Pre-Term Labor Dangers Research Paper
Preterm labor, when a pregnant woman is going into labor before the full pregnancy term is completed. A normal full term pregnancy is 38 to 40 weeks. An infant that is delivered at 37 weeks and under are considered to be preterm deliveries. There has not yet been determined a specific cause of preterm labor/delivery but there are certain factors that play a part in the onset of early labor/delivery. The factors of preterm labor/labor are patients that have recurring bladder and kidney infections, vaginal infection, sexually transmitted diseases such as gonorrhea, trichinosis, bacterial vaginosis, and syphilis. Women who are also at risk for preterm labor/delivery are women who have vaginal bleeding after 20 weeks gestation, hypertension, more than two first trimester abortions and thrombophilia (clotting disorder).Pre-Term Labor Dangers Research Paper Some women will experience these risk factors but it may not turn over into preterm labor/delivery. Pregnant women or women that are planning to become pregnant should that their lifestyles play apart in preterm labor/delivery. Doctors and nurses will go over this risk, which are smoking, drinking, alcohol, using drugs, working and standing long periods of time, and being highly stressed. Studies done by the (Center Disease Control and Prevention) “show that ethic disparities play apart in the preterm birth, the preterm birth among African American women (13%) was about 50% higher than the rate of preterm births in white women (9%)”(Mayo Clinic, 2005).Pre-Term Labor Dangers Research Paper
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When is born before the full pregnancy term is completed (38-40 weeks) it puts the baby at risk for multiple disabilities, deformities, and or death. When the baby full gestation, the baby’s lungs, brain, and liver are not fully developed or functioning properly and this will cause the baby to have difficulty breathing and can cause death. When the brain does not fully develop this will cause the baby to be at risk for vision problem, the inability to move extremities and maintain balance (cerebral palsy). Preterm babies are at risk for impairment in physical doings, learning, speech, behavior ad hearing. Usually before the complication and defects arise there are symptoms the pregnant women will experience. If these symptoms are detected at the early stages then preterm birth can be avoided. It is very important as a care provider to provide expecting mothers with the information on premature labors/deliveries that include signs and symptoms. Pregnant women that are not educated on the symptoms and signs are more at risk due to the fact that they are unaware of the risk factors and signs and symptoms so nothing gets reported. By the time the caregiver detects the signs and symptoms it is more than likely to be reversed. Pregnant women should be seen by a doctor immediately if she is experiencing persistent pressure in the pelvis, cramps and aches in the thighs and lower back. These signs should be talked over and checked out by the physician. Having unexplained bleeding and cramps may get the patient an order for bed rest for a certain amount time to make sure everything is okay. After being monitored for preterm labor the mother will be examined by a physician for pulse, temperature, and respiration. A vaginal smear test will be done to check for sexually transmitted diseases as well as blood and urine test. If an STD is present, doctors can treat the transmitted disease so that it does not affect the baby during delivery. A vaginal exam will let the doctors know if contractions are starting to open and efface the cervix. The mother is hooked to electronic fetal monitor that monitors the fetal heart rate and ultrasound is performed to see placement of the fetus. Depending on the circumstance the baby can be delivered vaginally or by Cesarean section. Before delivery in 24-32 weeks of gestation, the physician will give the pregnant women medications to temporarily cease the preterm contractions and mature the fetus lungs.Pre-Term Labor Dangers Research Paper Corticosteroids and magnesium sulfate is given to the pregnant women to prevent infant brain damage (cerebral palsy). After the baby is born, the baby will be taken to the NICU until the new born lungs and organs are developed fully and are beginning to function properly. Parents are allowed to visit the baby and at some point will be able to hold their newborn. When the discharge day comes the mother and father of the premature baby will be given a teaching on how to do premature infant care parents are educated and are required to demonstrate and verbally expel in a manner that the physician will know that the teaching was effect and the parents fully understand the care their newborn needs. Some of the teaching will cover (1) CPR, (2) how to identify certain problems with apnea and feedings, (3) how to maintain and monitor body temperature. There will be discharge paper work that will need the mother and father signature and copies will be administered to both parents. Within the discharge papers there will be a list of resources and phone numbers and names of providers that can do follow up appointments of the mother and baby. The infant should be taken into a physician’s office once every one or two weeks until the desired weight is gained and measurements are normal. Upon leaving the hospital, the nurse will make sure that the parents have the appropriate car seat for the newborn; the car seat has to be appropriate in size and affective. The car seat is part of the teaching nursing staff will show the parents how to place the seat in the car. The car seat should be placed with the feet pointing towards the back seat and visual to the person in the front passenger seat and seat belted in.
