Chapter 32 Highlights Preterm Labor and Birth  Tocolytic Therapy for Preterm Labor Premature Rupture of Membranes Induction/Augmentation of Labor  Amniotomy  Oxytocin Cesarean Birth Obstetric Emergencies 1

2 Preterm Labor and Birth Preterm labor and birth Labor: cervical changes and uterine contractions occurring weeks of pregnancy Birth: birth that occurs before the completion of 37 weeks of pregnancy Predicting spontaneous preterm labor and birth Biochemical marker Fetal fibronectins Cervical length Causes of preterm labor and birth Unknown, presumed to be multifactorial

3 Care Management Preterm labor and birth Prevention Early recognition and diagnosis Lifestyle modifications Activity restrictions Restriction of sexual activity Home uterine activity monitoring

4 Care Management (cont.) Preterm labor and birth Suppression of uterine activity Tocolytics Promotion of fetal lung maturity Antenatal corticosteroids Management of inevitable preterm birth Fetal and early neonatal loss

5 Premature Rupture of Membranes (PROM) Spontaneous rupture of amniotic sac and leakage of fluid prior to the onset of labor at any gestational age Preterm premature rupture of membranes (PPROM) Responsible for one third of all preterm births Etiology unknown Often preceded by infection Chorioamnionitis

6 Induction & Augmentation of Labor Induction of labor Bishop score Cervical ripening methods Chemical agents Mechanical and physical methods Alternative methods Amniotomy Oxytocin Augmentation of labor

7 Operative Obstetrics Expectant parents benefit from learning about operative obstetrics (e.g., forceps-assisted, vacuum-assisted, or cesarean birth) during prenatal period Basic purpose of cesarean birth is to preserve life or health of mother and her fetus Unless contraindicated, vaginal birth is possible after a previous cesarean birth

8 Obstetric Emergencies Obstetric emergencies occur rarely but require immediate intervention to preserve the health or life of the mother and fetus/newborn Shoulder dystocia Prolapsed cord Rupture of the uterus Amniotic fluid embolism