MS. JECELI ALVIOLA NOBLEZA, BSN-RNGENERAL OBJECTIVECritically analyze the nursin i!"licati#ns #$ the client %ith intra"artal c#!"licati#nsSPECIFIC OBJECTIVESE&"lain a'n#r!alities that !ay result in (ys$uncti#nal la'#r.)escri'e !aternal an( $etal ris*s ass#ciate( %ith "re!ature ru"ture #$ the !e!'ranes.Analyze $act#rs that increase a %#!an+s ris* $#r "reter! la'#r.E&"lain !aternal an( $etal "r#'le!s that !ay #ccur i$ "renancy "ersists 'ey#n( ,- %ee*s.)escri'e c#!!#n intra"artu! e!erenciesE&"lain thera"eutic !anae!ent #$ each intra"artu! c#!"licati#n.A""ly the nursin "r#cess t# care #$ %#!en %ith intra"artu! c#!"licati#ns an( t# their $a!ilies.INTRAPARTUM"ertainin t# the "eri#( #$ la'#r an( 'irth.DYSFUNCTIONAL LABOR)ys$uncti#nal la'#r is #ne that (#es n#t result in n#r!al "r#ress #$ cer.ical e$$ace!ent, (ilati#n, an( $etal (escent.Dystocia is a general ter! that (escri'es any (i$$icult la'#r #r 'irth.A (ys$uncti#nal la'#r !ay result $r#! "r#'le!s %ith/ powers of laborthe passengerthe passagethe psyche, or a combination of these. , 0+s An #"erati.e 'irth 1.acuu! e&tract#r2 #r $#rce"s-assiste( #r cesarean3 !ay 'e nee(e( i$ (ys$uncti#nal la'#r (#es n#t res#l.e #r i$ $etal #r !aternal c#!"r#!ise #ccurs.Sins that in(icate the nee( $#r an #"erati.e 'irth$etal heart rate 145R3 "atterns$etal aci(#sis, an( !ec#niu! "assae. Maternal e&hausti#n #r in$ecti#n !ay #ccur, es"ecially (urin l#n la'#rs.Problems of the Powers6he "#%ers #$ la'#r !ay n#t 'e a(e7uate t# e&"el the $etus ine$$ecti.e c#ntracti#ns ine$$ecti.e !aternal "ushin e$$#rts.Inefective ContractionsMaternal $atiue Maternal inacti.ity4lui( an( electr#lyte i!'alance5y"#lyce!iaE&cessi.e analesia #r anesthesiaMaternal catech#la!ines secrete( in res"#nse t# stress #r "ain)is"r#"#rti#n 'et%een the !aternal "el.is an( the $etal "resentin "art8terine #.er(istenti#n, 1!ulti"le estati#n #r hy(ra!ni#s30#ssi'le causes/6%# "atterns #$ ine$$ecti.e uterine c#ntracti#ns are 5y"#t#nic (ys$uncti#nhy"ert#nic (ys$uncti#nHypotonic Dysfunction Hypertonic DysfunctionCON6RAC6IONSC##r(inate( 'ut %ea*.Bec#!e less $re7uent an( sh#rter in (urati#n.Easily in(ente( at "ea*.9#!an !ay ha.e !ini!al (isc#!$#rt 'ecause the c#ntracti#ns are %ea*.8nc##r(inate(, irreular.Sh#rt an( "##r intensity, 'ut "ain$ul an( cra!"-li*e.86ERINE RES6IN: 6ONEN#t ele.ate(. 5iher than n#r!al.05ASE O4 LABORActi.e. 6y"ically #ccurs a$ter ,-c! (ilati#n.M#re c#!!#n than hy"ert#nic (ys$uncti#n.Latent. 8sually #ccurs 'e$#re ,-c! (ilati#n.Less c#!!#n than hy"#t#nic (ys$uncti#n.65ERA0E86IC MANA:EMEN6A!ni#t#!y 1!ay increase the ris* #$ in$ecti#n3.O&yt#cin au!entati#n.Cesarean 'irth i$ n# "r#ress.C#rrect cause i$ it can 'e i(enti$ie(.Liht se(ati#n t# "r#!#te rest.5y(rati#n.6#c#lytics t# re(uce hih uterine t#ne an( "r#!#te "lacental "er$usi#n.NURSING CR!;Inter.enti#ns relate( t# a!ni#t#!y an( #&yt#cin au!entati#n.;Enc#urae "#siti#n chanes. An a'(#!inal 'in(er !ay hel" (irect the $etus t#%ar( the !