Introduction to Preterm Labor (Nursing)

00:01 Today, we're going to talk about what happens when labor starts too early or preterm labor.

00:08 Preterm labor describes contractions that result in cervical change prior to 37 weeks.

00:15 Preterm labor may also lead to a preterm delivery or a preterm birth.

00:20 When we look at preterm birth and preterm labor worldwide, 15 million babies were born premature.

00:28 Remember, less than 37 weeks gestation.

00:31 When we break that statistic down to the United States that translates into 1 in 10 births.

00:37 Interestingly, you might think with all of our technology and medications, that our rates of preterm births would go down, but actually since 2014, we've experienced a steady increase in preterm birth.

00:51 And that rate of preterm birth is not the same in all of our clients.

00:56 So when we look at that preterm birth statistic, then we know that 14% of those belong to African-American birthing persons, while only 9% belong to Caucasian birthing persons.

01:10 Now, let's look at the risk factors for preterm delivery. There are a lot, so stay tuned.

01:16 Stress, abnormal levels of amniotic fluid, cervical trauma, vaginal bleeding, ethnicity, but not just the fact that someone is a different ethnicity, but because of their exposure.

01:31 When we think about structural racism and its impact in terms of stress, that begins to become a little more clear.

01:37 Infection can lead to preterm delivery as can abdominal surgery, cocaine use, periodontal disease, and you may be saying to yourself, what your teeth have to do with having preterm delivery? Well, we know there are certain bacteria that's produced when you have periodontal disease or dental issues that can actually cause your uterus to start contracting.

01:59 And multiple gestation.

02:01 So if you remember back to our labor discussion, that one of the triggers for labor is distention of the uterus.

02:07 If you have a lot of babies in there and they could both be 3 lbs., that's already 6 lbs. of weight.

02:14 So if your uterus has a magic size to trigger labor, then having those babies in there will trigger that early.

02:21 A previous preterm birth is also a risk factor for a subsequent preterm delivery.

02:26 And finally, age. Being on either extreme of the childbearing age spectrum can place one at increased risk for a preterm birth.

02:35 Now, you might think, according to our statistics that preventing preterm delivery is obviously not something we're doing very well.

02:41 But there are some strategies that are showing promise.

02:44 The first one is progesterone.

02:46 So providing progesterone during the early part of pregnancy can help stabilize the endometrium so it doesn't break down. We can also do a procedure called the cerclage.

02:57 The cerclage can either be placed through the cervix, or in the abdomen, and this helps to give some integrity to the cervix and to the uterus, so that the baby just doesn't slip through.

03:09 We can also predict preterm birth and we can do this early on with an ultrasound and we're looking for cervical length, and typically this is done around 9 weeks all the way up to 24 weeks or so, and based on the cervical length, we can make predictors about whether this client is likely to deliver preterm, that maybe a deciding factor in placing a cerclage, exactly.

03:36 Later on in the pregnancy, we can use a test called a fetal Fibronectin test.

03:42 So prior to labor, there's a substance that's released by the fetus called fetal Fibronectin, so we actually would swab to see if we can find that substance.

03:52 So if it's present, then there's a possibility the fetus could deliver within the next two weeks, so we might use that along with some other indicators to determine whether we really think this client is going to deliver.

04:03 So sometimes we have preterm contractions, but that doesn't mean we're having preterm labor where the cervix is open. So this might help us work through that.

04:13 So when we assess someone who's experiencing preterm contractions, these are some of the things that we need to make sure we do.

04:20 First, we want to verify the dates.

04:22 We want to know exactly when that patient is supposed to be due because maybe our dates are wrong.

04:28 Maybe this person is actually full term and the contractions are okay.

04:32 We also want to take a history.

04:35 So, if they've had a preterm delivery previously, that might make us think, you know what, the fact that you're having contractions today, and you're 36 weeks, and you've delivered all four of your other children at 35 weeks, I might be a little bit more suspicious, this is the real deal.

04:51 If they have an infection.

04:53 We know that's a risk factor, so we need to make sure that their white count is within normal limits and they're not showing signs of fever or abdominal tenderness that might indicate an infection.

05:04 We also want to see if they're actually in labor.

05:07 So, remember, in order for it be preterm labor, there has to be cervical change, so we're looking to see if there's any sort of dilation of the cervix.

05:16 And then, finally, we want to check on the membrane status.

05:18 So have the membranes ruptured? Because if they ruptured, that's a slightly different story than just having contractions.

05:26 Speaking of rupture, a PROM, premature rupture of the membranes, means that the membranes have ruptured before the onset of contractions, so sometimes we can have labor contractions that clue as in that something's going on.

05:40 And sometimes, the water breaks, the membranes release and there haven't been any contractions at all.

05:46 That is PROM, premature rupture of the membranes.

05:50 We can also have PPROM, or preterm premature rupture of the membranes, that's definitely a mouthful.

05:57 So that's when we have premature rupture of the membranes before 37 weeks, so those two things are happening together.

06:05 So how can we confirm that the membranes have ruptured? We can look for a positive nitrazine test.

06:11 So remember that's that little piece of paper that checks for pH.

06:15 If it turns blue, then that may indicate that the membranes have released.

06:19 We can also see it, sometimes it will pool in the vaginal vault, or we might see it on the chucks, or the client may have it on their underwear.

06:28 We may also be able to do a fern test, and a positive fern test, if you remember, we collect that fluid, we put it on the slide with no cover slip, we let it dry, we look under the microscope and we actually can see a fern pattern.

06:43 So that may also be an indicator that the membranes have ruptured.