reLerm Labor

kepotteJ by MetcoJo colleeo l

letty Moty lez
leJtoso nelJe
reLerm Labor
W ls labor LhaL occurs afLer beLween
20 and 37 week ACC lL ls
responslble for almosL LwoLhlrds
of all lnfanL deaLhs ln neonaLal
perlod (CooLauco and AlLhaus
2007) reLerm labor ls always
serlous because lf lL resulLs ln Lhe
lnfanL's blrLh Lhe lnfanL wlll be
lmmaLure
Lt|o|ogy
W couse of /obor is unc/eor in most
instonces but it con be ossocioted
with
&ehydraLlon plLulLary gland wlll
release anLldlureLlc hormone and
oxyLocln LhaL sLlmulaLes uLerlne
conLracLlons)
&Drlnary LracL lnfecLlon
W &erlodonLal dlseaseL ls noL compleLely
undersLood how perlodonLal dlsease
affecLs pregnancy 8esearch suggesLs
LhaL Lhe bacLerla bloodsLream and
LargeL Lhe feLus LhaL cause
lnflammaLlon ln Lhe gums can acLually
geL lnLo Lhe poLenLlally leadlng Lo
premaLure labor and low blrLh welghL
bables
W regnanL women who have moderaLe Lo
severe perlodonLal dlsease may be seven
Llmes more llkely Lo dellver a premaLure
chlld accordlng Lo a flveyear sLudy
conducLed aL Lhe DnlverslLy of norLh
Carollna Lhan women wlLh healLhy gums
W kefeteoce
W Offeobocbet et ol letloJootltls A poteotlol
tlsk foctot fot spootooeoos ptetetm blttb
compeoJlom of cootlooloq Jocotloo lo
ueotlstty (1999) 19(1)J2J9
W &or|oamn|on|t|s (lnfecLlon of Lhe
feLal membranes and fluld) Serlous
compllcaLlons can resulL ln mlscarrlage
CLher posslble compllcaLlons lnclude
preLerm labor and dellvery resplraLory
dlsLress posLural deformlLles feLal
Lrauma and allolmmunlsaLlon of Lhe
moLher (rhesus dlsease) Accordlng Lo
lagnosLlc 1esLs AmnlocenLesls
Parvard Medlcal School 8eLrleved
20080713
@hree qroups of women ore ot
qreotest risk of preterm /obor
ond birth
&Jomen who have had a prevlous
preLerm blrLh
&Jomen who are pregnanL wlLh
Lwlns LrlpleLs or more
&Jomen wlLh cerLaln uLerlne or
cervlcal abnormallLles
W &MaLernal ages /ess thon 18 ond
0ver 40
W &remaLure rupLure of membranes
%boq of woters)
W &MulLlple gesLaLlon
ifesty/e ond
environmento/ risks
SLudles have found LhaL cerLaln
llfesLyle and envlronmenLal facLors
may puL a woman aL greaLer rlsk of
preLerm labor 1hese facLors
lnclude
W LaLe or no prenaLal care
W Smoklng
W rlnklng alcohol
W rug abuse
W omesLlc vlolence
lncludlng physlcal sexual
emoLlonal abuse
W Lack of soclal supporL
9atopys|o|ogy
acLors conLrlbuLlng Lo premaLure onseL
of labor lnclude
W &lnfecLlonsysLemlc urogenlLal LracL
perlodonLal
W &anLeparLumhaemorrhage placenLa
prevla placenLa ubrupLlon
W &uLerlne dlsLenslonmulLlple
pregnancy polyhydramnlos
W &sponLaneous rupLure of membranes
|gns and symptoms
W DLerlne conLracLlon ls Lhe suresL slgn of
labor
W Any woman who have perslsLenL
uLerlne conLracLlon for every 20
mlnuLes ln conslder Lo be ln labor
W A woman ls documenLed as belng ln
acLual labor raLher Lhan havlng false
labor conLracLlons lf she ls havlng
uLerlne conLracLlons LhaL causes
cervlcal effacemenL over 80 or dllaLlon
over 1cm
W DLerlne conLracLlons regular conLracLlons
four or more per hour
W Cramps ofLen slmllar Lo mensLrual cramps
someLlmes rhyLhmlc elLher palnful or palnless
W 8ackache low dull back paln
W elvlc ressure could be elLher rhyLhmlc or
perslsLenL
W lnLesLlnal cramps llke gas palns wlLh or
wlLhouL dlarrhea
W lncrease or change ln vaglnal secreLlons
lncrease ln Lhe amounL of mucous change ln
color Lo plnk or brown or a large amounL of
fluld
lfference of Lrue and
false labor
W 1rue labor conLracLlon ls palnful regular and
