3. INTRODUCTIONINTRODUCTION
Premature labour is generally a labourPremature labour is generally a labour
that occurs after 20 wks & beforethat occurs after 20 wks & before
37 completed wks of gestation37 completed wks of gestation
4. DEFINITIONDEFINITION
Pre term labour is defined by WHOPre term labour is defined by WHO
as onset of labour prior to theas onset of labour prior to the
completion of 37 weeks of gestationcompletion of 37 weeks of gestation
in a pregnancy beyond 20 weeks ofin a pregnancy beyond 20 weeks of
gestationgestation..
5. INCIDENCEINCIDENCE
Approx. 10% of deliveries in publicApprox. 10% of deliveries in public
hospital occur before the 37hospital occur before the 37thth
weekweek
A much smaller %age is involved inA much smaller %age is involved in
the 24-32 weeks period.the 24-32 weeks period.
6. ETIOLOGYETIOLOGY
In about 50%, the cause of pretermIn about 50%, the cause of preterm
labour is not knownlabour is not known
But some of theBut some of the high risk factors are:high risk factors are:
HISTORY
COMPLICATIONS
In Present
Pregnancies
IATROGENIC
IDIOPATHIC
7. Conti..Conti..
HISTORYHISTORY--
--previous history of abortion orprevious history of abortion or
preterm deliverypreterm delivery
--recurrent UTIrecurrent UTI
--smoking habitssmoking habits
--low socio-economic & nutritional statuslow socio-economic & nutritional status
8. ContiConti....
COMPLICATIONS IN PRESENTCOMPLICATIONS IN PRESENT
PREGNANCYPREGNANCY-- It may be due to 3It may be due to 3
causes:-MATERNALcauses:-MATERNAL
-FETAL-FETAL
-PLACENTAL-PLACENTAL
A)A) MATERNALMATERNAL ::
13. Conti..Conti..
IATROGENIC:IATROGENIC:
-Elective induction with wrong-Elective induction with wrong
estimation of gestational period.estimation of gestational period.
- IDIOPATHICIDIOPATHIC::
-Premature effacement of cervix with-Premature effacement of cervix with
hyper-irritable uterushyper-irritable uterus
-Early engagement of head-Early engagement of head
14. Risk factorsRisk factors
Low BMILow BMI
Short maternal heightShort maternal height
History of spontaneous pre term birthHistory of spontaneous pre term birth
Bacterial vaginitis.Bacterial vaginitis.
Asymptomatic bacteriuriaAsymptomatic bacteriuria
Low socio economic statusLow socio economic status
Short cervical lengthShort cervical length
15. SIGN AND SYMPTOMSSIGN AND SYMPTOMS
BackacheBackache
Contractions every 10 minutes are moreContractions every 10 minutes are more
oftenoften
Cramping in lower abdomenCramping in lower abdomen
Menstrual like cramps( feel like gas pain ,Menstrual like cramps( feel like gas pain ,
not a/w diarrhea)not a/w diarrhea)
Fluid leaking from vaginaFluid leaking from vagina
Flu like symptoms- nausea, vomiting,Flu like symptoms- nausea, vomiting,
diarrheadiarrhea
16. Cont..Cont..
Increased pressure in pelvisIncreased pressure in pelvis
Increased vaginal bleedingIncreased vaginal bleeding
Pelvic pressurePelvic pressure
17. INVESTIGATIONSINVESTIGATIONS
Full blood countFull blood count
Routine urineRoutine urine-analysis,culture &-analysis,culture &
senstivitysenstivity
Cervicovaginal SwabCervicovaginal Swab --
culture,FIBRONECTINculture,FIBRONECTIN
Serum electrolytes & glucose levelsSerum electrolytes & glucose levels
when tocolytic agents are to bewhen tocolytic agents are to be
usedused
18. USGUSG-fetal well being,-fetal well being,
cervical length &cervical length &
placentalplacental
localizationlocalization
19. FIBRONECTINFIBRONECTIN
AA PROTEINPROTEIN that bindsthat binds
thethe FETALFETAL MEMBRANESMEMBRANES
toto DECIDUADECIDUA
Normally found inNormally found in
CERVICOVAGINALCERVICOVAGINAL
dischargedischarge beforebefore 22wks22wks &&
againagain afterafter 37wks37wks ofof
pregnancypregnancy
PRESENCE OFPRESENCE OF
FIBRONECTIN IN CVDFIBRONECTIN IN CVD
B/W 24Wks & 34 WksB/W 24Wks & 34 Wks
PREDICTSPREDICTS PRE-TERMPRE-TERM
LABOURLABOUR
21. Prevention of PretermPrevention of Preterm
LabourLabour
Primary CarePrimary Care ––
to reduce the incidence of pretermto reduce the incidence of preterm
labour by reducing the high risk factorslabour by reducing the high risk factors (e.g.(e.g.
