Pre Term Case Olie

8/13/2019 Pre Term Case Olie

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I. INTRODUCTION

Premature labor (or pre-term labor) is when you start having contractions and true laborafter your 20th week of pregnancy and more than 3 weeks before your due date.Contractions (tightening of the uterus muscles) cause the cervix (lower end of the

uterus) to open earlier than normal.

Pre-term labor may result in the birth of a premature baby. However, labor often can bestopped to allow the baby more time to grow and develop in the uterus. Premature labortreatments include bed rest, fluids given intravenously (in your vein), and medications torelax the uterus.

If born prematurely after the seventh month, a baby would likely survive, but may needto stay in the hospitals neonatal intensive care unit (NICU). If the baby is born earlierthan the seventh month, he or she may be able to survive with specialized care in theNICU.

Recognizing the signs and knowing what to do about them increase the chance that you

can get help quickly to stop pre-term labor.

II. ANATOMY AND PHYSIOLOGY

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Functions:

Fallopian Tube are one of the main components of the female reproductive system, and

they must work properly to ensure fertility. Each side of theuterus has a fallopian tube

extending from it that reaches to the ovary on the corresponding side. The main function

of the fallopian tubes is to catch eggs released from the ovaries each month

duringovulation,and guide them into the uterus.

Uterus consists of the following 3 tissue layers the inner layer, called the Endometrium,

is the most active layer and responds to cyclic ovarian hormone changes; the

endometrium is highly specialized and is essential to menstrual and reproductive

function, the middle layer, or Myometrium, makes up most of the uterine volume and is

the muscular layer, composed primarily of smooth muscle cells, the outer layer of the

uterus, the serosa or Perimetrium, is a thin layer of tissue made of epithelial cells that

envelop the uterus.The uterus is a dynamic female reproductive organ that is

responsible for several reproductive functions, including menses, implantation, gestation,

labor, and delivery. It is responsive to the hormonal milieu within the body, which allowsadaptation to the different stages of a womans reproductive life.

Ovary are small, lumpy, almondshaped organs near the lateral walls of the pelvic

cavity. The ovaries perform three main functions: (1) produce immature female gametes,

or oocytes, (2) secrete female sex hormones, including estrogens and progestins, and

(3) secrete inhibin, involved in the feedback control of pituitaryFSH production.

Cervix is the lower third portion of the uterus which forms the neck of the uterus and

opens into the vagina which is also called the endocervical canal. The narrow opening of

the cervix is called the os. The cervical os allows menstrual blood to flow out from the

vagina during menstruation. During pregnancy the cervical os closes to help keep the

fetus in the uterus until birth. Another important function of the cervix occurs during labor

when the cervix dilates, or widens, to allow the passage of the fetus from the uterus to

the vagina.

Vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication

and sensation. The vagina connects the uterus to the outside world. The vulva and labia

form the entrance, and the cervix of the uterus protrudes into the vagina, forming the

interior end.The vagina receives the penis during sexual intercourse and also serves as

a conduit for menstrual flow from the uterus. During childbirth, the baby passes through

the vagina (birth canal).
http://www.wisegeek.com/what-is-the-uterus.htmhttp://www.wisegeek.com/what-is-ovulation.htmhttp://www.wisegeek.com/what-is-ovulation.htmhttp://www.wisegeek.com/what-is-the-uterus.htm


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PATHOPHYSIOLOGY


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SYNTHESIS OF THE DISEASES

Risk factors:

There are a number of risk factors, but keep in mind that more than half of spontaneous

preterm births occur in pregnancies where there's no identifiable risk factor. Although it'simpossible to say whether you'll give birth prematurely, it may be more likely if you:

Previously had a preterm delivery (the earlier in gestation your baby was born and themore spontaneous preterm births you've had, the higher your risk)

Are pregnant with twins or other multiples Are younger than 17 or older than 35 Are African American Were underweight before you got pregnant or don't gainenough weightduring your

pregnancy Have hadvaginal bleedingin the first or second trimester. Vaginal bleeding in more

than one trimester means the risk is even higher. Had moderate to severeanemiaearly in your pregnancy Smoke,abusealcohol,or use drugs (especially cocaine) during pregnancy Gave birth in the last 18 months (particularly if you became pregnant within six

months of giving birth) Were born to a mother who took the drug DES. (Note: DES was taken off the market

in the United States in 1971 but remained available in some other countries. If you'rein your late thirties or older or your mother lived in another country when she carriedyou, ask her whether or not she took DES.)

