Preterm labor
-1/10 babies are born premature
- regular contractions accompanied by cervical change between 20 and 37 weeks
Preterm birth
any birth prior to 37 weeks gestation
Late preterm birth
birth occurs between 34 and 36 weeks of gestation
Very preterm birth
birth occurs before 32 weeks gestation
Impact of preterm labor
- neonatal morbidity and mortality –> immense burden on families, health, education
- leading cause of neonatal mortality and most common reason for antenatal hospitalization
- daily cost of a day in the NICU is from 3000-20,000 dollars/day
Complications of preterm for the newborn
- respiratory distress syndrome
- neurodevelopment impairments
- infections
- jaundice
- thermoregulation problems
- hypoglycemia
- feeding issues
- lifelong disability (cerebral palsy, hearing loss, vision loss)
Risk factors
for preterm labor
50% of women who deliver preterm have no risk factors
3 most common: prior preterm, multiple gestation, uterine/cervical abnormalities
Medical risk factors
for preterm labor
- genital tract infections, UTI, STI
- second trimester bleeding
- IVF
- underweight before pregnancy
- obesity/preeclampsia/high BP
Lifestyle risk factors
for preterm labor
- little/no prenatal care
- smoking/substance abuse
- domestic violence, sexual abuse
- lack of social support
- stress
Symptoms of preterm labor
- contractions every 10 mins or more
- change in vaginal discharge/leaking fluid
- vaginal bleeding
- low, dull backache
- cramps that feel like menstrual cramps
- abd cramps with or without diarrhea
Proposed causes of preterm labor
- uterine distention
- infection: UTI, pyelonephritis, bacterial vaginosis, periodontal
- bleeding
- poverty, lack of support, stress
Predicting preterm labor
- fetal fibronectin (FFN)
- shortened cervical length
- prior spontaneous pre term birth
Fetal fibronectin (FFN)
- diagnostic test for preterm labor
- glycoprotein “glue” found in plasma and is produced during fetal life
- it is found in the cervical/vaginal area about 2 weeks before delivery
- negative result = unlikely to go into labor preterm
- done between 24-34 weeks gestation
- no cervical intercourse or vag exams in past 24 hrs
Assessment of PTL
- cervical exam
- sterile speculum exam for rupture of membranes (ROM)
- amnisure
- screen for UTI
- assess fetal well being
- monitor uterine activity (toco)
Management of preterm labor
focus on delaying delivery for 48-72 hours to administer antenatal steroids to facilitate fetal lung maturity
ex: betamethosone
Lifestyle modification
for delaying PTL
- activity restriction
- restriction of sexual activity
- modified bed rest
- monitor uterine activity at home
- manage stress
- utilize social support
PTL tocolytics
- ibuprofen
- indocin
- toradol
- nifedipine
- terbutaline
- magnesium sulfate
Ibuprofen
PTL
blocks the production of prostaglandin which slows or stops contractions
- 600mg every 6-8 hours
- can decrease amniotic fluid if given after 32 weeks
- amniotic fluid infusion given if needed
Indocin
PTL
NSAID = decreases prostaglandin –> stop uterine contraction
- may cause indigestion, take with food/antacid
- two potential serious side effects: reduction in the amount of urine the fetus produces and changes the way the blood circulates through the fetus’s body
Toradol
PTL
non steroidal & anti-inflammatory
- 60mg IM or IV single dose
- 30 mg multiple doses
Nifedipine
PTL
calcium channel blocker
- relaxes smooth muscle
- 20 mg PO
- watch for hypotension
Terbutaline
PTL
relaxes uterus
- .25mg SQ q 30 minutes x3
- no longer given PO for home management
- side effects: nervousness, tremor, tachycardia, palpitations
Magnesium Sulfate
PTL
calcium channel blocker
- relaxes smooth muscle
- slows contractions down
- given IVPB, loading dose 6 grams, maintenance dose 3 gm or more
- requires 2 RNs
drug of choice for delaying labor when already dilated
Side effects of magnesium sulfate
- hot flashes
- sweating
- burning at IV site
- n/v
- muscle weakness
