Obstetric & Gynaecology Malaysia


What is preterm labor?

Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal). 

Why is preterm birth a concern?

Preterm birth is a concern because babies who are born too early may not be fully developed. They may be born with serious health problems. Some health problems, like cerebral palsy, can last a lifetime. Other problems, such as learning disabilities, may appear later in childhood or even in adulthood.

Which preterm babies are at greatest risk of health problems?

The risk of health problems is greatest for babies born before 32 weeks of pregnancy. But babies born between 32 weeks of pregnancy and 36 weeks of pregnancy also are at risk.

What are risk factors for preterm birth?

Factors that increase the risk of preterm birth (maternal stress) include the following:

  • Having a previous preterm birth
  • Having a short cervix
  • Short time between pregnancies (less than a year spacing)
  • History of certain types of surgery on the uterus or cervix
  • Certain pregnancy complications, such as multiple pregnancy and vaginal bleeding
  • Lifestyle factors such as low prepregnancy weight or poor weight gain during pregnancy, smoking during pregnancy,         and substance abuse during pregnancy.
  • Maternal infection (fever) eg viral infection, urinary tract infection, gum infection(gingivitis-dentist) or listeriosis(food       poisoning)

Can anything be done to prevent preterm birth if I am at high risk?

When you become pregnant, be sure to start prenatal care early with an obstetrician. In addition, you may be given certain medications or other treatment to help prevent preterm birth if you have risk factors. Treatment is given based on your individual situation and your risk factors for preterm birth.

What are the signs and symptoms of preterm labor and what should I do if I have any of them?

Go to Delivery Suite right away if you notice any of these signs or symptoms:

  • Change in type of vaginal discharge (watery, mucus, or bloody)
  • Ruptured membranes (your water breaks with a gush or a trickle of fluid)
  • Increase in amount of discharge than usual.
  • Pelvic or lower abdominal pressure ≥ 2 hours of rest.
  • Constant low, dull backache ≥ 2 hours of rest.
  • Mild abdominal cramps, with diarrhea
  • Regular or frequent contractions or uterine tightening, often painless ie. every 15 minutes for 2 hour
  • Fever more than 37.8^ Celsius (fever is temperature > 37.5^C)
  • No fetal movement for more than 6 hours.

How is preterm labor diagnosed?

Preterm labor can be diagnosed only when changes in the cervix are found. Your obstetrician or midwife may perform a pelvic exam to see if your cervix has started to change.

transvaginal ultrasound exam may be done to measure the length of your cervix. The level of a protein called fetal fibronectin in the vaginal discharge may be measured. The presence of this protein is linked to preterm birth.

If I have preterm labor, will I have a preterm birth?

It is difficult for health care professionals to predict which women with preterm labor will go on to have preterm birth. Only about 1 in 10 women with preterm labor will give birth within the next 7 days. For about 3 in 10 women, preterm labor stops on its own.

What happens if my preterm labor continues?

If your preterm labor continues, how it is managed is based on what is thought to be best for your health and your fetus’s health. When there is a chance that the fetus would benefit from a delay in delivery, certain medications may be given. These medications include corticosteroidsmagnesium sulfate, and tocolytics.

What are corticosteroids?

Corticosteroids are drugs that cross the placenta and help speed up development of the fetus’s lungs, brain, and digestive organs. Corticosteroids are most likely to help your fetus when they are given between 24 weeks of pregnancy and 34 weeks of pregnancy. They also may be given between 23 and 24 weeks of pregnancy.

What is magnesium sulfate?

Magnesium sulfate is a medication that may be given if you are less than 32 weeks pregnant, are in preterm labor, and are at risk of delivery within the next 24 hours. This medication may help reduce the risk of cerebral palsy that is associated with early preterm birth.

What are tocolytics?

Tocolytics are drugs used to delay delivery for a short time (up to 48 hours). They may allow time for corticosteroids or magnesium sulfate to be given or for you to be transferred to a hospital that offers specialized care for preterm infants. In addition to its role in protecting against cerebral palsy, magnesium sulfate also can be used as a tocolytic drug.

What happens if my labor does not stop?

If your labor does not stop and it looks like you will give birth to your baby early, you and the baby usually will be cared for by a team of health care professionals. The team may include a neonatologist, a doctor who specializes in treating problems in newborns. The care your baby needs depends on how early he or she is born. High-level neonatal intensive care units (NICUs) provide this specialized care for preterm infants. If financial cost can an issue for some women, an in-utero transfer will be arranged to a public hospital with ventilator available.