Have had noprenatal careor got a late start on prenatal care Are pregnant with a single baby that's the result of fertility treatments Have low socioeconomic status

There also appears to be an association between high levels of stress, particularlychronic stress, and preterm birth. The theory is that severe stress can lead to the releaseof hormones that can trigger uterine contractions and preterm labor.

This may explain why women who are victims of domestic abuse have a higher risk forspontaneous preterm labor. Those who endure physical violence have an even higherrisk, of course, particularly if there's trauma to the abdomen.

Some research suggests that night shift workers are at higher risk of preterm birthcompared to women who work during the day. There's also evidence that pregnantwomen who stand for more than 40 hours a week or who have extremely tiring jobs areat higher risk than women with less physically demanding jobs. Other studies have not

confirmed these findings, though.
http://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bchttp://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bchttp://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bchttp://www.babycenter.com/0_vaginal-bleeding-or-spotting-during-pregnancy_3081.bchttp://www.babycenter.com/0_vaginal-bleeding-or-spotting-during-pregnancy_3081.bchttp://www.babycenter.com/0_vaginal-bleeding-or-spotting-during-pregnancy_3081.bchttp://www.babycenter.com/0_iron-deficiency-anemia-in-pregnancy_3073.bchttp://www.babycenter.com/0_iron-deficiency-anemia-in-pregnancy_3073.bchttp://www.babycenter.com/0_iron-deficiency-anemia-in-pregnancy_3073.bchttp://www.babycenter.com/0_how-smoking-during-pregnancy-affects-you-and-your-baby_1405720.bchttp://www.babycenter.com/0_how-smoking-during-pregnancy-affects-you-and-your-baby_1405720.bchttp://www.babycenter.com/0_drinking-alcohol-during-pregnancy_3542.bchttp://www.babycenter.com/0_drinking-alcohol-during-pregnancy_3542.bchttp://www.babycenter.com/0_drinking-alcohol-during-pregnancy_3542.bchttp://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bchttp://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bchttp://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bchttp://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bchttp://www.babycenter.com/0_drinking-alcohol-during-pregnancy_3542.bchttp://www.babycenter.com/0_how-smoking-during-pregnancy-affects-you-and-your-baby_1405720.bchttp://www.babycenter.com/0_iron-deficiency-anemia-in-pregnancy_3073.bchttp://www.babycenter.com/0_vaginal-bleeding-or-spotting-during-pregnancy_3081.bchttp://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bc


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Signs and Symptoms of Pre-term Labor:

Contractions in your uterus every 10 minutes or more often

Tightening or low, dull backache that may be constant or come and go, but

changing positions and other comfort measures don't ease it

Menstrual-like cramps or lower abdominal cramping that may feel like gas pains,

with or without diarrhea

Increased pressure in your pelvis or vagina

Increased vaginal discharge

Leaking of fluid from the vagina

Vaginal bleeding

Flu-like symptoms such as nausea, vomiting, or diarrhea

Less movement or kicking by your baby

Complications

Many women treated for preterm labor deliver at or near term. Sometimes, however,

preterm labor can't be stopped or an infection or other complications make an early

delivery safer for mother or baby.

If preterm labor can't be stopped, your baby will be born prematurely. This could pose

various health concerns, such as low birth weight, breathing difficulties, underdeveloped

organs and vision problems. Children who are born prematurely also have a higher risk

of learning disabilities and behavioral problems. The risks are greatest for babies born

before 32 weeks of pregnancy.

Babies born before the 37th week of gestation are considered premature. Premature

newborns are sometimes referred to as preemies. Mothers who have their baby

prematurely are often frightened and nervous. Premature newborns face increased risk

of one or more complications. The risk of complications increases the earlier the baby is

born. Any complication that a premature newborn experiences will be treated in the

neonatal intensive care unit (NICU). Below is a list of the most common complications

that a premature newborn may experience.