Parents of preterm infants and those at risk for preterm delivery face two major unknowns: Will this child survive? And, if he or she does, will major long-term disabilities ensue? Caregivers attempt to use the limited information available to guide parents as they make complicated decisions regarding the initiation, escalation, or withdrawal of intensive care for their children. An understanding of the early complications and long-term morbidities associated with premature birth provides the foundation for this guidance.Pre-Term Labor Dangers Research Paper
Complications in the Early Newborn Period
Respiratory distress syndrome. The earliest recognized complication associated with premature birth is respiratory distress syndrome (RDS). RDS is the result of insufficient surfactant production by the immature lung, leading to decreased lung compliance and inadequate gas exchange. Both the incidence and severity of this disorder are inversely related to the infant’s gestational age. Within hours of delivery, affected infants develop symptoms of respiratory distress that include tachypnea, grunting, retractions, hypoxemia, hypercarbia, and acidosis. Administration of antenatal steroids, improved ventilatory strategies, and surfactant replacement therapy have improved survival rates, but RDS remains a leading cause of morbidity and mortality in premature infants.
Sepsis. Sepsis is a systemic inflammatory response, often uncontrolled, resulting from infection, such as bacterial infections with Staphylococcus or Streptococcus, or a blood stream infection with gram negative bacteria. Studies suggest that as many as 25 percent of very low-birth-weight infants (those weighing less than 1,500 grams) have one or more positive blood cultures over the course of their hospitalization [1]. This relatively high rate of infection is understandable, given that the preterm infant is an immune-compromised host; both the innate and adaptive immune systems are underdeveloped. Moreover, many of the procedures required to sustain these infants, such as central line placement, endotracheal intubation, and frequent blood draws, increase the risk of infection from invasive bacteria. In severe cases, sepsis progresses to multi-organ system failure and sometimes death, despite appropriate antimicrobial therapy. An uncontrolled inflammatory response can be more hazardous than the primary infection itself. Neonatal sepsis has been associated with poor neurodevelopmental and growth outcomes, particularly in infants with recurrent infection.Pre-Term Labor Dangers Research Paper
Necrotizing enterocolitis. The most serious gastrointestinal complication affecting preterm infants is necrotizing enterocolitis (NEC). The pathogenesis of NEC is complex and remains poorly understood despite decades of research. Immaturity of the gastrointestinal mucosa results in compromised barrier functions, immune defense, and abnormal motility. This intestinal immaturity together with abnormal bacterial colonization and ischemic insult are all theorized to contribute to the development of NEC [2]. The onset of disease may be insidious, with mild abdominal distention, lethargy, and feeding intolerance. Alternatively, it may begin abruptly with sudden development of intestinal perforation, hypotension, metabolic acidosis, and disseminated intravascular coagulopathy. Medical management consisting of antibiotic therapy and bowel rest is sufficient in the majority of cases. However, 20 to 40 percent of infants typically need intervention. Long-term morbidities include feeding intolerance, intestinal strictures, and short bowel syndrome. Preterm infants with a history of NEC�particularly those who require surgical management�are at increased risk for neurodevelopmental disabilities. Mortality rates for infants who develop NEC range from 15 to 30 percent [2, 3].Pre-Term Labor Dangers Research Paper
Intraventricular hemorrhage and periventricular leukomalacia. The most significant forms of perinatal brain injury observed in premature infants are intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). IVH refers to bleeding within the ventricles of the brain, which, in severe cases, may extend into the surrounding parenchyma. The hemorrhage originates in the subependymal germinal matrix, a site of neuronal proliferation in the developing fetus, which typically begins to regress at 32 weeks’ gestational age. The blood vessels supplying this tissue matrix are extremely fragile and may rupture with abrupt alterations in cerebral blood flow and pressure. The bleeding can destroy cerebral tissue and, in some cases, lead to post-hemorrhagic hydrocephalus. A recent study found that infants with severe IVH have a 28 to 37 percent mortality rate [4]. Surviving infants face a significant risk for long-term disabilities that include cognitive impairment, cerebral palsy, and recurrent seizures.
