PRE TERM LABOUR
- 1. PREMATURE LABOUR(PRETERM LABOUR PRESENTED BY MRS.JOHN BRITTO MARY (PROFESSOR IN NURSING)
- 2. DEFINITION • PML is defined as one where the labor before the 37th completed week (<259 days), counting from the first day of the last menstrual period.
- 3. INCIDENCE • The prevalence widely varies and ranges between 5-10%.
- 4. ETIOLOGY Unknown causes • But ,the following are, however related with increased incidence of premature labour. High risk factors: 1.History- • Previous history of induced or spontaneous abortion or preterm delivery. • Pregnancy following assisted reproductive techniques(ART) . • Asymptomatic bacteriuria or recurrent urinary tract infection, Smoking habits . • Low socio – economic and nutritional status. • Maternal stress.
- 5. • 2.complications in present pregnancy: may be due to • Maternal • Fetal • Placental
- 6. • Maternal –Pregnancy complications, uterine anomalies, medical and surgical illness, chronic diseases, genital tract infection PREGNANCY COMPLICATIONS: Preeclampsia, APH, PROM, Polyhydrominos. • Uterine anomalies: Cervical incompetence, Malformation of uterus. • Medical and surgical illness: Acute fever, Acute pyleonephritis, Diarrohea, Acute diabetes, Decompensated heart lesions, severe anemia, low body mass index(LBMI). • Genital tract infection: BACTERIAL vaginosis, Beta haemolytic streptococcus, Bacterioides, Chlamydia, Mycoplasma. • Fetal- Multiple pregnancy, Congenital malformations , Intra uterine death. • Placental- Infraction , Thrombosis , Placenta previa , or Abruptia placenta.
- 7. • 3.Itrogenic: indicated preterm delivery due to medical or obstetric complication. • 4.Idiopathic(majority): premature effacement of the cervix with irritable uterus and early engagement of the head are often associated .
- 8. DIAGNOSIS • Regular uterine contractions with or without pain (at least one in every 10 minute) • Dilatation>2cm and effacement 80% of the cervix • Length of the cervix <2.5cm • Pelvic pressure, backache and vaginal discharge or bleeding
- 9. INVESTIGATIONS • Full blood count • Urine for routine analysis,culture and sensitivity • Cervico vaginal swab for culture and fibronectin • Ultrasonography for fetal well being, cervical length and placental location • Serum electrolytes and glucose levels.
- 10. MANAGEMENT: • To prevent preterm onset of labour • To arrest preterm labour, if not contraindicated • Appropriate management of labour • Effective neonatal care
- 11. FIRST STAGE: • The patient is put to bed to prevent early rupture of membranes. • To ensure adequate foetal oxygenation by giving oxygen to the mother by mask. • Epidural analgesia is of choice. • Labour should be carefully monitored preferably with continuous EFM. • Caesarean delivery is done for obstetric reasons only. • NICU is a sin-quanom for good outcome.
- 12. SECOND STAGE: • The birth should be gentle and slow to avoid rapid compression and decompression of the heal. • Episiotomy may be done to minimise heal compression if there is perineal resistance. • Tendency to delay is curtailed by low forceps. as such, routine forceps is not indicated. • The cord is to be clamped immediately at birth to prevent hypervolaemia and hyperbilirubinaemia. • To shift the baby to neonatal intensive care unit under the care of a neonatologist.
- 13. PREDICTORS OF PREMATURE LABOUR: • Multiple pregnancy • History of preterm birth • Presence of genital tract infection • Symptoms of PTL
- 14. PREVENTION OF PML: • Primary care is aimed to reduce the incidence of preterm labour by reducing to high risk factors eg.infection. • Secondary care includes screening tests for early detection and prophylactic treatment eg.tocolytics. • Tertiary care is aimed to reduce the perinatal morbidity and mortality after the diagnosis eg.use of corticosteroids.
Editor's Notes
- #13: hypervolaemia -medical condition where there is too much fluid in the blood. Hyperbilirubinaemia-abnormal increase of BILIRUBIN in the blood,