Introduction

Fetal Development

The Danger Signs of Pregnancy

The Pregnant Patient's

Sexual Intimacy

Weight Gain

Communication Skills

Labor Coping Strategies

Birth Options and Preferences

What to Take to the Hospital

Labor

Addendum

Addendum Continued

• Food Groups
• Progressive Relaxation
• Preterm Labor: Diagnosis and Treatment
• Prelabor Readiness
• APGAR Scoring System
• Concepts and Terminology Quiz
• Glossary
• Bibliography

Preterm Labor: Diagnosis and Treatment

Preterm labor is defined as labor which occurs after the 20th week of conception, but prior to the 37th week of gestation.  It is important to manage cases of preterm labor as maturational deficiencies and/or mortality increases for infants delivered prior to the 37th week of pregnancy.  It is important to support the mother in preterm labor by restricting her to bed rest, monitoring her vital signs, measuring intake and output of fluids, continuously monitoring fetal activity and/or the fetal heart rate, and, especially, uterine contractility.

The signs and symptoms of preterm labor are the same as for normal labor while including the following:

• Regular, rhythmic uterine contractions
• Cervical dilatation and effacement
• Bloody show

Preterm rupture of membranes occurs in 20-30% of the cases of preterm labor.  (No known cause of preterm rupture of membranes has been identified in 70-0% of these cases although it is suspected that sub-clinical infections of B-streptococcus may be responsible.)

Some possible causative factors of preterm labor are:

Maternal Factors

• DES exposure
• Cigarettes-more than 10/day
• Second trimester abortion x 2 (major risk factor) or x 1 (minor risk factor)
• More than 2 first trimester abortions
• Cervix dilated>1 cm at 32 weeks
• Maternal hypertension disease such as PIH/Pregnancy Induced Hypertension (high blood pressure, sudden edema or swelling, protein in the urine, and hyperreflexia)
• Chronic maternal disease or disorder such as cardiovascular disease, renal disease, or diabetes
• Previous preterm delivery
• Previous preterm labor with term delivery
• Placenta previa or abruption placenta
• Incompetent cervix
• Uterine abnormalities
• Abdominal surgery or other abdominal trauma
• History of cone biopsy
• Unknown

Fetal Factors

• Multiple gestation (twins, triplets)
• Hydramnios (excessive amniotic fluid in the amniotic sac)
• Fetal infections (e.g. rubella), or congenital defects

Preterm labor is usually not interrupted if one or more of the following conditions are present:

• Active labor with cervical dilation of 4 centimeters or more.
• Presence of severe PIH which creates a risk to the woman and the infant if the       pregnancy continues.
• Fetal complications (isoimmunization, gross anomalies, or fetal death).
• Ruptured membranes which significantly increases the risk of uterine and fetal infection.

There are several medications currently used in the treatment and prevention of preterm labor.  They are as follows:

• Magnesium Sulfate – is a medication which is generally used in the treatment of prevention of seizures in PIH/Pregnancy Induced Hypertension.  This medication inhibits the contractility of smooth muscles of which the uterus is composed and, therefore, it has an affect on preterm labor.  Side effects of magnesium sulfate administration include a feeling of warmth,   flushing, sweating, hypocalcemia, depressed cardiac function and respiratory depression.  The blood vessels of magnesium sulfate are monitored regularly in patients receiving this medication.
• Ritodrine (Yutopar) may be given initially by IV infusion.  Once labor has ceased,  Ritodrine may be continued by IM/intramuscular injection or by oral ingestion. Ritodrine also inhibits the contractability of smooth muscle: i.e., uterus.
• Terbutaline Sulfate (Brethine) may be given initially by subcutaneous injection to inhibit uterine contractions.  It may be continued by an oral pill maintenance dose method.  These pills must be taken around the clock on an ever 4-hour, 3-hour, or 2-hour schedule. Maternal side effects include tachycardia (rapid heart beat), nervousness, tremors and/or headaches. These side effects usually subside in about a weeks time.  Fetal side  effects include mild tachycardia (rapid heart beat) and neonatal hypoglycemia (low blood sugar).

Once a patient has been identified as being at risk for preterm labor, and that patient is being successfully managed on maintenance doses of a labor inhibiting  medication, the patient may be sent home on strict bedrest.  The patient’s primary caregiver may also have the patient assume more responsibility for her care by insisting that the patient participate in home uterine monitoring.  Home uterine  monitoring entails the patient wearing a belt-like device (a tacodynamometer or “toco”) around her abdomen for one hour in the morning and for one hour in the evening.  The “toco” can detect uterine contractions if they are present.  This information is then relayed over the telephone lines to a monitoring center where specially trained R.N.s evaluate the information received.  The R.N.s consult with   the patient and interpret the received information for her.  The patient’s primary caregiver is also given regular updates of the patient’s home monitoring results by the R.N.  In this way, preterm labor can be identified earlier and managed  appropriately so as to increase the chances of an optimal outcome to the pregnancy.

There are common parental responses to the occurrence of preterm labor.  These responses include feelings of anxiety and guilt about the possibility that something done, or not done, initiated the onset of preterm labor.  There are concerns about the baby’s health and possible concerns about the mother’s health, if this is a factor in the onset of preterm labor.  Unexpected costs associated with possible prolonged hospitalization of the mother and of the baby are concerns. Following the delivery of a premature infant, parents may find it difficult to bond  with their infant if admitter to the Special Care Nursery.  This may diminish the  parents’ ability to freely touch and spend time with their newborn.  The medical equipment used in the treatment of the infant in the Special Care Nursery may cause stress and anxiety in the parents.

Many hospitals which have Special Care Nurseries or Neonatal Intensive Care Units, also have parent support groups which minister on a parent-to-parent basis to the immediate families of infants admitted to a SCU or NICU.  One parent support group specifically for families experiencing preterm labor and birth is “Parents of Prematures”,  13613 Northeast Twenty-Sixth Place, Bellevue, WA., 98005.

Next: Addendum Continued

Final Step: Course Exam