Premature Labor in maternal health nursing.ppt

Presentation on premature labora

1. PREMATURE LABOUR
BY RUTH MTONGA
CLINICAL MENTOR

2. LEARNING OUTCOMES
Define premature labour
Explain the diagnosis of premature
labour
Discuss the predisposing factors to
premature labour
Explain the prevention of premature
labour
Explain the management of premature
labour

3. Definition
Labour that occurs before 37 completed
weeks of pregnancy regardless of birth
weight
Presence of contractions of sufficient
strength and frequency to effect
progressive effacement and dilatation of
the cervix
Birth prior to 20 weeks is an abortion

4. Prematurity continues to be the major
perinatal and neonatal problem causes of
fetal morbidity in Malawi
Most mortality and morbidity is experienced
by babies born before 34 weeks gestation

5. Diagnosis
Prompt diagnosis is difficult because many of its
symptoms are also common in normal pregnanc
Abdominal pain
Pelvic pain
Menstrual like cramps
Pelvic pressure
Onset of regular uterine contractions
Progressive change in cx dilatation & effacement
Vaginal bleeding

6. Criteria for diagnosis of
preterm labour
Gestation 28-37 weeks
Documented uterine contractions
Documented cervical changes ( effacement
and dilatation)

7. Predisposing factors
Unknown
Trauma
Medical/obstetrical complications
Severe anaemia
Systemic conditions
Renal disease
genital tract infections
Previous preterm labour
Multiple pregnancy
hypertension

8. Predisposing factors
Poverty/social deprivation
Marital status
Overworking
Psychological distress

9. Prevention
Identification of patients at risk and their
referral for medical investigation and
management
Patient identification for those at risk i.e.
importance of hygiene and cleanliness
Special investigations for the cause, if
patient has any history of preterm labour
or abortion
Treatment of any local infections

10. Medical management
Management is controversial and depends
on many circumstances and on the
facilities available
Controversial issues include:
Whether to suppress labour or not
Whether to use steroids to accelerate fetal
lung maturity

11. Indications for allowing labour to
progress
Fetus is more than 36 weeks
There is placental insufficiency
There is serious maternal disease
Gross fetal malformation
Cervix has dilated more than 3-4 cm
The fetus is distressed, dead,

12. Tocolytics (uterine antispasmodics)
The intervention aims to delay delivery
until the effect of corticosteroids has
been achieved
Attempt tocolysis if
Gestation is less than 37 weeks
Cervix is less than 3 cm dilated
There is no amnionitis, pre-eclampsia or
active bleeding
There is no fetal distress

13. Drugs used
Currently administered drugs:
Nifedipine 10-20 mg OD or 12 hourly
for suppressing labour
Drugs not being used currently
Salbutamol (reduces uterine activity)
Magnesium sulphate

14. Steroids
These are indicated if gestational age is not
less than 28-34 weeks and membranes are
intact
Given for lung maturity of the baby before
birth
Betamethasone 12mg IM 2 doses 12 hours
apart or
Dexamethasone 12mg IM 12hourly for 4
doses for surfactant/maturing lungs

15. Conservative management
First determine if it is true labour
Monitor contractions
Complete bed rest in hospital
Sedation may be used to relieve anxiety
No vaginal examination, only a sterile
speculum examination ( if done keep to the
minimum)

16. Conservative management
Administration of drugs on doctors
orders
Monitoring maternal condition with 4
hourly temperature and other vital signs
Monitor progress of labour
Monitor pads for liquor
Maintain strict output and intake chart

17. Conservative management
Preserve the membranes to prevent
infection
Adequate pain relief measures
Close fetal and maternal monitoring
Advise woman to lie on left lateral
position to facilitate maternal fetal
circulation

18. Labour and delivery
If the labour progresses despite
attempt to control it, inform the doctor
Continue to monitor labour progress,
fetal condition, maternal condition and
manage as in normal labour
Stop all labour suppressing drugs

19. Labour and delivery
Paediatrician to be present at delivery
Avoid rapid delivery of the baby with
careful delivery of the head
Avoid compression and decompression of
the fetal head
There should be skilled resuscitation
team available

20. BABY
Keep baby warmth-very essential for
preterm baby
Handle baby very gently
Administer oxygen, if required
Perform suctioning of air passages
where necessary
Transfer baby to nursery ward

21. THANK YOU!!!!!!!!!!