Preterm labor is when the body begins preparing for delivery earlier than expected. A normal pregnancy lasts 40 weeks, but in preterm labor, contractions cause the cervix to begin to change and open before 37 weeks gestation. This may happen between 20-36 weeks and can be dangerous if not managed properly. Once the determination is made regarding fetal lung maturity, labor may be allowed to progress or may be postponed to allow the fetus to continue normal development. Preterm births are at higher risk of health complications and infection.
Preterm labor may be the result of one or more risk factors that include previous preterm labor, incompetent cervix, hypertension (chronic and gestational), being pregnant with multiples (twins or more), abdominal trauma or stress, poor prenatal care and use of alcohol or street drugs during pregnancy. Other causes can include being pregnant with a fetus that has known birth defects or is the result of in vitro fertilization. Any of these factors may cause the uterus to begin contracting and changes in the cervix causing it to thin out and open.
Labor will be suppressed and pregnancy maintained until fetal maturity
Preterm Labor / Premature Labor Nursing Care Plan
- Regular or frequent contractions
- Dull backache
- Pelvic pressure
- Change in type of vaginal discharge
- Vaginal spotting or light bleeding
- Premature rupture of membranes
- Cervical dilation greater than 4 cm
Nursing Interventions and Rationales
- Obtain gynecological and obstetrical history from the patient
Previous preterm labor or pregnancies too close together can increase the risk of preterm labor. Determine what symptoms began and when.
- Assess the patient’s vital signs
Get a baseline set of vitals before any interventions
- Place external fetal monitoring device to monitor fetal activity/ heart rate and contractions
This allows you to observe and monitor the frequency and quality of contractions as well as notice any signs of fetal distress
- Place the patient in a position of comfort on the left side
Positioning patient in the left side-lying position may help with comfort, reduce contractions and maintain maternal-fetal blood flow
- Initiate IV access and administer medications
- Magnesium sulfate
IV fluids should be given to prevent or treat dehydration, which can cause premature labor. Medications are given to try to stop labor from progressing, or to prepare for delivery.
- Magnesium sulfate- to relax the uterus and stop contractions
- Antiemetics – to control nausea
- Tocolytics – to stop labor from progressing
- Corticosteroids – to speed up fetal lung maturity
- Antibiotics – prophylactic if membranes have ruptured
- Analgesics – to manage pain
- Perform vaginal exam to assess for dilation and effacement
Avoid multiple digital exams if membranes have ruptured. Determine progression, if any, of labor. If the cervix is dilated >4 cm, it may not be possible to stop labor from progressing.
- Provide patient education
- Symptoms of early labor
- When to notify the doctor
- How to time contractions
- Avoid smoking
- Avoid alcohol and substance abuse
- Chronic condition management
- Educate patients and caregivers regarding warning signs and symptoms, a healthy diet, and lifestyle choices to help prevent repeat preterm labor.
- Encourage patients to properly manage chronic medical conditions to prevent further labor symptoms.
- If labor cannot be stopped, prepare the patient for delivery
In cases where labor cannot be stopped, prepare patients for delivery by providing education and information, resources for family members, and emotional support.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell