What should you know about early labour warning signs?

Preterm labour is labour that begins before the baby is ready for the expected time of birth. Tightenings may become regular, stronger or closer together, but early labour can also begin with a dull backache, menstrual-like cramps, pelvic pressure or a change in vaginal discharge. A gush or ongoing trickle of fluid may mean the waters have broken.

These symptoms can have other explanations, and only an examination and monitoring can tell what is happening. A cervix that is shortening or opening supports a diagnosis. Do not use symptom improvement as a reason to ignore the episode, because early assessment can guide monitoring and treatment.

Note when tightenings start, how long they last and whether they settle with rest. Put on a sanitary pad if fluid is leaking; do not use a tampon or put anything into the vagina. Contact your maternity unit for advice, especially if you are before your expected time of birth. Take your pregnancy records and mention previous early birth, bleeding, infection or cervical treatment.

Seek urgent maternity assessment for regular contractions, bleeding, suspected ruptured membranes, persistent pelvic pressure, severe abdominal pain, fever, or reduced fetal movements. Call emergency services for heavy bleeding, collapse, severe breathing difficulty or severe pain. A suspected preterm labour episode should be assessed promptly even when symptoms are mild.

Which symptoms should prompt an immediate call, how will the cervix and baby be assessed, and when might an antenatal steroid injection be considered? Ask whether cervical cerclage or other monitoring has a role in your situation.