Preterm Labor and

Birth
Jeannet E. Canda, RN
NDDU
College of Nursing
Objectives
Define preterm labor
Discuss trends in epidemiology
Review risk factors
Discuss diagnosis, treatment, and prevention
Preterm Birth
Term pregnancy - 37 to 42 weeks gestation
12.5 % of deliveries/yr are preterm
About 500,000
71.2% 34-36 weeks
13% 32-33 weeks
10% 28-31 weeks
6% <28 weeks

Survival in Premature Infants
26 wks 80%
27 wks 90%
28-31 wks 90 to 95%
32-33 wks 95%
34-36 wks approaches
term survival rates
Complications of Prematurity

Feeding difficulties
Apnea
Infection
Jaundice
Hypothermia
Neurobehavioral
Anemia
Preterm Birth
Spontaneous preterm labor 30-50%
Multiple gestation 10-30%
Preeclampsia/eclampsia 12%
Antepartum bleeding 6-9%
Fetal growth restriction 2-4%
Other 8-9%
Pathogenesis
Premature activation of maternal Decidual
hemorrhage
Inflammation/infection
Pathological uterine distention
Risk Factors for PTD
Multiple gestation
Polyhydramnios
Uterine anomalies
Infection
Placental pathology
Smoking
Substance abuse

Maternal age extremes
Anemia
Low BMI
Hx cervical surgery
Severe stressors
Short interpregnancy
interval
The Challenge: Identification
Labor = regular, painful uterine contractions
that produce cervical dilation and/or effacement
Uterine contractions are seen in normal
pregnancies at early gestational ages
Up to 50% of women hospitalized for PTL go
on to deliver at term
Goals of Treatment of PTL
Tocolysis often halts contractions only
temporarily
Allow 48 hr+ for steroids to be given
Allow for transport to delivery location with
NICU capability
Allow for correction of reversible causes
Tocolysis
Risk/benefit ratio for continuation of pregnancy
34 weeks
Risk/benefit ratio of various treatments
Tocolysis
Nifedipine
Low cost
Oral
Low incidence of side effects (hypotension,
dizziness, flushing)
Often considered first line


Tocolysis
Beta agonists (ritodrine, terbutaline)
Tachycardia, hypotension, tremor, palpitations, chest discomfort,
hypokalemia, hyperglycemia
Magnesium sulfate
Nausea, flushing, fatigue, diaphoresis, loss of DTRs, respiratory
depression, cardiac arrest
Indomethacin
Maternal GI SE, premature closure of ductus, oligohydramnios
Atosiban
Possible increase in fetal/neonatal morbidity/mortality; not available in
US
CAUTION when combining tocolytics
Management after Tocolysis
If maternal and fetal conditions are stable, can
be managed at home
Avoid excessive physical activity; most advocate
pelvic rest
Continued tocolytics have not shown definite
benefit
Prevention of PTB
Reduce/eliminate risk factors, if possible
Not proven to be effective: bedrest, home
uterine monitoring, prophylactic tocolytics,
prophylactic antibiotics, abstinence
Prevention of Preterm Birth
Supplemental progesterone
Women with previous spontaneous preterm delivery
at less than 34 weeks gestation
Weekly 17OHprogesterone IM or daily vaginal
progesterone suppositories
Start at 16-20 wks gestation, continue through 36
weeks