Premature Birth Symptoms: Early Signs & Warning Symptoms

Quick Glance: Common Premature Birth Symptoms

Warning signs of preterm labour may be mild at first and do not always involve severe labour pain. Therefore, symptoms occurring before 37 weeks should be taken seriously.

Common symptoms of premature birth include:

Regular or frequent contractions or abdominal tightenings
Period-like abdominal cramps
Pressure low in the pelvis or lower abdomen
A constant or unusual dull lower backache
A change or increase in vaginal discharge
Watery, mucus-like or blood-stained discharge
A gush or persistent trickle of fluid from the vagina
Mild abdominal cramps, with or without diarrhoea

The waters can break before labour contractions begin. Therefore, unexplained fluid leakage before 37 weeks needs prompt maternity assessment.

Premature Birth Symptoms That Should Not Be Ignored

Some pregnancy discomforts can resemble early labour, but regular contractions, unusual pelvic pressure, bleeding or fluid loss before 37 weeks may indicate preterm labour or ruptured membranes.

The table below explains warning signs of premature birth that should be medically assessed:

Symptom	What It May Indicate
Regular or increasingly frequent contractions	The uterus may be contracting as part of preterm labour and causing cervical change
Persistent pelvic or lower abdominal pressure	The baby or a changing cervix may be creating increased pressure in the pelvis
A constant or unusual dull lower backache	Can occur as part of preterm labour
Change or increase in vaginal discharge	May accompany cervical changes or early labour
Vaginal bleeding	Requires maternity assessment because bleeding during pregnancy can have several important causes
A gush or continuous trickle of watery fluid	May indicate PPROM, where the membranes rupture before 37 weeks

Braxton Hicks, or practice contractions, can also cause abdominal tightening later in pregnancy. They are generally irregular and often not painful. Painful or regular contractions before 37 weeks should not simply be assumed to be Braxton Hicks.

Why Do Premature Birth Symptoms Occur?

Premature birth symptoms usually develop when the processes involved in labour begin before 37 completed weeks. Repeated uterine contractions can cause the cervix to thin and open, producing abdominal tightenings, period-like cramps, pelvic pressure or lower back discomfort.

As the cervix changes, vaginal discharge may increase or become mucus-like or blood-stained. If the amniotic membranes rupture early, amniotic fluid may escape through the vagina as a sudden gush or persistent trickle. PPROM can occur before contractions begin and increases the risk of infection.

Premature Birth Symptoms That Require Immediate Medical Attention

Symptoms suggesting preterm labour or ruptured membranes before 37 weeks need prompt maternity assessment. Other warning signs may indicate infection, bleeding or problems affecting the baby's wellbeing.

It is recommended to contact your gynaecologist urgently if the following symptoms of premature birth occur:

Regular contractions or repeated painful tightenings before 37 weeks
A gush or continuous trickle of fluid from the vagina
Vaginal bleeding
Baby movements that slow down, stop or noticeably change
Fever, chills or feeling unusually unwell after the waters have broken
Greenish, discoloured or unpleasant-smelling vaginal fluid
Persistent or worsening abdominal or back pain after the waters break

These symptoms require professional assessment rather than waiting for them to settle at home.

Symptoms of Premature Birth-Specific Conditions

A premature birth can follow spontaneous preterm labour or occur after the waters break early. PPROM has a particularly recognisable symptom pattern.

Preterm Prelabour Rupture of Membranes (PPROM)
PPROM occurs when the membranes surrounding the baby break before 37 weeks and before labour has started. Its main symptoms are:
- A sudden gush of watery fluid from the vagina
- A slow or repeated trickle of fluid
- Persistent wetness that cannot easily be controlled

Contractions may not begin straight away. After the waters break, fever, chills, abdominal or back pain, vaginal bleeding, reduced fetal movements or greenish or unpleasant-smelling fluid need urgent maternity assessment. They may indicate infection or another complication.

Can You Have a Premature Birth Without Symptoms?

Yes. Premature birth can occur without clear preceding symptoms of spontaneous preterm labour. In some pregnancies, the cervix may shorten or begin to open without noticeable contractions and may only be identified during examination or ultrasound assessment.

Preterm birth may also be medically planned when continuing the pregnancy poses greater risks to the pregnant woman or baby. In these cases, birth may occur before 37 weeks without spontaneous contractions, fluid leakage or other signs of preterm labour.

When Can Premature Birth Symptoms Become Life-Threatening?

