7/03/25 MIDW703ALL - Art & Science of Midwifery 4 * Preterm Labour - Risks 7 March 2025

Notes to look back at lecture slides for:

• World Health Organisations

• PMMRC Recomendations (2021)

• Learning outcomes

• Causes of PTL (lee 2023)

• PMMR 2018

• Knowledge of RISKS to discuss referals

• Working in partnership

• References

Pre-term Labour and Gestational Diabetes Mellitus (GDM)

• Introduction to important topics for assessment and review.

• Pre-term labour (PTL) is a significant subject in obstetrics, closely linked to GDM.

• If topics are not fully covered, continuation is possible in future sessions.

Definition of Pre-term Labour

• Definition: Birth occurring between 20 and 37 weeks of pregnancy.

  • Not to be confused with miscarriages, which occur before 20 weeks.

• Guidelines state that any birth before 37 completed weeks is classified as pre-term.

Mortality and Management of Pre-term Labour

• Major mortality associated with pre-term births occurs at around 34 weeks gestation.

• Management involves collaboration among obstetric teams, emphasizing teamwork.

• Identification of signs and symptoms is crucial for early intervention.

Signs and Symptoms

• Signs of PTL:

  • Uterine contractions, which may or may not be painful.

  • Detailed history and observations are essential for assessment.

  • Important vital signs include:

    • Blood pressure

    • Temperature

    • Respiration rate (not commonly emphasized, but important).

Clinical Assessments

• Fetal assessment includes:

  • Checking fetal position and heart rate.

  • Monitoring for any vaginal discharge related to membrane rupture.

  • Color and nature of any fluid leakage, as meconium presence is rare at this stage.

• Common causes of pre-term labour include asymptomatic urinary tract infections (UTIs).

  • Asymptomatic infections can go unnoticed but may lead to complications such as pyelonephritis.

Timing of Interventions

• Risk assessments should include weekly checks for women between 26 to 32 weeks gestation.

• Continuous monitoring from healthcare professionals is necessary for any signs of labor.

Team Collaboration and Referrals

• Upon identifying PTL, effective communication with obstetric teams is important for coordinated care.

• Referral considerations include:

  • Facilities with neonatal intensive care units for potential early births.

  • Consultations prior to 16 weeks gestation for high-risk patients or previous PTL histories.

Psychological Support and Sensitivity

to the emotional and physical needs of the mother, ensuring she has access to counseling services and support groups.

Potentially preventable preterm labour and birth risks increase with:

• Cigarette smoking - increase in spontaneous and iatrogenic preterm birth - increase perinatal and neonatal mortality - decreases with ‘smoking cessation’ programs

• Smoking Marijuana - increases risks of preterm birth by 5.4x if continued > 20 weeks - increases the risk of PT birth independent of socioeconomic status, age, cigarette smoking, BMI, and alcohol - 64% of users birth <32 weeks - risks need to be clearly described to users along with support to stop