1. Motherhood Wellness Guide
2. Fertility
3. Pregnancy
4. Birth Preparation
5. Breastfeeding
6. Postpartum
7. Support

Preterm Labor

Preterm labor occurs prior to 37 weeks gestation and has many causes that may lead you to a stay in the antepartum unit.

Typical causes for starting labor between 20 and 37 weeks

  • pregnancy with multiples
  • premature rupture of membrane
  • use of drugs or alcohol in pregnancy
  • placenta abruption
  • infected uterus, UTI, or other uterus/cervix complications
  • smaller than expected fetal growth
  • High-risk pregnancies

If admitted to the antepartum unit for preterm labor, goals include: prevention of labor through medicinal treatment, antibiotics to treat or prevent infection, steroids to mature fetal lungs, treat medical problems causing the issues, and then lastly delivering the baby.

Specific issues that may arise causing preterm labor:

Premature rupture of membrane (PROM) or preterm premature rupture of membranes (pPROM)

  • Typically characterized by a big gush or a slow leak.
  • Whoops! The amniotic sac sprung a leak! There is a small crack or “the water broke” before contractions started and/or before baby reached 37 weeks.
  • Antepartum goal: keep baby safely in that womb! Typical treatment plan includes a special steroid shot (at or before 34 weeks) to help boost fetal lung development, antibiotics to prevent infection since the amniotic sac is exposed to bacteria , bedrest and observation, and possibly starting the labor process (induction).

Vaginal Bleeding

  • Categorized by:
    • Severe (soaking pad/tampon hourly for 2+ hrs)
    • Moderate (soaking more than 1 pad/tampon in 3 hrs)
    • Mild (soaking < 1 pad/tampon in 3+ hrs)
    • Minimal (spotting).
  • First trimester: bleeding may be a sign of miscarriage or preterm labor, though can sometimes be normal.
  • Second and third trimester: bleeding may be a sign of placenta problems.
    • Placenta abruptio: placenta separating from the uterus wall before it is supposed to separate (during delivery). This separation can cut off the baby’s ability to exchange oxygen.
    • Placenta previa: a normal placenta attaches at the top of the uterus. In this case, the placenta is attached low in the uterus which can partially or completely block the cervix. As the cervix begins to open (or dilate) it can tear the parts of the placenta that provide blood to both the mom and baby. This can cause bleeding that may lead to a lack of blood supply for both mom and baby.
  • Antepartum goal: since the reasoning for the bleed can vary, the goal is to find the reason for the bleeding and stop or minimize the bleeding until mother reaches  a safe date to deliver.

Diabetes

  • Uncontrolled blood sugar/glucose levels can cause issues with both the developing baby and mother. Working with a physician to create a plan to control the patient’s blood sugar levels during pregnancy, as well as before and after. A woman can come into pregnancy with type 1 or type 2 diabetes. However, she can also be diagnosed with gestational diabetes during pregnancy, which can only be diagnosed during pregnancy and ends once the baby is delivered.

Polyhydramnios

  • At times, polyhydramnios (excessive amniotic fluid) can result in admission  to the antepartum unit. Besides maternal diabetes, polyhydramnios can be caused by twin-twin transfusion, birth defects of the nervous system or gastrointestinal system, mother/baby blood incompatibility, fetal anemia, and certain infections.
  • Antepartum goal: prevention of premature labor or premature rupture of membranes.

High Blood Pressure

  • Chronic high blood pressure: high blood pressure diagnosed before pregnancy.
  • Gestational hypertension/pregnancy induced hypertension (PIH): Blood pressure that increases to extremely high levels (above 140/90) in second or third trimester.
  • Preeclampsia: high blood pressure after the 20th week of pregnancy or after delivery (up to six weeks) that can affect kidneys, liver, brain, and placenta. This can affect both the mother and baby, as the placenta is not functioning properly.
    • Characterized by an unrelieved headache, blurred or spotted vision, pain in stomach, and excess swelling of the hands and face, and protein in the urine. At times, these symptoms can be missed or unnoticed due to the how quickly the disease can advance. Proper prenatal care is important to diagnose and manage preeclampsia. Currently, there is not a definite cause of preeclampsia. However, the following may put women at increased risk:
      • History of preeclampsia, high blood pressure, or kidney disease
      • Family history of preeclampsia
      • Excess weight (BMI >30)
      • Pregnancy with multiples
      • Woman younger than 20 or older than 40 years of age
  • Antepartum Goal: this can vary based on the type of blood pressure issue, but the overall goal is to maintain a healthy blood pressure through things like medications, bed rest, specialized diet.

Hyperemesis gravidarum

  • Continuous nausea and vomiting that keeps the patient from eating and drinking normally, possibly leading to dehydration.
  • Antepartum Goal: rehydration of patient through intravenous fluids, management of nausea and vomiting through medication, and the ability of the patient to keep food down.

Pregnancy with multiples

  • Pregnancy that includes more than one fetus.
  • Antepartum Goal: the goal can vary, but it is generally to keep the uterus in the most optimal state to carry the babies to the desired due date.

*Please note that anyone experiencing the symptoms described should seek medical care immediately.*


Ashlee Fleck received her Bachelor of Science in both Health and Nursing. She has worked in both Labor and Delivery and the Antepartum Unit. Ashley is passionate about creating healthy moms and a healthy babies and believes that knowledge is a huge influence in achieving that goal.

Edited by Kelly Riechers DiCristina