Preterm Labour: Warning Signs and What to Do
Medically reviewed by Dr. Priyadatt Patel, MBBS, MS (Obstetrics & Gynaecology) — Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead, IVF Specialist & Advanced Laparoscopic Surgeon, Balaji Horizon Women’s Hospital, Ahmedabad. · Last reviewed: 14 July 2026. Reading time: about 9 minutes. This article is educational and does not replace an individual assessment.
Most pregnancies reach full term, but roughly one in ten babies worldwide arrives early — and India accounts for more preterm births than any other country. What makes this topic worth ten minutes of your time is a simple fact: when labour threatens to start early, the treatments that genuinely help your baby work best when they are started promptly. That means the single most useful thing you can do is know the warning signs and act on them the same day, rather than waiting to see whether they settle. This article explains what preterm labour looks and feels like, how it differs from harmless practice tightenings, what happens when you come in for assessment, and what can be done — following current WHO and NICE guidance. It sits alongside our pregnancy care overview and antenatal care guide.
The short answer
Labour that starts before 37 completed weeks is preterm. Contact your maternity team the same day — do not wait until morning — if before 37 weeks you notice regular tightenings or period-like cramps, a rhythmic low backache, pelvic pressure, a watery leak from the vagina, bleeding, or a marked change in discharge. Many of these episodes turn out to be false alarms, and no one will mind checking. But when it is the real thing, the interventions that matter most — steroid injections for the baby’s lungs, magnesium for brain protection, and arranging the right place and timing of birth — depend on getting there early.
What counts as preterm labour?
A normal pregnancy runs to about 40 weeks, and anything from 37 weeks onward is considered term. Preterm labour means regular contractions with changes in the cervix before 37 weeks. Doctors further describe prematurity by how early birth happens: late and moderate preterm (32 to 37 weeks) accounts for the great majority of cases, while very preterm (28 to 32 weeks) and extremely preterm (before 28 weeks) are less common but need the most support. This distinction matters because both the urgency and the plan change with gestation — and because most babies born a little early do well. Preterm birth remains the leading cause of death in children under five worldwide, which is precisely why early recognition, rather than fear, is the message of this page.
The warning signs you should never ignore
Preterm labour is often subtler than labour at term. The tightenings may be less painful at first, and some women describe only a vague sense that something has changed. Before 37 weeks, treat the following as signals for a same-day call or visit:
- Regular tightenings or contractions — especially four or more in an hour, or tightenings that keep returning at intervals rather than fading away.
- Period-like cramps in the lower abdomen, constant or coming in waves.
- Low backache that is dull and rhythmic, different from the ordinary backache of pregnancy.
- Pelvic or vaginal pressure — a feeling that the baby is pushing down.
- A change in vaginal discharge — suddenly more, more watery, or mucus-like; passing the mucus plug (a “show”) before 37 weeks deserves review.
- A watery leak, whether a gush or a slow trickle — possible early breaking of the waters (see below).
- Vaginal bleeding at any stage needs assessment in its own right.
- Your baby moving less than usual — not strictly a sign of labour, but a same-day check in its own right; see our guide to reduced fetal movements.
None of these signs proves that labour has begun — but none of them can be safely judged over the phone or by waiting at home. Assessment settles it, usually within a couple of hours.
Braxton Hicks or the real thing?
From mid-pregnancy onward, most women feel Braxton Hicks tightenings — the uterus practising. These are irregular, usually painless or only uncomfortable, do not become progressively longer, stronger and closer together, and typically settle with rest, a change of position, emptying the bladder, or a glass of water. True preterm labour behaves differently: the tightenings develop a rhythm, persist despite rest, and gradually intensify. The honest caveat is that the two can be hard to distinguish in the early hours — even for professionals without an examination. So use the pattern as a guide, not a verdict: tightenings that are regular, strengthening, or accompanied by any of the other warning signs above deserve same-day assessment, and a false alarm is a good outcome, never a wasted visit.
Leaking watery fluid — when the waters break early
If the membranes rupture before 37 weeks without contractions, this is called PPROM (preterm prelabour rupture of membranes). It may be an obvious gush, but just as often it is a slow trickle or simply persistent dampness that keeps returning. PPROM needs same-day assessment even if you feel entirely well, because the plan from here — a sterile speculum examination to confirm fluid, checks for infection, a course of antibiotics (usually erythromycin), steroids at the appropriate gestation, and a monitoring plan — is time-sensitive. With careful monitoring, many women with PPROM gain valuable days to weeks of further pregnancy. Two practical points: wear a pad (its pattern of soaking genuinely helps the assessment), and avoid tampons and intercourse once you suspect your waters have gone.
Who is at higher risk of preterm labour?
Some situations raise the chance of an early birth, and knowing them changes the surveillance plan:
- A previous preterm birth or PPROM — the strongest single predictor.
- A previous late miscarriage (after 16 weeks).
- A short cervix found on a transvaginal scan in mid-pregnancy.
- Previous surgery to the cervix, such as LLETZ or cone biopsy for abnormal smears.
- Twins or higher multiples, and some variations in the shape of the uterus.
- Infections, including untreated urine infections.
- Tobacco use, and a very short gap (under about 18 months) between pregnancies.
Two balancing truths belong here. First, having a risk factor does not mean you will deliver early — most women with one still reach term. Second, and just as important, many preterm births — perhaps half — happen in women with no known risk factor at all. That is why the warning signs above are worth knowing in every pregnancy, not only in “high-risk” ones. If your pregnancy is already under closer surveillance, our high-risk pregnancy care page explains how that monitoring works.
