Premature Labour

Mrs. Shwetha Rani C.M.

Associate Professor & H.O.D.
Department of Obstetric & Gynecological Nursing
SCPM College Of Nursing & Paramedical Sciences,
Gonda. U.P.
SPECIFIC OBJECTIVE:-
• At end at the class presentation, students will able to :-

1 To define the premature labour.

2 To explain the incidence & etiology at PTL.

3 To discuss the diagnosis & complication.

4 To describe the pathophysiology of PTL.

5 To discuss the management of PTL.

LABOR

• Series of event that take place in the genital organ in an effort

to expel the viable product of conception out of the womb
through the vagina into the outer world is called labor .
PREMATURE LABOR -
• Preterm labor can be defined as regular uterine contraction
that couse progressive dilation of the cervix after 20 wk of
gestation and 37 wk of gestation .

• Premature labor is one of the leading couse of perinatal

morbidity and mortality .
INCIDENCE-
• The premature labor effect almost 23% pregnancies in India
• Recent in India 5-18 % of developing country in India
pregnancies in developing countries in India
• Africa and south Asia 60 % premature babies develop
• Europe 5-9%
TYPES -
• 1. Late preterm labor = 34-37 wks. 71.2%

• 2. Very preterm labor =30-34 wks. 12.7%

• 3. Extremely preterm labor = 24-30 wks. 16.0%

AETIELOGY-
1. 50% couse are unknown
2. infection
3. multiple pregnancy
4. pre-eclampsia
5. placenta praevia
6. abruptio placenta
7. polyhydroamnios
8. oligohydroamnios
9. maternal disease
10. maternal stress
11. smoking and alcohol abuse
12. uterine malformation
13. maternal age <18 ->40yr .
14. ISCHEMIA.
RISK FACTOR -
1. short maternal ht. And wt.
2. long working hr.
3. short cervical length
4. low socio – economic status
5. racial
6. previous abortion
7.Poor nutrition
8.domestic violence
PATHO-PHYSIOLOGY
SIGN / SYMPTOM-
1. back ache [lower back pain ]
2. contraction [every 10 min.]
3. cramping
4. fluid leaking from vagina
5. flu like symptom –Nousea , vomiting ,diarrhoea .
INVESTIGATION -
1. history collection
2. physical examination
3. blood study
4. urine analysis
5. cervical culture
6. trans vaginal ultrasound
7. fetal fibro nectin evaluation
8. fetal survillance study
9. drug screening
MANAGEMENT
Pharmacological management :-
1. maternal administration of corticosteroid is advocated in
the pregnancy is less then 34 wks
• A. Beta methasone -2 dose :-12mg |IM |24 hr
• B. Dexa methasone -4 dose:-6mg|IM|12 hr.
• 2.magnisium sulphate mgso4:- 4-6mg|IV [20% solution]brain
development
• 3. Antibiotic to reduce the infection .
4 .Initially use of tocolytic agent to supress the uterine
contraction for an acute episode of the premature labor
a. NEFEDIPINE –
dose ;- 20-30 mg/ orally / 4- 6hourly
b. TURBUTALINE :-
dose:-dissolve 5mg of turbutaline in 500ml RL /IV
infusion
c. RITRODINE :-
dose-50ug/IV/10-20 min
maximum dose :-350 ug
• D.ISOXSURINE:-
DOSE-=0.2-0.5mg/iv/min- 12hr.
10mg/IM/6-8hr.

• E.INDOMETHACINE:-
DOSE=25-50mg/orally.

• F.NITROGIYCERIN:-
DOSE=0.1-0.4mg/iv/hr.
EXPACTANCE TREATMENT:-

Progestrone given patient with history of premature labor.

progestrone injection administration weekly 10 -20 wks of
gestation.
SURGICAL MANAGEMENT:-
• Cervical carclage :- A surgical procedure that classes the cervix with
stitches to present the cervix from.
NURSING MANAGEMENT :-
1. Assess the mother condition to evaluate sign of labor.
2. obtain the obstetric history.
3. determine the frequency, duration and intensity of uterine contraction.
4. determine the cervical dilatation and effacement of the patient
5. assess the status of membrane and bloody show.
6. Place the client on bed rest in the side lying position.
7. prepare for possible ultrasonography, amniocentesis ,tocolytic therapy
or steroid therapy
8. administer tocolytic agent as prescribe .
9. assess the patient level of anxiety .
 IMMEDIATE MANAGEMENT :-
1. The cord is to be clamped quickly.
2. the Airway should be cleared.
3. provide adequate oxygenation.
4. aqeouse solution of vitamin. 1mg given IM to prevent hemarrhage
5. the baby should be wrapped in sterile warm Towel.
6. fetous are death for hand over the relatives.
7. provide NICU care of the baby.
PREVENTION :-
1. identification of the risk factor from history and employing measure .
2. provide nutritional supplement
3. avoidance the substance abuse and smoking
4. detect the medical risk .
5. provide adequate rest .
6. assess the domestic violence .
7. Avoid the heavy burden during pregnancy .
COMPLICATION :-
• MATERNAL COMPLICAATION
1 Sevier preeclampsia
2 heart disease
3 placenta previa
4 abruptio placenta
5 intra amniotic infection
6 uterine malformation
B.FETAL COMPLICATION
1 fetal death
2 respiratory distress syndrome
3 intraventricular hemorrhage
4 neurological problem /cerebral palsy.
5 growth restriction
6 fetal anomaly incompatible with life.
7 neonatal jaundice
8 brain injury.