Preterm Labor Nursing Care Plan & Management

Description

• Preterm labor is labor that begins after 20 weeks’ gestation and before 37 weeks’ gestation.

Etiology

• Among the many causes of preterm labor are:

1. PROM
2. Preeclampsia
3. Hydramnios
4. Placenta previa
5. Abruptio placentae
6. Incompetent cervix
7. Trauma
8. Uterine structural anomalies
9. Multiple gestation
10. Intrauterine infection (chorioamnionitis)
11. Congenital adrenal hyperplasia
12. Fetal death
13. Maternal factors, such as stress (physical and emotional), urinary tract infections, and dehydration.

Pathophysiology

• The uterus begins the process of contraction prior to term gestational age.

Assessment Findings

• Clinical manifestations of preterm labor are basically the signs of true labor that occur when the gestational age of the fetus is greater than 20 and less than 37 weeks.

1. Low back pain
2. Suprapubic pressure
3. Vaginal pressure
4. Rhythmic uterine contractions
5. Cervical dilation and effacement
6. Possible rupture of membranes
7. Expulsion of the cervical mucus plug
8. Bloody show

Nursing Management

1. Assess the mother’s condition and evaluate signs of labor.

• Obtain a thorough obstetric history.
• Obtain specimens for complete blood count and urinalysis.
• Determine frequency, duration, and intensity uterine contractions.
• Determine cervical dilation and effacement.
• Assess status of membranes and bloody show.

2. Evaluate the fetus for distress, size, and maturity (sonography and lecithin-sphingomyelin ratio)

3. Perform measures to manage or stop preterm labor.

• Place the client on bed rest in the side-lying position.
• Prepare for possible ultrasonography, amniocentesis, tocolytic drug therapy, and steroid therapy.
• Administer tocolytic (contraction-inhibiting) medications as prescribed.
• Assess for side effects of tocolytic therapy (e.g., decreased maternal blood pressure, dyspnea, chest pain, and FHR exceeding 180 beats/min).

4. Provide physical and emotional support. Provide adequate hydration.

5. Provide client and family education.

Exam

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Nursing Care Plan

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Risk for [Fetal] Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

Risk factors

• Delivery of preterm infant

Possibly evidenced by

• [Not applicable]

Desired Outcomes

• Patient will maintain pregnancy at least to the point of fetal maturity.

Nursing Interventions	Rationale
Assess for maternal conditions that would contraindicate steroid therapy to facilitate fetal lung maturity.	In PIH and chorioamnionitis, steroid therapy may aggravate hypertension and mask signs of infection. Steroids may increase serum glucose levels in the patient with diabetes. Drug will not be effective if unable to delay birth for at least 48 hours.
Assess FHR; note presence of uterine activity or cervical changes. Prepare to possible preterm delivery.	Tocolytics can increase FHR. Delivery may be extremely rapid with small infant if persistent uterine contractions are unresponsive to tocolytics, or if cervical changes continue.
Provide information about the actions and side effects of the drug therapy.	Important for the client or couple to know the purpose of the drugs being administered: Beta-agonist therapy: may cause fetal tachycardia, hyperglycemia, acidosis, and hypoxia. Steroid therapy: most effective for increasing lung surfactant when the fetus is between 30 and 32 weeks’ gestation.
Review potential side effects of steroid therapy with client or couple.	Short-term effects may include hypoglycemia, increased risk of sepsis, and possible suppression of aldosterone for 2 weeks following delivery.
Stress necessity of follow-up care.	If fetus is not delivered within 7 days of administration of steroids, dose should be repeated weekly.
Assist as needed with analysis of amniotic fluid from amniocentesis or vaginal pool specimen; test for ferning.	L/S ratio, presence of PG, and shake test results indicate fetal lung status. Ferning indicates rupture of membranes with increased risk of infection.
Administer betamethasone (Celestone) deep IM.	Betamethasone is a synthetic cortisol that can accelerate fetal lung maturity by stimulating surfactant production and thereby preventing or decreasing the severity of respiratory distress syndrome. Administration into the deltoid muscle may result in local atrophy.
Administer antibiotics, as indicated.	In the event of PROM and fetal lung immaturity, antibiotics may be used to prevent or reduce risk of infection, while allowing an additional 24 hours to elapse after administration of Celestone.
Initiate tocolytic therapy, as ordered.	Helps reduce myometrial activity to prevent or delay early delivery.