Your visit to the preterm birth prevention clinic – what to expect

Most pregnancies deliver at term, which is between 37 and 41 weeks. Preterm birth is when a baby is born before 37 weeks, sometimes called a premature birth. 

In the UK, preterm birth is not uncommon, with 8 in 100 babies being born preterm. Around 1 in 4 preterm births are because the medical team have advised an early birth is needed due to concerns about the baby’s or mother or birthing person’s health. Most preterm babies are born early because labour starts naturally sooner than it should. 

Preterm babies have an increased risk of health problems including breathing, feeding and being at increased risk of infection. The earlier a baby is born, the more likely they are to have these problems and need admission to the Neonatal Unit. More than 9 out of 10 babies born preterm after 28 weeks survive and only a small number go on to have long term disability.

The clinic cares for people who may have a higher risk of their baby being born too early. This is usually due to:

• a previous birth at less than 34 weeks or a late miscarriage after 16 weeks
• a previous pregnancy where the waters broke at less than 34 weeks
• previous surgery to their cervix after an abnormal cervical screening test
• a cervical stitch placed in a previous pregnancy
• a bicornuate (heart shaped) shaped uterus (womb)
• a previous Caesarean section performed when fully dilated in labour

If you have any of these risk factors, it does not necessarily mean you will have a preterm birth.

The reason preterm birth happens is still largely unknown, but there are certain factors, such as the ones above that can increase risk. Other factors include:

• vaginal bleeding after 14 weeks
• carrying twins or triplets
• excess fluid around the baby
• smoking in current pregnancy
• infections, e.g. a urine or vaginal infection

You will have your history reviewed by one of the obstetric (childbirth) doctors. Your care and monitoring throughout your pregnancy will be planned specifically for you. Early treatment or intervention may be offered if you are a particularly high risk but usually monitoring of the length of your cervix is offered if you are identified as being at risk. 

You may also be offered a vaginal swab test at around 24 weeks  pregnant, which can help to estimate your chance of going into labour early.

Cervical length scans are usually offered after 16 weeks pregnant, or later. You may be recommended to have no scans, only one scan, or regular scans every two weeks up until 24 weeks pregnant, depending on your risk of early labour. 

Your neck of your womb is measured by a transvaginal ultrasound (an internal scan where a probe is gently inserted into your vagina). Some people get anxious about this scan, but it is generally very well tolerated. An abdominal scan (across the tummy) cannot measure the neck of your womb accurately. 

You will not usually need any treatment and can continue routine care after the 24 week scan including growth scans where planned, unless you have other risk factors not to do with having a preterm birth.

However, if the scans find that you have some shortening of your cervix, you may be offered:

• A cervical stitch (also called suture or cerclage)
  This is done under a light spinal anaesthetic (injection into your back) where we place a stitch around the cervix like a ‘drawstring’ to try and keep it closed. This is then removed around 36 weeks, or if you go into labour, whichever comes first. You may be offered this stitch routinely at 13 to 15 weeks pregnant, before you have any scans if the healthcare professionally recommend this at your first clinic appointment.
• Progesterone pessaries
  This is a hormone tablet that is given vaginally, or into your rectum (back passage). You can start this at around 16 to 24 weeks pregnant and use until 34 weeks pregnant. 

More information will be given at the time if either of these options are recommended.

• Stop smoking - Smoking is strongly associated with preterm birth risk and so if you are finding it difficult to quit, you’ll be offered support to help you.
• Speak to your midwife or doctor if you feel stressed, have poor mental health or are in an abusive situation as you may be more likely to birth early.

Otherwise, the most important thing is to seek advice if you have any signs of labour, or if you are unsure of what you may be experiencing, including:

• backache (intermittent or continuous)
• cramps like strong period pains
• feeling of pressure in your pelvis
• feeling sick (nausea), vomiting (being sick) or having diarrhoea (liquid poo)
• your waters breaking – this could be a slow trickle or a gush of fluid from your vagina
• bleeding
• losing your mucus plug

Having any of these symptoms may not mean you are in preterm labour, but it is important to tell your healthcare team so that treatments can be started to help with baby’s wellbeing if early labour is starting. 

This may also include being transferred to a larger centre if you are very early in your pregnancy, or where a suitable neonatal cot is available.

If preterm labour is diagnosed or suspected you may be offered:

• To go or be transferred to a larger centre that will meet your needs
  Attempts to ‘stop’ labour with medication do not benefit the baby, but may be used to help ‘buy time’ so that other medicines can be given to you
• Steroid injections
  These are usually two separate injections 12 to 24 hours apart to help improve baby’s lungs and breathing. You may be recommended to have these if you are at very high risk of early labour, but ideally need to be given within a week of your planned or natural preterm birth
• Magnesium sulphate
  This medicine can help with baby’s brain development when preterm birth is looking likely to be soon
• Antibiotics
  Preterm babies are more likely to have problems with infections, so having antibiotics anyway as a precaution can be helpful
• A discussion with the paediatric team on what to expect when your baby is born 
• A discussion with the obstetric team about ‘mode of delivery’. You can decide together whether a vaginal or Caesarean birth is more appropriate for you and your baby at the time
• You may be encouraged to express some colostrum (the first breast milk produced in pregnancy and after birth) to help reduce some of the complications to baby, if you are in labour or have your labour planned. 

These will all be discussed in more detail during your pregnancy. 

It is important to let your healthcare team know early if you have any concerns.

• Tommy’s Pregnancy Hub - What happens if I'm told I am at risk of premature birth?
• Tommy's Pregnancy Hub - Premature birth
• NHS website - Premature labour and birth
• Bliss charity

Early Pregnancy Assessment Unit 

01709 427072
Monday to Friday, 8am to 4pm

Labour Ward/Triage 

01709 424491