Prior Preterm Birth

Women who deliver a child between 16 to 36 weeks gestation have a higher risk of preterm birth in a later pregnancy. Women with two preterm births have about a 25 to 30 percent chance of another preterm birth in a later pregnancy. African Americans are also at a higher risk; about one in five women of African-American descent will have a preterm birth.

The more mature a baby is at birth, the higher their rate of survival and good health. Babies born early can face many health challenges immediately after birth such as breathing problems, infections, jaundice and difficulty maintaining body temperature.

Long-term effects of prematurity can include problems with the lungs, developmental delays, vision and hearing challenges or cerebral palsy. Some researchers suspect that preterm babies may be more vulnerable to metabolic diseases like diabetes and hypertension later in life.

If a woman has had a prior preterm birth, her pregnancy is considered high-risk. The maternal fetal medicine team at Riley at IU Health provides expert care to help mothers have the healthiest pregnancies and safest deliveries possible.

Mothers at risk of preterm birth may have specialized care before, during and after delivery. Our Level 4 Neonatal Intensive Care Unit (NICU) is one of the largest in the Midwest and provides the highest level of care for newborns in Indiana, offering peace of mind to families whose babies are born at Riley at IU Health.

Diagnosis of Preterm Birth Risk

When a birth occurs prior to 37 weeks and it is not induced or scheduled Cesarean section, it is known as a spontaneous preterm birth. Causes of spontaneous preterm birth can include:

1. Infection in the genital tract
2. Non-uterine infections like a kidney infection, pneumonia or appendicitis
3. Urinary tract infections known as asymptomatic bacteriuria
4. Problems with the placenta
5. A large uterus, which can be common with women carrying more than one child
6. Structural abnormalities of the uterus or cervix
7. After-effects of abdominal surgery during pregnancy

When you become pregnant, your physician will ask if you have ever had a premature delivery. You will give a complete obstetrics history to help determine what may have caused the preterm birth.

Maternal fetal specialists and obstetricians look at all circumstances related to the previous pregnancy, noting if an infection, trauma or other medical conditions might explain the previous preterm birth. You may be closely monitored for signs of infection.

In addition, your physician will examine the cervix to determine its length. A short cervix and other cervical issues can lead to preterm labor. If your doctor determines you are at risk of preterm birth, you and your unborn child are monitored closely for signs of early labor.

Symptoms of Preterm Labor

Regular contractions that cause changes in the cervix before 37 weeks of pregnancy are considered preterm labor. If the cervix thins (effacement) or dilates (opens), the baby can enter the birth canal.

You should let your physician know immediately about any signs of preterm delivery such as contractions, bleeding or changes in vaginal discharge. Other preterm delivery symptoms include pelvic or low abdominal pressure, abdominal cramps or ruptured membranes, which happens when a woman’s water breaks.

You may be asked to come to the hospital where your cervix can be examined for changes and contractions can be monitored over a period of time. The baby’s heart rate is monitored, and additional tests are done to see if membranes have ruptured or there are any signs of infection or the start of delivery.

You may be given drugs to stop labor and medications to help your baby’s lungs and other systems mature more quickly. If labor can be stalled for up to 48 hours, this can help medications develop your baby’s lungs prior to delivery. Additional time and medications can aid the respiratory system and decrease the likelihood that your baby is born with fragile blood vessels.

For about 30 percent of women, premature labor stops on its own. If contractions stop, you may be able to go home.

If a preterm birth does occur, you and your baby can receive care from a team of healthcare professionals at Maternity & Newborn Health . Depending on your baby’s needs, the team may include a neonatologist (a doctor who specializes in treating problems in newborns), as well pediatric cardiologists, surgeons, neurologists, neurosurgeons, urologists, nurses and other healthcare professionals who are experts in caring for infants and children. If an infant must stay in the NICU, services for new parents gives access to family support, lactation services and more.