Q&A: I want to know if I am going into labor prematurely.

Premature labor, is one of the most costly complications of pregnancy. Although we still don't know all of the reasons patients may experience preterm labor, there are nevertheless many things that we do know can provoke it:

• Infection of the uterus or pregnancy (amnionitis), usually with group B beta-strep.
• Multiple gestations (twins, triplets, etc.) which cause the uterus to reach "critical mass" earlier, at which time it tries to expel the contents like it would a term single pregnancy.
• Incompetent cervix, in which the structural integrity of the cervix cannot maintain it in a tightly closed condition. Dilation may invoke several neurological and chemical reflexes which may cause labor to continue the process.
• Bleeding within the uterus, usually caused by abruption of the placenta (premature separation of the afterbirth).
• Vaginal infections (although still not conclusively proven) like yeast, bacterial vaginosis; infections that are usually fairly inconsequential, but in this case may induce early labor.
• Urinary tract infections (bladder or kidney).
• Other systemic infections, like pneumonia, peritonitis, appendicitis, and so on.
• Previous history of preterm labor with prior pregnancy.
• The largest category: Unknown reasons.

• Tocometry: equipment is worn in a belt around the abdomen and recordings for an hour are sent by modem to a central station where nurses notify your doctor if there are troubling runs of contractions or irritabilities.
• Fetal fibrinectin: a test from a vaginal exam that may indicate those at risk.
• SalEst: salivary estriol read in, of all things, the mother's saliva, under the theory that fetal estriol is released prior to the onset of active pre-term labor. It presents in the mother's saliva and her saliva can be tested every two weeks.