Preterm birth is the leading cause of death among children under five worldwide. According to the WHO, an estimated 13.4 million babies were born preterm in 2020, with India accounting for the largest number of any country. Recognising preterm labour signs early allows obstetric teams to administer treatments that improve newborn outcomes and arrange delivery in a hospital equipped with appropriate neonatal intensive care.

What Is Preterm Labour and How Is Preterm Birth Classified?

Preterm labour is defined as regular uterine contractions, accompanied by cervical change (dilatation or effacement), that occur before 37 completed weeks of gestation.

The WHO classifies preterm birth as:

Late preterm: 34 to under 37 weeks
Moderate preterm: 32 to under 34 weeks
Very preterm: 28 to under 32 weeks
Extremely preterm: Less than 28 weeks

Complications and the need for intensive care increase with decreasing gestational age.

What Causes Preterm Labour and Who Is at Risk?

Preterm labour may be spontaneous, follow preterm prelabour rupture of membranes (PPROM), or be medically indicated due to maternal or foetal complications. Proposed mechanisms include infection and inflammation, uterine overdistension, decidual haemorrhage and premature activation of the maternal or foetal stress response.

Key risk factors include:

• Previous spontaneous preterm birth, the strongest single predictor
• Short cervix, typically a cervical length under 25 mm on transvaginal ultrasound before 24 weeks
• Multiple pregnancy
• Urinary tract infection, bacterial vaginosis or intra-amniotic infection
• Pre-eclampsia and hypertension
• Diabetes
• Antepartum haemorrhage and placental abruption
• Polyhydramnios
• Uterine anomalies or previous cervical surgery
• Smoking and tobacco use
• Short interpregnancy interval
• Assisted reproduction
• Maternal age under 18 or over 35
• Low pre-pregnancy body weight

What Are the Early Signs of Premature Delivery?

The early signs of premature delivery can be subtle and are sometimes mistaken for normal pregnancy discomfort:

• Regular contractions, commonly defined as four or more in 20 minutes or eight or more in 60 minutes
• Menstrual-like cramping
• Persistent low backache
• Pelvic pressure
• Increased or altered vaginal discharge, whether watery, mucoid or blood-stained
• Leakage or gush of fluid, suggesting ruptured membranes
• Vaginal spotting or bleeding
• Abdominal cramps with or without diarrhoea

How Can I Tell If My Labour Is Starting Too Early?

Braxton Hicks contractions are irregular, usually painless or mildly uncomfortable, and do not cause cervical change. They often ease with rest, hydration or a change in position. Preterm labour contractions become regular, progressively stronger and closer together, and persist despite rest.

Any fluid leakage, bleeding or regular tightening before 37 weeks warrants immediate obstetric assessment.

How Is Preterm Labour Diagnosed?

Assessment includes:

• Speculum and digital examination: To assess cervical dilatation and check for ruptured membranes.
• Transvaginal cervical length measurement: A cervical length above 30 mm has a high negative predictive value for imminent delivery.
• Foetal fibronectin testing: Where available, a negative result indicates a low likelihood of delivery within 7 to 14 days.
• Cardiotocography (CTG): Monitors contractions and the foetal heart rate.
• Infection screening: Urine culture, vaginal swabs and, where indicated, blood tests.
• Obstetric ultrasound: Assesses foetal size, presentation, amniotic fluid volume and placental position.

What Treatments Are Used in Preterm Labour?

Management depends on gestational age, maternal and foetal condition, and membrane status.

• Antenatal corticosteroids: Betamethasone or dexamethasone accelerates foetal lung maturation and reduces the risk of respiratory distress syndrome, intraventricular haemorrhage and neonatal death. The WHO recommends them between 24 and 34 weeks when preterm birth is considered imminent and appropriate newborn care is available.
• Tocolytics: Medicines such as nifedipine or atosiban may delay delivery for up to 48 hours, primarily to allow corticosteroids to take effect and enable in-utero transfer. They do not improve outcomes when used for longer durations.
• Magnesium sulphate: Given before anticipated birth at about 32 weeks, it reduces the risk of cerebral palsy in the baby.
• Antibiotics: Recommended for PPROM to prolong pregnancy and reduce infection and for Group B Streptococcus prophylaxis when indicated.
• In-utero transfer: Transferring the mother to a hospital with a suitable NICU before delivery is associated with better neonatal outcomes than postnatal transfer.

For women at high risk in future pregnancies, vaginal progesterone or cervical cerclage may be considered based on history and cervical length.

When Does a Premature Baby Require Level III NICU Care?

A Level III NICU provides comprehensive care for critically ill newborns, including sustained mechanical ventilation, surfactant therapy, continuous monitoring and access to paediatric subspecialists.

Level III care is typically required for babies:

• Born before 32 weeks of gestation
• With birth weight below 1,500 grams
• With respiratory distress syndrome requiring ventilation or surfactant
• With suspected or confirmed sepsis
• Unable to maintain temperature or blood glucose
• With significant jaundice, feeding intolerance or suspected necrotising enterocolitis
• With other major medical complications

Premature infants are at risk of conditions such as respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia, which require specialised monitoring and treatment.

Families seeking the best Level III NICU hospital in Jaipur should look for 24-hour neonatologist presence, trained neonatal nursing staff, ventilator support and on-site blood gas analysis.

When Should You Go to the Hospital?

If you are under 37 weeks pregnant, seek immediate care for regular contractions, fluid leakage, vaginal bleeding, pelvic pressure, persistent backache, reduced foetal movements, or fever with abdominal pain.

Can Preterm Birth Be Prevented?

• Attend all antenatal visits and recommended scans, including cervical length screening where advised.
• Treat urinary and vaginal infections promptly.
• Manage blood pressure and blood glucose closely.
• Avoid smoking and tobacco.
• Maintain adequate nutrition and hydration.
• Plan an interpregnancy interval of at least 18 months where possible.
• Inform your doctor early about any previous preterm birth.
   

After preterm delivery, NICU teams support parents with kangaroo mother care, breast milk feeding and discharge planning. Follow-up for growth, neurodevelopment, vision and hearing continues after discharge.

Conclusion

Early recognition of preterm labour gives obstetric and neonatal teams time to use treatments that meaningfully improve outcomes for premature babies. Knowing the Preterm Labour Signs and seeking care without delay can cause serious issues. If you experience symptoms before 37 weeks, contact your obstetrician immediately. Maternite Hospitals offers a NICU Level III with 24/7 neonatologist support and high-risk pregnancy care for mothers and babies who need specialised support.