A.DESCRIPTION. Preterm labor is labor that begins after 20 weeks gestation and before 37 weeks gestation.
B. 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 (chorioamniotics)
11. Congenital adrenal hyperplasia
12. Fetal death
13. Maternal factors, such as stress (physical and emotional), urinary tract infection, and dehydration
C. PATHOPHYSIOLOGY. T he uterine begins the process of contraction prior to term gestational age.
D. 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
E.NURSING MANAGEMENT
1.Assess the mother’s condition and evaluate signs of labor.
a. Obtain a thorough obstetric history.
b. Obtain specimen for complete blood count and urinalysis.
c. Determine frequency, duration and intensity uterine contractions.
d. Determine cervical dilation and effacement.
e. Assess status of membranes and bloody show.
2. Evaluate fetus from distress, size and maturity (sonography and lecithin-sphingomyelin ratio).
3. Perform measures to manage or stop preterm labor.
a. Place client on bed rest in the side-lying position.
b. Prepare for possible ultrasonography, amniocentesis, tocolytic drug therapy, steroid therapy.
c. Administer tocolytic (contraction-inhibiting) medication as prescribed.
d. Assess for side effects of tocolytic therapy (such as decreased maternal blood pressure, dyspnea, chest pain and FHR exceeding 180 beats/minute)
4. Provide physical and emotional support. Provide adequate hydration.