Diagnosing Preterm Labor

October 06, 2008

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Diagnosing Preterm Labor

by Elisa Ross, MD
reviewed and revised by Marjorie Greenfield, M.D.

The diagnosis of preterm labor requires the presence of contractions and a change in the cervix. Most pregnant women can tell if they are contracting, but still require an internal exam to evaluate the cervix.

Detecting preterm labor

Complicating matters is that contractions are quite common toward the end of pregnancy. If contractions are weak and irregular, and if they go away with rest and fluids, they are unlikely to be preterm labor. Strong, regular contractions, or contractions that don't resolve with rest and hydration, are cause for a phone call to your practitioner.

Other symptoms that may be associated with preterm labor:

Lower back pain

Constant mucus from the vagina

Pink or bood-tinged vaginal discharge

Wetness from the vagina that soaks through underwear

Menstrual-like cramps

Pelvic or vaginal pressure

Most of these symptoms can also be normal in pregnancy, but they may be worth a phone call.

High tech tests can help with the diagnosis

Although the diagnosis can usually be made with physical examination, some other tests may be used to define risk in unclear cases.

Ultrasound may be used to assess the cervix. The examining finger can only evaluate the cervix from the vaginal aspect. An ultrasound can actually measure the length of the internal cervical muscle, or note a change in shape called funneling. If either of these is present, early delivery is not inevitable, but there is a higher chance. Women with non-reassuring findings may be followed more closely.

Fetal fibronectin is a test that can often help determine if persistent contractions are likely to lead to delivery. A swab is taken near the cervix and sent to a laboratory for analysis. If it comes back negative, it is very unlikely that you will deliver in the next week or so. Even if it comes back positive, it is still more likely that your delivery won't take place, but you will continue to be watched closely.

Not all preterm contractions are preterm labor

Not all preterm contractions are preterm labor

If the cervix is not changing, the baby cannot be born, no matter how many contractions there are. It is not known why some contractions lead to delivery while some do not.

Dehydration and bladder infections are noted to cause contractions, but only rarely lead to actual labor.

Not all preterm labor leads to preterm delivery

Some preterm labors just stop on their own for no apparent reason. Conversely, some cannot be stopped, even with the use of medication. In many cases, the labor is stopped, but only temporarily. The best way to minimize risks of preterm labor, if you suspect this might be a problem, is to consult with your doctor or practitioner promptly.
RELATED INFORMATION
The Developing Fetus, Weeks 25-40
True vs. False Labor
Preterm Labor

Created September 09, 2000
Reviewed and revised September 09, 2004

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