Preterm birth in Warsaw - risk assessment and consultations
Preterm birth is a birth that happens before the end of the 37th week of pregnancy. Its risk may be linked to, among other things, a shortening cervix, a previous preterm birth, a multiple pregnancy or earlier procedures on the cervix. Well-planned diagnostics make it possible to identify certain risk factors, assess the condition of the cervix and decide on further management before any signs of starting labour appear.
At OpenMed Warsaw we offer obstetric consultations and care for pregnancies that need closer monitoring. During the visit the doctor reviews the course of the pregnancy, the previous obstetric history and ultrasound results, and refers the patient for the appropriate tests and further monitoring. Outpatient diagnostics mainly concern risk assessment in patients who are in a stable condition. Suspected onset of preterm labour requires urgent assessment in hospital.
What is a risk of preterm birth?
We speak of preterm birth when a baby is born before the end of the 37th week of pregnancy, that is at 36 weeks and 6 days at the latest. Based on gestational age, a distinction is made between extremely preterm births before 28 weeks, very preterm births between 28 weeks and 31 weeks and 6 days, and later preterm births from 32 weeks to 36 weeks and 6 days.
A risk of preterm birth does not, however, mean that labour has already started. It may apply to a patient who has been found to have factors that increase the likelihood of the pregnancy ending earlier, e.g. a short cervix, a previous birth before the due date or cervical insufficiency.
In practice, three situations should be distinguished:
- Increased risk of preterm birth - the patient has no signs of labour, but her obstetric history or test results point to a need for closer monitoring.
- Suspected threatened preterm labour - symptoms appear, e.g. regular uterine contractions or a feeling of pressure in the pelvis, which require urgent assessment.
- Established preterm labour - there is contraction activity leading to changes in the cervix, such as dilation and shortening.
It is also important to distinguish between spontaneous birth and a pregnancy ended before the due date for medical reasons. In some pregnancies earlier delivery is necessary because of the condition of the mother or the baby, e.g. with severe pre-eclampsia. The mechanism of such a birth differs from spontaneous labour.
Early identification of risk makes it possible to plan additional check-ups and consider preventive management in suitably selected patients. However, there is no single test that can predict the date of birth with complete certainty.
What symptoms may indicate threatened preterm labour?
The symptoms of starting preterm labour can resemble typical pregnancy complaints. They are not always very painful, which is why it matters to watch their frequency, nature and whether they are getting stronger.
The most important symptoms include:
- Regular uterine contractions - repeated tightening of the abdomen, sometimes every 10 minutes or more often, even without obvious pain.
- Lower abdominal pain - discomfort similar to period pain that comes in waves or gradually gets worse.
- Lower back pain - especially a new, dull, persistent pain in the lumbosacral area.
- A feeling of pressure in the pelvis - the sensation of the baby pushing down towards the vagina or perineum.
- A change in vaginal discharge - a sudden increase in its amount, or watery, mucous or blood-stained discharge.
- Spotting or bleeding - blood from the genital tract, especially together with contractions.
- Leaking amniotic fluid - a sudden gush of a larger amount of clear fluid or a persistent trickle from the vagina.
Not every contraction means labour is starting. Braxton Hicks contractions also occur in pregnancy, and these are usually irregular and do not lead to progressive dilation of the cervix.
However, practice contractions cannot be reliably told apart from preterm labour based on how painful they are alone. Regular or recurring contractions before the end of the 37th week of pregnancy require urgent obstetric assessment.
It is also worth remembering that cervical insufficiency can develop without typical contractions or severe pain. In some patients the first sign is only an abnormal cervical length found during an ultrasound scan.
When do symptoms require urgent help in hospital?
Some symptoms in pregnancy require going straight to the admissions unit of a maternity hospital. In such situations you should not wait for a planned outpatient consultation.
Urgent hospital assessment is needed in particular with:
- regular uterine contractions before the end of the 37th week of pregnancy,
- suspected leaking of amniotic fluid, even if there are no contractions,
- bleeding from the genital tract,
- severe or worsening abdominal pain,
- a marked feeling of bearing down or pressure towards the perineum,
- fever, chills and abdominal pain that may indicate an infection,
- a significant reduction in or absence of fetal movements at a stage of pregnancy when they are already felt regularly.
In the case of heavy bleeding, loss of consciousness, severe pain or a sudden deterioration in general condition, call for medical help on 112.
