Premature Labor: Signs and Symptoms of Preterm Labor

I am 23 weeks pregnant and I worry a lot about going into labor before the time is right. Can you please tell me all the signs of preterm labor?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

If a baby is born before 37 weeks gestation, or weighs less than about five pounds, he or she is considered premature. The single greatest risk factor for preterm labor is a history of preterm labor.

Factors commonly associated with preterm labor between 20 and 37 weeks can be divided into maternal factors and fetal factors.

Maternal risk factors include:
-- Infection (urinary tract, amnionitis, systemic, sexually transmitted)
-- Uterine anomalies, fibroids, retained IUD
-- Cervical abnormalities: Short or funnel shaped
-- Overdistended uterus: Polyhydramnios (too much fluid), multifetal gestation
-- Rupture of membranes
-- Uterine bleeding: Abruption, previa
-- Substance abuse: Cocaine, amphetamine, smoking

Fetal risk factors include:
-- Congenital anomalies
-- Intrauterine death
-- Multifetal gestation

Signs and symptoms to watch for would be related to these risk factors:
-- Discharge: If you notice any clear fluid discharge, or any abnormal or malodorous discharge, you should notify your care provider immediately.

-- STDs or Beta Strep: If you have ever been diagnosed with a sexually transmitted disease or with group B beta strep, your care provider may wish to do typical cultures at your initial visit and then repeat them later in the pregnancy.

-- Changed pattern of movement: If your baby changes his or her pattern of movement, you should also alert your doctor or midwife.

-- Multiple gestation: If you have been diagnosed with twins or any higher order gestation, or if ultrasound has detected a "greater than average" volume of amniotic fluid, you should be alert for symptoms of premature labor.

-- Uterine abnormality or placental problem: If ultrasound has ever detected a uterine abnormality or fibroid -- or if you have experienced a premature separation of the placenta or have a low lying placenta -- you are at higher risk for preterm labor and need to be alert for signs and symptoms.

Symptoms can include, but are not limited to:
-- Pressure in the pelvis or vagina, or a sense that the baby has "dropped" prior to 36 weeks.
-- Tightenings or contractions that seem to occur at more or less regular intervals (more than four to five per hour).
-- Pain that comes and goes, whether it occurs in the lower abdomen or in the back.
-- Any fluid loss or spotting.

It is important to keep well-hydrated to both prevent uterine irritability and to prevent urinary tract infections that can lead to preterm labor. When my clients feel that things are "not quite right," I have them come in so that they can be checked. Diagnosed early, premature labor can be stopped and the pregnancy can be carried to term.

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