PRETERM LABOUR OR PREMATURE LABOUR

 Labour that start after 20 weeks but before completion of 37 weeks from the last menstrual period.

Causes: 

• Previous history of spontaneous abortion
• Polyhydramnios 
• Pre-eclampsia 
• APH in present pregnancy
• Medical or surgical illness & operation 
• Substance abuse 
• Present and past obstetric problems
• Infection like TORCH 
• Intra uterine death, multiple pregnancies, placental abnormality  

Assessment:

• Uterine contractions (painful or painless)
• Abdominal cramping may be with diarrhea 
• Low back pain with pelvic pressure or heaviness 
• Thicker, bloody, brown or colorless odorous discharge from vagina

Diagnosis: 

• Cervical dilation more than 2 cm 
• Cervical effacement 
• Regular uterine contraction more than 4 times per hour 
• Funneling of internal Os
• Vaginal discharge 

Management:

• Advice to take rest in a left-lateral position or supine with a wedge under the right hip to prevent hypotension.
• The women's physical & psychological rests are the highest priority, as anxiety is known to compromise uterine blood flow.
• Give toolytic drugs (any agent that diminished uterine contractions by reducing myometrial excitability) to hold/reduce the labour pain, like ritodrine.
• Administer corticosteroids to stimulate fetal pulmonary surfactant production.
• Uterine activity is monitored continuously.
• Vital signs and FHR are checked every 15 minutes.
• Maternal pulse should not exceed 140/min and FHR should not exceed 180 bpm.
• Fetal fibronectin enzyme immunoassay may be carried out on a sample of vaginal secretions taken from the posterior vaginal fornix.

Fetal Fibronectin Assay:

• A screening test that identifies the probability of preterm labor.
• Fibronectin is usually found in cervicovaginal fluid during the first 20 weeks and after 34 weeks of pregnancy.
• Fibronectine protein binds deciduas with fetal membrane.
• A positive test result (presence of fibronectin protein between 20 to 34 weeks of pregnancy) in women with symptoms of threatended preterm labor indicates the probability of delivery within 1 week.

Posted in: Maternal Nursing