Early births can pose health risks for both mothers and their children. Approximately one in ten babies are born early, according to the Centers for Disease Prevention and Control. Infants born before 37 weeks of pregnancy (gestation) are considered preterm deliveries.
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:
- Infection in the genital tract
- Non-uterine infections like a kidney infection, pneumonia or appendicitis
- Urinary tract infections known as asymptomatic bacteriuria
- Problems with the placenta
- A large uterus, which can be common with women carrying more than one child
- Structural abnormalities of the uterus or cervix
- 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.
If a woman has had a preterm birth before, it is important that she has good prenatal care throughout her pregnancy. At-risk mothers may be prescribed medications that can help reduce the risk of another preterm delivery.
One such option is hydroxyprogesterone caproate (HPC), an FDA-approved drug that has been shown to reduce the recurrence of preterm delivery by 30 to 40 percent. HPC is a variation of progesterone, a natural hormone in the body that supports pregnancy.
If this treatment is recommended, you will receive a weekly shot from weeks 16 to 36 of your pregnancy.
Some women have a cerclage—a procedure that stitches a band of thread around the cervix to help keep it closed. This treatment is typically suggested for women who have lost a pregnancy due to a weak cervix or those who have had a preterm birth before 34 weeks. Your physician can help determine the best treatment options for you and your baby.
Key Points to Remember
Key Points to Remember
- Preterm birth occurs when an infant is born before 37 weeks of pregnancy.
- Women who have had a prior preterm birth are at higher risk of having a preterm birth in later pregnancies.
- Preterm labor or delivery has a number of possible causes, including infections, problems with the cervix or placenta.
- Medications taken during pregnancy or when prelabor symptoms begin can help prevent or stall a preterm birth.
- Signs of preterm labor include contractions, bleeding or changes in vaginal discharge, pelvic or low abdominal pressure, abdominal cramps or ruptured membranes.
- Women who have any signs of early labor should contact their physician immediately.
Support Services & Resources
Support Services & Resources
Families who want to learn more about premature deliveries can explore the following resources.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The CDC is the leading U.S. agency for protecting public health and offers information about the causes and problems of premature birth.
This international agency works to improve worldwide health and offers a fact sheet about premature births.
The American Academy of Pediatrics is dedicated to the health of children and publishes resources that describe how to care for a premature baby and information to help parents deal with their response to a child who is monitored in a NICU. They also share information about health issues related to prematurity.
This professional association for physician shares patient information about health risks such as preterm birth.
You can learn more about the risk factors for premature labor and birth through this federally-funded agency of the United States, which supports research in all aspects of human development.
Prior Preterm Birth Research
Prior Preterm Birth Research
Our maternal fetal medicine team conducts extensive research on preterm birth. Recent studies focus on medications like progesterone and hydroxyprogesterone caproate (HPC), which are used to prevent preterm birth. We also study cerclage, a procedure used to close the cervix and help mothers carry their babies longer.
These research efforts aim to help physicians learn how to identify women at-risk for preterm birth. We are also searching for treatments that can help prevent preterm labor. The goal of research is to decrease the number of preterm births and complications, which may ultimately reduce healthcare costs and improve care for mothers and babies.
Speak with your doctor if you have an interest in being a volunteer in clinical trials and ongoing studies.