Preterm Birth and the Complications it Can Bring

A premature birth can leave your family facing NICU care, unfamiliar diagnoses, and questions about whether earlier warning signs were recognized. This page can help you understand preterm birth, the complications it may cause, and when the medical care may deserve a closer review.

What is preterm birth?

Preterm birth, also called premature birth, occurs when a baby is born before 37 completed weeks of pregnancy. Preterm labor is labor that begins before 37 weeks and involves contractions that lead to changes in the cervix. Preterm labor does not always result in an early delivery.

Some babies are born early after spontaneous preterm labor or preterm prelabor rupture of membranes. In other situations, the medical team may recommend an early induction or cesarean delivery because continuing the pregnancy presents a greater risk to the mother or baby. Prematurity is not automatically a birth injury, and outcomes vary widely, but babies born earlier may need more specialized support because the brain, lungs, liver, and other organs are still developing.

Signs and symptoms of preterm labor

Preterm labor can begin gradually or develop quickly. Anyone experiencing possible labor symptoms before 37 weeks should contact a medical provider promptly for guidance and evaluation.

• Regular or frequent contractions, which may or may not be painful
• Pressure in the pelvis or lower abdomen
• A constant low, dull backache
• Cramps that feel like menstrual cramps
• Abdominal cramping, with or without diarrhea
• A change in vaginal discharge, including an increase in watery, mucus-like, or bloody discharge
• Vaginal spotting or bleeding
• A gush or steady leaking of fluid that may indicate the membranes have ruptured

These symptoms do not always mean that preterm birth will occur. A medical evaluation may include monitoring contractions and the baby’s heart rate, examining the cervix, measuring cervical length by ultrasound, and checking for ruptured membranes or infection.

What causes preterm birth?

The exact cause of preterm birth is often not identified. It may happen after spontaneous labor, after the membranes rupture before labor, or because a maternal or fetal complication makes early delivery medically necessary.

Circumstances that may cause or contribute to preterm birth include:

• Spontaneous uterine contractions and cervical change without a clearly identified trigger
• Preterm prelabor rupture of membranes, often called PPROM
• Cervical insufficiency or a cervix that shortens or opens too early
• Infection or inflammation involving the reproductive tract, uterus, or membranes
• Placental complications or significant bleeding that make continued pregnancy unsafe
• A pregnancy involving twins, triplets, or other multiples
• Maternal or fetal conditions that require a medically indicated early delivery, such as severe hypertensive disease, impaired fetal growth, or evidence that the baby may be compromised

These risk factors do not prove that an early birth was preventable, and preterm birth can occur without an obvious warning pattern.

When preterm birth may be medical malpractice

Not every preterm birth is caused by medical malpractice. Many premature deliveries occur despite appropriate care, and early delivery is sometimes necessary to protect the mother or baby. However, the following circumstances may point to negligence when a provider’s failure to meet accepted standards contributes to a preventable early birth or worsens the resulting harm:

• Dismissing or failing to promptly evaluate contractions, bleeding, leaking fluid, pelvic pressure, back pain, or other reported signs of preterm labor
• Failing to review a history of preterm birth, cervical surgery, multiple pregnancy, or other important risk factors and arrange appropriate monitoring
• Failing to measure or properly interpret cervical length when clinically indicated
• Failing to respond to progressive cervical shortening, funneling, dilation, or other evidence of cervical insufficiency
• Failing to discuss or provide vaginal progesterone or cervical cerclage when the patient meets accepted clinical criteria
• Failing to recognize or appropriately manage PPROM, infection, or another condition associated with premature delivery
• Failing to provide antibiotics after PPROM when they are clinically indicated to reduce infection risk or help prolong the pregnancy
• Proceeding with a preterm induction or cesarean delivery without a supported maternal or fetal indication
• Delaying consultation, hospital admission, transfer, or access to a facility with an appropriate level of maternal and neonatal care

Wais, Vogelstein, Forman, Koch & Norman, LLC works with qualified medical experts to review prenatal records, cervical measurements, labor and delivery care, fetal monitoring, medication timing, and neonatal records and determine whether the care met accepted standards.

Treatment and long-term outlook

Preterm labor cannot always be stopped, and in some circumstances delivery is the safest option. When there is time and it is medically appropriate, treatment may include corticosteroids to support fetal development before birth, magnesium sulfate to help protect the baby’s brain before an anticipated early preterm delivery, short-term medication to delay labor, antibiotics for PPROM or group B streptococcus, treatment of an underlying infection or complication, and transfer to a hospital equipped for high-risk delivery and neonatal care.

After birth, a premature baby may need care in a neonatal intensive care unit. Support can include help with breathing, temperature control, nutrition and feeding, blood sugar management, treatment for jaundice or infection, and monitoring of the heart, brain, eyes, and hearing. The specific plan depends on gestational age, birth weight, the baby’s condition at delivery, and any complications that develop.

The long-term outlook varies widely. Many children born prematurely grow and develop well, while others may experience breathing or feeding difficulties, brain bleeding, cerebral palsy, developmental delays, or vision and hearing problems. Pediatric follow-up, developmental screening, early intervention, and physical, occupational, speech, or feeding therapy may be recommended based on the child’s individual needs.