Treatments to prevent a premature (preterm) birth
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Making choices about treatment
Why might I be offered treatment to help prevent preterm labour and birth?
Which treatments may I be offered?
Going into spontaneous premature labour
Premature birth, also called preterm birth, is when a baby is born before 37 weeks of pregnancy. Most of the time, premature births happen spontaneously (naturally) and often doctors will not know why.
Being told you are at risk of premature birth can be very worrying. But if your healthcare professional thinks you are at risk, they will monitor you closely and may offer you treatment to try to prevent you having a preterm birth. This will give your baby more time to grow in your womb.
Read more about causes of premature birth and about things you may be able to do to reduce your risk
Making choices about treatment
Making decisions in pregnancy can be difficult. You need to think about the risks and benefits of different options, as well as what matters most to you, and decide what’s best for you and your baby.
It’s always your choice. You have a right to say ‘yes’, ‘no’ or ‘not now’ to any test, treatment or procedure you’re offered. Your healthcare team should talk to you about the reasons why they are offering a treatment (or test or procedure) and what the risks, benefits and alternatives are. Don’t be afraid to ask any questions that will help you make an informed decision.
Read more about making decisions in pregnancy.
Monitoring and tests
At your booking appointment, your midwife will assess whether you are someone who would benefit from extra monitoring.
If your midwife or doctor thinks you may go into labour early, they may offer you a vaginal ultrasound scan to measure your cervix. Having a cervix shorter than 25mm is linked to a higher risk of preterm labour and birth.
Why might I be offered treatment to help prevent preterm labour and birth?
You may be offered treatment if:
- you've given birth at less than 34 weeks pregnant before
- you've had a miscarriage after 16 weeks pregnant before
- your waters have broken before 37 weeks in previous pregnancies
- your cervix has been injured in the past, such as through surgery
- your cervix is shorter than expected (measured with a vaginal ultrasound scan).
Which treatments may I be offered?
Your treatment may depend on why you are at risk of premature birth and your previous pregnancy history.
You may be offered a choice between cervical stitch or vaginal progesterone. There is no evidence to show that one of these two treatments is better than the other. Treatment usually starts before 24 weeks of pregnancy.
Your midwife or doctor will discuss with you the risks and benefits of treatments. Your circumstances and your preferences will be important in deciding which treatment is best for you.
Vaginal progesterone
Treatment with vaginal progesterone involves regularly putting a progesterone pessary into your vagina, usually up until 34 weeks of pregnancy. The pessary is shaped like a small tampon and most people find it easy to put in.
Progesterone is a hormone that is important in supporting pregnancy in several ways, including helping keep the womb relaxed, lowering the risk of early labour. It does not always work.
Cervical stitch
Putting a stitch into your cervix (a cervical stitch) can help keep it closed and reduce your risk of having a preterm birth, though it does not always work.
The cervix is the opening to your womb from your vagina. Most people who have a cervical stitch have it put in through the vagina. It’s usually done as a planned procedure between 12 and 24 weeks of pregnancy. It’s done in an operating theatre. You may have a spinal anaesthetic, where you will stay awake but be numb from the waist down, or a general anaesthetic where you are asleep.
There may be reasons why a stitch isn’t a good option for you – if you have vaginal bleeding or signs of infection, or are pregnant with more than one baby, for example. If your cervix is already too short or too far open, it may not be possible to put a stitch in.
If you have a stitch and are planning to have a vaginal birth, it will need to be taken out before you have your baby. This would normally be at around 36 to 37 weeks, unless you go into labour sooner. If you are having a planned caesarean the stitch can be taken out then.
If you have had a cervical stitch before and it hasn’t worked, or if you have had extensive surgery on your cervix, you may be offered a cervical stitch that is put in through your abdomen (tummy). It may be done through a cut in your abdomen or via keyhole surgery. This type of cervical stitch is not taken out and you would need to have your baby by c-section.
Read more about preterm cervical shortening (weak cervix).
Threatened preterm labour
Threatened preterm labour happens when you have contractions before 37 weeks, but your cervix hasn’t started to thin or shorten yet. Most people who have this do not go on to have a preterm birth. However, if you think you’re in premature labour, contact your maternity unit immediately—they may advise you to go to the hospital or arrange an ambulance for you.
Going into spontaneous premature labour
If you go into labour before 34 weeks, you may be offered a medicine to try to slow down the labour or delay the birth.
Your midwife or doctor will discuss possible treatments with you. They will consider:
- how many weeks pregnant you are
- whether it might be safest for your baby to be born without delay
- what neonatal care facilities are available
- your preferences.
You may also be offered medicine to:
- prevent your baby getting an infection
- help protect your baby’s brain and nervous system
- help your baby’s lungs develop.
If you have any concerns or questions about premature birth or treatment to prevent it, you can talk to a Tommy’s midwife for free from 9am–5pm, Monday to Friday on 0800 0147 800 or email them at [email protected]. Tommy’s Midwives also run a specialist Black and Black-Mixed Heritage Helpline – you can book a call with them.
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Lai TJ et al (2024). Progesterone in Pregnancy: Evidence-Based Strategies to Reduce Miscarriage and Enhance Assisted Reproductive Technology. Med Sci Monit. 30:e943400. doi: 10.12659/MSM.943400. PMID: 38501164; PMCID: PMC10929293.
National Institute for Health and Care Excellence (2015). Preterm labour and birth. (NICE guideline NG25) Available at: https://www.nice.org.uk/guidance/ng25/chapter/Recommendations#care-of-women-at-risk-of-preterm-labour (Accessed: 1 November 2024) (Last updated: 10 June 2022)
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Royal College of Obstetricians and Gynaecologists (2022). Cervical cerclage: Green-top Guideline No. 75). Available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/cervical-cerclage-green-top-guideline-no-75/ (Accessed: 19 December 2024)
Royal College of Obstetricians and Gynaecologists (2022). Cervical stitch. Available at: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/cervical-stitch/ (Accessed: 9 December 2024)
World Health Organization (2023). Preterm birth. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth (Accessed: 4 November 2024)