What happens when you come in for assessment
Assessment for suspected preterm labour is systematic and usually quicker than women expect. It typically includes a careful history and examination, your pulse, blood pressure and temperature, a urine test, and monitoring of the baby’s heartbeat and any tightenings (CTG). A gentle speculum examination looks at the cervix and checks for leaking fluid, and swabs may be taken. Two tests help predict whether early birth is actually likely: a transvaginal ultrasound measurement of cervical length — the same quick, safe scan described on our cervical length scan page — and, where the scan is unavailable or unclear, a swab test (fetal fibronectin) from the top of the vagina. A long, closed cervix with a negative swab makes birth in the next one to two weeks unlikely, and many women are reassured and go home the same day with a clear plan of what to watch for. That is the value of being checked: the answer is usually either genuine reassurance or genuinely useful time.
If preterm labour is confirmed — what actually helps
When assessment suggests early birth is a real possibility, treatment focuses on making that birth as safe as possible rather than on promises to stop it:
- Antenatal corticosteroids — a short course of injections that speeds the maturing of the baby’s lungs. This is one of the best-proven treatments in obstetrics, reducing breathing difficulty and other complications of prematurity; it is usually offered between 24 and about 35 weeks when birth is expected within days.
- Magnesium sulfate — given by drip at the earliest gestations (broadly before 30–34 weeks) when birth is imminent, to help protect the baby’s developing brain.
- Tocolysis — medication (most often nifedipine) that can quieten contractions for a short time. Its honest purpose is to buy 48 hours for the steroids to work or for transfer to the right unit — not to hold off labour for weeks, and it is only used when delaying birth is safe for mother and baby.
- Antibiotics — when the waters have broken early, to reduce infection and prolong the pregnancy.
- Planning the birth itself — the right place, timing and, where it matters, mode of birth for the gestation, so the baby is born where the appropriate level of newborn support is ready. Our birth options page explains how these decisions are shared.
Can preterm birth be prevented?
Not always — and any clinic that promises otherwise is overpromising. But in the right women, risk can be meaningfully reduced. Vaginal progesterone is offered when there is a history of preterm birth or a short cervix on scan; large pooled analyses (the EPPPIC meta-analysis) show it lowers the chance of early birth in exactly these groups. A cervical stitch (cerclage) helps in selected situations, such as a short cervix with a previous preterm birth or late miscarriage. Beyond these, the practical measures are unglamorous but real: treating urine infections promptly (including infection found on routine testing before it causes symptoms), stopping tobacco in any form, allowing a reasonable gap between pregnancies, and good control of blood pressure, diabetes and anaemia through regular antenatal care. In higher-risk pregnancies, scheduled cervical-length scans in mid-pregnancy pick out women who would benefit from progesterone or a stitch before any symptoms appear.
What an early birth means for your baby
The outlook after preterm birth depends chiefly on how early the baby arrives, and it improves with every additional week — often with every additional day at the earliest gestations. Babies born a few weeks early usually need little more than some extra attention to feeding, warmth and jaundice. Babies born very early need neonatal intensive care, and the weeks that follow ask a great deal of parents. It is precisely because gestation matters so much that the unglamorous steps in this article — recognising signs early, steroids at the right moment, magnesium, and delivering in the right place — carry such weight: they are the levers that shift outcomes. What deserves equal emphasis is what preterm birth is not: it is not a failure of the mother, and it is rarely caused by anything a woman did or did not do.
What to do right now if you have symptoms
If you are under 37 weeks and something on the warning-signs list is happening: call your maternity unit now and be seen today. While arranging that — not instead of it — empty your bladder, sit or lie on your left side, drink some water, and time any tightenings (how long each lasts, and the gap between them); this information genuinely helps the team assessing you. Put on a pad if there is any leaking or discharge. Do not wait for symptoms to become “bad enough”, do not take medication to quieten things at home, and do not drive yourself if contractions are strong. If you cannot reach your usual team and symptoms are persisting, go directly to a hospital with maternity services.
Preterm labour care in Ahmedabad
At Balaji Horizon Women’s Hospital on Science City Road, Ahmedabad, preterm-birth risk is assessed as part of routine and high-risk pregnancy care — including transvaginal cervical-length surveillance where indicated, preventive treatment such as vaginal progesterone or cerclage in the right candidates, and same-day assessment of women with symptoms. When early birth cannot be avoided, the focus shifts to timing, steroids and safe planning of the birth for the gestation. If you are pregnant and unsure whether what you are feeling needs review, the safe default is simple: be checked.
When to seek advice
Before 37 weeks, seek same-day review for regular tightenings, period-like cramps, rhythmic backache, pelvic pressure, a watery leak, bleeding, a marked change in discharge, or reduced fetal movements. Seek review at any gestation if you simply feel something is wrong — that instinct is taken seriously. And as always, this article is general education: your own gestation, history and findings decide your plan, which belongs in a face-to-face consultation.
Frequently asked questions
How do I tell Braxton Hicks from real preterm labour?
I think my waters have broken early — what should I do?
Can preterm labour be stopped?
Will my baby be okay if born early?
Can preterm labour happen without any risk factors?
Sources: WHO fact sheet on preterm birth; NICE guideline NG25 — Preterm labour and birth; RCOG patient information on preterm labour and PPROM; Cochrane review of antenatal corticosteroids for accelerating fetal lung maturation (Roberts et al., updated McGoldrick et al.); EPPPIC meta-analysis of progestogens for preventing preterm birth, The Lancet (2021). Guidance is summarised for education; individual care may reasonably differ.
Disclaimer: This article is for educational purposes only and does not replace a consultation with a qualified obstetrician. If you have symptoms of preterm labour, contact your maternity unit today.
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