Premature labour signs: what to watch for before 37 weeks, where to go and how the NICU helps

The signs of premature labour are the signs of labour, arriving before 37 weeks: regular tightenings or contractions, period-like cramps, a dull low backache that isn't usual for you, a show of blood-stained mucus, or fluid leaking from the vagina. KKH says preterm labour is when these appear before 37 weeks, and a KKH survey found 67% of pregnant women weren't sure what the symptoms were. Don't wait to see if they pass. From 22 weeks, KKH asks you to go straight to its Delivery Suite; before 22 weeks, to its 24-hour Urgent O&G Centre; at SGH, the Labour Ward from 20 weeks. Doctors can often slow labour for a couple of days so steroid injections have time to help your baby's lungs. Singapore's preterm birth rate is 8.5%, close to 3,000 babies a year, and KKH runs the largest NICU in Southeast Asia.

Signs of premature labour

Go to hospital, or call your maternity unit, if you're less than 37 weeks pregnant and have any of these:

• Regular tightenings or contractions, even if they don't hurt much
• Period-type pains or cramps
• A dull backache that isn't usual for you
• A show: blood-stained or pinkish mucus from the vagina
• A sudden gush or a steady trickle of fluid, which may be your waters breaking
• Vaginal bleeding
• Your baby moving less than usual

KKH defines preterm labour as the usual signs of labour, regular painful contractions or tightening of the tummy, a bloody show, or waters breaking, appearing before 37 weeks. The NHS adds period-type pains and unusual backache. Practice contractions (Braxton Hicks) can feel similar, but before 37 weeks it's safer to let a midwife check than to guess. Our guide to the signs of labour explains how to time contractions.

Where to go in Singapore

If you're booked at a private hospital, call its delivery suite. For heavy bleeding or severe pain at any stage, KKH says to go to its Urgent O&G Centre or your nearest emergency department straight away. SGH adds that if you think your waters have broken, go straight to hospital because of the risk of infection.

What happens at the hospital

The midwife or doctor asks how strong and how far apart your contractions are and whether any fluid has leaked, checks your pulse, blood pressure and temperature, may offer a vaginal examination, and checks your baby, says the NHS. What happens next depends on how many weeks pregnant you are. Singapore's Guidelines on the Management of Preterm Birth, launched by KKH and the College of Obstetricians and Gynaecologists in April 2026, set out the main treatments:

Doctors won't try to stop labour if delivering is safer for you or your baby, for example with an infection, heavy bleeding, severe pre-eclampsia or a baby in distress. If your waters break early, the guidelines advise steroids and antibiotics without labour-stopping drugs, watching and waiting before 34 weeks if you and your baby are well, and delivery by 37 weeks if labour hasn't started.

Who is at higher risk, and what helps

The 2026 guidelines list these risk factors:

• A previous early birth, or a pregnancy loss between 16 and 34 weeks
• Waters breaking early (before 34 weeks) in a previous pregnancy
• A previous stitch in the cervix (cerclage) or cervical surgery
• Twins or more; more than half of twins are born early
• Infections

For women carrying one baby, the guidelines recommend measuring the cervix with an internal scan at 18 to 22 weeks. If it's short, vaginal progesterone, started between 16 and 24 weeks and continued to at least 34 weeks, or a cervical stitch may be offered. KKH says a previous preterm birth is the only strong, reliable risk factor it has today, and refers these women to the KKH Preterm Birth Clinic for close follow-up; the clinic managed 420 patients from January to August 2024. Our second trimester guide lists the other checks due in those weeks.

If your baby is born early: NICU support in Singapore

Babies born early may go to a neonatal intensive care unit (NICU) or a high dependency unit. KKH says its NICU is the largest in Southeast Asia and takes babies referred from other hospitals. NUH provides Level II and III neonatal care, and SGH's Ward 53 has a nursery, a high dependency unit and a NICU.

You'll be part of your baby's care. KKH's NICU practises Family Integrated Care, where parents help with nappies and feeds, and encourages kangaroo care, holding your baby skin to skin, as soon as your baby is ready. Your expressed breast milk can be given to your baby; our guide to pumping and storing breast milk explains how to keep it safe.

KKH's NICU brochure lists the feelings parents commonly have: shock at the early birth, worry, helplessness, guilt and self-blame, and grief. It says every parent experiences the NICU differently and there's no right or wrong way to feel. Talk to the nurses and the medical social worker, and accept help at home.

Frequently asked questions

What are the first signs of premature labour?

Signs can include a dull backache, period-like cramps or tightenings that come regularly, before 37 weeks. A show of blood-stained mucus or a trickle of fluid can also be early signs. KKH says preterm labour is when the signs of labour appear before 37 weeks.

When should I go to hospital for premature labour?

Straight away, if you have any signs before 37 weeks. At KKH, go to the Delivery Suite from 22 weeks or the Urgent O&G Centre before that; at SGH, the Labour Ward from 20 weeks.

Can premature labour be stopped?

Sometimes slowed. Singapore's 2026 guidelines say oral nifedipine delays birth by 48 hours in most cases, enough for steroid injections to help the baby's lungs. Doctors won't delay birth if delivering is safer.

How common is premature birth in Singapore?

KKH says 8.5% of births in Singapore are preterm, close to 3,000 babies a year.

What support is there for parents of premature babies?

KKH runs the Early Bird Baby Club and monthly NICU parent meetings, NUH has a Neonatal Parental Support Group, and every hospital has medical social workers. Parents can help care for their baby in the NICU through feeding, nappy changes and kangaroo care.