Q&A: I am concerned that at 32 weeks pregnant I am having contractions.

by Dr. Gerard M. DiLeo

I am 32 weeks pregnant and have been having slight problems with this pregnancy. I have a toddler (normal pregnancy) and I had a pregnancy terminated in the first trimester many years ago.

I am experiencing constant contractions. I was admitted to the hospital at 29 weeks and underwent every test you can think of from CAT scans to amniocentesis. All results were normal. The only finding was that I might have scarring and adhesions from a laparoscopy last year. I have been on bed rest for two and a half weeks, but my contractions are still very strong and sporadic. I just found out that I am 1 centimeter dilated. Is that a bad thing at this stage, and what can I do to prevent further dilation? Is it possible that I will go into labor early?

At 32 weeks, you've hit a major milestone. A baby delivered right now would probably do well after a stay in the neonatal ICU. But the ideal is to get you as close to term as possible. Your next milestone will be 36 weeks, when the baby's lungs are usually ready (or close to ready) to function, so all efforts will be geared to helping you make it to 36 weeks. The vast majority of cases of preterm labor are for unknown reasons, hence all of your negative tests. The crucial question boils down to the laws of physics—do your contractions amass a net vector force in one direction: outward? If so, your cervix will change, which is the real definition of labor (not just contractions). One centimeter of dilation means nothing without effacement (the thinning out of the cervix). Effacement is the deal breaker as far as predicting a pending delivery preterm. If your cervix is 1 centimeter but still thick, this is not a problem; but if your cervix is 1 centimeter but 90 percent effaced, this would be a worry. Here's hoping your cervix is not effaced. Ask your doctor.

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