Worldwide, about 1 in 10 babies is born early, and India has more preterm births than any other country - roughly 3 million a year. Babies born very early can need intensive care, and the earlier the birth, the greater the difficulties with breathing, feeding and development. A plan that starts in early pregnancy can lower the chance of an early delivery.
I rely on two tools. The first is measuring the cervix with a transvaginal scan in mid-pregnancy. The second is treatment matched to that measurement and to your history - vaginal progesterone, or a cervical stitch for selected women. The hospital's labour ward and neonatal support run 24×7 in case a baby does arrive early.
The Different Routes to an Early Birth
About two-thirds of preterm births are spontaneous - labour starts early, or the waters break early (PPROM). The remainder are early deliveries that are planned because of conditions such as pre-eclampsia or poor growth of the baby; those are covered on their own pages.
Spontaneous preterm birth can come about through:
- infection or inflammation in the womb
- the cervix shortening and opening too soon
- the womb being over-stretched, by twins or extra fluid
- bleeding behind the placenta
- stress or illness in the mother
Prevention works better when I can identify which route is most likely for you.
| How early | Gestation | What the baby usually needs |
|---|---|---|
| Extremely preterm | Before 28 weeks | Intensive neonatal care for weeks to months |
| Very preterm | 28 to 31+6 weeks | Neonatal care with support for breathing and feeding |
| Moderately preterm | 32 to 33+6 weeks | Often a shorter neonatal stay, with feeding support |
| Late preterm | 34 to 36+6 weeks | Often stays with the mother, with extra checks of sugar, jaundice and feeding |
Women I Consider at Higher Risk of Preterm Birth
The strongest single risk is an earlier spontaneous preterm birth, or a pregnancy loss between 16 and 24 weeks; the chance of it happening again is roughly 15–30%. Other risk factors are:
- waters breaking early in a previous pregnancy
- surgery on the cervix (cone biopsy, LEEP) or repeated D&Cs
- a previous caesarean done at full dilatation
- a short cervix on scan in this pregnancy
- twins or more, an unusually shaped womb, or large fibroids
- urine infection, very low body weight, tobacco use, and a short gap between pregnancies
Short Cervix in Pregnancy: Measuring the Cervix by Scan
A transvaginal scan measures the length of the closed part of the cervix. It takes a few minutes and does not harm the baby. For women at higher risk I repeat it about every 2 weeks from roughly 16 to 24 weeks.
- A typical mid-pregnancy cervix measures 30–40 mm.
- 25 mm or less before 24 weeks counts as short.
- Below 15 mm, the chance of birth before 32 weeks is substantial if nothing is done.
Women at low risk can have the cervix measured during the anomaly scan; if it is short, it is treated in the same way. A short cervix usually causes no symptoms at all, which is exactly why scanning matters.
Cervical Stitch in Pregnancy or Progesterone: How I Choose
These options are not interchangeable - each suits a different situation.
| Option | What it involves | Who it is for |
|---|---|---|
| Vaginal progesterone | A pessary or capsule each night, commonly 200 mg, continued to about 34–36 weeks | A cervix of 25 mm or less, with or without an earlier preterm birth |
| History-indicated cerclage | A stitch placed at about 12–14 weeks | Three or more earlier preterm births or mid-trimester losses, or a clear history of the cervix opening without contractions |
| Ultrasound-indicated cerclage | A stitch placed when the cervix shortens on scan | An earlier preterm birth or loss, with a cervix of 25 mm or less before 24 weeks |
| Rescue (emergency) cerclage | A stitch placed after the cervix has started to open | Selected women before 24 weeks with no contractions, bleeding or infection |
| Abdominal cerclage | A stitch placed higher up on the cervix through the abdomen, usually before pregnancy | Women whose vaginal stitch failed before, or who have very little cervix left; the baby is then born by caesarean. I do not place abdominal stitches; if one is advised, I refer you to a centre that does |
Cervical Cerclage Procedure, Step by Step
- A vaginal cerclage is a short procedure done under spinal anaesthesia, with a day or overnight stay.
