Preterm Birth Clinic 

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What is this information about?

This information is about preterm birth and your Preterm Birth Clinic appointment. It explains:

• what preterm birth is
• why some babies are born preterm
• why you might have been referred to the Preterm Birth Clinic
• some things that might increase the chance of you going into preterm labour
• things that you can do to reduce the chance that you will go into preterm labour
• what happens at your appointment
• what might happen after your appointment including information about further tests or treatment
• the signs that show you may be going into preterm labour and what to do if you have them
• where to get further help and support.

Why have I been given this information?

We have given you this information because we believe there may be an increased chance of you going into labour preterm and your baby having a preterm (premature) birth. Because of this you have been sent (referred) for an appointment at our Preterm Birth Clinic. 

Reading this information and following the advice in it can help you:

• understand what preterm birth is and why you may have a greater chance of your baby or babies being born preterm
• reduce the chance that you may go into labour preterm
• get ready for your Preterm Birth Clinic appointment and understand what will happen in your appointment. This includes what tests and scans you may be offered.
• know what treatments you may be offered to reduce your chance of preterm birth
• know the signs or symptoms that can show you may be in preterm labour
• know who to contact if you think you are in preterm labour or need other help or support. 

What is preterm birth?

Most babies are born between 37 to 42 weeks of pregnancy. 

Preterm birth is when babies are born before 37 weeks of pregnancy. About eight out of 100 babies will be born preterm (be premature). 

Some babies are born very early (very premature), between 22 and 28 weeks of pregnancy. This is more unusual and happens to fewer than 1 in one hundred babies.

Why are some babies born preterm?

• Three out of four babies are born preterm because labour starts on its own sooner than is usual 
• One out of four babies are born preterm because the doctor thinks that an early birth will be better for the mother or baby for health reasons. For example, the mother may have pre-eclampsia (high blood pressure and signs of liver or kidney damage) or the baby may have fetal growth restriction (the unborn baby is smaller than expected for the number of weeks of pregnancy).

Most babies born preterm arrive without warning. We are not able to explain exactly why this is. There are some things that can increase the chance of preterm labour. They are explained below and can be related to:

• things that have happened in a previous pregnancy
• your current pregnancy
• medical conditions that you have now or have had in the past.

Why might I have been referred to the Preterm Birth Clinic?

We offer to refer you to the Preterm Birth Clinic if:

• you went into labour before 34 weeks 
• your waters broke before 34 weeks. 
• you have had previous pregnancy loss after 16 weeks when your baby did not pass away (die) earlier. 
• you have had a previous caesarean section in labour when you were fully dilated (your cervix was fully open) 
• you had a cervical stitch (suture or cerclage) in a previous pregnancy. 
• you have had a previous operation or procedure on your cervix (neck of your womb). This is often to remove an unusual area of body tissue or cells that were found on your smear test. You may be referred if:
  • more than 15mm in depth of tissue was removed or
  • you had more than one operation or procedure or
  • you had what is sometimes known as the ‘cold knife procedure’. 
  • you have ever had treatment for cervical cancer
  • the shape of your womb (uterus) is unusual. This might be called a bicornuate, unicornuate, septate, or arcuate (heart shaped) womb.
  • you are pregnant with twins or triplets
  • you have scarring (adhesions) inside your womb caused by an operation on it. This is sometimes called Asherman’s syndrome
  • we have found something unusual on a transvaginal ultrasound scan done for other reasons (for example, a placental position scan) 

Are there other things which could increase the chance that I might go into labour preterm?

Yes. There are conditions and issues which can increase the chance that you may give birth preterm. 

Do tell us at your appointment about any of these:

• urinary tract infections​ such as a bladder infection. 
• sexually transmitted infections such as gonorrhoea, chlamydia, or trichomoniasis​ 
• smoking​ 
• alcohol​ 
• substance misuse​ 
• trauma​ 
• domestic abuse 
• IVF pregnancy 
• diabetes 
• hypothyroidism 
• high blood pressure

What else can I do to reduce the chance of going into preterm labour?​

Do:

• Attend all your antenatal clinic appointments with your midwives and obstetrician (doctor who specializes in delivering babies and caring for you during pregnancy and after you give birth). 
• Ask the Preterm Birth Clinic team  any questions that you have about preterm labour and birth that are not answered in this information. Writing your questions down can help you to remember to ask them. 
• Ask us for support to help you cut back or give up smoking and drinking alcohol or to maintain a healthy weight. You can find further information on the NHS Live well webpages
• Maintain good hygiene: 
• avoid any vaginal showers (excessively washing this area) 
• look out for any symptoms that could mean you have a vaginal infection such as: 
• itchiness 
• burning feeling 
• vaginal discharge that smells bad.

What happens at my clinic appointment?

We look forward to meeting you in the Preterm Birth Clinic. We aim to provide you with the best possible care for you and your baby. 

If we need to see you face-to-face, you will be sent an appointment to meet a consultant (a doctor who is an expert in preventing babies from being born preterm) or the preterm specialist nurse (or both).

