Preterm Labour

Preterm labour is labour that begins before 37 weeks of pregnancy and needs prompt maternity assessment.

It may involve regular contractions that change the cervix, sometimes with the waters breaking or bleeding. Early assessment can distinguish labour from temporary tightening and identify care that may help delay birth or prepare the baby for an early arrival.

Preterm labour commonly presents with repeated tightenings or contractions, period-like cramps, pressure low in the pelvis, a dull ache in the lower back, or a change in vaginal discharge. It can also present with fluid leaking when the waters break.

Braxton Hicks contractions are often irregular and may settle with rest or a change of activity, whereas labour contractions tend to become more organised and persistent. Severe abdominal pain, bleeding, reduced fetal movement, or suspected fluid leakage should be assessed urgently. Read more about Back Pain in Pregnancy, Braxton Hicks Contractions, Severe Abdominal Pain in Pregnancy, and Waters Breaking.

Preterm labour can start when the uterus contracts and the cervix begins to open earlier than expected. It may follow the waters breaking, an infection or inflammation, bleeding, or stretching of the uterus. Sometimes no single cause is found.

A maternity team will consider your pregnancy history and current findings rather than relying on one symptom alone.

Some episodes settle after monitoring and treatment, while others continue toward birth. The course depends on whether the cervix is changing, whether the waters have broken, how far along the pregnancy is, and the health of you and your baby.

Your team may repeat examinations or monitoring because the picture can change over time.

Risk is higher with a previous preterm birth, a short or weakened cervix, a multiple pregnancy, some uterine or cervical differences, infection, bleeding, or early rupture of the membranes. Certain long-term health conditions and pregnancy complications can also affect timing of birth.

Having a risk factor does not mean preterm labour will happen. Tell your maternity team about a previous early birth or cervical procedure so monitoring and preventive options can be considered.

Assessment usually includes questions about contractions, pain, bleeding, discharge and fluid loss, along with checks of your temperature, pulse and blood pressure. The team may monitor contractions and the baby's heart rate.

A physical examination can show whether the cervix is changing. Depending on your situation, clinicians may use a speculum examination, a vaginal swab, urine testing, ultrasound assessment of the cervix, or imaging to check the baby and the placenta.

Treatment is tailored to the weeks of pregnancy, the cause, cervical changes, infection status, and the condition of you and your baby. Care may include observation, medicines to reduce contractions for a short period, antibiotics when infection or membrane rupture is suspected, and transfer to a unit with newborn care when needed.

Antenatal steroid injections may help prepare a baby's lungs when early birth is a concern. In selected pregnancies, a cervical cerclage may support the cervix before labour begins. Your clinician will explain the expected benefit, limits and possible effects of each option. Read about Antenatal Steroid Injection and Cervical Cerclage.

A hospital assessment may mean staying for observation or returning for follow-up. Keep your maternity unit's contact details available, follow instructions about medicines and activity, and ask who to call if contractions, fluid loss or pain changes. Emotional support from a trusted person or a perinatal mental-health professional can make an uncertain period easier to manage.

Earlier birth can mean a baby needs extra support with breathing, feeding, temperature control or infection monitoring. For the pregnant person, complications may relate to infection, bleeding, high blood pressure or the reason labour began. The maternity and newborn teams will discuss the specific concerns for your pregnancy and gestational age.

Not every episode can be prevented, but early antenatal care helps identify cervical, medical and pregnancy-related risks. Depending on your history, your team may offer cervical-length monitoring, medicines, treatment for infection, or a planned cervical stitch. Do not ignore new contractions, fluid leakage or bleeding while waiting for a routine appointment.

Contact your maternity unit, obstetrician or midwife promptly if you have signs of preterm labour. A maternal-fetal medicine specialist may coordinate care when there is a significant pregnancy complication or a history of early birth. If fluid is leaking, pain is severe, bleeding occurs, or you feel unwell, use the urgent route advised by your local maternity service.