What is preterm labor?
defined as any other birth prior ro 37 weeks of pregnancy
What is late term?
Occurs between 34 & 36 weeks gestation
What is very preterm?
Occurs before 32 weeks gestation
Complications of preterm for newborn
Respiratory distress syndrome and Neurodevelopment impairments
3 common risk factors of preterm labor
Prior preterm, multiple gestation, and uterine or cervical abnormalities
Cervix incompetency
cervix begins to close leading to losses
Medical risk factors
- previous PTB
-multifetal gestation
-Uterine/cervical abnormalities
-Genital tract infections
-UTI/STD
-2nd trimester bleeding
-IVF
-underweight before pregnancy
-obesity
-Hight BP/preeclampsia
Lifestyle risk factors
late/no prenatal care
smoking
substance abuse
domestic violence
sexual abise
lack of social support
stress
S/S of PTL
contractions every 10 minutes or more often
change in vaginal discharge/leaking fluid
vaginal bleeding
low, dull backache
cramps that feel like menstrual cramps
abdominal cramps w or without diarrhea
3 most influential factors in prediction
- Fetal Fibronectin (FFN)
- Shortened cervical length
- Prior spontaneous PTB
What is Fetal Fibronectin?
FFN is a glycoprotein “glue” found in plasma and produced during fetal life.
Normally appears in cervical and vaginal secretions early and late pregnancy
24-34 weeks gestation
Predicts who will not go into preterm labor
*No cervical intercourse or CL within 24 hours of test
Positive= may deliver in 2 weeks
Negative= reassuring
What is cervical length?
Transvaginal ultrasound to measure the length of the cervix.
Normal is >20mm w/ a strong positive predictive value
Cervical length <15mm at 22-24 weeks gestation is very abnormal and high risk of PTL
Additional assessments
-Cervical exam
-sterile speculum exam of ROM
-Amnisure
-Screen for UTI and other infections
-Assess fetal well being
-Monitor uterine contractions
Ibuprofen
-NSAID
-blocks the production of prostaglandin which slows or stops the contractions
- 600-800 every 6-8 hours
- can decrease amniotic fluid if given after 32 weeks
-AFI is needed if given past 32 weeks
Indocin
-NSAIDS keep the body from making prostaglandins, substances which cause uterine contractions
-May cause indigestion in women, take with food or antacid
-Two potential serious side effects for fetus: a reduction in the amount of urine the fetus produces and changes in the way the blood circulates through fetus’ body
Toradol
- 60 MG IM or IV single dose
-30 MG multiple doses
-Non-steroidal and anti-inflammatory
Nifedipine
- Calcium channel blocker
-relaxes smooth muscle
-20MG PO
-Watch for hypotension
Terbutaline
- .25 mg SQ every 30 minutes x3
-relaxes uterus
-No longer given PO for home management
-Side effects: nervousness, tremor, tachycardia, palpitations
-Nursing interventions: Pulse less than 120 bpm prior to administration of med
Magnesium sulfate
-Calcium channel blocker, smooth muscle relaxer
-Slows contractions down
-Neuroprotection for baby brain
Mag sulfate administration
-IVPB
-infusion pump needed
-Loading dose, 6gm
-maintenance dose 3 or more
-needs 2 RN’s
-Side effects: hot flashes, sweating, burning at IV site, N/V, muscle weakness
Mag sulfate interventions
-Education
-Ice to IV site
-cool wash rags and cool room
-Antiemetics available: Zofran
-Assess: resp. status, deep tendon reflexes, change in LOC, oliguria (less than 30 ml/hr)
Management of Antenatal Glucocorticoids
-used prophylactically
-reduces incidence of RDS
-24-34 weeks gestation
-Bethamethasone: most commonly used: 2 injections of 12 mg every 24 hours apart
-Dexamethasone: 4 doses of 6 mg IM, every 12 hours apart
-Single rescue dose: if 2 doses have elapsed after ANS and patient is not delivered and less than 33 weeks
Glucocorticoids
-contraindicated in women with systemic infections
-Women who are on medication for GDM or pregestational DM are at high risk of significant hyperglycemia
-HTN may worsen
Management of PTL prophylactic progesteron
-Effective with patients with a history of SAB’s given up to 12 weeks gestation
-Recommended for women who have previously given birth prematurely- weekly IM injections or daily vaginal suppositories from 16-34 weeks
