Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Preterm Labor

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In one line

·The uterus starts squeezing and the cervix begins to open before 37 weeks — the goal is to buy more time for the baby to grow.

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Normal physiology

·During pregnancy, the uterus (the muscular womb) stays relaxed and the cervix (the firm, tube-shaped doorway at the bottom of the uterus) stays long, thick, and tightly closed to hold the baby inside until around 37 weeks. At term, rising levels of oxytocin (the hormone that tells the uterus to squeeze) and prostaglandins (chemical messengers that soften the cervix) trigger coordinated contractions and cervical ripening so labor begins when the baby's lungs and brain are ready.

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What goes wrong

·The cervix opens or thins too early and the uterus starts squeezing in a regular pattern before 37 weeks, driven by infection, inflammation, stretching, stress, or structural weakness.

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Hallmark signs

·Regular contractions that come every 5 to 10 minutes or closer
·The cervix (the opening at the bottom of the uterus) starts to thin out or open up before 37 weeks
·Low, dull backache that does not go away
·Pelvic pressure or a feeling that the baby is pushing down
·Leaking fluid or a gush of watery fluid from the vagina
·More vaginal discharge than usual, or discharge that looks different (watery, mucus-like, or streaked with a small amount of blood)
·Cramping low in the belly that feels like menstrual cramps
·Vaginal bleeding (bright red or dark brown)

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Red flags · escalate now

·Leaking or gushing watery fluid from the vagina (sign the amniotic sac may have broken, raising risk of infection and early delivery)
·Vaginal bleeding that is more than spotting or streaking (can mean the cervix is opening fast or the placenta is pulling away)
·Fever over 100.4°F (38°C) with contractions or leaking fluid (sign of infection inside the uterus, which can harm the baby and mother)
·Contractions that keep coming every few minutes and do not stop with rest or changing position (means labor is progressing and the cervix is likely changing)
·Baby is not moving as much as usual (can mean the baby is not getting enough oxygen or is under stress)

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Workup

·Sterile speculum exam
·Fetal fibronectin (fFN) swab from vagina or cervix
·Transvaginal ultrasound to measure cervical length
·Urine culture
·Group B Streptococcus (GBS) vaginal-rectal swab
·Complete blood count (CBC)
·Ultrasound for amniotic fluid volume and placental position
·Non-stress test (NST) or biophysical profile (BPP)

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Treatment

·Betamethasone (12 mg IM every 24 hours × 2 doses) or dexamethasone (6 mg IM every 12 hours × 4 doses) between 24 and 34 weeks if delivery expected within 7 days
·Nifedipine (20 mg by mouth, then 10–20 mg every 4–6 hours) or indomethacin (50–100 mg rectal or oral, then 25–50 mg every 6 hours for ≤ 48 hours) to stop contractions (tocolysis)
·Magnesium sulfate (4–6 g IV load, then 1–2 g/hour infusion) if gestational age < 32 weeks and delivery expected within 24 hours
·Penicillin G (5 million units IV load, then 2.5–3 million units IV every 4 hours) or ampicillin (2 g IV every 6 hours) during labor if GBS-positive or status unknown
·Ampicillin (2 g IV every 6 hours) plus azithromycin (1 g oral once, or 500 mg IV daily) for 7 days if preterm premature rupture of membranes (PPROM) before 34 weeks
·Transfer to a hospital with a Level III or IV neonatal intensive care unit (NICU) before delivery if time allows
·Progesterone supplementation (17-hydroxyprogesterone caproate 250 mg IM weekly from 16–36 weeks, or vaginal progesterone 200 mg nightly) in high-risk mothers to prevent recurrence

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NCLEX trap

·Do a full exam first—check the cervix by hand (digital exam). If it has changed (opened or thinned), preterm labor is real and mild pain does NOT mean mild danger. This baby may be born in hours. Give betamethasone (a steroid shot that speeds up the baby's lung growth) and tocolytics (medicines that slow down contractions, such as nifedipine or indomethacin)—not just pain pills.
·Braxton-Hicks contractions do NOT change the cervix—they are random, irregular, and stop with rest. Preterm labor contractions come regularly (like every 5–10 minutes), last longer, and DO change the cervix (it opens or thins). Check the cervix. If it is opening or thinning, this IS preterm labor—not practice squeezes—and the mom needs betamethasone, tocolytics, and transfer to a hospital with a NICU (a newborn intensive care unit that has breathing machines, feeding tubes, and warming beds for tiny babies).
·Tocolytics buy time for the steroids to work—usually 48 hours. Stop them too early and contractions come roaring back before the baby's lungs are protected. Keep the medicine running for the full 48 hours so the baby gets the full benefit of the steroids. After 48 hours, you can taper the tocolytics slowly.
·Magnesium sulfate protects the baby's brain from bleeding inside the fluid-filled spaces (intraventricular bleeding (hemorrhage), or IVH—bleeding in the brain's ventricles) and cuts the risk of cerebral palsy (brain damage that affects movement and muscle tone) if the baby is under 32 weeks. It is NOT extra—it is standard care. Give it even if contractions stop, as long as delivery looks likely within 24 hours.
·Move her to a hospital WITH a NICU before delivery (this is called in utero transfer—moving the baby inside the mom, which is safer than moving a sick newborn in an ambulance). If the baby comes out at 30 weeks, you need advanced breathing support (ventilators, CPAP machines), feeding tubes, IV lines, and warming beds right away. Transport before delivery, not after—the baby is safer when born at the right hospital.
·If preterm labor is real (contractions plus cervical change before 37 weeks), give betamethasone whether she stays in the hospital or goes home. The baby needs lung protection NOW, not later. Steroids work best when given early, before delivery happens—they take 48 hours to reach full effect, so every hour counts.

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