PVL is a form of cerebral white matter injury that has been highly correlated with the subsequent development of cerebral palsy. The key factors implicated in the development of PVL are cerebral ischemia and systemic inflammation following intrauterine or neonatal infection. These injurious processes result in the activation of brain microglia, which in turn release a variety of toxic mediators including cytokines, reactive oxygen species, and excitatory amino acids that damage the premyelinating oligodendrocytes [5]. PVL may be diagnosed in the early neonatal period by magnetic resonance imaging, which frequently reveals the presence of parenchymal cysts, areas of abnormal signal intensity, or reduced white and gray matter volumes. The associated neurocognitive and motor deficits, however, often do not manifest until well after discharge from the hospital.Pre-Term Labor Dangers Research Paper
Long-Term Complications
Bronchopulmonary dysplasia. Bronchopulmonary dysplasia (BPD) is a chronic lung disease of preterm infants typically defined by the presence of a supplemental oxygen requirement at 36 weeks’ gestational age and affects nearly 30 percent of extremely low-birth-weight infants [6]. Factors such as inflammation, barotrauma, and the production of reactive oxygen species are all believed to contribute to the pathogenesis of BPD by injuring small airways and interfering with alveolarization and the development of the pulmonary microvasculature. Therefore, preterm infants who require prolonged or aggressive ventilatory support and those with a history of antenatal or postnatal infection are at increased risk for developing BPD [7]. These individuals commonly experience recurrent pulmonary infections, increased airway reactivity, and poor postnatal growth.
Retinopathy of prematurity. Retinopathy of prematurity (ROP) is a major cause of severe visual impairment or blindness in infants born prematurely, with approximately 50,000 infants affected worldwide each year [8]. The disease is characterized by abnormal vascular proliferation in the immature retina, likely due to the presence of increased local reactive oxygen species and angiogenic growth factors. Extreme prematurity, growth restriction, male gender, hyperoxia, and septicemia are most consistently associated with the development of ROP [8]. Although changes in clinical practice, namely more judicious oxygen administration, have resulted in a decreased incidence of ROP in developed countries over the past several years, affected infants are still at risk for subsequent ophthalmologic complications such as strabismus, amblyopia, cataracts, and impaired visual acuity.Pre-Term Labor Dangers Research Paper
In sum, preterm infants, particularly those who experience one or more of the complications discussed above, are at risk for neurodevelopmental disabilities such as cerebral palsy, developmental delay, and mental retardation. Approximately 42 percent of very low-birth-weight infants have been found to have borderline IQ scores (70-84), and 7 percent had subnormal IQ scores (less than 70) when tested at 20 years of age, compared to 31 percent and 2 percent respectively in normal-birth-weight infants [9]. An additional 6 to 9 percent of these infants were classified as having cerebral palsy. Recent follow-up studies have also revealed that these infants may demonstrate more subtle impairments such as learning disabilities, impaired social skills, and behavioral problems, particularly attention-deficit-hyperactivity disorder [10].
Although we have data describing significant long-term morbidities and neurodevelopmental outcomes based upon birth weight and gestational age at delivery, the early identification of individuals at risk for these impairments remains an ongoing challenge for physicians. Recognizing and acknowledging our limited capability to predict which infants will be most severely affected is crucial for effective and honest communication with families.
Having a premature baby presents a lot of physical and emotional challenges, so it’s natural—if you’re thinking of having another child—to wonder (and perhaps worry) about your risk for another premature birth. Learn about your risks and what you and your doctor can do to lessen them.Pre-Term Labor Dangers Research Paper
Risks of Additional Preterm Births
Previous preterm birth is one of the biggest risk factors for having another premature infant. The risk goes up when mothers have had more than one premature birth, and goes down when mothers have a term pregnancy after a preterm birth.