#ther+s "el.is i$ her a'(#!inal %all is .ery la&.;A!'ulati#n i$ n# c#ntrain(icati#n an( i$ acce"ta'le t# the %#!an.;E!#ti#nal su""#rt/ All#% her t# .entilate $eelins #$ (isc#urae!ent. E&"lain !easures ta*en t# increase e$$ecti.eness #$ c#ntracti#ns. Inclu(e her "artnerlet #? #$ her 'a'yNursing care:@. 8"riht "#siti#ns such as " s#uatting - a(( the $#rce #$ ra.ity t# her e$$#rts. - Se!isittin, si(e-lyin, an( "ushin %hile sittin #n the t#ilet are #ther #"ti#ns. -. Rei#nal analesia !eth#(s !ay restrict "#ssi'le !aternal "#siti#ns an( !ay alter a %#!an+s s"#ntane#us ure t# "ush. A. Enc#urain t# "ush %ith inter!ittent c#ntracti#ns als# all#%s her t# !aintain a(e7uate "ushin e$$#rt. ,. Oral #r intra.en#us $lui(s "r#.i(e enery $#r the strenu#us %#r* #$ sec#n(-stae la'#r.a((s ra.ity t# her "ushin e$$#rts.$cRobert%s maneu&er 'Suprapubic pressureB. Su"ra"u'ic "ressure 'y an assistant "ushes the $etal anteri#r sh#ul(er (#%n%ar( t# (is"lace it $r#! a'#.e the !#ther+s sy!"hysis "u'is. 4un(al "ressure sh#ul( n#t 'e use(, 'ecause it %ill "ush the anteri#r sh#ul(er !#re $ir!ly aainst the !#ther+s sy!"hysis.Problems With the Passener 4etal size 4etal "resentati#n #r "#siti#n Multi$etal "renancy 4etal an#!alies4ran* 'reech4ull 'reechSinle $##tlin 'reechSh#ul(er "resentati#n1trans.erse lie3Fetal SizeMacrosomiain$ant %eihs !#re than ,BBB1C.C l'3 at 'irth.Shoulder Dystocia)elaye( #r (i$$icult 'irth #$ the sh#ul(ers !ay #ccur as they 'ec#!e i!"acte( a'#.e the !aternal sy!"hysis "u'is.Abnormal Fetal Presentation or PositionAn un$a.#ra'le $etal "resentati#n #r "#siti#n !ay inter$ere %ith cer.ical (ilati#n #r $etal (escent.Multifetal PregnancyUterine o&er(istention "#tential $#r $etal hy"#&ia (urin la'#r is reater.6%ins can "resent in any c#!'inati#n #$ "resentati#ns an( "#siti#ns.Fetal Anomalieshy(r#ce"halus #r a lare $etal tu!#r!ay "re.ent n#r!al (escent #$ the $etus. A'n#r!al "resentati#ns, such as 'reech #r trans.erse lie, are als# ass#ciate( %ith $etal an#!alies. A cesarean 'irth is sche(ule( i$ .ainal 'irth is n#t "#ssi'le #r i$ it is ina(.isa'le.Problems of the Passae)ys$uncti#nal la'#r !ay #ccur 'ecause #$ .ariati#ns in the !aternal '#ny "el.is #r 'ecause #$ s#$t tissue "r#'le!s that inhi'it $etal (escent.PelvisMaternal Soft Tissue ObstructionsGynecoi( nthropoi( n(roi( )latypelloi(DBE-DE 9hiteDBE N#n%hiteABEAER#un(, cylin(ric sha"ethr#uh#ut. 9i(e "u'ic arch 1FB (erees #r reater3.L#n, narr#% #.al.Anter#"#steri#r (ia!eter is l#ner than trans.erse (ia!eter. Narr#% "u'ic arc5eart- #r trianular-sha"e( inlet. Narr#% (ia!eterst hr#uh#ut. Narr#% "u'ic arch.4lattene(/ %i(e, sh#rt #.al. 6rans.erse (ia!eter %i(e, 'utanter#"#steri#r (ia!eter sh#rt.9i(e "u'ic arch.Maternal Soft Tissue Obstructionsa full bla((er is a c#!!