PREMATURE LABOR

labor that begins after

20 weeks gestation and before 37 weeks gestation

ETIOLOGY
PROM Incompetent cervix

Multiple gestation
Previous history of

Preterm labor

Emotional & Physical

stress Hydramnios Abnormality of fetus & placenta Maternal age <18 or >35 Low socio-economic

Unknown: asso.

With dehydration, UTI & chorioamnionitis

SIGNS /SYMPTOMS Rhythmic uterine contractions occurring at 10mins or less with or without pain

Cervical dilatation <4 cm

(2-3cm) effacement 50% or less (60-80%) Bloody show Leaking amniotic fluid Low back pain Suprapubic & Vaginal pressure

MANAGEMENT Goal: PREVENTION OF PRETERM DELIVERY

A.Place on CBR in side-

lying position B.Provide adequate hydration C.continuous fetal and uterine contraction monitoring

rest for 30mins & slowly

resume activity if symptoms disappear Avoid sex Provide emotional support If symptoms do not subside w/n 1 hr, contact HCP

MEDICAL MANAGEMENT

A. TOCOLYTIC DRUGS 1. Ritodrine (Yutopar)

2. Terbutaline 3. Magnesium sulfate

Ritodrine

(Yutopar)
1.assess for crackles

and dyspnea 2.Watch out for hypokalemia

Terbutaline 1. Monitor heart rate MgSO4

1. Check for DTR,

RR,UO, BP

TOCOLYTIC

THERAPY SE: tachycardia, hypotension, hyperglycemia, headache, N/V

Report:

tachycardia, hypotension, chest pain, cardiac arrhythmia

CONDITIONS TO HALT LABOR

Membrane intact Good FHT

Cervix not dilated

more than 3-4cm Effacement not more than 50% Under 34wks

B. BETAMETHASONE

OR DEXAMETHASONE Facilitate surfactant maturation preventing RDS

PRECIPITATE LABOR
labor and delivery that

is completed in less than 3 hours after the onset of true labor pains

Predisposing Factors:
Multiparity History of rapid labor Premature or small

fetus Large bony pelvis

following

Oxytocin administration or amniotomy

MATERNAL

RISKS: a.cervical, vaginal, rectal lacerations b.Hemorrhage

FETAL RISKS: a.Intracranial

hemorrhage b.Injury at birth

ASSESSMENT
1. Cervical dilatation: a. nullipara- 1cm q 12 min b. Multipara- 1cm q 6 min 2. Tachycardia 3. Restlessness 4. Hypotension

MANAGEMENT
Monitor client and fetus

closely Do not leave the client Position: T-burg Instruct to pant or blow

Prepare for

emergency birth Check baby for injury after birth

UTERINE RUPTURE
occurs when the

uterus undergoes more straining than it is capable of sustaining

CAUSES:
Scar

from a previous classic CS Unwise use of oxytocin Overdistention Muliple gestation

oProlonged labor

oPrecipitate L & D
oH-mole

MANIFESTATIONS:
Sudden, severe pain Tearing sensation Strong uterine

contractions w/o cervical dilation

BANDLS RING

Fetal/maternal

distress Profuse bleeding Hemorrhage

INCOMPLETE
Contractions continue, but

cervix fail to dilate Vaginal bleeding may be present Rising pulse rate and skin pallor Loss of fetal heart tones

COMPLETE
Cessation of

contractions Fetus easily palpated, FHT ceased Signs of shock

MANAGEMENT: BT/IVF O2 therapy Laparotomy Hysterectomy

UTERINE INVERSION
fundus is forced

through the cervix so that the uterus is turned inside out

Causes:
Placenta

attaches at the fundus, the passage of fetus pulls placenta down Strong fundal push when mother fails to bear nd down properly during 2 stage of labor

Attempts to deliver the

placenta before signs of placental separation appear Pressure applied to not contracted uterus Traction applied to umbilical cord

MANAGEMENT
Never attempt to replace

the inversion Do not remove the placenta if it is still attached IVF & Admin. oxygen Hysterectomy

UTERINE PROLAPSE
Uterus has descended

in the vagina due to overstretching of uterine supports and trauma

CAUSES:
Birth of large infant

Bearing down efforts

Prolonged second stage of

labor Loss of muscle tone as the result of aging

Injury during

childbirth, especially if the woman has had many babies or large babies Obesity chronic coughing or straining
may contribute to the development of uterine prolapse.)

and chronic constipation all place added tension on the pelvic muscles, and

S/S:
Vaginal pressure

Pain in the pelvis,

abdomen or lower back Pain during intercourse Protrusion of tissue from the opening of the vagina

Recurrent bladder

infections Unusual or excessive discharge from the vagina Difficulty with urination Symptoms may be worsened by prolonged standing or walking

DIAGNOSIS
Pelvic examination

MGT
Depend on the

severity of the condition, as well as the woman's general health, age and desire to have children

NON-SURGICAL OPTIONS
Exercise -- Kegel

exercises

SURGICAL OPTIONS
Hysterectomy

- removing the uterus means pregnancy is no longer possible

Uterine suspension

-- involves putting the uterus back into its normal position by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place

POSTPARTUM BLUES
overwhelming sadness

that cannot be accounted for due to hormonal changes, fatigue or feelings of inadequacy

Onset: 1-10 days

postpartum lasting 2 weeks or less Fatigue Weeping anxiety Mood instability

POSTPARTUM DEPRESSION
Onset: 3-5 days lasting

more than 2 weeks Confusion Fatigue Agitation

Feeling of hopelessness

and shame let down feeling Alterations in mood roller coaster emotions Appetite and sleep disturbance

POSTPARTUM PSYCHOSIS
Onset: 3-5 days

postpartum Symptoms of depression plus delusions Auditory hallucinations Hyperactivity