Friday, November 18, 2011

Preterm Labor – What You Need to Know

Risk factors and what to look for to determine if an early delivery may occur...

By Kristin L. Clark, MD
View Kristin's Video

Patients often ask me, “How will I know when I go into labor?” If they have had a healthy pregnancy and are of a term gestation, I usually tell them not to worry; that signs and symptoms of labor aren’t subtle. Preterm labor, however, can be a little bit harder to detect. Fortunately, it’s not a common complication, but when it happens, early recognition and treatment are key in a successful outcome.

Risk Factors
There are some risk factors for preterm labor, the biggest of which is a prior history of preterm labor and delivery. Other risk factors include:
• previous cervical surgery
• multiple first or second trimester D&Cs (procedure to empty the uterus after a miscarriage)
• previous second trimester loss
• uterine infection
• premature rupture of membranes

Causes of Preterm Labor
Ultimately, we don’t really know what causes preterm labor. As I mentioned, the symptoms can be more subtle than labor at term. Some people will notice:
• an increase in pelvic pressure and spotting
• rhythmic tenable tightening
• cramping
• significant pain

It can also be very normal to have Braxton Hicks contractions during your second and third trimesters, so if you are having any of these symptoms, I would advise that you discuss them with your doctor so that he or she can help you sort through what’s normal and what needs to be addressed.

If your doctor is concerned that you might be in early labor, he or she will likely perform a cervical exam. Other tools that can be utilized include an ultrasound measurement of your cervical length and a fetal fibronectin swab. If this swab is negative, it gives us a 95% reassurance that you will not deliver in the next two weeks and a 99% reassurance that you will not deliver in the next week. If it’s positive, it doesn’t mean you are going to deliver, it just means that we need to watch you closer.

At times, I place my patients in the hospital for observation to see whether or not they are contracting regularly and to observe them for any change in cervical dilation. There are both oral and IV medications that can be used to treat preterm labor, and I use both differently in my practice.

Further, if your doctor feels that you are at risk for preterm delivery, he or she may advise two injections of a steroid called Betamethasone, 24 hours apart. This will help enhance your baby’s lung maturity so that if the baby did deliver before 34 weeks gestation, he or she has an easier time transitioning to breathing outside of the womb.

Ultimately, most people will not have to worry about preterm labor and delivery, but if it happens to you, we are lucky that we live in a day and age where we can treat it aggressively, and frequently help keep you pregnant until a term gestation.

I always tell my patients, “It’s your job to worry and it’s my job to make you feel better.” So keep this information in mind. If you have concerns, be sure to address them with your physician.

Dr. Kristin L. Clark is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Clark at 920-729-7105 or meet her here.

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