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PREMATURE LABOR
labor that begins after 20 weeks
gestation and before 37 weeks gestation
ETIOLOGYPROMIncompetent cervixMultiple gestationPrevious history of Preterm labor
Emotional & Physical stress
HydramniosAbnormality of fetus & placenta
Maternal age <18 or >35
Low socio-economic
Unknown: asso. With dehydration, UTI & chorioamnionitis
SIGNS /SYMPTOMSRhythmic uterine contractions occurring at 10mins or less with or without pain
Cervical dilatation <4 cm (2-3cm)
effacement 50% or less (60-80%)
Bloody showLeaking amniotic fluid Low back painSuprapubic & Vaginal pressure
MANAGEMENT
Goal:PREVENTION OF
PRETERM DELIVERY
A.Place on CBR in side-lying position
B.Provide adequate hydration
C.continuous fetal and uterine contraction monitoring
rest for 30mins & slowly resume activity if symptoms disappear
Avoid sexProvide emotional support
If symptoms do not subside w/n 1 hr, contact HCP
MEDICAL MANAGEMENT
A.TOCOLYTIC DRUGS1.Ritodrine (Yutopar)2.Terbutaline3.Magnesium sulfate
Ritodrine (Yutopar)
1.assess for crackles and dyspnea
2.Watch out for hypokalemia
Terbutaline1.Monitor heart rateMgSO41.Check for DTR, RR,UO, BP
TOCOLYTIC THERAPY
SE: tachycardia, hypotension, hyperglycemia, headache, N/V
Report: tachycardia, hypotension, chest pain, cardiac arrhythmia
CONDITIONS TO HALT LABOR
Membrane intact
Good FHT
Cervix not dilated more than 3-4cm
Effacement not more than 50%
Under 34wks
B. BETAMETHASONE OR DEXAMETHASONE
Facilitate surfactant maturation preventing RDS
PRECIPITATE LABOR
labor and delivery that is completed in less than 3 hours after the onset of true labor pains
Predisposing Factors:MultiparityHistory of rapid laborPremature or small fetus
Large bony pelvis
following Oxytocin administration or amniotomy
MATERNAL RISKS:
a.cervical, vaginal, rectal lacerations
b.Hemorrhage
FETAL RISKS:a.Intracranial hemorrhage
b.Injury at birth
ASSESSMENT1. Cervical dilatation:a. nullipara- 1cm q 12 minb. Multipara- 1cm q 6 min2. Tachycardia3. Restlessness4. Hypotension
MANAGEMENTMonitor client and fetus closely
Do not leave the clientPosition: T-burgInstruct to pant or blow
Prepare for emergency birth
Check baby for injury after birth
UTERINE RUPTURE
occurs when the uterus undergoes more straining than it is capable of sustaining
CAUSES:Scar from a previous classic CS
Unwise use of oxytocin
OverdistentionMuliple gestation
oProlonged laboroPrecipitate L & DoH-mole
MANIFESTATIONS:Sudden, severe painTearing sensationStrong uterine contractions w/o cervical dilation
BANDL’S RINGFetal/maternal distress
Profuse bleedingHemorrhage
INCOMPLETEContractions continue, but cervix fail to dilate
Vaginal bleeding may be present
Rising pulse rate and skin pallor
Loss of fetal heart tones
COMPLETECessation of contractions
Fetus easily palpated, FHT ceased
Signs of shock
MANAGEMENT:BT/IVFO2 therapy Laparotomy Hysterectomy
UTERINE INVERSION
fundus is forced through the cervix so that the uterus is turned inside out
Causes:Placenta attaches at the fundus, the passage of fetus pulls placenta down
Strong fundal push when mother fails to bear down properly during 2nd stage of labor
Attempts to deliver the placenta before signs of placental separation appear
Pressure applied to not contracted uterus
Traction applied to umbilical cord
MANAGEMENTNever attempt to replace the inversion
Do not remove the placenta if it is still attached
IVF & Admin. oxygenHysterectomy
UTERINE PROLAPSE
Uterus has descended in the vagina due to overstretching of uterine supports and trauma
CAUSES:Birth of large infantBearing down effortsProlonged second stage of labor
Loss of muscle tone as the result of aging
Injury during childbirth, especially if the woman has had many babies or large babies
Obesitychronic coughing or straining and chronic constipation all place added tension on the pelvic
muscles, and may contribute to the development of uterine prolapse.)
S/S:Vaginal pressurePain in the pelvis, abdomen or lower back
Pain during intercourseProtrusion of tissue from the opening of the vagina
Recurrent bladder infections
Unusual or excessive discharge from the vagina
Difficulty with urinationSymptoms may be worsened by prolonged standing or walking
DIAGNOSIS
Pelvic examination
MGTDepend on the severity of the condition, as well as the woman's general health, age and desire to have children
NON-SURGICAL OPTIONS
Exercise -- Kegel exercises
SURGICAL OPTIONS
Hysterectomy –
- removing the uterus means pregnancy is no longer possible
Uterine suspension -- involves putting the uterus back into its normal position by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place
POSTPARTUM BLUES
overwhelming sadness that cannot be accounted for
due to hormonal changes, fatigue or feelings of inadequacy
Onset: 1-10 days postpartum lasting 2 weeks or less
FatigueWeeping anxietyMood instability
POSTPARTUM DEPRESSION
Onset: 3-5 days lasting more than 2 weeks
ConfusionFatigueAgitation
Feeling of hopelessness and shame “let down feeling”
Alterations in mood “roller coaster emotions”
Appetite and sleep disturbance
POSTPARTUM PSYCHOSIS
Onset: 3-5 days postpartum
Symptoms of depression plus delusions
Auditory hallucinationsHyperactivity