Art___Science_of_Midwifery_4___Preterm_Labour_-_Collaborative_Care_7_March_2025

Collaborative Care in Pre-Term Labour

Overview of Pre-Term Labour

• Concern involving early pregnancy interventions, diagnostic tests, and collaborative care

• Focus on early identification and prevention of pre-term labour

• Importance of interprofessional teamwork in healthcare settings

Learning Outcomes

• Identifying key decision points to prevent pre-term labour

• Understanding interprofessional guidance for supporting health practitioner decision making

• Recognizing aspects of midwifery care relevant to women at risk

• Learning about common obstetric interventions for diagnosed pre-term labour

Referral Pathways and Decision Points

• Early referral is crucial and should follow multidisciplinary guidelines

• Discuss with obstetricians and appropriate healthcare providers when signs of pre-term labour present

• Continuous assessment based on gestational age, past labour history, and current clinical status

• Consider the use of progesterone to prolong pregnancy when indicated

Diagnostic Considerations

Ultrasound and Cervical Assessment

• Routine cervical length ultrasounds are not supported unless necessary

• Assessing effacement and dilation can indicate potential intervention needs

• Structural abnormalities must be identified to determine intervention strategies

Important Indicators of Pre-Term Labour

• Signs can be similar to normal pregnancy symptoms

• Common symptoms:

  • Sudden abdominal pain

  • Supra pubic and pelvic pressure

  • Low dull back pain or menstrual-like cramps

  • Changes in vaginal discharge or any bleeding

Testing for Pre-Term Labour

• Fetal fibronectin (fFN) testing is crucial for assessing pre-term labour

• Negative fFN test indicates a low likelihood of pre-term labour within seven days

• The test should ideally be conducted sterilely, using saline or sterile water

• Swabs should be collected in accordance with sterile procedures

Management Strategies

Medications and Interventions

• The main goal: Prolong pregnancy for neonatal readiness

• Common interventions: corticosteroids, magnesium sulfate for neuroprotection, and tocolytics

  • Tocolytics administer to alleviate contractions and facilitate fetal lung maturity

  • Corticosteroids help mature baby’s lungs, digestive system, and immune response

  • Administered primarily for pregnancies gestated under 34 weeks and repeated if necessary

Preparing for Delivery

• Clinical staff must be aware of plans in case of pre-term delivery

• Understanding potential neonatal needs after birth, especially for pre-term infants

• Ongoing assessments and adjustments must be made leading up to delivery

Patient Interaction and Education

During Clinical Consultations

• Engage with the patient to assess their symptoms and concerns

• Provide reassurance while informing of the situation and next steps

• Encourage open discussions about signs of pre-term labour

• Assess mental state, as anxiety can impact perceived symptoms

Working in Groups

• Discussing the importance of collaboration in managing pre-term labour

• Exploring physiological signs of labour in depth to encourage understanding

  • Groups work together to identify and debate symptoms and responses

• Each group covers different medications, interventions, and physiologic background for shared knowledge

Conclusion

• Emphasize the collaborative nature of managing pre-term labour

• The combined effort of the healthcare team is crucial for patient safety and effective outcomes

• Encourage continuous education and engagement with current guidelines for managing pre-term labour.

Collaborative Care in Pre-Term Labour

Overview of Pre-Term Labour

• Concern involving early pregnancy interventions, diagnostic tests, and collaborative care.

• Focus on early identification and prevention of pre-term labour.

• Importance of interprofessional teamwork in healthcare settings.

Learning Outcomes

• Identifying key decision points to prevent pre-term labour.

• Understanding interprofessional guidance for supporting health practitioner decision making.

• Recognizing aspects of midwifery care relevant to women at risk.

• Learning about common obstetric interventions for diagnosed pre-term labour.

Referral Pathways and Decision Points

• Early referral is crucial and should follow multidisciplinary guidelines.

• Discuss with obstetricians and appropriate healthcare providers when signs of pre-term labour present.

• Continuous assessment based on gestational age, past labour history, and current clinical status.

• Consider the use of progesterone to prolong pregnancy when indicated.

Important Indicators of Pre-Term Labour

• Signs can be similar to normal pregnancy symptoms.

• Common symptoms include:

  • Sudden abdominal pain

  • Supra pubic and pelvic pressure

  • Low dull back pain or menstrual-like cramps

  • Changes in vaginal discharge or any bleeding

Preventing Pre-Term Labour

• Prevention of pre-term labour while safeguarding the baby is paramount in an assessment.

• Tocolytics are commonly used to alleviate contractions.

Preparing Baby for Early Birth

• Corticosteroids: Help mature the baby’s lungs, digestive system, and immune response, primarily administered for pregnancies gestated under 34 weeks, can be repeated if necessary.

• Magnesium Sulfate (MgSO4): Used for neuroprotection, particularly in cases of imminent delivery.

Testing for Pre-Term Labour

• Fetal fibronectin (fFN) testing is crucial for assessing pre-term labour.

• A negative fFN test indicates a low likelihood of pre-term labour within seven days.

• The test should ideally be conducted sterilely, using saline or sterile water.

• Swabs should be collected in accordance with sterile procedures.

Management Strategies

• Medications and interventions aim to prolong pregnancy for neonatal readiness.

• Common interventions include corticosteroids, magnesium sulfate for neuroprotection, and tocolytics.

Preparing for Delivery

• Clinical staff must be aware of plans in case of pre-term delivery.

• Understanding potential neonatal needs after birth, especially for pre-term infants.

• Ongoing assessments and adjustments must be made leading up to delivery.

Patient Interaction and Education

• During Clinical Consultations: Engage with the patient to assess their symptoms and concerns, provide reassurance while informing of the situation, encourage discussions about signs of pre-term labour, and assess mental state as anxiety can impact perceived symptoms.

• Working in Groups: Discuss the importance of collaboration in managing pre-term labour, exploring physiological signs of labour in depth to encourage understanding.

• Prevention of pre-term labour while safeguarding the baby is paramount in an assessment.

• Tocolytics are commonly used to alleviate contractions.

• ts and adjustments must be made leading up to delivery.

• orative nature of managing pre-term labour.

• The combined effort of the healthcare team is crucial for patient safety and effective outcomes.

• Encourage continuous education and engagement with current guidelines for managing pre-term labour.