- I place a strong tape or suture around the cervix through the vagina, using the McDonald or Shirodkar technique.
- Most women are back to light everyday 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.
- Risks include bleeding, infection and, rarely, rupture of the membranes during the procedure. They are higher with a rescue stitch.
- I do not routinely advise a stitch for twins on history alone, and I avoid it when there is infection, active bleeding or the membranes have ruptured.
Cervical Stitch Removal at 36–37 Weeks: What Happens
Cervical stitch removal is usually planned for 36–37 weeks, when the baby is close to term and the stitch has done its job. It takes a few minutes: you lie as for an internal examination, a speculum is passed, and the knot of the suture is cut and the thread drawn out. A McDonald stitch is normally removed in the clinic without anaesthesia; a Shirodkar stitch sits under the lining of the cervix and sometimes needs a short anaesthetic in theatre. A little spotting and mild cramps afterwards are common.
Removing the stitch does not start labour by itself. Some women go into labour within days, while many carry on for one or more weeks. If a caesarean is already planned for another reason, the stitch can be taken out at the time of the operation instead. The stitch is removed earlier, whatever the week, if labour starts, the waters break, there is significant bleeding or there are signs of infection. Contractions against a closed stitch can tear the cervix.
Preterm Labour Prevention: Everyday Steps That Lower the Risk
- A urine test at booking to find silent infection, treated if positive.
- Stopping all tobacco, including the smokeless forms common in Gujarat.
- Correcting anaemia and gaining a healthy amount of weight, with regular meals rich in protein.
- Getting dental and gum infections treated - this can be done during pregnancy.
- Leaving at least 18 months between a birth and the next conception.
Strict bed rest is not something I recommend: it does not prevent preterm birth and it raises the risk of clots.
Cervical Stitch Cost in Ahmedabad: What the Charge Depends On
Many families ask about the cost before the scan has even shown whether a stitch is needed. I do not quote a figure on this page, because the total depends on several parts. The type of stitch matters: a planned history-indicated stitch at 12–14 weeks is a shorter, simpler admission than an ultrasound-indicated or rescue stitch. Spinal anaesthesia, the theatre time, a day-care stay or an overnight one, and the suture or tape used all add to the bill. Before the procedure there are usually a urine culture and routine blood tests. Afterwards come follow-up cervical scans, progesterone if it is also advised, and removal of the stitch at 36–37 weeks.
Whether insurance covers a cervical cerclage in India depends on your policy, especially its maternity terms and waiting period, so check with your insurer before the date. The hospital gives current charges for the procedure and the stay on request.
If Labour Starts Early or Your Waters Break
Suspected preterm labour. A cervical scan and, where available, a fetal fibronectin test help tell true labour from a false alarm. Most women with tightenings do not deliver within the following week.
If birth looks likely before 34–35 weeks:
- two steroid injections, 24 hours apart, to mature the baby's lungs
- magnesium sulphate before 32 weeks to help protect the baby's brain
- nifedipine or atosiban, for up to 48 hours, to delay labour so that the steroids have time to work
If the waters break without labour: antibiotics (usually erythromycin), monitoring for infection, and - if all stays well - delivery generally planned at around 37 weeks.
The Next Pregnancy and Your Baby's Longer-Term Outlook
I plan the next pregnancy from the first trimester. That means an early dating scan, a urine culture, cervical scans from 16 weeks, and a decision about progesterone or a stitch based on your history. After a stitch that worked, many women have a history-indicated stitch the next time.
Most babies born after 32 weeks generally do well. Babies born earlier benefit from developmental follow-up with a paediatrician, covering vision, hearing and learning. An early birth can also be hard emotionally, especially when the baby needs neonatal care; a review after the birth can help.
My Preterm Birth Prevention Plan in Five Steps
- Going through your historyearlier deliveries, losses and any cervical surgery, ideally before or early in pregnancy.
