PRE-TERM LABOR
DEFINITION: Also known as preterm labor, the onset of rhythmic uterine contractions that produce cervical changes after fetal viability but before fetal maturity. Usually occurs between 20 to 37 weeks gestation Fetal prognosis depends on birth weight and length of gestation Neonates who weigh less than 737 g and are less than 26 weeks gestation have a survival rate of about 10% Those who weigh 737 to 992 g and are between 27 and 28 weeks gestation have a survival rate of more than 50% Those who weigh 992 to 1,219 g and are more than 28 weeks gestation have a 70% to 90% of survival rate Premature labor increases the risk of neonate morbidity or mortality from excessive maturational deficiencies
CAUSES AND RISK FACTORS: 1. Maternal Cardiovascular and renal disease Diabetes mellitus Gestational hypertension Infection Abdominal surgery or trauma Incompetent cervix Placental abnormalities Premature rupture of membranes 2. Fetal Infection Hydramnios Multiple Pregnancy
SIGNS AND SYMPTOMS: Onset of rhythmic uterine contractions Possible rupture of membranes, passage of the cervical mucus plug and a bloody discharge Typically 20 to 37 weeks of gestation
Cervical effacement and dilation on vaginal examination
PATHOPHYSIOLOGY: Spontaneous preterm birth is a physiologically heterogeneous syndrome. The cascade of events that culminate in spontaneous preterm birth has several possible underlying pathways. Four of these pathways are supported by a considerable body of clinical and experimental evidence: excessive myometrial and fetal membrane overdistention, decidual hemorrhage, precocious fetal endocrine activation, and intrauterine infection or inflammation. These pathways may be initiated weeks to months before clinically apparent preterm labor. The processes leading to preterm parturition may originate from one or more of these pathways; for example, intrauterine infection or inflammation and placental abruption often coexist in preterm births. Decidual hemorrhage and intrauterine infection share several inflammatory molecular mechanisms that contribute to parturition. Our understanding of the nature of the molecular cross-talk among these pathways is in its infancy. The etiologic heterogeneity of preterm birth adds complexity to therapeutic approaches. Although the ultimate clinical presentation of women with preterm labor may appear to be homogeneous, the antecedent contributing factors probably differ considerably from woman to woman
NURSING MANAGEMENT: Bed rest To relieve the pressure of the fetus in the cervix Encourage the patient to maintain adequate nutrition and do not smoke cigarettes both poor nutrition and smoking can put them at high risk for pre-term birth. Encourage the patient to drink plenty of water - to promote hydration Encourage the patient to lie on her left side or sit up during labor - to prevent vena caval compression, which can cause supine hypotension and subsequent fetal hypoxia
MEDICAL MANAGEMENT Administer fluids as ordered to keep the patient hydrated, this may help stop contractions Administer oxygen to the patient through a nasal cannula Vaginal and cervical cultures and a clean urine sample obtained to rule out infection
PHARMACOLOGICAL MANAGEMENT:
Antibiotics if urinary track infection is present in the woman Antibiotic for Group B streptococcus prophylaxis as an infection with this could be fatal in a newborn. Tocolytic agents an agent that halts labor. Terbutaline Ritodrine hydrochloride Beta-sympathomimetic Steroid (betamethasone) attempts to hasten fetal lung maturity thus leads to lower rates of respiratory distress syndrome orbronchopulmonary dysplasia in newborns.
