Premature Labor--Risks Of and Tests For

December 14, 2007

Symptoms Of Preterm Labor

What are some symptoms of premature labor? Can you tell if you might go into labor early?

Premature labor is one of the most costly complications of pregnancy--in the way of money, loss of work, and most of all, emotions. Although we still don't know all of the reasons patients may experience preterm labor, there are nevertheless many things that we do know can provoke it:

1) Infection of the uterus or pregnancy (amnionitis), frequently with group B beta-strep.

2) Multiple gestations--twins, triplets, etc., which cause the uterus to reach "critical mass" earlier, at which time it tries to expel the contents like it would a term single pregnancy.

3) Incompetent cervix--in which the structural integrity of the cervix cannot maintain it in a tightly closed condition. Dilation may invoke several neurological and chemical reflexes which may cause labor to continue the process.

4) Bleeding within the uterus, usually caused by abruption of the placenta (premature separation of the afterbirth).

5) Vaginal infections (still not conclusively proven) like yeast, bacterial vaginosis, etc.--infections usually fairly inconsequential otherwise.

6) Urinary tract infections--bladder or kidney.

7) Other systemic infections, like pneumonia, peritonitis (appendicitis, etc.)

8) Previous history of preterm labor with prior pregnancy.

9) The largest category--Unknown reasons.

Are You At Risk For Premature Labor?

How can one tell whether they're at risk for preterm labor? Certainly any of the risk factors above can raise the possibility. When treatable, preterm labor might be avoided.  Three services by private companies may also aid in predicting, and these services are used sporadically in private practice.

1) Tocometry--equipment is worn in a belt around the abdomen and recordings for an hour are modem'd in to a central station where nurses notify your doctor if there are troubling runs of contractions or irritabilities.

2) Fetal fibronectin--a test from a vaginal exam that may indicate those at risk.

SalEst--salivary estriol read in, of all things, the mother's saliva, under the theory that fetal estriol is released prior to the onset of active pre-term labor. It presents in the mother's saliva and her saliva can be tested every two weeks.

Also, ultrasound to check for the length of the cervix should be part of the evaluation.

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