A birth before 37 weeks is called preterm. Around one in ten babies worldwide is born early, and India has the largest number of preterm births of any country - roughly three million each year. Babies born very early can need intensive care, and the earlier the birth, the greater the challenges for breathing, feeding and development.
For women at higher risk, a planned approach from early pregnancy can lower the chance of an early delivery. The two most useful tools are a measurement of the cervix by transvaginal ultrasound in mid-pregnancy, and treatments matched to that measurement and to your history - vaginal progesterone and, in selected women, a cervical stitch (cerclage).
Dr. Devang Patel, FNB in High Risk Pregnancy & Perinatology and a laparoscopic surgeon, offers cervical length assessment, progesterone treatment and cerclage at Divine Women’s Hospital, Gota, Ahmedabad, with 24×7 labour care and neonatal support if a baby does arrive early.
Why babies are born early
About two-thirds of preterm births happen spontaneously, either because labour starts early or because the waters break early (preterm prelabour rupture of membranes, PPROM). The remaining third are planned early deliveries for problems such as pre-eclampsia or a baby not growing well, which are covered on their own pages.
Spontaneous preterm birth has several pathways: infection or inflammation in the uterus, a cervix that shortens and opens too soon, overdistension of the uterus with twins or excess fluid, bleeding behind the placenta, and stress or illness in the mother. Prevention works by identifying which pathway is most likely for you.
| Category | Weeks at birth | What it usually means for the baby |
|---|---|---|
| Extremely preterm | Before 28 weeks | Intensive neonatal care for weeks to months |
| Very preterm | 28 to 31+6 weeks | Neonatal care, breathing and feeding support |
| Moderate preterm | 32 to 33+6 weeks | Often a shorter neonatal stay, feeding support |
| Late preterm | 34 to 36+6 weeks | Many go to the mother, with extra checks on sugar, jaundice and feeding |
Who is at higher risk
- A previous spontaneous preterm birth or a pregnancy loss between 16 and 24 weeks - the strongest single risk factor, with a recurrence chance of roughly 15–30%
- Previous preterm rupture of the membranes (waters breaking early)
- Previous surgery on the cervix, such as cone biopsy or LEEP, or repeated D&Cs
- A previous caesarean at full dilatation, which can weaken the cervix in a later pregnancy
- A short cervix found on scan in this pregnancy
- Twins or more, a uterus of unusual shape, or large fibroids
- Urine infections, very low body weight, tobacco use and a short gap between pregnancies
Cervical length scans
A transvaginal scan measures the closed length of the cervix accurately; it takes a few minutes and is safe for the baby. For women at higher risk, scans are usually done every two weeks from about 16 to 24 weeks. Most women measure 30–40 mm in mid-pregnancy, and a cervix of 25 mm or less before 24 weeks is considered short.
The shorter the cervix, the higher the risk. A cervix under 15 mm carries a substantial chance of birth before 32 weeks without treatment. For women without risk factors, the cervix can be measured at the anomaly scan, and a short cervix found by chance is treated as well.
A short cervix usually causes no symptoms, which is why measurement on scan matters for women at risk.
Treatment options
Treatment is chosen according to your history and what the scans show. These options are not competing alternatives for everyone; each suits a particular situation.
| Treatment | How it works | Suited to |
|---|---|---|
| Vaginal progesterone | Nightly pessary or capsule (commonly 200 mg) supports the cervix and calms the uterus | A short cervix of 25 mm or less, with or without a previous preterm birth; continued to about 34–36 weeks |
| History-indicated cerclage | Stitch placed around the cervix at about 12–14 weeks | Three or more previous preterm births or mid-trimester losses, or a clear history of the cervix opening without contractions |
| Ultrasound-indicated cerclage | Stitch placed when the cervix shortens on scan | A previous preterm birth or loss, with a cervix of 25 mm or less before 24 weeks |
| Rescue (emergency) cerclage | Stitch placed when the cervix has already opened | Selected women before 24 weeks without contractions, bleeding or infection |
| Abdominal cerclage | Stitch placed higher, at the upper end of the cervix, before or early in pregnancy | Women whose vaginal stitch has failed before, or with very little cervix left; birth is then by caesarean |
About the cervical stitch
A vaginal cerclage is a short procedure performed under spinal anaesthesia, usually with a day or overnight stay. A strong tape or suture is placed around the cervix through the vagina to support it (McDonald or Shirodkar technique). Most women return to light routine activity within a few days.
The stitch is removed in the clinic at about 36–37 weeks, usually without anaesthesia, or earlier if labour starts, the waters break or there is bleeding. Small risks include bleeding, infection and, rarely, breaking the waters during the procedure; these are higher with a rescue stitch.
A stitch is not suitable for everyone. It is not routinely advised in twin pregnancies on history alone, and it is avoided when there is infection, active bleeding or ruptured membranes.
Everyday measures that help
- Urine is tested for silent infection at booking and treated if positive, as untreated bacteriuria is linked to preterm labour
- Stopping all tobacco, including smokeless forms common in Gujarat
- Correcting anaemia and keeping a healthy weight gain with regular, protein-rich meals
- Treating dental and gum infections, which is safe in pregnancy
- Allowing at least 18 months between a birth and the next conception
- Strict bed rest is not recommended; it does not prevent preterm birth and increases clot risk
If early labour or waters breaking happens
When preterm labour is suspected, a cervical scan and, where available, a fetal fibronectin test help separate true labour from false alarms - most women with tightenings do not go on to deliver within a week. If birth seems likely before 34–35 weeks, steroid injections (two doses 24 hours apart) are given to mature the baby’s lungs, and magnesium sulphate before 32 weeks to protect the baby’s brain.
