Preterm Labour: Warning Signs, Tests and Hospital Care
Key message: Preterm labour begins before 37 completed weeks. Many people with symptoms do not give birth soon,…
Key message: Preterm labour begins before 37 completed weeks. Many people with symptoms do not give birth soon, but early assessment matters because steroids, transfer and other treatment are most useful before birth.
Get urgent help: Before 37 weeks, contact maternity care now for regular contractions or tightenings, period-like pain, patterned backache, pelvic pressure, fluid leakage, bleeding, fever or changed movements. Do not wait for severe pain.
What are possible signs?
- Regular or increasingly frequent tightenings.
- Period-like lower-abdominal pain.
- Patterned backache or pelvic pressure.
- A change in discharge, bleeding or mucus.
- A gush or trickle of fluid.
- Reduced or changed fetal movements.
Who has a higher chance?
- Previous spontaneous preterm birth or late miscarriage.
- Short cervix or cervical surgery.
- Multiple pregnancy.
- Ruptured membranes or infection.
- Uterine anomaly or bleeding.
- No known risk factor in many cases.
What happens during assessment?
- History of timing, frequency, bleeding, fluid and movements.
- Temperature, pulse, blood pressure and abdominal assessment.
- Fetal-heart and contraction monitoring according to gestation.
- Sterile speculum examination, swabs and urine tests.
- Cervical-length ultrasound or fetal fibronectin/another validated test at suitable gestations.
- Ultrasound for presentation, growth, fluid or another concern.
What are antenatal corticosteroids?
Steroid injections are offered at selected gestations when preterm birth is likely, to reduce breathing and other prematurity complications. Benefit depends on timing, so they are not automatically given for every contraction.
A repeat course is considered only under defined circumstances.
What is tocolysis?
A medicine may delay birth briefly to allow steroids to work or transfer to a hospital with suitable neonatal care. It does not permanently stop preterm labour and is not appropriate with some infection, bleeding or fetal conditions.
Choice depends on gestation and contraindications.
Why is magnesium sulphate used?
At selected early gestations when birth is imminent, magnesium sulphate can reduce the risk of cerebral palsy in surviving babies. The mother is monitored for side effects and toxicity.
It is a time-limited hospital treatment, not a home supplement.
What if labour is not confirmed?
Symptoms may settle and the patient may go home after observation with clear safety-net advice. A reassuring first visit does not mean future or changed symptoms should be ignored.
Routine strict bed rest is not proven to prevent preterm birth and can increase clot and deconditioning risks.
How is birth and newborn care planned?
Transfer to a unit with the right neonatal level may be recommended. The neonatal team explains likely breathing, feeding, temperature and hospital-stay needs.
Birth route depends on fetal presentation, gestation, labour progress and complications, not prematurity alone.
Frequently asked questions
Does every contraction before 37 weeks mean labour?
No, but regular or changing symptoms need assessment.
Will bed rest prevent birth?
Routine strict bed rest is not proven and may cause harm.
Do steroids make the baby grow faster?
No. They mature organs, particularly lungs, when birth is likely soon.
Can labour be stopped until term?
Tocolysis generally provides only a short delay.
Should I drive myself to hospital?
Not if bleeding is heavy, pain severe, you feel faint or birth may be imminent.
Your next step
Save the maternity-unit number and know which hospital provides preterm newborn care. New or recurrent symptoms before 37 weeks require immediate reassessment.
Medical and content review: Dr Mohamed Abdelghany, Obstetrics & Gynecology Specialist, MRCOG (UK), MSc Obstetrics & Gynecology – Kasr Al-Ainy, Cairo University.
Last reviewed: 23 August 2026.
This information is for general education and does not replace individual medical assessment. Severe, sudden or concerning symptoms should not wait for a routine appointment.
