Can a female with a history of preterm labor present with complications during pregnancy?

Can a Female with a History of Preterm Labor Present with Complications During Pregnancy?

Yes, women with a history of preterm labor are at significantly increased risk for complications in subsequent pregnancies, with 1.5 to 2 times higher likelihood of recurrent preterm birth and associated maternal and neonatal morbidity. 1

Risk of Recurrent Preterm Birth

Women with prior preterm labor face substantial recurrence risks in subsequent pregnancies:

• Nearly 50% of women with previous preterm prelabor rupture of membranes (PPROM) at <24 weeks will experience recurrent preterm birth, with 30% delivering at <34 weeks, 23% at <28 weeks, and 17% at <24 weeks 2
• The only independent predictor of recurrent preterm birth after previable PPROM is a history of another previous preterm birth 2
• Women with prior spontaneous preterm delivery should be managed according to established guidelines for recurrent preterm birth prevention 2

Maternal Complications Associated with Preterm Labor

Women experiencing preterm labor face multiple serious maternal complications:

• Antenatal bleeding, preterm labor, and preterm prelabor rupture of membranes are associated with unscheduled delivery and significant maternal morbidity 2
• In expectant management of previable PPROM, more than one-third of women experience both perinatal demise AND maternal morbidity, while only approximately 15% achieve neonatal survival without maternal complications 2
• Women with these complications are most likely to benefit from hospitalization for monitoring 2

Specific Complications During Pregnancy

Infectious Morbidity

• At least 40% of preterm births are associated with intrauterine infection, which triggers inflammatory cascades involving cytokines, chemokines, and prostaglandins 3
• Cervicovaginal infections have been directly associated with preterm labor 4
• Women with preterm labor and rupture of membranes require GBS screening and prophylaxis at hospital admission 2

Hemorrhagic Complications

• Decidual hemorrhage (abruption) is a recognized pathophysiologic trigger for spontaneous preterm birth 4
• Women with previa and one bleeding episode are at increased risk of subsequent bleeding 2

Cervical Complications

• Mechanical factors including cervical incompetence contribute to spontaneous preterm birth 4
• Cervical cerclage placement in subsequent pregnancies after previous previable PPROM was associated with dramatically increased odds of preterm birth (63.2% vs 10.9%; OR 14.0), though this data requires cautious interpretation 2

Neonatal Complications

The fetus faces severe risks when preterm labor occurs:

• Preterm delivery is the leading cause of neonatal morbidity and mortality in the United States 1
• Long-term morbidities include neurodevelopmental handicap, cerebral palsy, seizure disorders, blindness, deafness, bronchopulmonary dysplasia, and retinopathy of prematurity 4
• Among surviving neonates from previable PPROM, there is high risk of chronic pulmonary disease and other long-term morbidities 2

Management Implications for Subsequent Pregnancies

In subsequent pregnancies after history of preterm labor, follow guidelines for management of pregnant persons with previous spontaneous preterm birth 2:

• Vaginal progesterone is recommended for women with shortened cervix and no history of preterm delivery 1
• Progesterone supplementation regardless of cervical length is recommended for women with history of spontaneous preterm delivery 1
• History-indicated cerclage should be reserved ONLY for individuals with classic historical features of cervical insufficiency or unexplained second-trimester loss in the absence of placental abruption 2

Critical Pitfalls to Avoid

• Do not routinely place cerclage in women with prior previable PPROM, as this may increase rather than decrease preterm birth risk 2
• Distance from hospital or referral center and logistic considerations should influence hospitalization decisions 2
• Less than 10% of women with clinical diagnosis of preterm labor will deliver within seven days of initial presentation, so avoid overtreatment 1