PREMATURE LABOR

General Information

DEFINITION--Labor that begins before the 37th week of pregnancy.

BODY PARTS INVOLVED--Female reproductive system.

SEX OR AGE MOST AFFECTED--Pregnant females.

SIGNS & SYMPTOMS

• Uterine contractions at regular intervals that begin before the fetus is mature, usually before the due date of delivery.
• Passage of bloody mucus (sometimes).
• Flow of fluid (amniotic fluid) from the uterus (sometimes). This may occur with a gush or may be only a continuous watery discharge.

CAUSES

• Premature rupture of the membranes (the "water breaks").
• Illness of the mother, including preeclampsia, high blood pressure or diabetes.
• Abnormal shape or size of the uterus.
• Weak cervix.
• Hormone imbalance.
• Vaginal infection that spreads to the uterus.
• Large fetus or more than one fetus.
• Abnormalities of the placenta, such as placenta previa.
• Excessive amniotic fluid.

RISK INCREASES WITH

• Poor nutrition, especially when associated with weight loss.
• Previous premature labor.
• Smoking.
• Injury to the uterus.
• Excess alcohol consumption.
• Urinary-tract infection.
• Use of mind-altering drugs, such as narcotics, psychedelics, hallucinogens, marijuana, sedatives, hypnotics or cocaine.
• Adolescent mothers.

HOW TO PREVENT

• Obtain good prenatal care throughout pregnancy.
• Don't smoke, use mind-altering drugs or drink alcohol during pregnancy.
• Eat a normal, well-balanced diet during pregnancy. Take prenatal vitamin and mineral supplements, if your doctor prescribes them.
• Don't use medications of any kind, including non-prescription drugs, without consulting your doctor.
• If you have a weak cervix, which is sometimes evident before pregnancy, ask your doctor about a minor operation to strengthen the cervix.
• Rest more and decrease activity in the 3rd trimester, especially if you have blood spotting or irregular contractions.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of watery vaginal drainage or regular uterine contractions.
• Medical history and exam by a doctor.
• Laboratory blood studies.
• Amniocentesis (in Surgery section) to determine fetal maturity.
• Ultrasound (See Glossary) to determine fetal maturity and position.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Hospitalization may be necessary and treatment provided for any underlying risk factors (infections, dehydration).

POSSIBLE COMPLICATIONS

• Premature infant.
• Uterine infection after delivery.
• Fetal death.

PROBABLE OUTCOME--Labor can often be stopped with treatment to allow more time for the fetus to mature. However, if the membranes have ruptured or the placenta has separated from the uterus, labor must proceed, sometimes by Cesarean section. The outcome depends on fetal maturity.

How To Treat

GENERAL MEASURES----Don't douche or use tampons to absorb fluid or blood. This increases the risk of infection.

MEDICATION--Your doctor may prescribe:

• Medication to stop labor or hasten maturity of fetal lungs.
• Antibiotics to fight infection, if it develops.
• No sedatives and pain relievers. These are withheld to give the fetus the greatest chance for survival.

ACTIVITY--Complete bed rest is necessary when premature labor begins. Discontinue all physical activities. Avoid any sexual activity.

DIET--Once labor begins, drink only clear liquids until after delivery.

Call Your Doctor If

• You have symptoms of premature labor. Call immediately. This is an emergency!
• During pregnancy, you think you have a urinary-tract infection.
• After delivery, you have abdominal pain, chills and fever, headache, muscle aches or a bad-smelling vaginal discharge.
• New, unexplained symptoms develop.