Preterm labour itself does not automatically mean that the pregnant woman or baby is in immediate danger. However, some accompanying symptoms may indicate infection, significant bleeding or fetal compromise and require urgent assessment.

The table below highlights warning symptoms of premature birth and why they can be serious:

Symptom	Why It Is Serious
Heavy or persistent vaginal bleeding	May indicate a serious pregnancy complication and can affect the health of the pregnant woman and the baby
Fever, chills or feeling very unwell after the waters break	May indicate infection after PPROM, which can become serious without prompt treatment
Greenish or foul-smelling fluid after the waters break	May be a warning sign of infection or another complication requiring urgent assessment
Baby movements are becoming markedly reduced or stopping	May indicate that the baby's well-being needs urgent assessment
Severe or persistent abdominal pain with bleeding	May indicate a serious obstetric complication rather than uncomplicated preterm labour
Strong contractions with a feeling that the baby may be coming	May indicate advanced labour and the need for immediate maternity care

Babies born before 37 weeks have a greater risk of health problems because important development continues during the final weeks of pregnancy. The risk is generally higher when birth occurs earlier, particularly before 32 weeks.

How are Premature Birth Symptoms Diagnosed?

Doctors and midwives assess whether symptoms represent preterm labour, whether the cervix has changed and whether the membranes have ruptured. The exact tests depend on the symptoms and stage of pregnancy.

The following assessments may be used by doctors to identify a premature birth:

Test or Assessment	Purpose
Symptom and contraction assessment	Checks the frequency and pattern of contractions, pain, discharge and fluid loss
Physical and maternity assessment	Checks temperature, pulse, blood pressure and the general well-being of the pregnant woman
Speculum or appropriate vaginal examination	Assesses cervical changes or looks for evidence that the membranes have ruptured
Transvaginal cervical-length ultrasound	Measures cervical length when clinically appropriate to help assess the likelihood of preterm labour
Fetal monitoring	Records contractions and assesses the baby's heart rate
Blood and urine tests	Check for infection or other problems that may be contributing to symptoms
Vaginal-fluid testing for suspected PPROM	May help determine whether the membranes have ruptured when examination findings are uncertain

A fetal fibronectin test may also be used in certain pregnancies with symptoms of preterm labour. Fetal fibronectin is a protein found between the membranes around the baby and the lining of the uterus. A negative result during the test period can make delivery within the next several days less likely.

Frequently Asked Questions (FAQs)

Q1. What are the first symptoms of premature birth?

Ans: Early symptoms of premature birth or preterm labour can include regular abdominal tightenings, period-like cramps, pelvic pressure or an unusual lower backache. A change in vaginal discharge, bleeding or leaking fluid may also occur before 37 weeks.
Q2. What do premature labour contractions feel like?

Ans: Premature labour contractions may feel like the abdomen tightening or cramping low down. The main warning sign is when these tightenings start coming regularly or more often before 37 weeks.
Q3. Can premature labour feel like period pain?

Ans: Yes. Preterm labour can cause cramps that feel similar to period pain. If the pain keeps returning before 37 weeks, especially with pelvic pressure, backache or a change in vaginal discharge, contact your gynaecologist.
Q4. Is lower back pain a symptom of premature labour?

Ans: Yes, a low, dull or unusual backache can occur with preterm labour. Back pain is common during pregnancy, so a new pattern that persists or appears with contractions, pressure or fluid leakage is more concerning.
Q5. Can your water break early without contractions?

Ans: Yes. With PPROM, the water can break before labour begins. You may notice a gush or repeated trickle of watery fluid even when contractions have not started.
Q6. Can a premature birth happen without labour symptoms?

Ans: Yes. Premature birth can occur without spontaneous labour symptoms when an early induction or caesarean birth is medically necessary.
Q7. How can I tell Braxton Hicks from premature labour?

Ans: Preterm labour is different from Braxton Hicks when contractions become regular or frequent before 37 weeks, especially with backache, pelvic pressure, bleeding or fluid leakage.
Q8. When should I go to the hospital for premature labour symptoms?

Ans: Premature birth warning signs such as regular contractions, unusual backache, bleeding or leaking fluid before 37 weeks should be reported to the gynaecologist and taken to the hospital.

References
- https://www.nichd.nih.gov/health/topics/preterm
- https://www.nhs.uk/pregnancy/labour-and-birth/premature-labour-and-birth/
- https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html
- https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/preterm-and-low-birth-weight
- https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/premature-labour