Immature LungsMost babies have mature lungs by 36 weeks of gestation. However,

since babies develop at different rates there are exceptions to this. If a mother and her

health care provider know that the baby might be coming early, amniocentesis may be

performed to check the maturity level of the lungs. In some cases, an injection of

steroids will be given to the baby before the delivery in order to speed the development


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of the lungs. The major concern in cases of premature labor is the development of the

newborns lungs. Immature lungs are associated with the following complications:

Respiratory Distress Syndrome (RDS) causes harsh, irregular breathing and

difficulties due to the lack of a specific agent (surfactant) in the lungs that helpsprevent the lungs from collapsing. Treatment involves one or more of the

following: supplemental oxygen (through an oxygen hood), use of a respirator

(ventilator), continuous positive airway pressure, endotracheal intubation and in

severe cases, doses of surfactant.

Transient tachypnea is rapid shallow breathing. This can occur in both premature

babies as well as full term babies. Recovery usually takes three days or less.

Until the newborn has recovered, feedings may be altered and in some cases

intravenous feedings may be done. There is usually no other treatment

necessary.

Bronchopulmonary Dysplasia (BPD) occurs when a babys lungs have shown

evidence of deterioration. Unfortunately, when preemies are put on a ventilator

(also known as respirators) their lungs are still immature and sometimes can not

withstand the constant pressure from the respirator. Preemies that have been on

a respirator for more than twenty-eight days are at risk of developing BPD.

Preemies can recover from this condition but some take longer to recover than

others.

PneumoniaComplications with premature-related respiratory problems can lead to

pneumonia. Pneumonia is an infection in the area of the lung involved in the exchange

of carbon dioxide and oxygen causing inflammation which reduces the amount of space

available for the exchange of air. This can result in inadequate amounts of oxygen for

the baby. Treatment can include antibiotics and supplemental oxygen and intubation. If

left untreated, it condition can develop into a deadly infection or lead to sepsis or

meningitis.

Apnea and BradycardiaApnea is the absence of breathing. In the NICU an alarm willsound if a newborn develops an irregular breathing pattern of intervals of pauses longer

than 10-15 seconds. Bradycardia is the reduction of heart rate. An alarm will also sound

if the newborns heart rate falls below 100 beats per minute. Usually a little tap or simple

rub on the back helps remind the preemie to breath and also increases the heart rate.


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InfectionA premature baby might not be able to resist certain infections. For its own

protection the baby is placed in an incubator to provide protection against these

infections.

JaundiceA yellowish skin color caused by the buildup of substances in the blood

called bilirubin. Treatment involves being placed under a bilirubin light called

phototherapy. The procedure can take from one week to 10 days.

Intraventricular hemorrhage (IVH)Babies born sooner than 34 weeks have

increased risk of bleeding in the brain because immature blood vessels might not

tolerate the changes in circulation that took place during labor. This can lead to future

complications such as cerebral palsy, mental retardation and learning difficulties.

Intracranial hemorrhage occurs in about 1/3 of babies born at 24-26 weeks gestation. If

preterm labor is identified and is inevitable, there are medications that can be given to

the mother to help reduce the risk of severe intracranial hemorrhage in the newborn.

Inability to maintain body heatA premature baby is born with little body fat and

immature skin which makes it harder to maintain body heat. Treatment involves warmers

or incubators to provide warmth.

Immature gastrointestinal and digestive systemPremature newborns are born with

gastrointestinal systems that are too immature to absorb nutrients safely. In such cases,

they receive their initial nutrients through intravenous (IV) feeding. This is referred to as

total parenteral nutrition (TPN). After a few days, newborns may be fed through a tubewith breast milk or formula because they might not yet have the ability to swallow or suck

on their own.

AnemiaThis is a medical condition caused by abnormally low concentrations of red

blood cells. Red blood cells are important because they carry a substance called

hemoglobin which carries oxygen. Most newborns should have red blood cell levels

higher than 15 grams. However, preemies are at a high risk of having lower levels with

subsequent risk of anemia. If the anemia is severe, treatment can involve a transfusion

of red blood cells to the newborn.

