College of Nursing

REPORT FOR NCM102 LEC

(Group 2)

Submitted to:

Mrs. Grace Antoni, RN

(Clinical Instructor)

Submitted by:

Salivio, Krizia-Ann Nicole

BSN 2A

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Preterm labor

Preterm labor is labor that comes too early—between 20 and 37 weeks of pregnancy.
In labor, the uterus contracts to open the cervix. This is the first stage of childbirth.
In a full-term pregnancy, this doesn't happen until at least week 37.
Preterm labor is also called premature labor.

Any woman having consistent uterine contractions (4 in every 20 minutes) should be considered in labor

Preterm labor can happen for unknown reasons but it can be associated with the ff:
Dehydration
UTI
Peridontal disease
Chorioamnionitis – inflammation of fetal membranes due to bacterial infection

S/sx:
Persistent, dull headache
Spotting
Pelvic pressure or abdominal tightening
Menstrual cramping
Inc. vaginal discharge
Uterine contractions

Therapeutic Mngt:
Analyse changes in vaginal mucous (fetal fibronectin)
If present, this predicts that preterm contractions are about to occur.
If absent, labor would not occur for atleast 14 days.

Labor could be stopped if:

Fetal membranes are intact
Fetal distress is absent
No evidence of bleeding
Cervix not dilated >4-5cm
Effacement not more than 50%

If woman is in labor, she will be given the ff:

Px will be given a antibiotic for group B strep prophylaxis to prevent infection

Tocolytic agent, such as terbutaline, may be prescribed.

If labor could not be halted, CS birth may be planned to reduce pressure on fetal head and reduce
possibility of subdural or intraventricular haemorrhage from vaginal birth

Oligohydramnios

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Amniotic fluid is produced soon after the amniotic sac forms at about 12 days after conception. It is first
made up of water that is provided by the mother
Around 20 weeks fetal urine becomes the primary substance.
In the second trimester, the baby will begin to breathe and swallow the amniotic fluid.

If the measurement of amniotic fluid is too low it is called oligohydramnios.

If the measurement of amniotic fluid is too high it is called polyhydramnios.

In detecting the amount fluid, the most common technique used is the amniotic fluid index (AFI)
evaluation or deep pocket measurements.

For one instance, if the amount of fluid is only 500ml at 32-36 weeks gestation then oligohydramnios is
suspected.

What causes low amniotic fluid?

Birth defects – Problems with the development of the kidneys or urinary tract which could cause little
urine production

Placental problems – If the placenta is not providing enough blood and nutrients to the baby, then the
baby may stop recycling fluid.

Leaking or rupture of membranes –This may be a gush of fluid or a slow constant trickle of fluid. This
is due to a tear in the membrane. Premature rupture of membranes (PROM) can also result in low
amniotic fluid levels.

Post Date Pregnancy– A post date pregnancy (one that goes over 42 weeks) can have low levels of
amniotic fluid, which could be a result of declining placental function.

Maternal Complications– Factors such as maternal dehydration, hypertension, preeclampsia, diabetes,

and chronic hypoxia can have an effect on amniotic fluid levels.

If oligohydramnios is detected in the first half of pregnancy, the complications can be more serious
and include:

Compression of fetal organs resulting in birth defects

Increased chance of miscarriage or stillbirth

If oligohydramnios is detected in the second half of pregnancy, complications can include:

Intrauterine Growth Restriction (IUGR)

Preterm birth
Labor complications such as cord compression, meconium stained fluid and cesarean delivery

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TX
The treatment for low levels of amniotic fluid is based on gestational age. Tests such as non-stress and
contraction stress test may be done to monitor your baby’s activity.
If you are close to full term, then delivery is usually what most doctors recommend in situations of low
amniotic fluid levels.

Management
Amniotransfusion

Isoimmunization

The Rh factor (ie, Rhesus factor) is a red blood cell surface antigen that was named after the monkeys in
which it was first discovered.

Rh incompatibility, also known as Rh disease, is a condition that occurs when a woman with Rh-negative
blood type is exposed to Rh-positive blood cells, leading to the development of Rh antibodies.

The most common cause of Rh incompatibility is exposure from an Rh-negative mother by Rh-positive
fetal blood during pregnancy or delivery.

Maternal antibodies may cross the placenta causing:

Hemolytic disease/Erythroblastosis fetalis

Assessment:
Anti D antibody titer-done at 1st pregnancy visit
If normal (0) or minimal (<1:8) , test repeated in 28th week

If normal, no therapy
If elevated (1:16) , fetal condition every 2 weeks

Factors that influence an Rh-negative pregnant female's chances of developing Rh incompatibility include
the following:
Ectopic pregnancy
Placenta previa
Placental abruption
Abdominal/pelvic trauma
In utero fetal death
Any invasive obstetric procedure (eg, amniocentesis)
Lack of prenatal care
Spontaneous abortion

Management
Passive Rh (D) antibodies against Rh factor is administered to women who are Rh-negative at 28 weeks
Given in the 1st 72 hours after childbirth
Cord blood is tested- if Rh (+) Coombs’ negative  mother will receive RhIG injection
If Rh (-), injection not necessary

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Intrauterine transfusion
Injection of RBC directly to the vessel of the fetal cord or depositing them in the fetal abdomen

References:
Maternal and Child Health Nursing by Pilliteri
https://emedicine.medscape.com/article/797150-overview

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