Monday lecture

Prenatal Visits

• Importance of antenatal visits for monitoring mother and baby health.

• Emphasis on sexual health education to prevent STIs (Sexually Transmitted Infections).

• Untreated STIs during pregnancy can lead to serious complications for the baby.

Preterm Labor

• Definition: Occurs when labor starts before 37 weeks of pregnancy.

• Indicators:

  • Contractions that occur every 10 minutes or more, lasting for at least an hour.

  • Other symptoms: pelvic pressure, back pain, urinary frequency, vaginal discharge, menstrual-like cramping.

• Risks:

  • Leading cause of neonatal mortality before 37 weeks.

  • Complications like rupture of membranes can indicate serious issues.

Risk Factors for Preterm Labor

• Infections (UTIs, STIs like HIV and Herpes, chorioamnionitis).

• History of previous preterm birth.

• Lifestyle factors: smoking, substance abuse, violence, lack of prenatal care.

• Low pre-pregnancy weight and advanced maternal age (defined as 35 years and older).

Signs of Preterm Labor

• Uterine contractions (real or Braxton Hicks).

• Pressure in the pelvis.

• Regular contractions, water breaking, back pain without frontal contraction sensations.

Management of Preterm Labor

• Immediate action: Aim to stop preterm labor if possible to allow for fetal maturation.

• Activities and care: Possible bed rest, activity restriction, and monitoring.

• Antibiotic Treatment: If chorioamnionitis is suspected to manage infection (e.g., Macrobid for UTIs).

Medications for Managing Labor

• Nifedipine: Calcium channel blocker to suppress contractions (not with magnesium sulfate).

• Magnesium Sulfate:

  • Used for seizure control; relaxes smooth muscle but does not stop contractions.

  • Administered as a 4-gram IV bolus followed by 2 grams per hour.

  • Monitor for side effects: hot flashes, respiratory depression, and loss of consciousness.

  • Vital assessments: pulmonary edema symptoms, deep tendon reflex checks.

Additional Medications

• Tributaline: Smooth muscle relaxant, used subcutaneously every four hours.

• Betamethasone: Glucocorticoid to enhance fetal lung maturity before preterm delivery.

  • Given as two doses of 12 mg IM, spaced 24 hours apart.

• Indomethacin: Non-steroidal anti-inflammatory drug for managing preterm labor.

Preterm Rupture of Membranes (PROM)

• Definition: Rupture of membranes before labor onset; can happen full-term or preterm.

• Diagnostics:

  • Nitrazine Test: Test for amniotic fluid (blue indicates positive).

  • Fern Test: Microscopy to check for fern-like patterns in cervical mucus.

Fetal Monitoring During Labor

• Monitoring fetal heart rate for signs of distress (bradycardia, tachycardia, decelerations).

• Use of EFM (Electronic Fetal Monitoring) to assess fetal condition through contractions.

  • Variability in fetal heart rate can indicate well-being or stress.

Complications of Labor

• Prolapsed Umbilical Cord: *Critical condition if felt on vaginal exam; must not leave patient, apply pressure to alleviate cord pressure.

• Meconium-Stained Amniotic Fluid: Indicates possible fetal stress; requires careful monitoring to prevent aspiration.

Pain Management in Labor

• Non-Pharmacologic Methods: Breathing techniques (Lamaze), support from doulas, sensory aids like music or aromatherapy.

• Pharmacologic Methods: Opioids (e.g., Nubain, medical management of side effects), epidural anesthesia for pain control during labor.

Recovery Post-Delivery

• Monitoring of the mother's vital signs and uterine tone in recovery, along with appropriateness of pain management.

  • 15-minute vital checks for two hours post vaginal delivery.

Special Population Considerations

• VBAC (Vaginal Birth After Cesarean): Potential option for women with previous cesarean births, with caution for uterine rupture risks.

• Historical considerations for families, including need for interpreters when necessary.

• Emotional support strategies for mothers during labor.