Sometimes, despite a straightforward pregnancy, you show symptoms of going into labour early. As we’ve covered earlier in this Unii Journey, showing some of the signs of preterm labour does not mean you’re going to have your baby before 37 weeks. If you do go into labour suddenly, it may be possible to delay it. Your doctor or midwife will take steps to find out exactly what’s happening and avoid unnecessary treatments, hospitalisation, or worry. This article is about what you can expect those steps to be like.

A physical examination

This is usually the first step. Your doctor will assess your vital signs, look for any signs of effacement (the thinning and shortening of the cervix), and measure the size and height of your uterus. They will also ask about pain, contractions, and changes in vaginal discharge.

A pelvic examination

A more localised version of the above, this examination includes looking for any cervical changes, including dilation or effacement. Your doctor or midwife will insert gloved fingers into your vagina to check your cervix and its condition. If the cervix is short or dilated, you may be in premature labour.

Foetal Fibronectin (fFN) Test

Foetal fibronectin (fFN) is a glycoprotein that can be detected in your cervicovaginal secretions throughout pregnancy, with low levels between 22 and 35 weeks of gestation. Foetal fibronectin concentrations greater than or equal to 50 ng/mL between 22 and 35 weeks of pregnancy are associated with an increased risk of preterm delivery. The accuracy of predicting spontaneous preterm birth within 7–10 days of testing among women with symptoms of threatened preterm labour before advanced cervical dilatation has been confirmed by large studies.

A very useful aspect of these test characteristics is that a negative fFN test makes it highly unlikely that your symptoms of preterm labour will result in delivery within the next 14 days (less than 1 ercent). A positive test result, on the other hand, indicates an increased risk of preterm labour within the next one to two weeks. The QUiPP app is a decision support tool that was rolled out at UK hospitals in 2020. Should you arrive with symptoms of threatened preterm labour, it uses your medical history and foetal fibronectin or cervical length to give an individualised score for the risk of having a spontaneous preterm delivery.

Getting an ultrasound

Imaging from an ultrasound will be extremely useful to your doctor or midwife. You will likely be referred for a scan of your cervix if you are showing signs of premature labour. This scan measures the length of your cervix and makes it easier to estimate the chances of you giving birth early. If your cervix is shorter than normal, you may be at higher risk of giving birth early. This scan is an internal examination. A probe will be inserted into your vagina so that it lies next to your cervix. This won’t hurt you or harm your baby.

Continuous foetal monitoring

The professionals taking care of you will aim to prolong your pregnancy for as long as is safely possible. Your baby's heart rate will be monitored for any signs of distress. This may involve electronic foetal monitoring, where sensors are placed on your abdomen to record the baby's heart rate and uterine contractions. Non-stress testing (NST) and biophysical profile (BPP) are other tests that can check your little one’s wellbeing and determine whether there’s any need to intervene.

Blood tests

This may feel like an odd time to be asked to give blood, but these tests can show your hormone levels, including progesterone, which plays a role in maintaining your pregnancy and preventing premature contractions. A blood test can also help your doctor screen for infections associated with preterm labour that couldn’t be confirmed by your pelvic exam.

It is important to note that the combination of signs, symptoms, and test results is taken into consideration to diagnose preterm labour accurately.

Please note that this article is not a list of every step you’ll be taken through if you show signs of premature labour. The professionals taking care of you will take the combination of steps right for you, and your consent will always be required.

If preterm labour is diagnosed or suspected, various interventions may be recommended to manage the situation. These interventions can include bed rest, hospitalisation, medication to stop or slow contractions, and the administration of corticosteroids to promote foetal lung development. We explore them in more detail later in this Unii Journey.

Diagnosing Preterm Labour: Tests and Procedures

Unii's Premature Baby Journey explores the steps your doctor will take to check if you are going into premature labour.