Pre-Term & Post-Term Labour & Birth

Question 1

Preterm Labor (PTL_

Answer 1

cervical changes and uterine contractions occurring at 20-37 weeks of pregnancy

Question 2

Preterm birth

Answer 2

birth that occurs before the completion of 37 weeks (< 37+0 weeks of gestation)

Question 3

Very preterm

Answer 3

< 32 weeks of gestation

Question 4

Moderately preterm

Answer 4

32-34 weeks of gestation

Question 5

Late preterm

Answer 5

34 0/7 to 36 6/7 weeks of gestation

Question 6

Preterm Birth vs Low Birth Weight

Answer 6

Preterm birth or prematurity: length of gestation regardless of birth weight
- more dangerous than birth weight alone because less time in the uterus correlates with immaturity of body systems (surfactant produced around 26 weeks keeps alveoli open and enables independent breathing after birth - no surfactant leads to collapsing lungs)

Question 7

Low Birth Weight

Answer 7

< 2500 grams at birth
- many potential causes, including preterm
- intrauterine growth restriction: oligohydramnios, malnutrition, multiples, abnormal uterus shape

Question 8

Spontaneous Versus Indicated Preterm Birth

Answer 8

Spontaneous: labour starts and happens, baby is coming
Indicated: need to have baby out for a medical reason

Question 9

Causes of Spontaneous Preterm Labor and Birth

Answer 9

Multifactorial; multiple pathologic processes
Infection
Congenital structural abnormalities of the uterus
Placental causes (expiry)
Maternal and fetal stress (emotional, physical, combination)
Uterine overdistention (multiples, grandmultip)
Allergic reaction (unusual but severe)
Decrease in progesterone (progesterone maintains the duration of the pregnancy)

Question 10

Predicting spontaneous preterm labor and birth

Answer 10

Risk factors
Cervical length:
- not predictive of PTL or birth
- But cervical length > 30 mm unlikely to give birth prematurely
Fetal Fibronectin (fFN) Test (present in cervical secretions)
- fFN is a glycoprotein “glue” found inbetween chorion & decidua
- binds fetal sac to uterine lining. Swab determines if glue is still there or if it is starting to leak out. means there is some movement that might indicate preterm labour

Question 11

Pre-Term Labour Care Management

Answer 11

Assessment: patient teaching
Interventions: prevention, early recognition and diagnosis
Lifestyle modifications: activity restriction, restriction of sexual activity (do not touch cervix, sexual activity stimulates the body and hormones are released that might cause uterine contractions - orgasm), home care

Question 12

Promotion of fetal lung maturity

Answer 12

Antenatal glucocorticoids: significantly reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitits, and death in neonates

Question 13

Premature Rupture of Membranes (PROM)

Answer 13

Spontaneous rupture of amniotic sac and leakage of fluid prior to the onset of labor at any gestational age

Question 14

Preterm Premature Rupture of Membranes (PPROM)

Answer 14

membranes rupture before 37 0/7 weeks of gestation
- responsible for 10% of all preterm births
- often preceded by infection (chorioamnionitis)
30 hours after ROM before baby should come out

Question 15

Care Management: PROM and PPROM

Answer 15

• Determined individually for each woman
• full-term birth is the best option
• PPROM < 32 weeks is managed expectantly and conservatively
• Vigilance for S&S of infections
• fetal assessment
• antenatal glucocorticoids
• 7-day course of broad-spectrum antibiotics
• Administering magnesium sulphate for fetal neuroprotection.
  FETAL assessment: NST

Question 16

Chorioamnionitis

Answer 16

• bacterial infection of the amniotic cavity
• major cause of complications for mothers and newborns at any gestational age
• occurs 1% - 5% of term births & 25% preterm
• diagnosed by the clinical findings of maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odor of amniotic fluid
• neonatal risks (preterm labour, could receive impact of infection - high temp)
• treatment is typically a cycle of IV antibiotics

Question 17

Postterm Pregnancy, Labour and Birth

Answer 17

Postterm pregnancy: >42 weeks of gestation
maternal and Fetal Risks
- increased maternal morbidity (risk trauma and overdistension of uterus are risk factors for PPH)
- Dysfunctional labor and birth canal trauma (placenta starts to remove because it is getting old - risk for PPH)
- Labor and birth interventions more likely (forceps, vacuum, opioid intervention, episiotomy)
- Abnormal fetal growth (macrosomia - baby that is big enough to have a larger than normal size head. fotanels don’t converge as easily)
- prolonged labor
- Shoulder dystocia or operative birth risks (give oxytocin IM when anterior shoulder comes out. causes firm contractions to decrease risk of PPH
- woman may experience fatigue and psychologic reactions as estimated date of birth passes