premature labor

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  • PREMATURE LABORlabor that begins after 20 weeks gestation and before 37 weeks gestation

  • ETIOLOGYPROMIncompetent cervixMultiple gestationPrevious history of Preterm labor

  • Emotional & Physical stressHydramniosAbnormality of fetus & placenta Maternal age 35Low socio-economic

  • Unknown: asso. With dehydration, UTI & chorioamnionitis

  • SIGNS /SYMPTOMSRhythmic uterine contractions occurring at 10mins or less with or without pain

  • Cervical dilatation
  • MANAGEMENTGoal:PREVENTION OF PRETERM DELIVERY

  • Place on CBR in side-lying positionProvide adequate hydrationcontinuous fetal and uterine contraction monitoring

  • rest for 30mins & slowly resume activity if symptoms disappearAvoid sexProvide emotional support If symptoms do not subside w/n 1 hr, contact HCP

  • MEDICAL MANAGEMENTTOCOLYTIC DRUGSRitodrine (Yutopar)TerbutalineMagnesium sulfate

  • Ritodrine (Yutopar)

    assess for crackles and dyspneaWatch out for hypokalemia

  • Terbutaline

    Monitor heart rateMgSO4

    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 LABORMembrane intactGood FHT

  • Cervix not dilated more than 3-4cmEffacement not more than 50%Under 34wks

  • B. BETAMETHASONE OR DEXAMETHASONEFacilitate surfactant maturation preventing RDS

  • PRECIPITATE LABORlabor and delivery that is completed in less than 3 hours after the onset of true labor pains

  • Predisposing Factors:MultiparityHistory of rapid laborPremature or small fetusLarge bony pelvis

  • following Oxytocin administration or amniotomy

  • MATERNAL RISKS:cervical, vaginal, rectal lacerationsHemorrhage

  • FETAL RISKS:Intracranial hemorrhageInjury at birth

  • ASSESSMENT1. Cervical dilatation:a. nullipara- 1cm q 12 minb. Multipara- 1cm q 6 min2. Tachycardia3. Restlessness4. Hypotension

  • MANAGEMENTMonitor client and fetus closelyDo not leave the clientPosition: T-burgInstruct to pant or blow

  • Prepare for emergency birthCheck baby for injury after birth

  • UTERINE RUPTUREoccurs when the uterus undergoes more straining than it is capable of sustaining

  • CAUSES:Scar from a previous classic CSUnwise use of oxytocinOverdistentionMuliple gestation

  • Prolonged laborPrecipitate L & DH-mole

  • MANIFESTATIONS:Sudden, severe painTearing sensationStrong uterine contractions w/o cervical dilation

  • BANDLS RINGFetal/maternal distressProfuse bleedingHemorrhage

  • INCOMPLETEContractions continue, but cervix fail to dilateVaginal bleeding may be presentRising pulse rate and skin pallorLoss of fetal heart tones

  • COMPLETECessation of contractionsFetus easily palpated, FHT ceasedSigns of shock

  • MANAGEMENT:BT/IVFO2 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 downStrong fundal push when mother fails to bear down properly during 2nd stage of labor

  • Attempts to deliver the placenta before signs of placental separation appearPressure applied to not contracted uterusTraction applied to umbilical cord

  • MANAGEMENTNever attempt to replace the inversionDo not remove the placenta if it is still attachedIVF & Admin. oxygenHysterectomy

  • UTERINE PROLAPSEUterus has descended in the vagina due to overstretching of uterine supports and trauma

  • CAUSES:Birth of large infantBearing down effortsProlonged second stage of laborLoss of muscle tone as the result of aging

  • Injury during childbirth, especially if the woman has had many babies or large babies Obesitychronic coughing or straining and chronic constipation all place added tension on the pelvic muscles, and may contribute to the development of uterine prolapse.)

  • S/S:Vaginal pressurePain in the pelvis, abdomen or lower backPain during intercourseProtrusion of tissue from the opening of the vagina

  • Recurrent bladder infectionsUnusual or excessive discharge from the vagina Difficulty with urinationSymptoms may be worsened by prolonged standing or walking

  • DIAGNOSISPelvic examination

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

  • NON-SURGICAL OPTIONSExercise -- Kegel exercises

  • SURGICAL OPTIONSHysterectomy

    - 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 BLUESoverwhelming sadness that cannot be accounted fordue to hormonal changes, fatigue or feelings of inadequacy

  • Onset: 1-10 days postpartum lasting 2 weeks or lessFatigueWeeping anxietyMood instability

  • POSTPARTUM DEPRESSIONOnset: 3-5 days lasting more than 2 weeksConfusionFatigueAgitation

  • Feeling of hopelessness and shame let down feelingAlterations in mood roller coaster emotionsAppetite and sleep disturbance

  • POSTPARTUM PSYCHOSISOnset: 3-5 days postpartumSymptoms of depression plus delusionsAuditory hallucinationsHyperactivity

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