Various signs herald a premature birth, for example
- premature rupture of the membranes,
- premature contractions, accompanied by cramp-like pain, and
- bright red bleeding.
An important indicator is the regularity of the contractions. The uterus contracts occasionally during pregnancy, which causes pain. However, if these contractions occur regularly, this could indicate the onset of labor.
If premature labor is suspected, the expectant mother should contact her doctor, midwife or hospital directly. The sooner medical care begins, the better the baby can be helped.
There are several risk factors associated with premature birth. However, the exact causes of premature birth are still not entirely clear.
The personal risk factors are recorded for each pregnant woman. They serve as the basis for planning medical care during pregnancy. The aim is to ensure that the child can develop fully in the womb for as long as possible.
The most important risk factor for a premature birth is the condition after a premature birth (i.e. if the pregnant woman has previously experienced premature births). Depending on the number of previous premature births and the time of their manifestation, the absolute risk of recurrence is 20 - 30 %.
Other possible risk factors for a premature birth are pre-existing illnesses
Pregnancy diseases, such as pre-eclampsia, are also a significant individual risk factor for a premature birth.
Premature birth often occurs due to cervical insufficiency (weakness of the cervix). A shortened cervix of less than 26 millimetres in length during the second trimester (2nd trimester) is also considered a risk factor or early sign of premature birth.
Ascending infections that develop from the maternal genital tract towards the cervix and uterus are also dangerous. They can trigger premature labor or premature rupture of the membranes.
There is also an increased risk of premature birth in pregnancies with multiples. Around 60% of all twins and, as a rule, all triplets are born prematurely.
Other risks are
- Smoking during pregnancy,
- long working hours of over 40 hours per week,
- heavy physical labor and
- severe emotional stress.

Children born prematurely sometimes require immense medical support © Toshi Photography | AdobeStock
If a premature birth is suspected, the pregnant woman is first thoroughly examined. The gynecologist will check the width of the cervix and the condition of the amniotic sac.
An ultrasound examination(sonography) provides information about
- the position of the cervix,
- the position of the baby and its size and weight,
- the position of the placenta and
- the amount of amniotic fluid.
A CTG (cardiotocography or cardiotopography) measures the frequency of contractions and the baby's heartbeat.
A biochemical test for premature birth can also be carried out as part of the gynecological examination. This examination is safe for mother and child and uses a vaginal swab to detect various proteins that indicate an increased risk of premature birth.
The treatment of premature labor depends on which week of pregnancy the pregnant woman is in.
After the 34th week of pregnancy, it may be advisable to let the contractions take their course. The child can be treated very well in modern neonatal units thanks to perinatal intensive care.
In the case of premature rupture of the membranes, there is often a risk of amniotic fluid infection, so delivery must take place promptly. In this case, an antibiotic is administered.
If contractions occur before the 34th week of pregnancy, it is advisable to delay the birth. Premature babies are at risk of breathing problems if their lungs are not yet fully developed. This is because sufficient lung maturity is a prerequisite for lung breathing to begin immediately after birth.
Medication can help to suppress premature labor. The mother is given so-called tocolytics for a period of up to 48 hours. This gives the baby time to reach the necessary lung maturity through the administration of glucocorticoids. The mother can then be transferred to a perinatal center.
If the mother is injected with glucocorticoids, they also enter the unborn child's body and lungs via the mother's blood. Especially between 24 and 34 weeks of pregnancy, cortisone can cause the child's lungs to mature quickly and increase the premature baby's chances of survival.
If the cervix is prematurely shortened, progesterone treatment can prevent a premature birth. If the cervix is weak, a Zerklage or Zervix pessary can help. During a cervical cerclage, a band is placed around the cervix under anaesthetic to stabilize the uterine closure apparatus. The insertion of a cervical pessary, a flexible silicone ring, can also help to relieve pressure on the pregnant woman's cervix.
If you give birth six weeks before your due date, your maternity leave and maternity benefit payments will be extended.
If the premature birth cannot be delayed any further, it is now important to bring the child into the world as gently as possible. Depending on the obstetric situation, a vaginal birth can be attempted, but a caesarean section is often necessary.
After birth, the premature baby is usually taken to the intensive care unit and placed in an incubator. There it can be optimally cared for. Humidity and temperature can be kept constant here and the baby's breathing can be monitored. If the baby cannot yet drink on its own, it is fed via a gastric tube or infusions.
The risk of recurrence of a premature birth is 20 percent if the first child was born before the 37th week of pregnancy. For a birth before the 32nd week of pregnancy, the risk is as high as 30 percent. The more premature births the mother has already had, the higher the risk of a recurrence.
If a woman has already suffered a premature birth, the gynecologist will monitor her more closely in the event of another pregnancy. He will then try to minimize the risks in advance.