Preterm birth

Every year in the UK, about 8 out of every 100 babies is born preterm (early) – this means before 37 weeks of pregnancy. Fortunately, most of these babies do very well, but some – especially those born very early – will need a lot of extra care.

Some of these early births are completely unexpected, but some women will have risk factors that we can identify during pregnancy. The information you gave your midwife at your pregnancy booking appointment suggests that you may have a risk factor for your baby being born early. This could be something that happened in a previous pregnancy or birth or could be related to a health condition or surgical procedure you have had in the past.

In this specialist clinic, we will discuss with you if we think that there is something we might be able to do to help reduce this risk or to monitor your pregnancy more closely to find any signs of early labour sooner. This may be through a telephone or face-to face appointment initially, usually around 16 weeks into your pregnancy. In certain situations, this may be earlier.

Please try not to worry about this – most women even with risk factors often do NOT give birth early and the monitoring we offer in this clinic, therefore, provides reassurance that all is well.

Premature labour, or preterm, is a labour that happens before the 37^th week of pregnancy. About 8 out of 100 babies will be born prematurely.

Sometimes there are signs that you may be going into early labour. Often this does not lead to labour but it is important to seek advice if you think this is happening to you. Signs may include;

• period-type pains or cramps
• a gush or trickle of fluid from your vagina – this could be your waters breaking
• backache that’s not usual for you, or a feeling of pressure
• bleeding from the vagina

You must call MAC straight away with any of these concerns.

You can also call MAC if you’re unsure or worried about anything else during your pregnancy.

A risk assessment is carried out at the beginning of pregnancy that identifies the risk of a baby coming early (premature). There are several things that may increase the chance of babies coming early;

• Any previous waters breaking, or babies born before 34 weeks
• Any previous baby loss due to early labour after 16 weeks
• Any previous need for a stitch in the cervix
• An unusually shaped womb
• Previous surgery to the neck of the womb
• A previous caesarean section at full dilatation

These factors may slightly increase the risk of a baby being born premature.

Cervical length scan

Scientific studies have shown that some women who go on to have early births, had a shortening cervix (neck of the womb) several days or weeks before the birth happened. Performing an internal scan (through the vagina) enables us to take a measurement of the length of your cervix and this can help decide how high your risk of early birth is. These scans are not dangerous in any way to you or to your baby.

Some women will have had similar internal scans in early pregnancy or when having fertility treatment or for other reasons. Most women do not find these scans too uncomfortable.

Cervical Suture

We may discuss a cervical stitch (sometimes called a suture or cerclage). This is a procedure usually done under a light spinal anaesthetic (injection in your back that makes your bottom half go numb for a short time) where we put a stitch around your cervix to try to keep it tightly closed. This aims to prevent early birth in some women who are at higher risk. It does not work for everyone though. The stitch is removed when a woman is in labour or at 36 weeks, whichever comes sooner. If the stitch is an option for you, we will give you much more information about it and help you decide if you want to have one.

Vaginal Progesterone

Progesterone is a hormone that is important in supporting pregnancy in several ways, including keeping the womb relaxed, lowering the risk of early labour. The treatment involves regularly putting a progesterone pessary into your vagina from 16-36 weeks, it is shaped like a small tampon and most people find it easy to put in.

Infection screening

You may be offered a vaginal examination to enable the doctor to visualise the cervix, swabs may be obtained to check for infections that may increase your risk of preterm birth.

Please see the resources below for more information on Preterm birth and options during pregnancy if you are at risk.

While you have appointments in this clinic, you should also continue with your regular midwife appointments.

You are always free to choose to accept or refuse any appointments, tests or treatments that are offered to you and we are always happy to explain things again if you are unsure or have more questions.

Smoking doubles the risk of premature birth. Speak to your midwife about how we can help you stop smoking.

Women who experience domestic abuse have more chance of having a baby early. Please speak to your midwife so we can help.

If you feel like you may have a urine infection, please speak to your midwife or GP as soon as possible.

Sexually transmitted infections (such as chlamydia and gonorrhoea) are associated with having a baby early. We can offer tests for this at the clinic. If you think you might be at risk of having an STI then speak to your midwife or local sexual health clinic as soon as possible.

Most importantly seek prompt advice for any changes in your pregnancy particularly with new pain, vaginal loss, reduced fetal movements or concerns you may have.

If you are in threatened pre-term labour or your waters have broken early you will be admitted to the Antenatal ward (M3) for close observation. Evidence suggests that the highest chance of pre-term delivery occurs in the first seven days after diagnosis.

The Neonatal Unit at Bradford Royal Infirmary provides all levels of newborn medical care and intensive care to babies from Bradford and across the Yorkshire region. It is also home to an intensive and high dependency care unit.

You will meet with members of the neonatal team who will discuss a variety of evidence-based care options for you and your baby to optimise the environment for your baby to be born. You and your family will be involved in making the decisions that are right for you and your baby.

If you would like to know more about our neonatal unit, please have a look at their website.

Babies may also be looked after on our transitional care unit. This is based on our postnatal ward, and is staffed by midwives and neonatal nurses, with the support of doctors.