Preterm Labor

• A labor that occurs before the end of week 37 of gestation

• Always potentially serious because the infant will be immature

preterm labor

Best preventive measure to avoid preterm birth

maintaining general health

Factors

• previous preterm birth

• short interval between pregnancies

• short cervical length

• smoking and illicit drug use

• perinatal infection

• placenta previa

• polyhydramnios

• uterine anomalies

• fetal birth defects

• African American, adolescents, older than 35 years old

S/S

• persistent, dull, and low backache

• vaginal spotting

• a feeling of pelvic pressure or abdominal tightening

• menstrual-like cramping

• increased vaginal discharge

• uterine contractions

• intestine cramping

How to predict which pregnancies will end early?

• analyzing changes in the length of the cervix by the following through ultrasound exam

• analysis of vaginal mucus for the presence of fetal fibronectin, a protein produced by trophoblast cells

The presence of this predicts that preterm contractions are ready to occur.

fetal fibronectin

Absence of this fetal fibronectin predicts that labor will not occur for at at least how many days?

at least 14 days (2 weeks)

Management

• hospitalization

• bed rest - relieve pressure of the fetus on the cervix

• attaching external fetal and uterine contraction monitors

• IV fluid therapy - ensure hydration

• vaginal, cervical cultures and a clean-catch urine sample - rule out infection

Medications

• terbutaline - tocolytic agent; inhibit uterine contractions

• magnesium sulfate - tocolytic agents

• betamethasone - a corticosteroid to hasten lung maturity

How long will betamethasone take effect?

about 24 hours, so it is important to halt labor for at least 24 hours

If fetus is not born within 7 days (effect of betamethasone last for 7 days), what to do?

dose of betamethasone may be repeated

What to do to help with fetal assessment aside from assessing FHR and activity?

fetal movement counting: ask patient to record a daily fetal “kick” count or “count to 10” test

Medical management for preterm labor is applicable for the following conditions:

• fetal membranes have not ruptures

• fetal distress is absent

• no evidence that bleeding is occurring

• cervix is not dilates more than 4 - 5 cm

• effacement is not more than 50%

This is not done as a rule in preterm labor until the fetal head is firmly engaged

artificial rupture of the membrane

If patient wants pharmaceutical pain management for labor, this is preferrable than analgesics

epidural

If a fetal monitor is attached, on what side should the patient rests on to prevent supine hypotension syndrome or an interference with uterine circulation

rests on their side

Why is the cord in preterm infants not immediately clamped?

this extra amount of blood can help reduce the possibility of preterm anemia and the need for post birth transfusion; it is acceptable to milk the cord