Preterm Labour, Birth, and Pregnancy Complications: Key Concepts and Management

What is the leading cause of mortality and morbidity related to childbirth?

Preterm Labour and Preterm Birth (PTL/PTB), accounting for ~75-85%.

What is the rate of preterm birth in Saskatchewan?

7.6%.

What are some factors that likely cause preterm labour?

Race, age extremes (<17 or >35), smoking/alcohol/drugs, infection/inflammation, stress, hypertensive disorders, cervical abnormalities, placental problems, uterine distention, and previous PTB.

What are common symptoms of preterm labour?

Low abdominal pain, cramps, backache, bleeding, pelvic pressure, increased vaginal discharge, and contractions every 10 minutes or more.

What is fetal fibronectin (ƒFN)?

A glycoprotein released in response to inflammation or separation of amniotic membranes, used to assess risk of preterm delivery.

What does a negative fetal fibronectin test indicate?

Pregnancy is likely to continue for at least another two weeks (95-98%).

What are tocolytics?

Medications used to delay preterm labour, such as Indomethacin and Nifedipine.

What is cervical insufficiency?

Premature painless dilation of the cervix, typically occurring between 20-28 weeks of gestation.

What is the recommended treatment for cervical insufficiency?

Bedrest, pelvic rest, avoid heavy lifting, and possibly cervical cerclage.

What are corticosteroids used for in the context of preterm labour?

Antenatal treatment for pregnant women between 24 and 34 weeks at risk of preterm delivery within 7 days.

What is the role of magnesium sulfate in the management of preterm labour?

It is used but has potential harm and no evidence of effectiveness for long-term use.

What is the incidence of preterm birth in Canada from 1983 to 2017?

Increased from 6.3% in 1983 to 8.2% in 2017.

What is the significance of previous preterm births?

Increases the risk of future preterm births; the earlier the previous PTB, the higher the risk.

What are some management strategies for preterm labour?

Assess and monitor vital signs, contractions, avoid stimulation, and maintain hydration.

What is the impact of assisted reproductive technology (ART) on preterm labour?

It is associated with an increasing role in preterm labour and preterm birth.

What is the risk of preterm birth for nulliparous women?

7%.

What are the risks associated with cervical cerclage?

Infection, blood loss, preterm premature rupture of membranes (PPROM), and preterm labour.

What should be avoided during the management of preterm labour?

Vaginal exams, sexual intercourse, nipple stimulation, and bladder fullness.

What is the role of progesterone in preterm labour management?

Currently in trials, it may prevent and reduce the incidence of preterm birth if there is a previous history of PTB.

What are the signs and symptoms of preterm labour?

Subtle and may include low abdominal pain, backache, and changes in vaginal discharge.

What is the effect of a single course of corticosteroids on perinatal outcomes?

It reduces perinatal mortality, respiratory distress syndrome, and intraventricular hemorrhage.

What are the two corticosteroid options for preterm labor?

Betamethasone 12 mg IM every 24 hours for 2 doses or Dexamethasone 6 mg IM every 12 hours for 4 doses.

What is the purpose of MgSO4 in pregnancy?

It is used for fetal neuroprotection in cases of imminent preterm birth at ≤ 31+6 weeks.

What is a spontaneous abortion?

The expulsion of a fetus before 20 weeks gestation or less than 500g.

What are the types of bleeding in pregnancy?

Spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease, placenta previa, abruption placentae, and uterine rupture.

What is the treatment for minimal bleeding in spontaneous abortion?

Bed rest and abstinence from sex.

What are the symptoms of ectopic pregnancy?

Sharp unilateral pain, decreased blood pressure, syncope, referred shoulder pain, lower abdominal pain, and vaginal bleeding.

What is gestational trophoblastic disease?

A rare pathologic tumor characterized by abnormal development of the placenta, which can lead to conditions like hydatidiform mole and choriocarcinoma.

What are the risk factors for placenta previa?

Previous placenta previa, uterine abnormalities, impeded endometrial vascularization, and large placental mass.

What is abruptio placentae?

The premature separation of a normally implanted placenta from the uterine wall.

What are the implications of abruptio placentae for maternal health?

Intrapartum and postpartum hemorrhage, disseminated intravascular coagulation (DIC), and hemorrhagic shock.

What are the classic signs of uterine rupture?

Abdominal pain not relieved by analgesia, vaginal bleeding, maternal and fetal tachycardia, and shape change of the abdomen.

What is vasa previa?

A condition where vessels of the umbilical cord divide some distance from the placenta, leading to fetal hemorrhage if torn.

What is the recommended immediate care for antepartum hemorrhage?

Complete history and physical assessment, frequent monitoring of maternal cardiovascular status, and fluid resuscitation if active bleeding.

What are the nursing care considerations for placenta previa and abruptio placentae?

Bed rest, possible hospitalization, avoiding sexual activity, and no vaginal exams.

What is the physiological response to significant blood loss in pregnancy?

Vasoconstriction of arterial and venous beds to preserve perfusion of vital organs, maintaining maternal vital signs until 20% blood volume is lost.

What is the role of corticosteroids in the context of preterm delivery?

Corticosteroids are given if preterm delivery is anticipated to aid fetal lung development.

What is the significance of MgSO4 administration in preterm labor?

It is administered for neuroprotection of the fetus in cases of imminent preterm birth.

What are the signs of hypovolemic shock in a pregnant woman?

Decreased blood pressure, tachycardia, pallor, and signs of shock.

What is the definition of therapeutic abortion?

Abortion performed by medical or surgical means.

What is the risk of maternal hemorrhage associated with abruptio placentae?

It can lead to significant maternal hemorrhage and fetal death.

What are the signs of hyperemesis gravidarum?

Severe nausea and vomiting during pregnancy that can lead to dehydration and weight loss.

What is the management for heavy bleeding during spontaneous abortion?

Cytotec (misoprostol), RU 486, Cervidil, IV therapy, or surgical dilatation and curettage (D&C).

What is the risk of uterine rupture in women with a history of cesarean delivery?

Increased risk due to previous uterine surgery or short inter-delivery intervals.

What is the typical management for patients with placenta previa?

Frequent monitoring with ultrasound and aiming for delivery at 36-37 weeks gestation.

What is the definition of placenta accreta?

A condition where the placenta attaches too deeply into the surface of the myometrium.

What is the worst form of placenta increta?

Placenta percreta, where the placenta penetrates through the myometrium into surrounding tissues or organs.