Medicines such as nifedipine or atosiban may be used for up to 48 hours to delay labour so steroids can take effect. If the waters break early without labour, antibiotics (usually erythromycin) are given, you are monitored for infection, and delivery is generally planned at about 37 weeks if all remains well.
Future pregnancies and long-term outlook
After one preterm birth, the next pregnancy is planned from the first trimester: an early dating scan, a urine culture, cervical length scans from 16 weeks, and a decision about progesterone or cerclage made with your history in view. After a stitch that worked, many women have a history-indicated stitch next time.
Most babies born after 32 weeks do very well. Babies born earlier benefit from developmental follow-up with a paediatrician, as some need extra support with vision, hearing or learning as they grow.
For the mother, a preterm birth can be emotionally draining, especially if the baby needed neonatal care. Talking through what happened at a postnatal review, and knowing there is a clear plan for next time, often helps.
Your care, step by step
- History reviewPrevious deliveries, losses and cervical surgery are reviewed to set your level of risk, ideally before or early in pregnancy.
- Cervical scansTransvaginal measurements every two weeks from about 16 to 24 weeks when indicated, alongside a urine culture.
- Targeted treatmentProgesterone or a cervical stitch is offered according to your history and scan findings, with risks explained.
- Readiness planClear symptoms to watch for, steroid cover if needed, and 24×7 access to labour care at Divine Women’s Hospital.
- Stitch removal and birthThe stitch is removed at about 36–37 weeks, after which most women labour naturally.
When to book a visit
- You had a baby before 37 weeks or a loss between 16 and 24 weeks
- You have had cone biopsy, LEEP or other surgery on the cervix
- A previous caesarean was done when the cervix was fully open
- A scan has shown a short cervix
- You are expecting twins or more
- A previous stitch did not prevent an early birth and you are planning again
Warning signs - get same-day care
- Regular tightenings or period-like cramps before 37 weeks
- A gush or steady trickle of watery fluid from the vagina
- Vaginal bleeding, or a change in discharge to watery, mucus-like or blood-stained
- Pelvic pressure, a feeling the baby is pushing down, or new low back ache
- Fever, or foul-smelling discharge after a cervical stitch
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Complete bed rest prevents preterm birth.
Bed rest has not been shown to prevent preterm birth and raises the risk of blood clots and muscle loss. Targeted treatment based on scans is what helps.
Myth: Every woman with a previous miscarriage needs a cervical stitch.
Most miscarriages are not caused by a weak cervix. A stitch is advised only for specific histories or a short cervix on scan.
Myth: Progesterone injections should be given to everyone at risk.
Vaginal progesterone helps women with a short cervix. Routine progesterone injections are not supported by current evidence for most women.
Myth: Tightenings in pregnancy always mean early labour.
Irregular Braxton Hicks tightenings are normal. Regular, increasing contractions, fluid leaking or bleeding are what need same-day assessment.
Frequently asked questions
What is a normal cervical length in pregnancy?
Between 16 and 24 weeks, a cervical length above 25 mm on transvaginal scan is generally considered normal, and most women measure 30–40 mm. A measurement of 25 mm or less before 24 weeks is considered short.
What causes a short cervix?
Sometimes previous cervical surgery or a full-dilatation caesarean, sometimes infection or inflammation, and often no clear cause. It usually causes no symptoms, which is why scans are used.
Does cervical cerclage hurt?
The stitch is placed under spinal anaesthesia, so you do not feel the procedure. Mild cramping and light spotting for a day or two afterwards are common. Removal at 36–37 weeks is done without anaesthesia in most women and feels similar to an internal examination.
Do I need bed rest after a cervical stitch?
Strict bed rest is not recommended, as it does not prevent preterm birth and raises the risk of blood clots. Avoid heavy lifting and intercourse as advised, and keep your follow-up scans.
Does progesterone prevent preterm birth?
In women with a short cervix, nightly vaginal progesterone reduces the chance of birth before 34 weeks by about a third. It is less clearly helpful in other situations, so it is prescribed when there is a specific reason.
Can a cervical stitch be done in twins?
A history-based stitch is not routinely advised in twins, as it has not been shown to help. In selected twin pregnancies where the cervix has already opened, a rescue stitch may be discussed.
At what week is a baby safe to be born?
Every extra week in the womb helps. Most babies born after 34 weeks do well with modest support, and outcomes improve steadily from 28 weeks onwards. Babies born before 28 weeks need intensive care.
Can I have a normal delivery after cerclage?
Yes. Once a vaginal stitch is removed at about 36–37 weeks, most women go into labour naturally and many have a vaginal birth. After an abdominal stitch, birth is by caesarean.
Is it safe to travel after a cervical stitch?
Short local journeys are usually fine once you have recovered. Avoid long trips far from a hospital, especially after 24 weeks, and discuss any travel plans at your visit.
Why are steroid injections given if early birth is likely?
Two doses of betamethasone 24 hours apart, or four doses of dexamethasone, help the baby’s lungs, brain and gut mature. They are most effective when birth happens between 24 hours and 7 days after the first dose, so they are given when delivery before 34–35 weeks looks likely rather than routinely.