Premature babies have less time to fully develop and mature in the womb. As a result, they're often at increased risk of medical and developmental problems. One of the biggest problems facing premature infants is underdeveloped lungs.

Your doctor may try to delay your baby's birth if you go into labor earlier than around 34 weeks into your pregnancy (preterm labor). Even a few extra days in the womb can give your baby's lungs a chance to become more mature. But sometimes, in spite of every effort, your baby may be born early.

Fortunately, the outlook for premature infants has improved dramatically in recent years. Great advances have been made in the care of premature infants, and even babies born as early as 23 weeks now have a good chance of survival.

Signs and symptoms

It's usually best for a baby to stay in the womb as close as possible to full term. Recognizing the signs of premature labor may help you prevent your baby from being born too soon. The following signs and symptoms can occur as early as four months before your due date:

• Regular contractions of your uterus. At first, contractions seem like a tightening in your abdomen that you can feel with your fingertips.

• Light vaginal spotting or bleeding.

• Menstrual-type or abdominal cramps.

• Low, dull back pain.

• Watery discharge from your vagina. This may be amniotic fluid, the protective liquid that surrounds your baby in the womb. If so, it's a sign that the membranes around your baby have ruptured.

• A feeling of pressure in your pelvis, as if your baby is pressing down.

If you suspect you're in premature labor but haven't had a watery discharge, drink two or three glasses of water and lie down on your left side. This helps improve circulation to your uterus.

• Abdominal cramps

• Back pain

Causes

About half of women who go into premature labor do so for unknown reasons. Or, you may have a medical condition that contributes to early labor. These conditions may include:

• A rupture of your bag of waters (amniotic sac). Normally, these membranes that surround your baby rupture during labor or just before labor begins. But sometimes they may rupture weeks or even months before your due date, for no apparent reason. In that case, there's a high risk that your labor will begin within a few days. You and your baby are also at increased risk of infection.

• Certain infections. These include infections of your uterus, cervix or urinary tract.

• Weak cervix. A cervix that opens (dilates) without contractions (incompetent cervix). In a normal pregnancy, your cervix dilates in response to uterine contractions. But if your cervix is weak, it may open just from the pressure on your uterus caused by your progressing pregnancy. The cervix may have been weakened by a previous pregnancy or during a previous surgery involving the cervix, such as a dilation and curettage (D and C) or a biopsy. Other factors that may weaken your cervix include carrying more than one fetus or having too much amniotic fluid (hydramnios).

• Certain chronic diseases. These include high blood pressure, diabetes, kidney disease and hypothyroidism.

• Uterine abnormalities. These include an abnormally shaped uterus or a benign tumor (fibroid) of the uterus.

• A previous premature delivery. Women who have had a premature delivery are at higher risk of going into premature labor again. For many women, though, early labor happens only once.

• Substance abuse. These include smoking, alcohol use, or misuse of other drugs.

• Malnutrition. Women who are undernourished or anemic are more likely to give birth prematurely.

• Other conditions. A fetus with congenital defects or production of an overabundance of amniotic fluid also can contribute to early labor.

• Alcohol addiction

• high blood pressure

• Hypothyroidism

• Nicotine dependence

When to seek medical advice

Good prenatal care includes regular visits to your doctor throughout your pregnancy to check on both your health and your baby's health. If you're at risk of premature labor, being in weekly contact with your doctor or another member of his or her staff and carefully monitoring your own signs and symptoms can be especially helpful.

If you develop any signs or symptoms of early labor, such as bleeding with cramps and pain, a watery discharge from your vagina, or more than five or six contractions an hour, call your doctor or hospital right away. It's a good idea to keep these phone numbers handy so that you can find them quickly.

Screening and diagnosis

If your doctor suspects premature labor, he or she will check to see if your cervix has begun to dilate and whether the fetal membranes have ruptured. In some cases, a monitor may be used to measure the duration and spacing of your contractions. Monitoring the length of your cervix with ultrasound imaging may be done. In addition, sampling of the cervical canal for the presence of fetal fibronectin, a glue-like tissue lost with labor, also may help guide your treatment.

If it turns out that you're in premature labor, you and your doctor will need to decide whether to try to stop your labor. Considerations include your baby's well-being, as well as your own, along with the risks and benefits of each option.

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