Class 6: Preterm Labour Flashcards
complications in L&D are usually r/t (6)
- 5 P’s
- timing (gestation ie. preterm, postterm)
what is included in uncomplicated labor and birth
- term pregnancy – routine, no health concerns
- singleton fetus
- spontaneous labor and birth with no maternal or fetal complications, that progresses at normal pace
complications in L&D generally require..
- continuous EFM
what is preterm labor
- cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy
- labor occurring at equal to or less than 36+6 weeks gestation
what is preterm birth
- any birth that occurs before completion of 37 weeks of pregnancy
- birth occurring at equal to or <36+6 weeks gestation
what is one of the most significant contributors to neonatal morbidity and mortality
- prematurity
what is considered a neonate? infant?
- neonate: 28 days or younger
- infant: >= 1 year
what is the main admin criteria for admin to NICU
- pre-term birth
preterm birth and prematurity describe….
- length of gestation, regardless of birth weight
frequently, infants born preterm also have…
- low birth weight (but not always)
low birth weight describes only…. what is considered low birth weight
- describes only birth weight
- 2500g or less, regardless of gestation
____ can often lead to low birth weight
- IUGR
which is more dangerous, low birth weight or preterm birth and why
- preterm birth –> the organs havent had the full term gestation to develop
what birth weight is considered macrosomia
4000 g
describe preterm baby appearance (3)
- very fragile skin
- very skinny
- no fat deposits
the lack of fat deposits with preterm babies causes issues w? (2)
issues controlling:
- temp
- BG
what are the categories of preterm labor and birth (2)
- spontaneous
- indicated
what is the occurrence of spontaneous preterm labor and birth
- most preterm births are spontaneous
when is indicated preterm labor and birth advisable?
- if there are fetal and/or maternal risk factors where birth is deemed necessary
what are examples of indications for induction (2)
- placental abruption with bleeding or distress
- HTN –> severe pre-eclampsia
what is required w indicated preterm labor and birth
- weighing gains in fetal maturity vs the risks (fetal and/or maternal) of continuing w the pregnancy
what are common cause of indicated preterm birth (8)
- diabetes
- HTN disorders of pregnancy
- placental disorders
- fetal disorders
- chronic IUGR or acute fetal compromise (abnormal NST, BPP, umbilical artery doptone analysis)
- oligo or polyhydramnios
- birth defects
- still birth (will give mother few days to go into labor spontaneously)
what are common causes of spontaneous preterm birth (4)
- preterm labor
- PPROM
- cervical insufficiency (incompetent cervix)
- amnionitis
what is amnionitis? what can it cause?
- infection in amnion
- can cause excessive distension of uterus
what is included in prevention of spontaneous preterm labor (5)
- preventive strategies to address risk factors –> each day gained in terms of fetal maturity is important
- education aimed at health promotion & disease prevention
- education about early symptoms of preterm labor (esp if risk factors)
- teach what to do if symptoms occur
- ongoing assessment of risk factors throughout pregnancy
pregnant people may sometimes ignore symptoms of preterm labour because of.. (2)
- lack of awareness regarding significance
- belief that symptoms are expected during pregnancy
what are risk factors for spontaneous preterm labor (9)
- history of previous spontaneous preterm birth
- family history of preterm labor
- african race
- genital tract infections
- multifetal gestation
- 2nd trimester bleeding (ie. abruption)
- low prepregnancy weight
- low socioeconomic status
- lack of access to prenatal care
how can placental abruption cause spontaneous preterm labpr?
- uterus contracts to control bleeding = can trigger contractions & labor
how can multifetal gestation cause spontaneous preterm labor?
- uterus distends earlier
what are early S&S of preterm labor (4)
- uterine activity
- discomfort
- vaginal discharge
- urinary freq
describe uterine activity in preterm labor and what can it be mistaken for?
- feels like strong menstrual cramps if fetus smaller
- can be mistaken for: pressure, sense of heaviness, gassy feeling
what type of vaginal discharge is an early sign of preterm labor (2)
- bleeding
- amniotic fluid
what S&S of discomfort are early signs of preterm labor (5)
- lower abdominal cramping –> feel like gas pains
- low back pain
- menstrual like cramps
- suprapubic pain or pressure
- pelvic pressure or heaviness
what should the pregnant person do if they are experiencing early signs of preterm labor (5)
- empty bladder
- hydrate
- lie down on side for 1 hr
- palpate for contractions
- notify care provider or go to triage if symptoms continue
why is early recognition & diagnosis of preterm labor so important? (3)
- allows for longer time to educate birther for what to expect
- more interventions available to prep fetus with underdeveloped lungs
- need time to get mother to NICU
what is the 3 criteria for diagnosis of preterm labor
- gestational age between 20 and 37 weeks
- uterine activity (contractions)
- progressive cervical change
progressive cervical change for the diagnosis of preterm labor includes.. (2)
- effacement of 80%
- cervical dilation of 2cm or greater
what is 1 intervention used for preterm labor?