A particular condition is preterm prelabour rupture of membranes (PPROM). It shows as a gush or trickle of amniotic fluid. Even a small, continuous leak requires diagnostics in hospital because of the risk of infection and the onset of labour.
In hospital the doctor may perform a speculum examination to check for the presence of amniotic fluid. If the result is not clear, in certain situations specialist tests are used that detect proteins characteristic of amniotic fluid, e.g. PAMG-1 or IGFBP-1.
If you suspect your waters are leaking, do not try to assess the cervix yourself or put off the visit because the amount of fluid is small.
Planned risk diagnostics at OpenMed are intended for patients without acute warning symptoms. If there is a suspicion that preterm labour has started, assessment is needed in a hospital with the appropriate obstetric and neonatal facilities.
What are the risk factors for preterm birth?
The risk of the pregnancy ending early may increase in connection with previous obstetric history, the structure of the reproductive organs, the course of the current pregnancy and the patient's health.
The most important factors include:
- A previous spontaneous preterm birth - especially before 34 weeks of pregnancy.
- Late miscarriage - especially in the second trimester, if it involved painless dilation of the cervix.
- A short cervix - in a singleton pregnancy, a length of 25 mm or less in mid-pregnancy may indicate an increased risk of preterm birth.
- Cervical insufficiency - weakened function of the cervix leading to its premature shortening or dilation.
- Previous procedures on the cervix - especially extensive conisation or procedures removing a large part of the cervix.
- Multiple pregnancy - a twin or triplet pregnancy is associated with a higher likelihood of birth before the due date.
- Abnormalities in the structure of the uterus - e.g. certain congenital anatomical defects.
- Infections in pregnancy - including certain urinary tract and genital tract infections, especially when accompanied by inflammation.
- Bleeding in pregnancy and some placental complications.
- Smoking and use of psychoactive substances.
- Some chronic diseases and pregnancy complications, e.g. severe hypertension or pre-eclampsia, which may make it necessary to end the pregnancy earlier.
What matters is not only whether a risk factor is present, but also its nature. A patient who had a spontaneous birth at 29 weeks of pregnancy may need a different monitoring plan than a woman whose previous pregnancy was delivered early for medical reasons.
Similarly, a previous procedure on the cervix does not always mean cervical insufficiency. The type of procedure, the depth of tissue removed, the number of procedures and the current appearance of the cervix on ultrasound all matter.
It is worth remembering that preterm birth can also happen to a woman with no identified risk factors. This is why regular obstetric care also includes watching for new symptoms and abnormalities that appear during pregnancy.
Who should come for preterm birth risk diagnostics?
Risk assessment is particularly important for patients whose previous obstetric history or current test results suggest a possibility of birth before the due date.
It is worth booking a consultation if:
- you had a spontaneous preterm birth in a previous pregnancy,
- you had a miscarriage in the second trimester,
- you were diagnosed with cervical insufficiency in the past,
- you had a cervical stitch in a previous pregnancy,
- you have had conisation or another procedure removing cervical tissue,
- an ultrasound scan showed a shortened cervix,
- a twin or multiple pregnancy has been diagnosed,
- there are abnormalities in the structure of the uterus,
- previous tests or the course of the pregnancy indicate a need for more frequent check-ups.
For patients at increased risk, it is worth starting to plan appropriate monitoring early in pregnancy. This matters especially when it may be necessary to check cervical length between 16 and 24 weeks.
Not every patient needs all the available tests. The doctor first assesses the history, the week of pregnancy and the results so far, and then decides whether an additional ultrasound, a specialist consultation or more frequent check-ups are needed.
Doctors assessing the risk of preterm birth at OpenMed
Assessing the risk of an early birth requires taking into account the course of previous pregnancies, the current gestational age, the condition of the cervix and the results of prenatal tests. OpenMed gynaecologists and obstetricians see patients who need closer pregnancy monitoring, including women with a complicated obstetric history, after previous complications and with abnormal test results. During the visit the doctor can review the existing records, decide whether additional tests are needed and determine whether a further perinatal consultation is advisable.
How is the risk of preterm birth diagnosed?
Diagnostics start with an assessment of individual risk. In a patient without symptoms, the aim is to identify factors that may increase the likelihood of an early birth and to plan check-ups that allow abnormalities to be detected early enough.
