Preterm Labor and Birth

Pathophysiology

• Regular contraction that cause cervical change prior to 37th week

• Early – up to 34 weeks

• Late – 34 to 37 weeks

• Does not always result in preterm birth

Risk Factors

• Maternal history of preterm birth

• Multiples

• Low BMI

  • They don't have the fat or nutritional storage to hold the baby

• Over age 35

• Early adolescent pregnancy

• Assistive reproductive technology

• Pregnancies < 18 months apart

• Substance abuse

• Partner violence

Co-morbidities

• Maternal depression

• Gestational DM

• Hypertensive disorders

• GU Tract Infections / STIs

• Cervical insufficiency

Clinical Presentation

• Subtle changes:

  • Pressure → Have to poop

Diagnostics

• NST:

  • Reactive

  • Non-reactive

• BPP / US

• Fetal fibronectin (fFN):

  • Test to see if they’re about to go into preterm labor

  • Positive test: Will give birth in 2 weeks

Medications

• Tocolysis

  • Terbutaline subQ:

    • Heart will be racing

    • HR increases, and relax uterus 

  • Oral nifedipine:

    • Works/doesn’t work

  • Mag Sulfate (IV):

    • Start them on

    • Neurodepressant

    • Close blinds, turn lights down, want to calm brain down

  • Allows for administration of corticosteroids in the event of preterm birth:

    • Bethametason

      • Betamethasone for lung maturity 

      • 2 doses in 24 hour timeframe

Other treatments other than the medications

• Cerclage:

  • 12 to 16 weeks

  • Up to 24 weeks in emergency

Interventions

• Sample collection for diagnostics

• Facilitation of comfort and adequate perfusion

• Monitoring VS

• Administration of tocolytics and other prescribed treatments

• Patient teaching and learning