- Cervical scanstransvaginal scans about every 2 weeks from about 16 to 24 weeks when indicated, plus a urine culture.
- Treatmentprogesterone or a cervical stitch offered according to your history and scans, with the risks explained.
- A readiness planthe warning symptoms to know, steroid cover if needed, and access to the 24×7 labour ward at Divine Women's Hospital.
- Removing the stitchat about 36–37 weeks; after this, most women go into labour naturally.
Reasons to See Me About Early Birth
- A previous birth before 37 weeks, or a loss between 16 and 24 weeks.
- A cone biopsy, LEEP or other surgery on the cervix.
- A previous caesarean at full dilatation of the cervix.
- A short cervix on an earlier scan.
- Expecting twins or more
- A previous stitch that did not prevent an early birth, and you are planning another pregnancy.
Preterm Labour Symptoms: Come In the Same Day
- Regular tightenings or period-like cramps before 37 weeks.
- A gush, or a steady trickle, of watery fluid.
- Bleeding from the vagina, or discharge that becomes watery, mucus-like or blood-stained.
- Pressure in the pelvis, a feeling of the baby pushing down, or a new low backache.
- Fever or foul-smelling discharge after a cervical stitch.
An early-labour check cannot wait for a booked visit. The hospital's labour room and emergency staff work 24×7, so ring on your way, mention whether you have a stitch in place, and come straight to the labour ward.
Preterm Birth Myths I Correct in Clinic
Belief: Bed rest will stop the baby coming early.
Bed rest does not prevent preterm birth and it increases the risk of clots and muscle loss. Targeted treatment based on scans is what helps.
Belief: My miscarriage happened because of a weak cervix.
Most miscarriages are not caused by a weak cervix. I advise a stitch only for specific histories or for a short cervix on scan.
Belief: Progesterone injections prevent early birth for everyone.
Vaginal progesterone helps women with a short cervix; routine progesterone injections are not supported by current evidence for most women.
Belief: Every tightening means labour.
Irregular Braxton Hicks tightenings are normal. Regular contractions that grow stronger, leaking fluid or bleeding need to be checked the same day.
Questions Patients Often Ask Me About Preterm Birth and Cerclage
What is a normal cervical length in pregnancy?
On a transvaginal scan between 16 and 24 weeks, a length above 25 mm is generally normal, and most women measure 30–40 mm. A length of 25 mm or less before 24 weeks is considered short.
What causes a short cervix?
It can follow surgery on the cervix or a caesarean at full dilatation, or result from infection or inflammation, but often there is no clear cause. It usually causes no symptoms, which is why scans are used to find it.
Does a cervical stitch hurt?
The stitch is placed under spinal anaesthesia. For a day or two afterwards, some mild cramping and a little spotting are common. Removal at 36–37 weeks is usually done without anaesthesia and feels similar to an internal examination.
Do I need bed rest after a cervical stitch?
No. Strict bed rest is not recommended. 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 lowers the chance of birth before 34 weeks by about a third. In other situations its benefit is less clear.
Can a cervical stitch be done in twins?
It is not routinely advised on history alone, because it has not been shown to help. A rescue stitch may be discussed in selected twin pregnancies where the cervix has opened.
From which week does a baby usually cope well if born early?
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.
Is a vaginal birth possible after cerclage?
Yes. Once a vaginal stitch is removed at 36–37 weeks, most women go into labour naturally and many give birth vaginally. After an abdominal stitch, the birth is by caesarean.
Can I travel after a cervical stitch?
Short local trips are usually fine once you have recovered. Avoid long journeys far from a hospital, especially after 24 weeks, and talk your plans over with me at a visit.
Why are steroid injections given if an early birth is likely?
Two doses of betamethasone 24 hours apart, or four doses of dexamethasone, help the baby's lungs, brain and gut to mature. They are most effective when the birth happens between 24 hours and 7 days after the first dose, so they are given when delivery before 34–35 weeks looks likely.