The first step is a detailed obstetric history. The doctor asks about the course of previous pregnancies, the week of any earlier birth, previous miscarriages, gynaecological procedures and treatment used in the current pregnancy.
The doctor then reviews the test results so far, especially prenatal ultrasound, descriptions of the cervix and records of previous hospital stays.
Depending on the indications, the assessment may include:
- Obstetric examination - assessment of the patient's condition and of symptoms that may indicate a need for further diagnostics.
- Transvaginal ultrasound - used to accurately assess the length of the cervical canal in suitably selected pregnant women.
- Analysis of the course of the pregnancy - including gestational age, number of babies, complications and earlier test results.
- Assessment of indications for additional tests - e.g. diagnostics for urinary tract or genital tract infections.
- Planning further monitoring - the dates of the next visits, the need to repeat measurements and a possible perinatal consultation.
When the onset of preterm labour is suspected, diagnostics look different. In hospital it may be necessary to assess uterine contractions, perform a speculum examination, assess the cervix and monitor the condition of the baby.
The aim of an outpatient consultation is not to diagnose acute labour, but above all to assess the risk in a patient who is in a stable condition and decide whether the pregnancy needs closer monitoring.
Transvaginal ultrasound and cervical length assessment
Measuring cervical length with transvaginal ultrasound, also called cervicometry, is one of the most important methods of assessing the risk of spontaneous preterm birth.
The scan makes it possible to measure the length of the closed part of the cervical canal between the internal and external os. Unlike the rough assessment of the cervix during a manual examination, it gives a result in millimetres.
Assessment of the cervix between 16 and 24 weeks of pregnancy is the most important for prevention, especially in patients with a previous preterm birth or other risk factors.
How is the cervix measured?
The scan is performed using an ultrasound probe inserted into the vagina. The patient usually lies on her back with an empty bladder.
The doctor views the cervix in a longitudinal section and measures the length of its closed canal. In a correctly performed scan it is important to avoid pressing too hard with the probe, which could artificially lengthen the cervix.
During the assessment it is also possible to check whether there is:
- shortening of the closed part of the cervical canal,
- opening of the internal os,
- funnel-shaped opening of the canal, known as funneling,
- a dynamic change in cervical length during observation.
The scan usually takes a few minutes and does not require anaesthesia. Transvaginal ultrasound does not use X-rays and is a method used in obstetric diagnostics.
What cervical length is normal?
In mid-pregnancy the cervix is often about 30-40 mm long, although values may vary. The key factors are the right week of pregnancy and a result obtained with correct measuring technique.
In a singleton pregnancy, in patients without a previous spontaneous preterm birth, when assessed before the end of the 24th week, the following clinically significant thresholds are used:
- Over 25 mm - the result does not meet the accepted criterion for a short cervix at this stage of pregnancy.
- 21-25 mm - a short cervix is diagnosed; risk assessment and consideration of appropriate management are advisable.
- 20 mm or less - in asymptomatic patients with a singleton pregnancy before 24 weeks, there are indications to consider preventive treatment in line with current recommendations.
These thresholds apply to a specific group of pregnant women and should not be applied directly to every pregnancy, especially a multiple or more advanced one.
A result of 23 mm at 21 weeks of pregnancy does not have the same meaning as a cervical length of 23 mm at 35 weeks. For this reason, interpretation always needs to take into account gestational age and the clinical picture.
What additional tests are done when preterm birth is suspected?
There is no single universal set of tests for every patient at risk of preterm birth. The scope of diagnostics depends on whether the woman comes for a planned risk assessment or already has symptoms that require urgent diagnostics in hospital.
Laboratory tests and diagnostics for infections
Some urinary tract and genital tract infections are linked to an increased risk of obstetric complications.
Depending on the symptoms and the results so far, the doctor may recommend:
- a urinalysis and urine culture,
- a vaginal swab or culture if there are clinical indications,
- testing for certain sexually transmitted infections,
- a full blood count and inflammatory markers when a significant infection is suspected.
Not every positive swab result means an infection that needs antibiotics. It is particularly important to tell bacterial colonisation apart from a true infection.
OpenMed offers gynaecological bacteriological tests, which can be part of the diagnostics when there are appropriate indications.
CTG - assessment of the fetal heart rate and uterine contractions
CTG, or cardiotocography, records the fetal heart rate and uterine contractions.
The test is used later in pregnancy if there are indications to monitor the wellbeing of the baby or assess contractions. However, it does not replace examination of the cervix.