infection etc.)infection etc.)
Secondary CareSecondary Care
includes screening tests for early detectionincludes screening tests for early detection
& prophylactic treatment& prophylactic treatment (e.g. tocolytics)(e.g. tocolytics)
Tertiary careTertiary care--
to reduce the perinatal morbidity &to reduce the perinatal morbidity &
mortality after the diagnosismortality after the diagnosis (e.g. use of(e.g. use of
corticosteroids)corticosteroids)
22. Conti..Conti..
Taking preventive medications , who hasTaking preventive medications , who has
short cervix( Progesterone)short cervix( Progesterone)
Restricting sexual activity.Restricting sexual activity.
Limiting certain physical activities.Limiting certain physical activities.
Managing chronic conditions such as DM,Managing chronic conditions such as DM,
Increased BP.Increased BP.
25. IMMEDIATEIMMEDIATE
MANAGEMENTMANAGEMENT
The cord is to be clamped quicklyThe cord is to be clamped quickly
The cord length is kept long in case exchangeThe cord length is kept long in case exchange
transfusion is requiredtransfusion is required
The air passage should be cleared of mucusThe air passage should be cleared of mucus
Adequate oxygenationAdequate oxygenation
Aqueous solution of vit.k 1mg given I/M toAqueous solution of vit.k 1mg given I/M to
prevent hemorrhagic manifestationsprevent hemorrhagic manifestations
The baby should be wrapped including head inThe baby should be wrapped including head in
a sterile warm towela sterile warm towel
26. NURSING MANAGEMENTNURSING MANAGEMENT
1.1. Assess the mother’s condition to evaluateAssess the mother’s condition to evaluate
signs of Labour.signs of Labour.
Obtain a through obstetrics historyObtain a through obstetrics history
Determine the frequency , duration,&Determine the frequency , duration,&
intensity of uterine contraction.intensity of uterine contraction.
Determine the cervical dilatation andDetermine the cervical dilatation and
effacement.effacement.
Assess the status of membranes, andAssess the status of membranes, and
bloody showbloody show
27. Cont..Cont..
2.Evaluate the factors for distress, size and2.Evaluate the factors for distress, size and
maturity.maturity.
(sonography & lecithin-sphingomyelin ratio)(sonography & lecithin-sphingomyelin ratio)
3. Perform measures to manage or stop pre3. Perform measures to manage or stop pre
term labour.term labour.
Place the client on bed rest in the sidePlace the client on bed rest in the side
lying position.lying position.
Prepare for possible ultrasongraphy,Prepare for possible ultrasongraphy,
amniocentesis, tocolytic drug therapy oramniocentesis, tocolytic drug therapy or
steroid therapy.steroid therapy.
28. TYPESTYPES
Administer tocoltyic agent as prescribed.Administer tocoltyic agent as prescribed.
Assess for side effects of tocolytic therapyAssess for side effects of tocolytic therapy
Decreased maternal Blood pressureDecreased maternal Blood pressure
DyspneaDyspnea
Chest painChest pain
FHS >180beats/minFHS >180beats/min
29. Cont..Cont..
4- provide physical and emotional support4- provide physical and emotional support
5- Provide adequate hydration5- Provide adequate hydration
6- Provide client and family education.6- Provide client and family education.
