In general, an obstetrician-gynecologist (ObGyn) will be more aggressive in attempts to delay labor when the patient is less than 32 weeks pregnant. If a physician orders the patient to the hospital, an examination of the cervix will help determine if the cervix is opening (dilating), which could indicate labor has begun. The physician will also check to see if fetal membranes have ruptured. Monitors are typically placed on the patient’s abdomen to measure the baby’s heart rate, and observe possible uterine contractions.

Some ObGyns may order a fetal fibronectin test (fibronectin is a protein that attaches the sac that holds the fetus to the uterus). This test requires that a sample be taken of the cervical and vaginal secretions. Most women consider it about as uncomfortable as a Pap smear. Though the results will not definitively determine if a woman has begun premature labor, it will clearly indicate if she has not begun labor. A negative test result means that it is highly unlikely that the woman will give birth within the next seven to 14 days, and can help the physician decide whether to delay giving medications to stall preterm labor.

Other tests might include a urine test, to exclude a urinary tract infection as a cause of preterm labor, or an amniocentesis, which can offer information about the baby’s lung development. Additional samples from the cervix may be tested for infection, which is a major cause of premature labor. If preterm labor is determined, initial treatment will most often include hydration with or without administration of terbutaline.  If this is unsuccessful in stopping labor, further treatment may include the intravenous administration of magnesium sulfate. An initial large dose, which may cause nausea, is followed by lower dose continuous intravenous administration over a period of 12 to 24 hours or more.

If labor continues to progress, and the patient is between 24 and 34 weeks gestation, a corticosteroid may be given to the woman by injection 24 hours before birth in order to increase the baby’s lung and brain development. Hospitals that have neonatal intensive care units (NICUs) offer premature babies the best chance for optimal health and survival. If premature labor continues and a premature delivery is expected, the patient may be transferred to a hospital with an NICU. Depending on how premature the labor is, the ObGyn may call in a neonatologist, a physician who specializes in premature intensive care. The neonatologist can help determine if any additional treatments are necessary for the premature infant.

Many infants born before 37 weeks of gestation will have respiratory distress syndrome (RDS). RDS is one of the most common complications associated with premature delivery. If left untreated, severe cases can lead to multiple organ failure and even death.

Treatment of RDS includes placing the baby on a respirator, which is a machine that helps the baby to breathe. In addition, the neonatologist may order oxygen treatments or treatments that include nitric oxide to improve breathing. In many cases, RDS usually resolves within four or five days. Additional treatment of a pulmonary surfactant, which keeps small air sacs in the lungs from collapsing, can help to speed recovery. In some cases, RDS can be avoided if labor can be delayed by 24 to 48 hours and specific medications (e.g., steroids) are administered to the mother to allow an accelerated development of the lungs.

Another common complication of premature infants and a serious concern for parents and physicians is bleeding in the brain (intracranial hemorrhage). This happens more often in very premature babies (before 34 weeks gestation), who are at higher risk of serious complications and conditions.

In addition to RDS and intracranial hemorrhage, other common complications that impact premature babies more often than full-term babies include:

• Low birth weight (less than 2,500 grams or about 5 pounds, 8 ounces)
  
  
• Very low birth weight (less than 1,500 grams or about 3 pounds, 5 ounces)
  
  
• Eye problems (retinopathy of prematurity)
  
  
• Intestinal problems
  
  
• Breathing problems (apnea)
  
  
• Jaundice (a yellow skin color due to an immature liver)
  
  
• Anemia (lack of red blood cells)
  
  
• Infections
  
  
• Sudden infant death syndrome (SIDS)