#n s#$t tissue #'structi#n.Bla((er (istenti#n re(uces a.aila'le s"ace in the "el.is an( intensi$ies !aternal (isc#!$#rt.GAssesse( $#r 'la((er (istenti#n an( enc#urae( t# .#i( e.ery @ t# - h#ursGCatheterizati#n !ay 'e nee(e( i$ sheGcann#t urinate #r i$ she recei.es rei#nal 'l#c* analesia suchGas an e"i(uralProblems of the Ps!"heA "ercei.e( threat cause( 'y "ain, $ear, n#nsu""#rt, #r #ne+s "ers#nal situati#n can result in reat !aternal stress an( inter$ere %ith n#r!al la'#r "r#ress.Responses to excessive or prolonged stress, however, interfere with labor in several ways/*. Increase( glucose consumption re(uces the enery su""ly a.aila'le t# the c#ntractin uterus.+. $aternal catecholamines can i!"air la'#r 'y inter$erin %ith a(e7uate uterine c#ntractility. Maternal 'l##( su""ly t# the "lacenta !ay als# 'e re(uce(.,. -abor contractions an( maternal pushing efforts are less effecti&e 'ecause these "#%ers are %#r*in aainst the resistance #$ tense a'(#!inal an( "el.ic !uscles... )ain perception is increase( an( pain tolerance is (ecrease(, %hich $urther increase !aternal an&iety an( stress.General nursing measures in!le:@. Esta'lishin a trustin relati#nshi" %ith the %#!an an( her $a!ily-. Ma*in the en.ir#n!ent c#!$#rta'le 'y a(=ustin te!"erature an( lihtA. 0r#!#tin "hysical c#!$#rt, such as cleanliness,. 0r#.i(in accurate in$#r!ati#nD. I!"le!entin n#n-"har!ac#l#ic an( "har!ac#l#ic "ain !anae!entAbnormal Labor D#rationAn unusually l#n #r sh#rt la'#r !ay result in !aternal, $etal, #r ne#natal "r#'le!s.Prolonged abor1n#r!ally3 acti.e "hase #$ la'#rcer.ical (ilati#n G@.- c! "er h#ur in the nulli"araG@.D c! "er h#ur in the "ar#us %#!an)escent #$ the $etal "resentin "art G@.B c! "er h#ur in the nulli"araG -.B c! "er h#ur in the "ar#us %#!anP!"en"ial ma"ernal an# $e"al %r!&lems in %r!l!nge# la&!r inclu#e:Maternal in$ecti#n, intra"artu! #r "#st"artu!Ne#natal in$ecti#n, %hich !ay 'e se.ere #r $atalMaternal e&hausti#n5iher le.els #$ an&iety an( $ear (urin a su'se7uent la'#rNursing measures"r#!#ti#n #$ c#!$#rtc#nser.ati#n #$ eneryE!#ti#nal su""#rt"#siti#n chanes that $a.#r n#r!al "r#ressassess!ents $#r in$ecti#n. #'ser.ati#n $#r sins #$ intrauterine in$ecti#n an( $#r c#!"r#!ise( $etal #&yenati#nmotherfetusPreci!itate aborra"i( 'irth that #ccurs %ithin A h#urs #$ la'#r #nset. 6here is #$ten an a'ru"t #nset #$ intense c#ntracti#ns rather than the !#re ra(ual increase in $re7uency, (urati#n, an( intensity that ty"i$ies !#st s"#ntane#us la'#rs.6he $etus !ay su$$er direct trauma, such as intracranial he!#rrhae #r ner.e (a!ae, (urin a "reci"itate la'#r. 6he $etus !ay 'ec#!e hy"#&ic 'ecause intense c#ntracti#ns %ith a sh#rt rela&ati#n "eri#( re(uce ti!e a.aila'le $#r as e&chane in the "lacenta.Pri!ri"' nursing care"r#!#ti#n #$ $etal #&yenati#nSi(e-lyin "#siti#nO&yen a(!inistrati#nSt#" #&yt#cin6#c#lytic (ru( sh#ul( 'e #r(ere(!aternal c#!