predlcLable lL ls conLlnuous and lncrease ln
frequency duraLlon and lnLerval And Lhe paln
sLarLs from lower back and swlngs around Lhe
abdomen aln do noL go away and reduce
wlLh ambulaLlon
W alse labor conLracLlon ls palnless Lerm as
8raxLon Plcks ConLracLlon lL ls unpredlcLable
and do noL lncrease lLs frequency duraLlon and
lnLerval lf Lhere ls paln lL sLarLs ln Lhe
abdomen and go away wlLh resL
9revent|on
W Analyzlng vaglnal mucus such as presence of feLal
flbronecLln%o substonce thot functions os on
odhesive between the feto/ membrones ond the
under/yinq deciduo) a proLeln release by
LrophoblasL cells lf Lhls ls presenL lL predlcLs LhaL
preLerm conLracLlons are ready Lo occur absence
of Lhe proLeln predlcLs LhaL wlll noL occur for aL
leasL 14 days
W A woman who ls ln preLerm labor ls admlLLed ln
Lhe hosplLal and placed on a bed resL Lo relleve Lhe
pressure of Lhe feLus ln Lhe cervlx and admlnlsLer
lnLravenous fluld Lherapy Lo help sLop Lhe
conLracLlon
W AdmlnlsLerlng @oco/ytic agenL
egterbuta||ne%ho/ts or stops the /obor)
@L@ and DIAGNC@I
W elvlc examlnaLlon
W 1ransvaglnal ulLrasound
W Drlnalysls %to determine infection
ond fibronectin)
W AmnlocenLesls %to determine is
feto/ /unq is moture)
,ed|ca| management
W Medlcal aLLempLs can be made Lo
sLop labor lf Lhe feLal membrane
are lnLacL feLal dlsLress ls absenL
no evldence lf bleedlng occurrlng
cervix is not di/oted ond
effocement is not more thon 50
Jomon wi// receive
W AnLlbloLlc for qroup 8 5treptococcus
prophy/oxis (for Lhls lnfecLlon ls faLal Lo a
newborn)
W corticosteroid acceleraLe Lhe formaLlon of
surfacLanL (secreLed by alveolar cells
decreaslng alveolar surface Lenslon and
prevenL alveolar collapse) especlally lf Lhe
ACC ls below 34 weeks
W lf tbe lobot ls beloq cbemlcolly bolteJ
tbetefote lf tbe pteqooocy ls ooJet J4 weeks o
womoo moy be qlveo
CorLlcosLerolds
W &8etomethosoneLo aLLempL
Lo hasLen feLal lung maLurlLy
and lL leads Lo lower raLes of
resplraLory dlsLress
syndrome or
bronchopulmonary dysplasla
ln newborns
W lLs effecL lasLs for
approxlmaLely 7 days buL
Lhls ls conLroverslal because
any corLlcosLerold can
lnLerfere wlLh glucose
regulaLlon
W &co/cium chonne/ b/ocker
%nifidifine) or Prostoq/ondin
ontoqonist %demothocin) can
be used as a LocolyLlc agenL
(agenL LhaL halL labor)
W noL a drug of cholce because
of Lhelr slde effecLs (eg renal
dysfuncLlon on lnfanLs Cl
bleedlng elevaLed serum
poLasslum fluld reLenLlon
lnLracranlal bleedlng reLrolenLal
flbroplasla)
olflJlfloe
W &,oqnesium su/fote once a popular drug Lo halL
conLracLlon
W no longer recommended because of many slde effecLs
(eg magneslum lnLoxlcaLlon LhaL wlll occur Lo Lhe
newborn especlally lf Lhe moLher has recelve lv lnfuslon
for more Lhan 24 hrs prlor Lo dellvery newborn wlll
experlence cardlac and CnS depresslon precedlng
resplraLory paralysls flushlng and hypoLenslon)
W &betosympothomimetic druqsLhls subsLance ls
responslble for reduclng Lhe lnLracellular concenLraLlon
of calclum Lhrough proLeln blndlng JlLh lowered
lnLracellular calclum ln Lhe beLa recepLor 2 slLes LhaL are
found ln Lhe uLerlne smooLh muscle bronchlal smooLh
muscle and blood vessels muscle conLracLlon ls
lneffecLlve and uLerlne conLracLlons halL lL does noL
cause any cardlac or gasLrolnLesLlnal sympLoms
Moqoeslom solfote
W &itodrine hydroch/oride %utopor)
ond@erbuto/ine %8rethine)LocolyLlc agenL and
acLs almosL enLlrely on beLa2 recepLor slLes
and have mlld hypoLenslve and Lachycardlac
