If a baby is born before 37 weeks gestation, or weighs less than about five pounds, he or she is considered premature. The single greatest risk factor for preterm labor is a history of preterm labor.

Factors commonly associated with preterm labor between 20 and 37 weeks can be divided into maternal factors and fetal factors.

Maternal risk factors include:

• Infection (urinary tract, amnionitis, systemic, sexually transmitted)
• Uterine anomalies, fibroids, retained IUD
• Cervical abnormalities: short or funnel shaped
• Overdistended uterus: polyhydramnios (too much fluid), multifetal gestation
• Rupture of membranes
• Uterine bleeding: abruption, previa
• Substance abuse: cocaine, amphetamine, smoking

Fetal risk factors include:

• Congenital anomalies
• Intrauterine death
• Multifetal gestation

Signs and symptoms to watch for would be related to these risk factors:

• Discharge. If you notice any clear fluid discharge, or any abnormal or malodorous discharge, you should notify your care provider immediately.

• STDs or Beta Strep. If you have ever been diagnosed with a sexually transmitted disease or with group B beta strep, your care provider may wish to do typical cultures at your initial visit and then repeat them later in the pregnancy.

• Changed pattern of movement. If your baby changes his or her pattern of movement, you should also alert your doctor or midwife.

• Multiple gestation. If you have been diagnosed with twins or any higher order gestation, or if ultrasound has detected a "greater than average" volume of amniotic fluid, you should be alert for symptoms of premature labor.

• Uterine abnormality or placental problem. If ultrasound has ever detected a uterine abnormality or fibroid -- or if you have experienced a premature separation of the placenta or have a low lying placenta -- you are at higher risk for preterm labor and need to be alert for signs and symptoms.

Symptoms can include, but are not limited to:

• Pressure in the pelvis or vagina, or a sense that the baby has "dropped" prior to 36 weeks.

• Tightenings or contractions that seem to occur at more or less regular intervals (more than four to five per hour).

• Pain that comes and goes, whether it occurs in the lower abdomen or in the back.

• Any fluid loss or spotting.

It is important to keep well-hydrated to both prevent uterine irritability and to prevent urinary tract infections that can lead to preterm labor. When my clients feel that things are "not quite right," I have them come in so that they can be checked. Diagnosed early, premature labor can be stopped and the pregnancy can be carried to term.