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Page 1: Premature Labor
Page 2: Premature Labor

PREMATURE LABOR

labor that begins after 20 weeks

gestation and before 37 weeks gestation

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ETIOLOGYPROMIncompetent cervixMultiple gestationPrevious history of Preterm labor

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Emotional & Physical stress

HydramniosAbnormality of fetus & placenta

Maternal age <18 or >35

Low socio-economic

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Unknown: asso. With dehydration, UTI & chorioamnionitis

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

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Cervical dilatation <4 cm (2-3cm)

effacement 50% or less (60-80%)

Bloody showLeaking amniotic fluid Low back painSuprapubic & Vaginal pressure

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MANAGEMENT

Goal:PREVENTION OF

PRETERM DELIVERY

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A.Place on CBR in side-lying position

B.Provide adequate hydration

C.continuous fetal and uterine contraction monitoring

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rest for 30mins & slowly resume activity if symptoms disappear

Avoid sexProvide emotional support

If symptoms do not subside w/n 1 hr, contact HCP

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MEDICAL MANAGEMENT

A.TOCOLYTIC DRUGS1.Ritodrine (Yutopar)2.Terbutaline3.Magnesium sulfate

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Ritodrine (Yutopar)

1.assess for crackles and dyspnea

2.Watch out for hypokalemia

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Terbutaline1.Monitor heart rateMgSO41.Check for DTR, RR,UO, BP

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TOCOLYTIC THERAPY

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

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Report: tachycardia, hypotension, chest pain, cardiac arrhythmia

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CONDITIONS TO HALT LABOR

Membrane intact

Good FHT

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Cervix not dilated more than 3-4cm

Effacement not more than 50%

Under 34wks

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B. BETAMETHASONE OR DEXAMETHASONE

Facilitate surfactant maturation preventing RDS

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PRECIPITATE LABOR

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

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Predisposing Factors:MultiparityHistory of rapid laborPremature or small fetus

Large bony pelvis

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following Oxytocin administration or amniotomy

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MATERNAL RISKS:

a.cervical, vaginal, rectal lacerations

b.Hemorrhage

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FETAL RISKS:a.Intracranial hemorrhage

b.Injury at birth

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

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MANAGEMENTMonitor client and fetus closely

Do not leave the clientPosition: T-burgInstruct to pant or blow

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Prepare for emergency birth

Check baby for injury after birth

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UTERINE RUPTURE

occurs when the uterus undergoes more straining than it is capable of sustaining

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CAUSES:Scar from a previous classic CS

Unwise use of oxytocin

OverdistentionMuliple gestation

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oProlonged laboroPrecipitate L & DoH-mole

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

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BANDL’S RINGFetal/maternal distress

Profuse bleedingHemorrhage

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INCOMPLETEContractions continue, but cervix fail to dilate

Vaginal bleeding may be present

Rising pulse rate and skin pallor

Loss of fetal heart tones

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COMPLETECessation of contractions

Fetus easily palpated, FHT ceased

Signs of shock

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MANAGEMENT:BT/IVFO2 therapy Laparotomy Hysterectomy

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UTERINE INVERSION

fundus is forced through the cervix so that the uterus is turned inside out

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Causes:Placenta attaches at the fundus, the passage of fetus pulls placenta down

Strong fundal push when mother fails to bear down properly during 2nd stage of labor

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Attempts to deliver the placenta before signs of placental separation appear

Pressure applied to not contracted uterus

Traction applied to umbilical cord

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MANAGEMENTNever attempt to replace the inversion

Do not remove the placenta if it is still attached

IVF & Admin. oxygenHysterectomy

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UTERINE PROLAPSE

Uterus has descended in the vagina due to overstretching of uterine supports and trauma

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CAUSES:Birth of large infantBearing down effortsProlonged second stage of labor

Loss of muscle tone as the result of aging

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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.)

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S/S:Vaginal pressurePain in the pelvis, abdomen or lower back

Pain during intercourseProtrusion of tissue from the opening of the vagina

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Recurrent bladder infections

Unusual or excessive discharge from the vagina

Difficulty with urinationSymptoms may be worsened by prolonged standing or walking

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DIAGNOSIS

Pelvic examination

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

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NON-SURGICAL OPTIONS

Exercise -- Kegel exercises

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SURGICAL OPTIONS

Hysterectomy –

- removing the uterus means pregnancy is no longer possible

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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

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POSTPARTUM BLUES

overwhelming sadness that cannot be accounted for

due to hormonal changes, fatigue or feelings of inadequacy

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Onset: 1-10 days postpartum lasting 2 weeks or less

FatigueWeeping anxietyMood instability

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POSTPARTUM DEPRESSION

Onset: 3-5 days lasting more than 2 weeks

ConfusionFatigueAgitation

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Feeling of hopelessness and shame “let down feeling”

Alterations in mood “roller coaster emotions”

Appetite and sleep disturbance

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POSTPARTUM PSYCHOSIS

Onset: 3-5 days postpartum

Symptoms of depression plus delusions

Auditory hallucinationsHyperactivity