What are the signs and symptoms of preterm labor?

The signs and symptoms of preterm labor are largely the same as those of normal labor, including contractions, changes in vaginal discharge or vaginal bleeding, and lower back pain. Sometimes it's subtle, so it's hard to recognize, or it's just so unexpected, it's not necessarily connected with any risk of preterm delivery. But even when they have those signs and symptoms, they may not recognize them or seek medical help.

What should a woman do if she's having these symptoms?

She should contact her obstetrical provider immediately, and if she can't get in touch with that person, she should go to a hospital or emergency service to be checked. Sometimes it's false labor, and she can be examined and reassured and sent home. But if it's real, then there are things that can be done to improve the outcome of her and the baby. For example, if she has an infection, the doctor can treat the infection with antibiotics.

What are some strategies to avert premature delivery?

Usually the woman would be given tocolytics drugs to help delay delivery for anywhere from one to seven days, usually. And then that would give her time to be treated with antibiotics or whatever, for other kinds of problems such as an infection. If the baby is very preterm, the mother may be given an injection of steroids which can help increase the maturation of the baby's lungs because the lung maturation takes a couple of days with the treatment.

Why is progesterone sometimes used to prevent preterm birth?

Progesterone is one of the hormones that helps maintain a pregnancy, and it's known that levels go down before delivery. That's why progesterone has been tried to prevent prematurity. But we don't really know if that's how progesterone is working. It may have to do with reducing the stretch effects on the uterus and/or the softening of the cervix that contribute to the onset of labor.

In a recently conducted multi-center trial of progesterone, women who had had a previously preterm birth were given weekly injections of progesterone. The women who received the progesterone had about a 30 percent decrease in their rate of premature delivery, and that translates into a big impact in terms of the length of gestation and the effect on the health of the babies who are born.

In response to that study and another one that's related, the American College of Gynecologists came out with clinical guidelines in November. They state that for those women who have had a previous preterm delivery, it appears that progesterone treatment may be effective for decreasing their risk of having another preterm delivery. Who would respond to the progesterone and who wouldn't and the way to deliver the progesterone still needs to be investigated.

What would you say is the biggest misconception about preterm birth?

We've done national surveys of the general public for their perceptions of prematurity, published in the American Journal of Preventive Medicine in the January-February 2003 issue. The two major misperceptions are that prematurity is not a serious problem and that it's the woman's fault if she delivers prematurely. There are ways that women can reduce their risks, but they can't eliminate them.

What kinds of problems do premature babies face?

Depending upon how premature and how small they are, they're at greater risk of a number of serious, immediate and in some cases long-term effects of being premature. Most of these effects are seen in the very premature baby (less than 32 weeks), and those include death and immediate neurologic problems, and then that translates into risks of cerebral palsy, mental retardation, learning and behavior problems. It's been estimated that about half of all long-term serious neurologic problems in childhood are related to prematurity and low-birth weight. So that's huge, and if you think about hospitalization costs and costs to the family and special schools and equipment and difficulties, that translates into an enormous impact on society.

Very premature babies are also at risk for lung problems, trouble with feeding and growth, and trouble fighting off infections. Some of them have risks of permanent problems with vision and hearing.

The babies between 32 and 37 weeks have fewer risks, but they still have increased risks of some of these immediate and long-term ill effects compared to full-term babies.

Christine Haran is a staff medical writer/editor. Haran has been a health journalist for more than seven years, and her work has appeared in Woman's Day, MAMM Magazine, Bride's Magazine, Publishers Weekly and other publications. In 2003, she received an Excellence in Women's Health Research Journalism Award from the Society for Women's Health Research. Haran has a master's degree in journalism from New York University and a bachelor's degree in english from Skidmore College.

Copyright © Christine Haran. Permission to republish retained by Pregnancy.org, LLC.