A record of contractions on CTG alone is not enough to confirm preterm labour, because the diagnosis also requires proper obstetric assessment.
Fetal fibronectin test
Fetal fibronectin (fFN) is a protein whose presence in cervicovaginal secretions can be used in selected situations to assess the likelihood of birth within a short time.
In some diagnostic protocols, including NICE, the fFN test can be used in patients with symptoms of suspected preterm labour after 30 weeks of pregnancy if cervical length measurement is not available or not acceptable.
With the accepted threshold of 50 ng/ml, a negative result helps to judge that birth within the next 48 hours is unlikely. A positive result does not, however, mean that the patient will definitely give birth within this time.
The test is not a routine screening test for every pregnant woman. It is done in strictly defined clinical situations.
Tests when leaking amniotic fluid is suspected
To diagnose suspected premature rupture of membranes, a speculum examination is used and, in unclear cases, tests that detect specific amniotic fluid proteins.
Diagnostics for suspected leaking waters should be carried out urgently in hospital. A positive test result is assessed together with the symptoms and the patient's condition, not as the sole basis for diagnosis.
Biomarker tests, CTG and tests for leaking amniotic fluid serve different purposes. They should not be treated as one standard set done at every consultation about the risk of an early birth.
What does a shortening cervix mean in pregnancy?
In a normal pregnancy the cervix stays closed and helps keep the pregnancy going until birth. As the due date approaches, it gradually ripens, softens and shortens.
If this process starts too early, the risk of spontaneous preterm birth may increase.
Of particular importance is a short cervix diagnosed before 24 weeks of pregnancy. The shorter its closed canal, the higher the risk of an early birth may be, although the measurement alone cannot accurately predict the date of delivery.
Shortening of the cervix can happen without symptoms. Some pregnant women have no contractions, pain or bleeding. This is why well-planned ultrasound scans matter for women with a complicated obstetric history.
Short cervix and cervical insufficiency
These terms do not mean exactly the same thing.
A short cervix is a description of an ultrasound result, showing a cervical canal length below the accepted threshold for a specific clinical situation.
Cervical insufficiency, on the other hand, means a condition in which the cervix does not hold the pregnancy properly, which can lead to its premature, often painless dilation, especially in the second trimester.
When cervical insufficiency is suspected, the doctor takes into account not only the current ultrasound result, but also the history of previous pregnancy losses, preterm births and procedures on the cervix.
Does a 25 mm cervix mean preterm birth?
No. A length of 25 mm or less before 24 weeks of pregnancy is an important parameter in risk assessment, but it does not mean that birth will definitely happen before the due date.
Many patients with a shortened cervix give birth after the end of the 37th week of pregnancy, especially with appropriate monitoring and the recommended management.
The result should always be interpreted together with the previous obstetric history, the number of babies, the week of pregnancy and any symptoms.
How is a pregnancy monitored after a previous preterm birth?
A woman who has previously given birth early may need closer monitoring in her next pregnancy. It is particularly important to establish whether the previous birth started spontaneously or was induced for medical reasons.
During the first consultations the doctor reviews the records of the previous birth. Important information includes the week of delivery, the presence of contractions, the condition of the cervix and any premature leaking of amniotic fluid.
After a previous spontaneous preterm birth, the monitoring plan may include:
- assessment of risk factors as early as the first trimester,
- analysis of the course and treatment of the previous pregnancy,
- serial cervical length measurements between 16 and 24 weeks,
- more frequent obstetric consultations if the results show this is needed,
- assessment of indications for drug-based prevention or a consultation about a cervical stitch,
- agreeing what to do if worrying symptoms appear.
In patients with a previous preterm birth, cervical measurements are sometimes planned every 1-2 weeks during a certain period of pregnancy, but the schedule depends on the protocol used and the individual clinical situation.
It is also very important to establish whether cervical insufficiency was found in the previous pregnancy. Such information may influence the decision about the need for more specialised prevention.
At OpenMed patients can use pregnancy care that takes increased obstetric risk into account. The doctor plans check-ups, reviews test results and recommends a perinatal consultation if needed.
What happens next after an increased risk of preterm birth is identified?
Once risk factors are identified, the doctor sets out a further care plan. Management depends mainly on the week of pregnancy, cervical length, previous obstetric history and the presence of symptoms.
