Editing Maternal and Newborn Nursing (section)

=== Preterm labor and PPROM ===

'''Preterm labor''' is regular contractions with cervical change between 20 0/7 and 36 6/7 weeks. Teach patients that preterm labor can feel like low dull backache, pelvic pressure, menstrual-like cramping, increased or changed vaginal discharge, and vague abdominal tightening, not necessarily classic painful contractions.

* '''Tocolytics''' (nifedipine, indomethacin before 32 weeks, terbutaline for short-term use only) buy roughly 48 hours, and that time is the point.
* '''Antenatal corticosteroids''' (betamethasone 12 mg IM in two doses 24 hours apart, or dexamethasone) accelerate fetal lung maturity and reduce respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Benefit is greatest 24 hours to 7 days after the first dose.
* '''Magnesium sulfate before about 32 weeks''' is given for '''fetal neuroprotection''' (reduced cerebral palsy), a different indication from seizure prophylaxis.

'''PPROM''' (preterm premature rupture of membranes) is rupture before 37 weeks and before labor. Priorities are avoiding infection (limit vaginal exams, monitor temperature, pulse, and uterine tenderness for chorioamnionitis) and watching for '''cord prolapse'''. Confirm rupture by pooling on sterile speculum exam, nitrazine paper turning blue (alkaline amniotic fluid), and ferning on microscopy. Blood, semen, and vaginal infection cause false-positive nitrazine results.