Premature Labor

PREMATURE LABOR

labor that begins after 20 weeks

gestation and before 37 weeks gestation

ETIOLOGYPROMIncompetent cervixMultiple gestationPrevious history of Preterm labor

Emotional & Physical stress

HydramniosAbnormality of fetus & placenta

Maternal age <18 or >35

Low socio-economic

Unknown: asso. With dehydration, UTI & chorioamnionitis

SIGNS /SYMPTOMSRhythmic uterine contractions occurring at 10mins or less with or without pain

Cervical dilatation <4 cm (2-3cm)

effacement 50% or less (60-80%)

Bloody showLeaking amniotic fluid Low back painSuprapubic & Vaginal pressure

MANAGEMENT

Goal:PREVENTION OF

PRETERM DELIVERY

A.Place on CBR in side-lying position

B.Provide adequate hydration

C.continuous fetal and uterine contraction monitoring

rest for 30mins & slowly resume activity if symptoms disappear

Avoid sexProvide emotional support

If symptoms do not subside w/n 1 hr, contact HCP

MEDICAL MANAGEMENT

A.TOCOLYTIC DRUGS1.Ritodrine (Yutopar)2.Terbutaline3.Magnesium sulfate

Ritodrine (Yutopar)

1.assess for crackles and dyspnea

2.Watch out for hypokalemia

Terbutaline1.Monitor heart rateMgSO41.Check for DTR, RR,UO, BP

TOCOLYTIC THERAPY

SE: tachycardia, hypotension, hyperglycemia, headache, N/V

Report: tachycardia, hypotension, chest pain, cardiac arrhythmia

CONDITIONS TO HALT LABOR

Membrane intact

Good FHT

Cervix not dilated more than 3-4cm

Effacement not more than 50%

Under 34wks

B. BETAMETHASONE OR DEXAMETHASONE

Facilitate surfactant maturation preventing RDS

PRECIPITATE LABOR

labor and delivery that is completed in less than 3 hours after the onset of true labor pains

Predisposing Factors:MultiparityHistory of rapid laborPremature or small fetus

Large bony pelvis

following Oxytocin administration or amniotomy

MATERNAL RISKS:

a.cervical, vaginal, rectal lacerations

b.Hemorrhage

FETAL RISKS:a.Intracranial hemorrhage

b.Injury at birth

ASSESSMENT1. Cervical dilatation:a. nullipara- 1cm q 12 minb. Multipara- 1cm q 6 min2. Tachycardia3. Restlessness4. Hypotension

MANAGEMENTMonitor client and fetus closely

Do not leave the clientPosition: T-burgInstruct to pant or blow

Prepare for emergency birth

Check baby for injury after birth

UTERINE RUPTURE

occurs when the uterus undergoes more straining than it is capable of sustaining

CAUSES:Scar from a previous classic CS

Unwise use of oxytocin

OverdistentionMuliple gestation

oProlonged laboroPrecipitate L & DoH-mole

MANIFESTATIONS:Sudden, severe painTearing sensationStrong uterine contractions w/o cervical dilation

BANDL’S RINGFetal/maternal distress

Profuse bleedingHemorrhage

INCOMPLETEContractions continue, but cervix fail to dilate

Vaginal bleeding may be present

Rising pulse rate and skin pallor

Loss of fetal heart tones

COMPLETECessation of contractions

Fetus easily palpated, FHT ceased

Signs of shock

MANAGEMENT:BT/IVFO2 therapy Laparotomy Hysterectomy

UTERINE INVERSION

fundus is forced through the cervix so that the uterus is turned inside out

Causes:Placenta attaches at the fundus, the passage of fetus pulls placenta down

Strong fundal push when mother fails to bear down properly during 2nd stage of labor

Attempts to deliver the placenta before signs of placental separation appear

Pressure applied to not contracted uterus

Traction applied to umbilical cord

MANAGEMENTNever attempt to replace the inversion

Do not remove the placenta if it is still attached

IVF & Admin. oxygenHysterectomy

UTERINE PROLAPSE

Uterus has descended in the vagina due to overstretching of uterine supports and trauma

CAUSES:Birth of large infantBearing down effortsProlonged second stage of labor

Loss of muscle tone as the result of aging

Injury during childbirth, especially if the woman has had many babies or large babies

Obesitychronic coughing or straining and chronic constipation all place added tension on the pelvic

muscles, and may contribute to the development of uterine prolapse.)

S/S:Vaginal pressurePain in the pelvis, abdomen or lower back

Pain during intercourseProtrusion of tissue from the opening of the vagina

Recurrent bladder infections

Unusual or excessive discharge from the vagina

Difficulty with urinationSymptoms may be worsened by prolonged standing or walking

DIAGNOSIS

Pelvic examination

MGTDepend on the severity of the condition, as well as the woman's general health, age and desire to have children

NON-SURGICAL OPTIONS

Exercise -- Kegel exercises

SURGICAL OPTIONS

Hysterectomy –

- removing the uterus means pregnancy is no longer possible

Uterine suspension -- involves putting the uterus back into its normal position by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place

POSTPARTUM BLUES

overwhelming sadness that cannot be accounted for

due to hormonal changes, fatigue or feelings of inadequacy

Onset: 1-10 days postpartum lasting 2 weeks or less

FatigueWeeping anxietyMood instability

POSTPARTUM DEPRESSION

Onset: 3-5 days lasting more than 2 weeks

ConfusionFatigueAgitation

Feeling of hopelessness and shame “let down feeling”

Alterations in mood “roller coaster emotions”

Appetite and sleep disturbance

POSTPARTUM PSYCHOSIS

Onset: 3-5 days postpartum

Symptoms of depression plus delusions

Auditory hallucinationsHyperactivity