For some patients it is enough to have more frequent check-ups and plan further cervical measurements. In other cases preventive management needs to be considered or the patient needs to be referred to a specialist centre.
Vaginal progesterone
Vaginal progesterone is one of the methods of reducing the risk of spontaneous preterm birth in suitably selected women.
According to SMFM recommendations, in asymptomatic women with a singleton pregnancy and no previous spontaneous preterm birth, a cervical length of 20 mm or less before 24 weeks is an indication for vaginal progesterone. With a length of 21-25 mm, treatment can be considered after discussing the benefits and limitations.
Other indications and management options apply to patients with a previous preterm birth.
However, progesterone is not a drug that can be used preventively in every pregnant woman, and taking it does not replace diagnostics if acute symptoms appear.
Cervical stitch
A cervical stitch, or cerclage, involves mechanically reinforcing the cervix to reduce the risk of it opening too early.
It may be considered, among others, in selected patients with a complicated obstetric history and properly documented cervical shortening. For example, according to NICE, this applies to some women with a previous spontaneous preterm birth or pregnancy loss from 16 weeks, in whom a cervix of 25 mm or less was found between 16 and 24 weeks.
Not every short cervix requires a stitch. The decision must take into account the full clinical picture and the indications for the procedure.
Cervical pessary
A pessary is a device placed around the cervix. It is sometimes discussed as one method of mechanical support for the cervix, but current recommendations do not advise its routine use to prevent preterm birth with a short cervix in a singleton pregnancy.
It should therefore not be presented as a standard solution for every patient with a shortened cervix.
Further monitoring and specialist consultation
For patients at higher risk, it is also important to set a schedule of tests, keep diagnosed complications under control and clearly define the symptoms that require urgent help.
Routine bed rest is not recommended as an effective way to prevent preterm birth. Long-term immobilisation may increase, among other things, the risk of thrombosis and worsen the patient's physical condition.
In the case of a real threat of preterm birth, treatment takes place in hospital. Depending on gestational age and the clinical situation, it may include drugs that suppress contractions, corticosteroids to help the baby's lungs mature, magnesium sulphate for neuroprotection and other obstetric interventions.
At OpenMed we focus on outpatient risk assessment, planning diagnostics and further monitoring of the pregnancy, and in situations that require hospital treatment, on proper assessment and referral of the patient to the appropriate centre.
How to prepare for an obstetric consultation?
Having your records ready makes it easier for the doctor to assess the risk and helps avoid repeating some tests.
It is worth bringing to the visit:
- your pregnancy record card and current medical records,
- ultrasound results from the current pregnancy, especially reports on the cervix,
- hospital discharge summaries after previous preterm births or miscarriages,
- records of previous procedures on the cervix, e.g. conisation,
- laboratory and microbiology test results,
- a list of medicines you take, including progesterone,
- information about previous treatment related to cervical insufficiency.
If you had a preterm birth in a previous pregnancy, information about the week of birth, the reason for the hospital stay, the course of contractions and any leaking of amniotic fluid is particularly useful.
A patient who has received a result showing a short cervix should bring not only the number of millimetres, but also the full ultrasound report with the date of the scan and the gestational age.
You do not need to fast for a typical obstetric consultation. If a transvaginal scan is planned, it is usually done with an empty bladder.
Do not stop taking progesterone or other medicines recommended by your doctor on your own.
If regular contractions, bleeding or suspected leaking of amniotic fluid appear before the planned visit, urgent hospital assessment is needed.
Preterm birth risk diagnostics at OpenMed Warsaw
At OpenMed Gynaecology and Obstetrics at ul. Wschowska 8 in the Wola district of Warsaw we provide obstetric consultations for patients who need closer monitoring of their pregnancy.
Our care also includes women with a high-risk pregnancy, previous obstetric complications and test results that need further assessment.
As part of the consultation the doctor can:
- review the previous obstetric history and risk factors for preterm birth,
- assess the results of previous cervical length measurements,
- decide on indications for an additional ultrasound scan,
- discuss any abnormalities found on ultrasound,
- refer the patient for further diagnostics,
- set a plan for monitoring the pregnancy,
- indicate the need for a perinatal consultation or hospital diagnostics.
OpenMed also offers ultrasound scans in pregnancy and prenatal diagnostics, which make it possible to monitor the baby's development and selected parameters of the pregnancy.