$#rt.C#"in s*ills - 'reathin techni7uesRe!ain %ith the clientch#ri#a!ni#nitis an( $etal in$ecti#nr#u" B stre"t#c#cci an( Escherichia coliSins Asso"iate$ With Intra%art#m Infe"tion4etal tachycar(ia 1H@IB 'eats "er !inute J'"!K3Maternal $e.er 1ACL C, #r @BB.,L 434#ul- #r str#n-s!ellin a!ni#tic $lui(Cl#u(y #r yell#% a!ni#tic $lui(I8I is !#st #$ten cause( 'y in$ecti#n ascen(in $r#! the .aina an( the cer.i&6he !#st c#!!#n 'acteria in s"#ntane#us "reter! la'#r %ith intact !e!'ranes are Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, "e"t#stre"t#c#cci, an( 'acter#i(es s"ecies15illier et al. @FCC, :i''set al. @FF-, Mr#hn et al. @FFD, :#l(en'er et al. -BBB3.Assess a!ni#tic $lui(/ Nell#% #r cl#u(y $lui( #r $lui( %ith a $#ul #r str#n #(#r suests in$ecti#n an( .erni& !ay 'e staine( 'y (isc#l#re( $lui(. Inter&entionsNurses sh#ul( %ash their han(s 'e$#re an( a$ter each c#ntact %ith the %#!an an( her in$ant t# re(uce trans!issi#n #$ #ranis!s.8se l#.es an( #ther "r#tecti.e %ear t# "re.ent c#ntact %ith "#tentially in$ecti#us secreti#ns 'e$#re an( a$ter 'irth 1Stan(ar( 0recauti#ns3.Li!it .ainal e&a!inati#ns t# re(uce trans!issi#n #$ .ainal #ranis!s int# the uterine ca.ity, an( !aintain ase"tic techni7ue (urin essential .ainal e&a!inati#ns. Mee" un(er"a(s as (ry as "#ssi'le t# re(uce the !#ist, %ar! en.ir#n!ent that $a.#rs 'acterial r#%th. 0eri#(ically clean e&cessi.e secreti#ns $r#! the .ainal area in a $r#nt-t#-'ac* !#ti#n t# li!it $ecal c#nta!inati#n an( "r#!#te the !#ther+s c#!$#rt.0r#"hylactic anti'i#tics t# "re.ent ne#natal se"sis are #$ten i.en.0reter! la'#r 'eins a$ter the -Bth %ee* 'ut 'e$#re the en( #$ the AOth %ee* #$ "renancy.0reter! la'#r, h#%e.er, !ay result in the 'irth #$ an in$ant %h# is ill e7ui""e( $#r e&trauterine li$e.'aternal Ris( Fa"tors for Preterm Labor$e(ical History /bstetric HistoryL#% %eiht $#r heihtO'esity8terine #r cer.ical an#!alies, uterine $i'r#i(s5ist#ry #$ c#ne 'i#"sy)iethylstil'estr#l 1)ES3 e&"#sure as a $etusChr#nic illness 1e.., car(iac, renal, (ia'etes, cl#ttin (is#r(ers, ane!ia, hy"ertensi#n30eri#(#ntal (isease0re.i#us "reter! la'#r0re.i#us "reter! 'irth0re.i#us $irst-tri!ester a'#rti#ns 1H-30re.i#us sec#n(-tri!ester a'#rti#n5ist#ry #$ "re.i#us "renancy l#sses 1- #r !#re3Inc#!"etent cer.i&Cer.ical lenth -D !! 1-.D c!3 #r less at !i(tri!ester #$ "renancyNu!'er #$ e!'ry#s i!"lante( 1assiste( re"r#(ucti.etechni7ues JAS6K3)resent )regnancy -ifestyle an( Demographics8terine (istenti#n 1e.., !ulti$etal "renancy, hy(ra!ni#s3A'(#!inal surery (urin "renancy8terine irrita'ility8terine 'lee(in)ehy(rati#nIn$ecti#nAne!iaInc#!"etent cer.i&0reecla!"sia0reter! "re!ature ru"ture #$!e!'ranes 100ROM34etal #r "lacental a'n#r!alitiesLittle #r n# "renatal care0##r nutriti#nAe @C yr #r ,B yrL#% e(ucati#nal le.elL#% s#ci#ec#n#!ic statusS!