Preterm Labor

I.

Introduction

Preterm labor occurs when regular contractions begin to open your cervix before 37 weeks of
pregnancy. A full-term pregnancy should last about 40 weeks.
If preterm labor can't be stopped, your baby will be born early. The earlier premature birth
happens, the greater the health risks for your baby. Many premature babies (preemies) need special care in
the neonatal intensive care unit. Preemies can also have long-term mental and physical disabilities.
While the specific cause of preterm labor often isn't clear, certain risk factors may up the odds of
early labor. But, preterm labor can also occur in pregnant women with no known risk factors. Still, it's a
good idea to know if you're at risk of preterm labor and how you might help prevent it.

Complications
Many women treated for preterm labor deliver at or near term. Sometimes, however, preterm
labor can't be stopped or an infection or other complications make an early delivery safer for mother or
baby.
If preterm labor can't be stopped, your baby will be born prematurely. This could pose a number
of health concerns, such as low birth weight, breathing difficulties, underdeveloped organs and vision
problems. Children who are born prematurely also have a higher risk of learning disabilities and
behavioral problems.

Prevention
You might not be able to prevent preterm labor but there's much you can do to promote a healthy, fullterm pregnancy. For example:

Seek regular prenatal care. Prenatal visits can help your health care provider monitor your
health and your baby's health. Mention any signs or symptoms that concern you, even if you think
they're silly or unimportant. If you have a history of preterm labor or develop signs or symptoms of
preterm labor, you might need to see your health care provider more often during pregnancy for
exams and tests.

Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron and other
essential nutrients. A daily prenatal vitamin ideally starting a few months before conception can
help fill any gaps.
Avoid risky substances. If you smoke, quit. Smoking might trigger preterm labor. Illicit drugs
are off-limits, too.
In addition, medications of any type even those available over-the-counter deserve caution. Get
your health care provider's OK before taking any medications or supplements.

Consider pregnancy spacing. Some research suggests a link between pregnancies spaced less
than six months apart and an increased risk of premature birth. Consider talking to your health care
provider about pregnancy spacing.

Be cautious when using assisted reproductive technology (ART). If you're planning to use
ART to get pregnant, consider how many embryos will be implanted. Multiple pregnancies carry a
higher risk of preterm labor.
If your health care provider determines that you're at increased risk of preterm labor, he or she might
recommend taking additional steps to reduce your risk, such as:

Taking preventive medications. If you have a history of premature birth, your health care
provider might suggest weekly shots of a form of the hormone progesterone called
hydroxyprogesterone caproate (Makena) during your second trimester. In addition, new research
shows that treatment with a vaginal progesterone gel during the second and third trimesters might
decrease the risk of premature birth in women who have short cervixes. These findings have
encouraged doctors to pay closer attention to the length of the cervix in women with risk factors for
preterm birth and in those who appear to have a shortened cervix on a routine ultrasound.

Limiting certain physical activities. If you're at risk of preterm labor or develop signs or
symptoms of preterm labor, your health care provider might suggest avoiding heavy lifting or
spending too much time on your feet.

Managing chronic conditions. Certain conditions, such as diabetes and high blood pressure,
increase the risk of preterm labor. Work with your health care provider to keep any chronic conditions
under control.
If you have a history of preterm labor or premature birth, you're at risk of a subsequent preterm labor.
Work with your health care provider to manage any risk factors and respond to early warning signs and
symptoms.

II.

Personal and Social History of the Patient

Norma Cayno is a 38 year-old pregnant woman who is admitted with a diagnosis of Preterm
Labor. She is Gravida 5 Para 4 (G5P4) with a gestational age of 33 weeks and 3 days.
Patient encountered this premature labor before during her third baby but stopped because of
medicine that her OB-Gyne gave her. She is drinking coffee and soda during the fifth month of
pregnancy. No history of Diabetes Mellitus, Hepatitis B, Tuberculosis but a Urinary Tract Infection ever
since she was not pregnant.

III.

Diagnosis

Identification of the symptoms of preterm labor will help ensure that the patient can be evaluated,
diagnosed and treated appropriately. The signs and symptoms that appear to predict preterm labor include
frequent contractions (more than four per hour), cramping, pelvic pressure, excessive vaginal discharge,

backache and low back pain. A diagnosis of preterm labor should be made in a patient between 20 weeks
and 36 weeks, six days of gestation if uterine contractions occur at a frequency of four per 20 minutes or
eight per 60 minutes, and are accompanied by one of the following: PROM, cervical dilation greater than
2 cm, effacement exceeding 50 percent, or a change in cervical dilation or effacement detected by serial
examinations.

IV.

Predisposing Factor

Preterm labor can affect any pregnancy and many women who have preterm labor have no known
risk factors. Many factors have been associated with an increased risk of preterm labor, however,
including:

Previous preterm labor or premature birth, particularly in the most recent pregnancy or in more
than one previous pregnancy

Pregnancy with twins, triplets or other multiples

Certain problems with the uterus, cervix or placenta

Smoking cigarettes or using illicit drugs

Certain infections, particularly of the genital tract

Some chronic conditions, such as high blood pressure and diabetes

Being underweight or overweight before pregnancy, or gaining too little or too much weight
during pregnancy

Stressful life events, such as the death of a loved one

Red blood cell deficiency (anemia), particularly during early pregnancy

Too much amniotic fluid (polyhydramnios)

Pregnancy complications, such as preeclampsia

Vaginal bleeding during pregnancy

Presence of a fetal birth defect

Little or no prenatal care

An interval of less than six months since the last pregnancy

Also, having a short cervical length or the presence of fetal fibronectin a substance that acts like a glue
between the fetal sac and the lining of the uterus in your vaginal discharge has been linked to an
increased risk of preterm labor.
While some past research suggested that gum disease might be linked with premature birth, treatment of
periodontal disease during pregnancy hasn't been proved to reduce the risk of premature birth.

