Question

Amber is 17 years old, in first time pregnancy, 32 weeks’ gestation.  Her first prenatal visit was just 2 weeks ago. Amber was brought to a clinic by her concerned mother. Amber was experiencing “strong” uterine contractions for the past few hours. Upon examination, cervical dilation and effacement was noted but fetal fibronectin was absent. After IV hydration, Amber was sent home with recommendations to maintain strict bed rest.

Questions:

1. What are the risks for preterm labor can you identify in Ambers’ situation?

2. How is preterm labor diagnosed?

3. What is fetal fibrinctin (fFN) and when is it monitored?

Why was Amber sent home with bed rest recommendations only?

4. List tocolytic drugs and their purpose

5. When tocolytics would be contradicted (list at least 3)

6. What patient teaching would you suggest for Amber (home care)

7.  in terms of health promotion and prevention of preterm labor, what suggestions and patient teaching would you provide (list at least 4)

Answer 1

1. The important points to be noted in the chance of preterm labor in this case are:

• Amber is just 17 years old and 32 weeks of gestation
• she has not done proper antenatal visits and might not have taken proper antenatal care
• strong uterine contractions for a few hours

2. Tests and procedures to diagnose preterm labor include:

• Pelvic exam.

Assess for the firmness and tenderness of uterus, baby’s size and position, placenta previa, ripening of cervix, uterine bleeding etc.

• Ultrasound.

The length of cervix is measured by transvaginal ultrasound scan. Also it checks the problems of placenta and baby, baby position, volume of fluid and baby weight.

• . Uterine monitoring.

The duration and frequency of contractions are monitored by uterine monitor.

• Lab tests.

Fetal fibronectin has been checked for risk of premature labor

3. Fetal fibronectin (fFN) is a fibronectin protein produced by fetal cells. It acts as an adhesive that binds uterine lining to fetal sac.

The test is done during 22-34 weeks of pregnancy. The secretions near the cervix are collected using cotton swab and send for examination.

A positive fFT means increased risk of premature labor within 7 days.

A negative fFT confirms the lady will not deliver in next two weeks.

Amber was sent home because fFT was negative.

4. Tocolytic drugs:

These drugs oppress uterine contractions or cause Tocolysis.

This suppression of uterine contractions prevent premature labor.

Tocolytics helps to avoid complications of premature labor.

List of Tocolytics are:

• Indomethacin
• Magnesium sulphate
• Orciprenaline
• Ritodrine
• Terbutaline
• Salbutamol
• Nifedipine
• Fenoterol

5. Tocolytics are contra indicated in conditions of severe fetal distress and when pregnancy can not be continued. The conditions like pregnancy induced hypertension, eclampsia/preeclampsia, active vaginal bleeding, cardiac disease of the mother and placental abruption are contra indications for use of tocolytics.

6. Teach her on home care like:

• take proper rest
• advice her if any bleeding or watery discharge is noted
• advice her to have proper nutrition
• teach her to take medicines on time

7. The health education for prevention of preterm labor includes:

• Gain healthy weight and appropriate weight during pregnancy. Antenatal care has to be continued regularly.
• Avoid smoking, alcohol and substance abuse strictly.
• Consult the prenatal care as soon as diagnosed pregnant. Continue regular prenatal check up through out pregnancy
• Treat conditions like hypertension, diabetes, thyroid issues, depression which occur during the pregnancy.
• Protect self from infections. Avoid chances of getting contracted with any illness.
• Stress reduction techniques have to be learned and implemented as pregnancy is high stress situation.