PROBLEMS OF THE PASSENGER

Question 1

• Labor that occurs before
  the end of 37th week of
  gestation.

*It occurs in approximately
9%-11% of all
pregnancies.

• It is responsible for almost two
  thirds of all infant deaths in the
  neonatal period (ACOG, 2016a).
• Often related to multiple
  risk factors & rarely due
  to a single risk factor.

Answer 1

PREMATURE/PRETERM LABOR (PTL)

Question 2

Risk Factors for Spontaneous PTL

Answer 2

1.) History of genital tract colonization, infection, or
instrumentation

2.) Dehydration

3.) African-American race

4.) History of a previous spontaneous preterm birth
between 16 and 36 weeks of gestation

Question 3

Signs & Symptoms

Answer 3

• Change in vaginal discharge
  (watery, mucus, or bloody)
• Pelvic or lower abdominal
  pressure

*Feeling of pelvic pressure or
abdominal tightening

• Constant, dull, low backache
• Mild abdominal cramps,
  with or w/o diarrhea
• Increased vaginal discharge

Question 4

Assessment

Answer 4

• Antepartal period - identify @ risk for PTL
• Intrapartal period - assess progress of labor & physiologic impact of labor
• Pelvic examination

*Ultrasound

• Fetal fibronectin (fFN) test

Question 5

Criteria for Diagnosis of PTL

Answer 5

• Gestational age between 20 0/7 and 36 6/7 weeks
• Regular uterine activity, accompanied by a change in
  cervical effacement, dilation, or both
• Initial presentation with regular contractions and
  cervical dilation of at least 2 cm

Question 6

Therapeutic Management

Answer 6

• corticosteroid medications
• cervical cerclage
• antibiotics
• Bed rest

*Intravenous fluid therapy

• Tocolytic medications

Question 7

Self-Care Measures to Prevent PTL

Answer 7

1. Rest two or three times a day lying on left side.
2. Drink 2 t0 3 quarts of water or fruit juice each day.
   Avoid caffeine drinks.
3. Empty bladder at least every 2 hours during
   waking hours.
4. Avoid lifting heavy objects.

Question 8

If the woman experiences any PTL symptoms for more than 15 minutes while physically active, she should be instructed to do the following:

Answer 8

• Empty bladder to relieve pressure on the uterus.
• Lie down on left or right side to encourage blood
  return to uterus.
• Drink 2-3 glasses of fluid or juice.
• Palpate for uterine contractions, & if contractions
  occur 10 minutes apart or less for 1 hour, consult
  or notify health care provider.