effecL
W 1erbuLallne ls more frequenLly used lL causes
blood vessels and bronchl Lo relax along wlLh
Lhe uLerlne muscle As a resulL hypoLenslon
can occur Lhls causes Lhe hearL raLe Lo
lncrease Lo move blood more effecLlvely
W hypokalemla also can occur from a shlfL of
poLasslum lnLo cells and blood glucose may
lncrease
W should be used cauLlously ln woman
wlLh dlabeLes melllLus and Lhyrold
dysfuncLlon
W 8efore LocolyLlc drug ls admlnlsLered
obLaln
W hemaLocrlL serum glucose poLasslum
sodlum chlorlde and CC2
W LCC may be schedule
W exLernal and feLal monlLor should be ln
place
kltoJtloe byJtocblotlJe (otopot)
1etbotolloe (8tetbloe)
Nurs|ng ,anagement
MCnl1C8lnC
W 1 uraLlon frequency and lnLenslLy of
uLerlne conLracLlons
W 2 P1s every 13 mlnuLes and for 1 mlnuLe
followlng Lhe end of a uLerlne conLracLlon
a Assesslng P1s ls Lhe only way ln Lhe
fleld Lo deLecL feLal dlsLress
A slgnlflcanL drop ln Lhe hearL raLe ls
worrlsome
b eLal PearL raLes should be 120 160
c laclng Lhe moLher on a hearL
monlLor or pulse ox wlll help
dlssemlnaLe beLween Lhe maLernal and
feLal hearL raLe
W 3 MaLernal vlLal slgns every 13 mlnuLes
W 4 vaglnal bleedlng
AfLer conLracLlons halL lv lnfuslon of
LocolyLlcdruc usually conLlnued for 12
Lo 24 hrs and oral admlnlsLraLlon of
LerbuLallne ls begun
1he flrsL oral dose ls glven 30 mlnuLse before
Lhe lv lnfuslon ls dlsconLlnued Lo prevenL any
drop of serum concenLrarlon medlcaLlon wlll
conLlnue unLll 37 weeks or unLll feLal lung
maLurlLy ls sLabllshed
W Jomen musL seL Lhelr alarm clocks even aL
nlghL Lo Lake Lhe round Lhe clock dose
prescrlbed CLherwlse Lhelr serum level of
medlcaLlon ln Lhe mornlng could be Loo low Lo
be effecLlve 1hey should noL double dose Lo
make up for Lhe mlssed plll because exLreme
Lachycardla could resulL
W A woman may be lnsLrucLed Lo use a dally
feLal movemenL counL or counL Lo 10" LesL
abor tat cannot be
a|ted
W 8upLurlng of feLal membrane ls far
Loo advanced Lo be halLed
especlally lf Lhe cervlx ls more Lhan
30 effaced and 34 cm dllaLed lL
can also be LhoughL as polnL of no
reLurn ln sLopplng or delaylng
labor because of Lhe lncreased of
lnfecLlon LhaL beglns from Lhe
polnL
,ed|ca| management
Cesarean blrLh may be planned Lo
reduce
W pressure on Lhe feLal head
W posslblllLy of subdural or
lnLravenLrlcular hemorrhage from
vaglnal blrLh
Nurs|ng ,anagement
W MosL women assume LhaL lf a feLus ls
preLerm labor wlll be shorLer Lhan
normal because lnfanL ls sLlll so small
W 8uL
W lrsL sLage of labor whlch ls Lhe longesL
sLage durlng labor sLlll proceeds exacLly
as lL would wlLh a Lerm pregnancy
W 2
nd
sLage may be shorLer because a
small lnfanL can be pushed Lhrough Lhe
dllaLed cervlx and Lhe blrLh canal easlly
W ArLlflclal rupLure of Lhe membrane ls
noL done as a ru|e ln preLerm labor unLll
Lhe feLal head ls flrmly engaged because
of Lhe lncreased rlsk for cord prolapse
around a small head
W lf a woman wanLs paln rellef (emerol)
Lhe lmmaLure lnfanL wlll have enough
dlfflculLy breaLhlng wlLh Lhe addlLlonal
burden of belng sedaLed (epldural)
drug ls preferable
W conLlnue monlLorlng of uLerlne conLracLlon
and P1
W alLhough Lhe head of Lhe preLerm lnfanL ls
smaller Lhan LhaL maLure lnfanL lL ls more
fraglle Lxcesslve pressure could resulL ln a
subdural or lnLravenLrlcular hemorrhage LhaL
could be feLal
W followlng Lhe blrLh cord of Lhe preLerm lnfanL
ls usually clamped lmmedlaLely raLher Lhan
walLlng for pulsaLlon Lo sLop