PRE TERM LABOUR

PROFESSOR

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 37 th 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.

15. THANK YOU