LESSON 14 CAUSES

PREMATURITY AND POST MATURITY

• Maternal factor
– Pre eclampsia
Premature Baby
– Heart or kidney disease
• Preterm labor is regular uterine contractions after – Infection (such as group B streptococcus,
20 weeks and before 37 weeks of pregnancy that urinary tract infections, vaginal infections,
cause cervical change or regular contractions with an infections of the fetal/placental tissues)
initial presentation with cervical dilation of 2 cm or
more. Preterm birth is birth after 20 weeks gestation – Drug use (such as cocaine)
and before 37 completed weeks gestation.
– Abnormal structure of the uterus
• A baby born before 37 weeks of gestation
– Cervical incompetence (inability of the
calculating from the first day of last menstural period cervix to stay closed during pregnancy)
is defined as preterm baby/ premature baby.
– Previous preterm birth
• These babies are known as preemies

Factors involving the pregnancy:

Age of Viability
• Abnormal or decreased function of the placenta
• Most neonatologist define the age of viability as
• Placenta previa
being about 24 weeks of gestation.
• Placental abruptia

• Premature rupture of membranes

Why do premature newborns need special care?
• Polyhydramnios
• A premature newborn is not fully ready to deal with our
world.

• Their little bodies still have areas that need to mature Fetal factor
and fully develop.
– Multiple pregnancy
Some of these areas include the
– IUGR
• Lungs
– Congenital malformation
• digestive system
– Rh incompatibility
• immune system

• skin.
CHARACTERISTICS
• Posture :
– hypotonic,

– assume extended posture due to poor

muscle tone
 • Face and head : face is small and head is large as
per body.

• Sutures are widely separated and frontanels are

large.

• Protuding eye due to shallow orbit and absent of

buccal pads of fat

• Ear cartilage is deficient with poor recoil

• Hair appears wooly and fuzzy

• Skin: • Planter creases; not so dark and very few in

number
– thin, gelatinous, shiny and excessive pink with
abundant lanugo and • Nails: Bright pink colored nail beds and very soft
nails
– very little vernix edema may be present.
• Activity : less activity of limbs
– breast nodules are small or absent,
• Sucking : poor sucking ability
• Cry : weak cry

• Breast : no breast tissue palpable

Central Nervous system

– poor reflexes

– Reflexes : moro, sucking, swallowing and

other reflexes are absent or sluggish

– Uncoordinated sucking swallowing leads

to feeding difficulties

Vulnerable to develop intra ventricular/ peri

ventricular hemorrhage
• Respiratory system
– Period of apnea usually less that 20 seconds

– Poor cough reflex leads to increase risk of

infection

– Deficiency of surfactant leads to respiratory

distress syndrome

• Gastro intestinal system

– Functional immaturity of liver cause
hyperbilirubinaemia, hypoglycemia and poor
detoxification of drug

– Tendency to regurgitate to an incompetent

cardio- esophageal sphincter and small
• Temperature regulation
capacity of the stomach – Loose more heat due to large area so
cause hypothermia

– Subcutaneous fat is less, less brown fat

– Inadequate thermal response

• Renal immaturity MANAGEMENT
– GFR and urine concentration are reduced • A baby born at 24 weeks would generally require
a lot of intervention, potentially including
• Metabolic distribution mechanical ventilation and other invasive
treatments followed by a lengthy stay in
– Hypoglycemia
a neonatal intensive care unit (NICU).
– Hypocalcemia
• Optimal management at birth
– Hypoproteinemia
• Give vitamin K 1mg to prevent
– Hypoxic hemorrhage

• Nutritional deficiency • Promptly dry and kept warm with gentle

– Prone to develop anemia at 6-8 weeks
because of low iron storage
• Susceptibility of infection
– 3 to 10 times more vulnerable to infection
than term babies
– Low level of IgG
handling
• The cord is to be clamped quickly to
prevent hypervolemia and development
of hyperbilirubinaemia
• Maintain body temperature
• Keep the baby in incubator with
temperature and humidity maintained

• Positioning
• Change the baby’s position from prone
position; it relives abdominal
discomfort by passage of flatus and
prevent aspiration

• Change position 2 hourly

• Kangaroo mother care

• Encourage KMC and exclusive
breastfeeding

• Oxygen therapy
• It should be administered only when
indicated

• O2 should administer with head box when

O2 saturation falls below 85%

• Feeding and nutrition

• Babies < 1.2 kg gestation <30 weeks and
sick babies should start IV dextrose
solution

• 10-20 ml EBM

2-3 hourly through NG can be started to all babies

irrespective of age and weight 2 hourly <1 kg and 3 hourly
> 12kg
 • Nutritional supplement • neonatal sepsis