- tocolytics
what are tocolytics
- medicals given to suppress labor after uterine activity and cervical changes have occurred
tocolytics have not been shown to reduce the rate of preterm birth, rather their purpose it to
gain time
tocolytics aim to gain time to: (2)
- for maternal transport to facility w NICU capabilities
- for admin of glucocorticoids for fetal lung maturity (to decrease neonatal morbidity and mortality)
what is an example of a tocolytic? what does it do?
- indomethicin
- NSAID which blocks production of prostaglandins
what is considered one of the most effective and cost-efficient interventions for preventing neonatal morbidity and mortality associated w preterm labor? how?
- admin of antenatal glucocorticoids IM to birth
= reduces the severity of neonatal resp distress syndrome
what are 2 types of glucocorticoids used for promotion of fetal lung maturity
- betamethasone
- dexamethasone
what dose of betamethasone is used for promotion of fetal lung maturity
12 mg IM x 2 doses, 24h apart
what dose of dexamethasone is used for promotion of fetal lung maturity
6 mg IM x 4 doses, 12 hrs apart
what is the NIH recommendation for glucocorticoids for promotion of fetal lung maturity
- women 24-34 weeks gestations
what is the SOGC recommendation for glucocorticoids for promotion of fetal lung maturity
- admin for bithers between 24 and 34+6 weeks gestation
if there is a need to transfer to a tertiary facility, when should the first dose of glucocorticoids be given
- first dose prior to transfer
what role does magnesium sulphate play in preterm labor
- used to reduce or prevent neonatal neurological morbidity (ex. cerebral palsy)
antenatal magnesium sulphate for fetal neuroprotection should be considered from…
- viability to <= to 33+6 weeks gestation
describe the duration of magnesium sulphate therapy (3)
- max of 24 hrs of therapy
- or discontinue if delivery is no longer imminent
- or dc at birth
what is the dose of magnesium sulphate for fetal neuroprotection
- 4g load
- then 1g/hr maintenance infusion until birth
labor that progresses to cervical dilation of ___ cm is likely to lead to preterm birth? this is termed?
- 4cm
= inevitable preterm birth
due to the small fetal size in preterm birth, birth may occur without?
- a fully dilated cervix = labor may progress quickly to birth
what is there a risk of with preterm birth?
- head getting caught on cervix
preterm births in _____ lead to better neonatal and maternal outcomes. therefore, women at risk should be…
- preterm births in tertiary care centers lead to better neonatal and maternal outcomes
- women at risk should be transferred quickly to ensure the best possible outcome
what needs to attend birth w preterm birth? why?
- neonatal time –> skilled in neonatal resus
preterm labor and birth can lead to..
- fetal demise or neonatal death –> one of the leading causes of neonatal mortality
if the fetus is not at gestational age of viability , what provision should be provided
- palliative care provision
what is neonatal loss
- newborn passes away after birth
define still birth
- newborn passes away before or during birth
what is preterm rupture of membranes
- rupture before 37 weeks gestation
what is premature rupture of membranes
- spontaneous rupture of membranes before the onset of labor at any gestational age
what is preterm premature ROM
- includes both aspects (before labor and preterm)
what are risk factors for PPROM (7)
- history of preterm birth, especially w PPROM
- history of cervical cerclage
- UTI or genital tract infection
- short cervical length
- preterm labor
- uterine overdistension
- 2nd and 3rd trimester bleeding
the mngmt of PPROM depends on (2)
- overall context –> fetal and maternal risks
- gestational age
if birth is delayed after PPROM for gains in fetal maturity, what should be closely monitored?
- closely monitored for infection
- monitor fetal status –> BPP
what is chorioamnionitis
- bacterial infection of the amniotic cavity
when does chorioamnionitis usually occur? what is its prevalance?
- usually occurs after ROM
- occurs in 25% of preterm births
what is the benchmark for being concerned about temperature? what is the intervention for this?
- > 38*
- admin of antibiotics
chorioamnionitis is the most common cause of..
- fetal tachycardia
chorioamnionitis can cause: (2)
- pneumonia
- sepsis for fetus