Combining the current test result with the full obstetric history is particularly important. The same cervical length may mean one thing in a patient with no previous complications and something else in a woman who had a spontaneous birth at 28 weeks of pregnancy.
The aim of diagnostics is to establish whether the pregnancy needs standard monitoring, more frequent check-ups, additional tests or referral to a specialist centre.
How much does preterm birth risk diagnostics cost?
The cost of the consultation depends on the scope of the visit and any additional tests. The basis is an obstetric consultation, during which the doctor reviews the pregnancy history and earlier test results and sets out further recommendations.
If additional ultrasound or laboratory tests or specialist consultations are recommended, their scope is decided individually.
Current prices of visits and tests can be checked in the OpenMed price list or confirmed with reception on 22 100 45 20.
Preterm birth - frequently asked questions
Preterm birth is a birth that happens before the end of the 37th week of pregnancy, that is up to and including 36 weeks and 6 days. The earlier a baby is born, the higher the risk of complications related to immature organs, especially the respiratory and nervous systems.
No. A short cervix increases the likelihood of an early birth, but it cannot predict the date of delivery with certainty. What matters most is the week of pregnancy, the measurement result, the history of previous pregnancies and any symptoms.
In many cases a length of 30 mm in mid-pregnancy is a normal result. However, the assessment should always be related to gestational age and earlier measurements. In patients with a complicated history, even a result that does not meet the short cervix criterion may need another check at the right time.
A length of 20 mm before the end of the 24th week of a singleton pregnancy means a short cervix and requires obstetric assessment. In asymptomatic women without a previous preterm birth, it is one of the thresholds for vaginal progesterone prevention. The result alone does not, however, mean that labour has started.
In assessing the risk of preterm birth, the period between 16 and 24 weeks of pregnancy is particularly important. In women at higher risk, the doctor may recommend a series of measurements within this window. A scan later in pregnancy may also be useful, but it then serves other diagnostic purposes.
Transvaginal ultrasound used to assess the cervix is usually not painful, although inserting the probe may cause slight discomfort. The measurement itself takes a few minutes and does not require anaesthesia.
Yes. In some patients shortening or premature opening of the cervix happens without pain or regular contractions. This is exactly why follow-up cervical length measurements are used in women with relevant risk factors.
No. Irregular tightening of the abdomen may be caused by Braxton Hicks contractions. However, regular or increasingly frequent contractions before 37 weeks require urgent assessment. Do not assume on your own that they are only practice contractions.
No. A previous spontaneous preterm birth increases the risk of it happening again, but it does not mean the situation has to repeat itself. The cause of the previous birth, the week in which it happened and the course of the next pregnancy all matter. Well-planned monitoring makes it possible to identify some abnormalities early.
Some urogenital infections and infections associated with inflammation may increase the risk of preterm birth. This does not mean, however, that every intimate infection will lead to complications. Correct diagnosis and treatment of infections for which there are medical indications is important.
Vaginal progesterone may reduce the risk of spontaneous preterm birth in certain groups of patients, especially with a short cervix diagnosed at the right stage of pregnancy. However, it does not give complete protection and should not be used routinely without indications.
Routine bed rest is not a recommended method of preventing preterm birth. Long-term restriction of activity has not been shown to effectively prevent early birth, whereas immobilisation may increase the risk of thrombosis. The level of activity should be discussed with the doctor in charge of the pregnancy, taking individual contraindications into account.
Yes. A twin pregnancy carries a higher risk of preterm birth than a singleton pregnancy. It requires an appropriate schedule of check-ups, but not all preventive methods used for a short cervix in a singleton pregnancy have the same indications in a multiple pregnancy.
In some cases birth can be delayed for a time with hospital treatment. Management may include drugs that suppress contractions, as well as treatment aimed at reducing the risk of complications for the baby. Effectiveness and safety depend on the week of pregnancy and the cause of the threat. Delaying birth is not possible or advisable in every situation.
No. A normal cervical length in a given week is a good result, but it does not rule out all causes of preterm birth. Labour may start because of other complications, e.g. premature rupture of membranes or infection. This is why the ultrasound result should be interpreted in the context of the whole pregnancy.
Yes. An obstetric consultation makes it possible to review risk factors, previous births, the course of the current pregnancy and the results of tests so far. Depending on the indications, the doctor may plan an additional cervical assessment, other diagnostic tests or a perinatal consultation. However, no test can predict with one hundred percent certainty whether and when preterm birth will happen.