• The team will ask you lots of questions about your previous pregnancies and any health conditions you have now or have had in the past 
• You may be offered some swab tests. We use a speculum (a medical instrument that gently opens your vagina, like in a smear test) when we are taking the swabs.  
• We may offer you a ‘cervical length scan’ scan if we think it is right for you. This is to check the length of your cervix (the opening to your womb). This type of scan helps us to assess the likelihood that you may give birth preterm. It is taken using a probe which is put gently inside your vagina (it is a ‘transvaginal’ scan).

A transvaginal scan is the only way we can get an accurate measurement of your cervix. We cannot use a scan taken through your tummy (a transabdominal scan). 

Might having a swab test or ultrasound scan increase the chance that I will have a miscarriage or go into labour preterm?

The swabs and the ultrasound scan do not increase the risk of you having a miscarriage or going into labour  preterm.

Can I bring someone to my appointment to support me?

Yes. You can bring someone such as a relative, friend or carer to support you if you would find this helpful. 

What should I do before I have my scan?

Do have a pee to empty your bladder. This lets us see the opening to your womb (the neck of your womb) more clearly and get better images from the scan.

Might I need to have further cervical length scans?

You may only need one cervical length scan, or you may need the scan repeated every 2 to 4 weeks between weeks 16 and 24 of your pregnancy. This depends on what is right for you and your baby. We will talk with you about this at your appointment.

What happens if you find that there is a high chance that I may go into labour preterm?

Most people who have an appointment at the Preterm Birth Clinic do not need any further treatment or other management. 

We will keep checking the length of your cervix until around week 24 of your pregnancy.

• If the length of your cervix does not show that you have an increased chance of preterm labour, you can continue your pregnancy care with your midwife. An obstetrician may also care for you if there are concerns about your pregnancy other than preterm labour and birth.  
• If your cervix is short, we may offer you options to reduce the chance that you go into labour and give birth preterm.

What treatment options might you offer me to reduce the chance that I might go into labour and give birth preterm?

We may offer you:

• cervical stitch (cervical suture). This is sometimes called a ‘cervical cerclage’. A stitch is placed around the cervix and tied to prevent the cervix opening too early during pregnancy.

We may offer you this: 

• at around 14 weeks of pregnancy. A cervical stitch is offered instead of regular ongoing checks of your cervix. We would offer it after we have reviewed you past and current health conditions if we feel it may be right for you or 
• after a regular check of your cervix where we find that your cervix is short.

• Vaginal progesterone (Cyclogest)

Our bodies make chemicals called hormones. They carry messages that control how our bodies work. Progesterone is one of these. It helps to maintain pregnancy and support the cervix. Some evidence shows that it can treat a shortening cervix. 

Vaginal progesterone is a small tablet (pessary) that goes into your vagina. It is smaller than a tampon and dissolves quickly. 

Your consultant will talk with you about vaginal progesterone if they think it may be right for you.

What are the signs and symptoms that I may be going into preterm labour?

After their internal scan and other tests, most people  will find that they do not have a greater chance than usual of having their baby early and be reassured.

However, please be aware of the signs and symptoms of preterm labour. These include:

• lower backache 
• cramps. These may feel like strong period pains 
• feeling of pressure in the pelvis 
• feeling sick (nausea), being sick (vomiting) or having diarrhoea (watery poos) 
• A ‘show” when the mucous plug comes away 
• vaginal bleeding 
• your waters breaking. Sometimes you may feel a soft ‘popping’, a trickle, or a gush.

Who can I contact if I need further information or support after I have read this information?

We look forward to meeting you in the preterm birth clinic where we aim to provide you with the best possible care for you and your baby. If you would like any further information, please contact:

Links to further information from other organisations

Links to further information from other organisations

Premature labour and birth booklet (Prem7+)

QR Code for Premature labour and birth booklet (Prem7+)

Pregnancy information (Tommy’s)

QR Code for Pregnancy information (Tommy’s)

Signs and symptoms of premature labour (Tommy’s)

QR Code for Signs and symptoms of premature labour (Tommy’s)

How to reduce your risk of premature (preterm) birth (Tommy’s)

QR Code for How to reduce your risk of premature (preterm) birth (Tommy’s)

Treatments to prevent a premature (preterm) birth (Tommy’s)

QR Code for Treatments to prevent a premature (preterm) birth (Tommy’s)

Weak cervix (cervical incompetence or cervical insufficiency) (Tommy’s)

QR Code for Weak cervix (cervical incompetence or cervical insufficiency) (Tommy’s)

Congenital Uterine Abnormality – Problems With The Womb (Tommy’s)

QR Code for Congenital Uterine Abnormality – Problems With The Womb (Tommy’s)

When your waters break prematurely (RCOG)

QR Code for When your waters break prematurely (RCOG)

When Your Waters Break Early (PPROM) (Tommy’s)

QR Code for When Your Waters Break Early (PPROM) (Tommy’s)

Waters breaking – preterm birth (PPROM) (Little Heartbeats)

QR Code for Waters breaking – preterm birth (PPROM) (Little Heartbeats)