– When the baby is stable and tolerate • Retinopathy of prematurity,

eternal feeding, EBM fortified multivitamin
• Risk of Disabilities
and folic acid can be given
• Low blood sugar (hypoglycemia)
– Iron supplementation (2-3mg/kg
elemental iron ) after 2-3 weeks • Neonatal respiratory distress syndrome

– Calcium supplementation (220mg/day ) • pulmonary hemorrhage

and phosphorus (100 mg/day) to prevent
osteopenia for < 1.5 kg • Kernicterus

• Patent ductus arteriosus

• Gentle rhythmic stimulation
• Severe intestinal inflammation(necrotizing
– Gentle tactile stimuli by the mother
enterocolitis)
– Soothing auditory stimuli as family voice,
music

– Eye to eye contact, colored object provide

Nursing Diagnosis
visual inputs • Impaired Gas exchange related to immature
pulmonary functioning
– Prevention of nosocomial infection

– Strict handing washing before and after • Ineffective thermoregulation related to lack
touching the baby of subcutaneous fat

– Minimal handeling • Altered nutrition : less than body requirements

related to weak feeding reflexes
• Phototherapy
– Early phototherapy is advice to keep the
serum bilirubin level within safe limit to
Impaired Gas exchange related to immature
prevent need for exchange transfusion pulmonary functioning
usually premature develops
• Assess respiratory status, noting signs
hyperbilirubinaemia
of respiratory distress (e.g., tachypnea, nasal
flaring, grunting, retractions, rhonchi, or crackles)

Factor to be avoid for pre term babies • Assess skin color for cyanosis

• Promote rest,minimize stimulation& energy

– Routine O2 administration without
expenditure.
monitoring

– Prophylaxis antibiotics Ineffective thermoregulation related to lack

of subcutaneous fat
– Formula feeding
• Assess Vital signs (especially temperature)
– Rough handling
• Place infant in a warmer, incubator, or open bed
– Excessive light and sound
with radiant warmer or open crib where in infant
also has appropriate clothing

Possible Complications • Use heat lamps during certain procedures & warm
objects coming in contact with the infants
• Anemia Possible long-time complications body such as clothing

• Bronchopulmonary dysplasia (BPD)

• Mental or physical disability or delay Infection or

Altered nutrition : less than body requirements
related to weak feeding reflexes
• Assess presence of reflexes associatedwith feeding
(i.e swallowing, sucking & coughing)

• Breast feeding or KS feeding 2 hourly

• Initiate intermittent or tube feedings as indicated

Prevention
• Identifying mothers at risk for preterm labor

• Prenatal education of the symptoms of preterm

labor

• Avoiding heavy or repetitive work or standing for

long periods of time that can increase the risk of
preterm labor

• Early identification and treatment of preterm labor

 POST MATURITY ASSESSMENT OF FETAL WELL BEING
 NST

DEFINITION  Bio physical profile

 USG-AFI
Pregnancy continuing beyond 2 weeks of the expected date
of delivery (>294 days) is called post maturity or post term  Doppler
pregnancy.
 Clinical findings-Baby general appearance, fetal
weight ,liqour amnii,placenta,cord

INCIDENCE
 The incidence of pregnancy continuing beyond 42 COMPLICATIONS-FETAL
completed weeks (> 294 weeks days) ranges between
 During pregnancy-fetal hypoxia- fetal distress
4- 14 %.the average is about 10%
- Diminished placental function

- Oligohydrominos
ETIOLOGY
- Meconium liquor
 Wrong dates

 Biological variability
DURING LABOUR
 Maternal factors- primiparity, previous post term
pregnancy , sedentary habit ,elderly multipara.  Fetal hypoxia and acidosis

 Fetal factors-congenital anomalies  Labour dysfunction

 Placental factors-sulphate deficiency –low estrogen  Meconium aspiration

 Risk of cord compression due to oligohydraminos

DIAGNOSIS  Shoulder dystocia

Menstrual history  Birth trauma-instrumental delivery

 Suggested clinical findings-weight record, abdomen  Operative delivery

girth,histroy of false pain, obstetric palpation internal
examination
FOLLOWING BIRTH
 Chemical pneumonitis ,atelectasis and pulmonary
INVESTIGATION AIMS
hypertension-meconium aspiration
1. To confirm the fetal maturity
 Hypoxia and respiratory failure
2. To detect placental insufficiency
 Hypoglycemia and polycythemia

 Increased NICU admission

ASSESSMENT OF FETAL MATURITY
 Sonography
COMPLICATIONS- MATERNAL
 Amniocentesis
 Hazards of induction
 Straight x-ray abdomen
 Instrumental delivery

 Operative delivery