Uterine Irritability and Preterm Labor: How Do They Relate?

At 19 weeks, I started having painless but strong Braxton-Hicks contractions when my bladder is full, after picking up my son, when I stand or walk for too long and sometimes when I'm sitting still! Occasionally, my uterus stays hard for several minutes. I'm now 22 weeks, and my obstetrician says my cervix is still long and closed. What's likely to happen as this pregnancy progresses? Will the risk of preterm labour increase or decrease? My first child was born spontaneously at 34 weeks after my membranes ruptured at 31 weeks.

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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

This is an important question and one that is being studied. Just what level of uterine activity can be considered normal and which type or frequency predicts preterm labor.

An article by Roberts -- entitled "The Irritable Uterus: A risk factor for preterm birth?" -- was published in the "American Journal of Obstetrics & Gynecology in January of 1995. The aim of the study was to determine the incidence and preterm delivery rate along with the indication for delivery in patients with uterine irritability. Results showed that the incidence of preterm labor in patients with uterine irritability was 18.7 percent, significantly lower than in those with other high-risk factors. However, women with uterine irritability who experience preterm labor, compared with other high-risk factors, are much more likely to deliver before 34 weeks' gestation and more than twice as likely to deliver as a result of advanced preterm labor or membrane rupture. They concluded that "because it appears that women with uterine irritability have more resistance to conventional tocolytic therapy, this condition should prompt the physician to use more aggressive perinatal assessment."

Tests that could be performed include fetal fibronectin levels, a new test which may predict onset of labor before it occurs. A transvaginal ultrasound might detect cervical changes before any office exam could. I'm assuming that chlamydia, gonorrhea and beta strep cultures and testing for bacterial vaginosis have been done, as these might predispose to premature rupture of the membranes and preterm labor.

I hope this helps. It is certainly something that cannot be dismissed, especially with your history.

Good luck with this and let us know how you are doing.

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