#*in @B ciarettes (ailyN#n%hiteE!"l#y!ent %ith l#n h#ursan('allin u".?Cra!"s si!ilar t# !enstrual cra!"s.C#nstant l#% 'ac*acheP inter!ittent #r irreular !il( l#% 'ac* "ainc!n"(n mani$es"a"i!nsSensati#n #$ "el.ic "ressure #r a $eelin that the 'a'y is "ushin (#%n. 0ain, (isc#!$#rt, #r "ressure in the .ul.a #r thihs.Chane #r increase in .ainal (ischare 1increase(, %atery, 'l##(y3.A'(#!inal cra!"s %ith #r %ith#ut (iarrhea.A sense #$ >=ust $eelin 'a(? #r >c#!in (#%n %ith s#!ethin.?Thera%e#ti" 'anaementManae!ent $#cuses #n i(enti$yin "reter! la'#r early(elayin 'irthacceleratin $etal lun !aturityIdentifying Preterm abor6he reas#n t# i(enti$y "reter! la'#r early is t# (elay 'irth, thus "r#!#tin $urther $etal !aturati#n."riteria are sugges"e# $!r %re"erm la&!r: @. :estati#n $r#! -B %ee*s t# 'e$#re AO %ee*s-. 0ersistent uterine c#ntracti#ns 1$#ur in -B !in #r eiht in IB !in3, andQ)#cu!ente( cer.ical chane, orQCer.ical e$$ace!ent #$ CBE #r reater, orQCer.ical (ilati#n #$ reater than @ c!Sto!!ing Preterm aborOnce the (ian#sis #$ "reter! la'#r is !a(e, !anae!ent $#cuses #n st#""in the uterine acti.ity 'e$#re it reaches the "#int #$ n# return, usually a$ter A c! (ilati#n. I$ "reter! (eli.ery is ine.ita'le, thera"y is (irecte( t#%ar( re(ucin the in$ant+s ris* $#r res"irat#ry (istress.Treating InfectionsIn$ecti#ns ass#ciate( %ith a !#re ra"i( "reter! 'irth are li*ely i$ the !e!'ranes ha.e ru"ture(.Br#a(-s"ectru! anti'i#tics, such as a!"icillin, "enicillin, a!in#lyc#si(e, clin(a!ycin #r !etr#ni(az#leRestricting Activitysi(e-lyin "#siti#n - increases "lacental 'l##( $l#% an( re(uces $etal "ressure #n the cer.i&Hydrating the Woman5y(rati#n t# st#" "reter! c#ntracti#ns has n#t 'een sh#%n t# 'e 'ene$icial $#r all %#!en.5#%e.er, (ehy(rati#n !ay c#ntri'ute t# uterine irrita'ility $#r s#!e %#!en.Tocolyticsusually (elay "reter! 'irth rather than "re.ent it. 6his (elay !ay "r#.i(e ti!e t# all#% the use #$ c#rtic#ster#i(s t# accelerate $etal lun !aturity #r t# trans$er the %#!an t# a $acility %ith a ne#natal intensi.e care unit that is a""r#"riate $#r the estati#n #$ her $etus4#ur ty"es #$ (rus are use( $#r t#c#lytic thera"y/G1@3 !anesiu! sul$ate, G1-3 'eta-a(renerics, G1A3 "r#stalan(in synthesis inhi'it#rsG 1,3 calciu! anta#nists.0/C/-10IC DRUGS$agnesium Sulfateuse( in the !anae!ent #$ "renancy-in(uce( hy"ertensi#n t# "re.ent seizures'eta"(renergicsRit#(rine 1Nut#"ar3 is a 'eta-a(reneric currently a""r#.e( 'y the 8.S. 4##( an( )ru A(!inistrati#n 14)A3 t# st#" "reter! c#ntracti#ns. 6er'utaline 1Brethine3, c#nsi(ere( in.estiati#nal t# treat "reter! la'#r, is the !#re %i(ely use( (ru in this class 'ecause it has a l#%er c#st, l#ner (urati#n #$ acti#n 'et%een (#ses, an( the a'ility t# "r#!"tly a(!inister a (#se 'y the su'cutane#us rather than #ral r#ute i$ nee(e( 1AA0 R ACO:, -BB-3.)rostaglan(in Synthesis Inhibitors0r#stalan(ins - sti!ulate uterine c#ntracti#ns, (rus !ay 'e use( t# inhi'it their synthesis. In(#!ethacin is the (ru in this class that is !