preterm birth compared to other races

Symptoms

If your pregnancy has not yet reached 37 weeks, here are some symptoms you might experience when approaching preterm labor:

• Fluid leakage from the vagina (watery, mucus, or bloody) or excessive discharge
• Pressure in the pelvis or lower abdomen, like the baby is pressing down
• Constant dull back pain
• Abdominal cramps with or without diarrhea
• Regular or frequent contractions that cause your abdomen to tighten and harden. These contractions may be painful and occur at least every 10 minutes
• Rupture of membranes

If you want to learn more about the rupture of membranes during preterm pregnancy, you can read here: Preterm Premature Rupture Of Membrane (PPROM) - Definition, Cause, Symptom, And Treatment.

Diagnosis

Routine consultations with a doctor help in the diagnostic process. The doctor may recommend a pelvic examination or transvaginal ultrasound (USG) to check if the cervix is starting to thin and prepare for labor. A transvaginal ultrasound uses sound waves to assess the condition of the fetus.

Management

The doctor will provide treatment to delay preterm birth so that labor occurs only after 37 weeks or to mature the baby’s organs even before reaching 37 weeks. If a baby is born prematurely, it may require extended hospital care. Depending on the medical needs, the baby may need to be cared for in a neonatal intensive care unit (NICU).

Complications

Complications from preterm labor can be short-term or long-term. Generally, babies born prematurely are at a higher risk of complications. Some of these complications include:

Short-Term Complications

During the first week, some complications of premature labor are:

• Respiratory problems: Premature babies have difficulty breathing due to an underdeveloped respiratory system.
• Heart problems: Common heart problems in premature babies include patent ductus arteriosus (PDA) and low blood pressure. PDA is a condition where there is an opening between the aorta and the pulmonary artery. If left untreated, it can lead to heart failure and other complications.
• Brain problems: Babies born prematurely are at risk of brain hemorrhage. In extreme cases, they may experience severe brain hemorrhage leading to permanent damage.
• Temperature control issues (hypothermia): Premature babies may have trouble maintaining body temperature.
• Digestive problems
• Blood disorders: Premature babies are at risk of conditions like anemia and jaundice.
• Metabolic issues: Premature babies may have low blood sugar levels due to a limited capacity to store glycogen, making it difficult for them to convert stored sugar into energy.
• Immune system problems

Long-Term Complications

• Cerebral palsy: This condition affects movement, muscle tone, and posture due to infection, insufficient blood flow, or brain injury during early pregnancy or infancy.
• Learning disabilities: Premature babies may lag in various developmental milestones.
• Vision and hearing problems: Vision problems, known as retinopathy, occur when blood vessels enlarge and cover the light-sensitive nerve (retina). Premature babies are also at higher risk for hearing impairments, requiring hearing tests.
• Dental issues
• Behavioral and psychological problems
• Chronic health issues

Prevention

You can reduce the risk factors leading to preterm labor. Some risk factors cannot be changed, such as a history of previous premature births, but others can be managed, such as:

• Maintaining a healthy lifestyle
• Keeping an ideal weight before and after pregnancy
• Avoiding smoking, alcohol, and substance abuse
• Managing stress with positive activities and environments
• Treating chronic health problems
• Waiting and planning a pregnancy at least 18 months after the last birth
• Cervical cerclage. This surgical procedure uses a single stitch to close the cervix until the baby is ready to be born.

When to See a Doctor?

Mothers should schedule regular doctor visits to check fetal development. Immediately contact your doctor if you experience any symptoms of preterm labor.

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