PRETERM LABOR : PRETERM LABOR -Labor that occurs before the end of the thirty-seventh week of gestation. It occurs approximately 9%- 11% of pregnancies. Any woman having persistent uterine contractions (4 very 20 min) should be considered to be in labor. A woman is documented as being in actual labor rather than having false labor contractions if she is having uterine contractions that cause cervical effacement over 80% and dilation over 1cm.
-Preterm labor is always serious because if it results in infant’s birth, the infant may be immature. Slide 2: ASSESSMENT:
During tocolytic therapy, assess the following:
Fetal status by electronic fetal monitoring
Uterine activity pattern
Patient education to S/Sx of PTL
Patient education to S/Sx of infection Slide 3: RISK FACTORS:
Race: African-American women
Those with inadequate prenatal care
Those who continue to work at strenuous jobs during pregnancy
Those who have shift works that leads to extreme fatigue Slide 4: Signs and Symptoms:
Persistent, dull, low backache
A feeling of pelvic pressure (abdominal tightening)
Feeling that baby is “pushing down” or that “something” is in the vagina Slide 5: Nursing Diagnosis & Interventions:
Anxiety r/t medication and fear of outcome of pregnancy
Know the C/I and potential complications of tocolytic therapy
Explain the purpose and common A/E of tocolytic therapy
Provide accurate information on the status of the fetus and labor (contraction pattern).
Allow the woman and her support person to verbalize their feelings regarding the episode of PTL and the treatment.
If a private room is not used, do not place the woman in a room with a woman who is in labor or who has lost an infant. Slide 6: Situational Low Self-Esteem r/t Inability to carry pregnancy
Provide support persons because she is apt to be more concerned than the average person about labor.
Encourage expression of feelings and anxieties to facilitate coping with actual situation.
Provide frequent assurance during labor that she is breathing well with contractions and continue until postpartum period because she may not be mentally prepared for the labor because it has come unexpectedly.
Comment on strengths of the family unit.
Convey confidence in client’s ability to cope with current situation. Slide 7: Risk for Fetal Injury r/t Preterm Birth
Monitor fetal status and labor problems.
Assess WBC count frequently. A count of 18,000-20,000/mm3 suggests infection.
Reassure misconceptions about difficulty of labor after preterm rupture of the membranes (dry labor) since amniotic fluid is always being formed so there is no such thing as dry labor
Encourage the woman to assume positions that will enhance placental perfusion.
Assist with delivery of infant as needed. Slide 8: Risk for Injury Secondary to Tocolytic therapy
Maintain accurate I/O at least every hour. Limit intake to 2,500mL/day.
Assess maternal VS.
Notify Physician if maternal pulse is greater than 120 bpm.
Assess for S/Sx of pulmonary edema.
Educate woman on tocolytic therapy, explaining the purpose and common A/E. Slide 9: Compromised Family Coping Secondary to Hospitalization
Encourage private time for woman and partner.
Encourage family members to verbalize feelings openly and clearly.
Allow visitation with other children as tolerated by the woman.
Comment on strengths of the family unit.
Promote assistance of family in providing client care as appropriate. Slide 10: Medical Management:
Calcium Channel Blockers
Betamethazone 12 mg IM q 24 hrs 2 doses
Dexamethazone 6 mg IM q 12 hrs 4 doses
Ritodrine hydrochloride (yutopar)
Terbutaline (brethine) Slide 11: Surgical Management Caesarean section Slide 12: NURSING MANAGEMENT:
Hydration (Oral or IV)
Bedrest (Home or Hospital), usually left side lying
Medications to stop labor (Magnesium sulfate, brethine, terbutaline, etc.)
Medication to help prevent infection (More likely if your membranes have ruptured or if the contractions are caused by infection)
Evaluation of your baby. Biophysical profile, non-stress or stress tests
Medications to help your baby's lung develop more quickly Slide 13: Preconception Care
Baseline assessment of health and risks with advice to decrease the risks attributable to preterm labor/PTB.
Pregnancy planning and identification of barriers to care.
Adjustment of prescribed and OTC that may pose a threat to the developing fetus.
Advise to improve maternal nutrition.
Screening for and treatment of diseases.
Genetic counseling for those with a history of genetic disease/ a previously affected pregnancy. Slide 14: Antepartum Treatment
Educate mother regarding S/Sx of PTL.
Instruct mother and provide resources for lifestyle modifications.
If mother smokes, encourage smoking cessation classes.
Ensure mother has a healthy diet and adequate maternal weight gain during pregnancy.
Initial treatment for a patient who is at risk for PTL is the use of bed rest in a left lateral position with continuous monitoring of fetal status and uterine activity.
Hydration with IV fluids, with careful assessment of I/O and auscultation of lungs to assess for the development of pulmonary edema.
If this stops the contractions, tocolytic therapy is not needed. Slide 15: PATHOPHYSIOLOGY