#st #$ten use( $#r t#c#lysis.Calcium 'loc2ersNi$e(i"ine 10r#car(ia3 is a calciu! channel 'l#c*er #$ten i.en $#r "r#'le!s such as chr#nic hy"ertensi#n. Calciu! is essential $#r !uscle c#ntracti#n in s!##th !uscles such as the uterus, s# 'l#c*in calciu! re(uces the !uscular c#ntracti#n.Accelerating Fetal ung MaturityA(!inistrati#n #$ c#rtic#ster#i( thera"y t# the !#ther 'e$#re "reter! 'irth re(uces the se.erity #$ c#!"licati#ns ass#ciate( %ith i!!ature estati#n.Ru"ture #$ the a!ni#tic sac 'e$#re the #nset #$ true la'#r, rear(less #$ lenth #$ estati#n, is calle( premature rupture of the membranes !"R#M$. )tiolo!)ACOG* +,,-. Gari"e* +,,/0:In$ecti#ns #$ the .aina #r cer.i&chla!y(ia, #n#rrhea, r#u" B stre"t#c#ccal in$ecti#n, an( Gardnerella vaginalis infectionA!ni#tic sac %ith a %ea* structureCh#ri#a!ni#nitis 1intraa!ni#tic in$ecti#n3 !ay 'e ass#ciate( %ith r#u" B stre"t#c#cci, %eisseria gonorrhoeae, &isteria monocytogenes, or species such as Mycoplasma, 'acteroides, an( Ureaplasma in the amniotic fluid5y(ra!ni#s4etal a'n#r!alities #r !al"resentati#nInc#!"etent cer.i&O.er(istenti#n #$ the uterusMaternal h#r!#nal chanesRecent se&ual interc#urseMaternal stressMaternal nutriti#nal (e$icienciesCom%li"ations6he !#ther is at hiher ris* $#r "#st"artu! in$ecti#n.6he ne%'#rn is at reater ris* $#r se"sis a$ter 'irth, %ith the !#st i!!ature "reter! in$ants ha.in the reatest ris* $#r the syste!ic in$ecti#n.Thera%e#ti" 'anaementfetus is ,3 wee2s gestation or moreI$ la'#r (#es n#t 'ein s"#ntane#usly, the %#!an+s "renancy is at #r near ter!, an( her cer.i& is $a.#ra'le, la'#r in(ucti#n !ay 'e (#ne. I$ the cer.i& is n#t $a.#ra'le an( n# in$ecti#n is "resent, in(ucti#n !ay 'e (elaye( -, h#urs #r l#ner t# all#% cer.ical s#$tenin an( a(!inistrati#n #$ (rus t# c#!'at in$ecti#n ass#ciate( %ith early !e!'rane ru"ture. I$ in(ucti#n is unsuccess$ul #r i$ in$ecti#n #r #ther c#!"licati#ns (e.el#", a cesarean 'irth is !#st c#!!#n.woman is ,. wee2s4 gestation or earlier5the "hysician %eihs the ris*s #$ in$ecti#n aainst the in$ant+s ris* $#r c#!"licati#ns #$ "re!aturity. Ceasarean 'irth is !#re c#!!#n i$ (eli.ery at the earlier estati#n is nee(e(.'aternal Antibioti"sA!"icillin:enta!icinErythr#!ycinclin(a!ycin,ce"hal#s"#rin anti'i#tic,"i"eracillinN#rsin Consi$erationsO'ser.e $#r sins #$ in$ecti#n5#!e !anae!ent/A.#i( se&ual interc#urse, #ras!, #r inserti#n #$ anythin int# the .ainaincreases the ris* $#r in$ecti#n, cause( 'y ascen(in #ranis!s, an( can sti!ulate c#ntracti#ns.A.#i( 'reast sti!ulati#n i$ the estati#n is "reter! it !ay cause release #$ #&yt#cin $r#! the "#steri#r "ituitary an( thus sti!ulate c#ntracti#ns.6a*e her te!"erature at least $#ur ti!es a (ay, re"#rtin any te!"erature #$ !#re than AO.CS C 1@BBS 43.Maintain any acti.ity restricti#ns rec#!!en(e(.N#te an( re"#rt uterine c#ntracti#ns.EN12