V.

Laboratory Test/Diagnostic Procedure

Test

Result

Normal Range

Hemoglobin

140

M: 140 - 180 F: 120 - 160 gms/L

Hematocrit

0.40

M: 0.40 - 0.50 F: 0.36 - 0.48

RBC Count

4.18

3.5 5.5 X 10^12/L

MCV

91.5

80.0 99.0 fl

MCH

28.0

26.0 32.0 pg

MCHC

33.0

32.0 36.0 g/dl

RDW

17.4

11.5 14.5

Platelet count

279

140 350 x 10^9/L

MPV

8.5

7.4 10.4 fl

PDW

9.9

10.0 17.0

WBC Count

8.3

5-10 x 10^9/L

Differential Count
Granulocytes

74.8

55 65 %

Lymphocytes

23.5

20 40 %

Mid-sized

4.0
Automated Complete Blood Count

1 15 %

Urinalysis Result
Macroscopic:
Color
Transparency
Ph
Specific Gravity
Protein
Sugar
Microscopic:
WBC
RBC

Reference Range
Straw Yellow to yellow
Clear to slightly cloudy
4.6 8.0
1.002 1.030
Negative
Negative

Result
Yellow
Clear
5.8
1.030
Negative
Negative

0 2 / hpf
0 2 / hpf

15-20
2-4

Epithelial Cells
Bacteria
Amorphous Sediments

Occasional to few
Occasional to few
Occasional to few

Few
Few

Ultrasound Report
IMPRESSION:
Single live intrauterine pregnancy in cephalic presentation with average ultrasonic age of 33
weeks and 6 days and estimated fetal weight of 1205 grams.
Anterior placenta with grade I maturity.
AFI of 17.3 cm. Suggestive of Normohydramnios.
No gross fetal anomalies. No evidence of previa.
EFW Appropriate for LMP correlated gestational age.

VI.

Patient Management

Symptoms of preterm labor are warning signs. They don't necessarily mean that you'll have a preterm
birth.
If you're less than 37 weeks pregnant and you're having more or stronger contractions than usual, try these
things:

Drink 2 or 3 glasses of water or juice. Not having enough liquids can cause contractions.

Stop what you are doing, and empty your bladder. Then lie down on your left side for at least 1
hour.

If your contractions get worse during the hour, call your doctor or nurse-midwife, or go to the
hospital.

Try to remember what you were doing when the symptoms started so that you can avoid starting
the contractions again later.
Although stress isn't thought to be a direct cause of preterm labor, do what you can to reduce stress in
your life. Try to do less, ask for help, and eat well.

VII.

Drug Study

Generic Name

Brand Name

Indications

Contraindications

Nursing Intervention

ISOXSUPRIN Duvadilan
E HCl
10 mg Tablet
5mg/ml
(10mg/2ml)
Solution for
Injection (IM or
IV)

VIII.

Circulatory
disturbances
Peripheral vascular
insufficiency with a
spastic component
showing symptoms
such as: coldness
and numbness of the
limbs, intermittent
claudication, color
changes, and
ischemic ulcers.
Uterine
hypermotility
Uncomplicated
premature labor.

Isoxsuprine is
contraindicated
following recent
arterial hemorrhage,
in patients with
known heart disease,
or in severe anemia.
It should not be
administered
parenterally to
patients with
hypotension,
tachycardia,
premature
detachment of the
placenta or
immediately
postpartum.

Monitor for therapeutic

effectiveness: Response to
treatment of peripheral
vascular disorders may take
several weeks. Evaluate
clinical manifestations of
arterial insufficiency.

Monitor BP and pulse;

may cause hypotension and
tachycardia. Supervise
ambulation.
Observe both mother and baby
for hypotension and irregular and
rapid heartbeat if isoxsuprine is
used to delay premature labor.

Outcome Evaluation

Although the diagnosis and treatment of preterm labor are fraught with controversy, there are
areas of consensus. Preconception counseling and early prenatal care that identifies and treats risk
conditions can optimize pregnancy outcome. The physician must try to accurately date a patient's
pregnancy, attempt to diagnose preterm labor at an early stage and make the appropriate management
decision for the patient. This decision may include transfer to a tertiary site or management with
appropriate consultation. Documented infections such as sexually transmitted diseases, urinary tract
infections and vaginitis should be treated. Tocolytic therapy should be used to delay delivery in order to
administer corticosteroids. At present, corticosteroid therapy is the only treatment shown to improve fetal
survival and outcome. Further studies are needed to find a marker with a high positive predictive value
for preterm labor. Intervention studies are also needed to evaluate outcomes.

IX.

Learning Experience

Experiencing this kind of case is not easy. When I am assisting the mother to delivery her baby, I
felt something nervousness. Why? Because Id never encountered that before. I am skilled for those
normal delivery and in term. I know what to do based on the DOH protocols. But for this premature baby,
I dont know what to do next. Luckily, a resident midwife in LMC is in my back to help me.
I therefore conclude that assisting mother to deliver her baby that is in preterm labor is a difficult
one. Midwife can help but needed an immediate resuscitation just in case and an accompanied doctor or
paediatrician.