Patent Ductus Arteriosus (PDA)This is a cardiac disorder that results in breathing

difficulties after delivery because of an open blood vessel called the ductus arteriosus.

During fetal development the ductus arteriosis is open to allow blood to be diverted from

the lungs into the aorta. A fetus makes a chemical compound called prostaglandin E

which circulates his or her blood thus keeping the ductus arteriosus open. At a full term,


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levels of prostaglandin E fall causing the ductus arteriosus to close and allowing a

babys lungs to receive the blood needed to function properly after it is born. With

preterm labor, the prostaglandin E may stay at the same level causing an open ductus

arteriosus. Treatment involves a medication that stops or slows the production of

prostaglandin E.

Retinopathy of Prematurity (ROP)This is a potentially blinding eye disorder. It

affects most preemies between 24-26 weeks gestation but rarely affects them beyond

33-34 weeks gestation. There are many different stages of this condition, and the

prescribed treatment will depend on its severity, and can include laser surgery or

cryosurgery.

Necrotizing Enterocolitis (NEC)This condition occurs when a portion of the

newborns intestine develops poor blood flow that can lead to infection in the bowel wall.

Treatment includes intravenous feeding and antibiotics. Only in severe cases is an

operation considered necessary.

SepsisThis is a medical condition where bacteria enter the blood stream. Sepsis often

brings infection to the lungs and can result in pneumonia. Treatment involves antibiotics.

Diagnostic test:

Fibronectin (fTN) test,If you have signs of preterm labor, your provider may want you to

have the fFN test. Its a protein that your body makes during pregnancy.ThefFN test islike a Pap smear. It checks to see how much fFN is in your vagina. If the test shows you

dont have any fFN, you probably wont have your baby for at le ast another 2 weeks.

Treatment:

Progesterone. This is a hormone thats normally present in the body. Treatment with

progesterone during pregnancy may help reduce the risk of giving birth early.

Cerclage. This is a stich that your provider puts in your cervix. The stich may help keep

your cervix closed so that your baby isnt born too early. Your provider removes the stich

at about 37 weeks of pregnancy. A cerclage is only used for certain women. Forexample, if you have a condition called cervical insufficiency, you may need a cerclage.

If you have preterm labor, your provider may give you treatments to try to stop your

contractions and help prevent health problems in your baby. These include:

Corticosteroids. These medicines speed up your babys lung development. They also

greatly reduce the risk ofhealth problems in your baby, like respiratory distress syndrome

and intraventricular hemorrhage.


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Tocolytics. These medicines may postpone labor, often for just a few days. This delay

may give you time to get treatment with corticosteroids and arrange to have your baby in

a hospital with a neonatal intensive care unit (NICU). This is part of a hospital that takes

care of sick newborns.

Magnesium sulfate. This medicine may help reduce the risk for cerebral palsy in

premature babies. However, magnesium sulfate shouldnt be used for more than 5 to 7

days. Using this medicine longer than that may lessen the amount of calcium in your

growing baby and lead to bone problems.

Reference:

http://americanpregnancy.org/labornbirth/complicationspremature.htm

http://www.babycenter.com/0_preterm-labor-and-birth_1055.bc?page=2

http://www.webmd.com/baby/premature-labor

http://pathophysiology-tlc.blogspot.com/2011_06_01_archive.html
http://americanpregnancy.org/labornbirth/complicationspremature.htmhttp://americanpregnancy.org/labornbirth/complicationspremature.htmhttp://www.babycenter.com/0_preterm-labor-and-birth_1055.bc?page=2http://www.babycenter.com/0_preterm-labor-and-birth_1055.bc?page=2http://www.webmd.com/baby/premature-laborhttp://www.webmd.com/baby/premature-laborhttp://pathophysiology-tlc.blogspot.com/2011_06_01_archive.htmlhttp://pathophysiology-tlc.blogspot.com/2011_06_01_archive.htmlhttp://pathophysiology-tlc.blogspot.com/2011_06_01_archive.htmlhttp://www.webmd.com/baby/premature-laborhttp://www.babycenter.com/0_preterm-labor-and-birth_1055.bc?page=2http://americanpregnancy.org/labornbirth/complicationspremature.htm


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Pre Term Case Olie