Preterm Labor

Preterm Labor Nursing Care Plans Diagnosis and Interventions

Preterm Labor NCLEX Review Care Plans

Nursing Study Guide on Preterm Labor

Preterm labor, also known as premature labor, occurs when the body starts the process of delivery of the fetus before the 37th week of pregnancy.

Labor is the process by which the pregnant body prepares for the delivery of the fetus. It is manifested by regular contractions and thinning and opening of the cervix to name a few.

Nursing Stat Facts

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Nursing Stat Facts

Labor is commonly expected to occur 2 weeks before or 2 weeks after the expected date of delivery (38-42 weeks). Labor that begins between the weeks 20-37 of pregnancy is considered preterm labor.

Premature labor is highly associated with preterm or premature births and morbidity to the newborn including learning difficulties, breathing problems, and other physical issues. 

Signs and Symptoms of Preterm Labor

The clinical manifestations of preterm labor are often discussed with high-risk women. Some of them are similar to normal symptoms of pregnancy which may prevent pregnant women from seeking medical assistance. However, it should be stressed that immediate medical attention can prevent serious complications such as preterm delivery.

  • Backache – lower back pain that is constant or intermittent is one of the most common symptoms of preterm labor; the pain is commonly described to stay despite regular position changes and other interventions
  • Contractions – contractions may occur in intervals of 10 minutes or less and may occur more frequently after they started
  • Cramping – cramping during labor is described to be similar to menstrual cramps; it may also feel like gas pain accompanied by diarrhea
  • Rupture or tear of the membranes or “bag of waters” – fluid leak from the vaginal canal
  • Increased pressure felt around the pelvic or vaginal area
  • Light to heavy vaginal bleeding
  • Flu-like symptoms, nausea, vomiting, and diarrhea- may also signify preterm labor; pregnant women are advised to seek medical attention even in mild cases

Causes of Preterm Labor

The exact cause of preterm labor is not fully understood. Risk factors have been identified to recognize women at higher risk of having preterm labor.

However, records show that pregnant women with no known risk factors can also have preterm labor.

  • History of preterm labor or premature birth -the risk increases if the history is from the most recent pregnancy rather than one or more pregnancies ago.
  • Having multiple pregnancies
  • Shortened cervix
  • Having medical problems in the uterus or placenta
  • Use of illicit drugs
  • Cigarette smoking
  • Infections – infections involving the amniotic fluid and lower genital organs.
  • Having chronic conditions such as hypertension, diabetes, and autoimmune diseases
  • Stress – stressful life events such as the death of a loved one
  • Polyhydramnios – having too much amniotic fluid
  • Constant vaginal bleeding during pregnancy
  • Presence of a fetal birth defect
  • Pregnancies with intervals of less than 12 months or more than 59 months
  • Age of the pregnant woman – both younger and older women are at higher risk of preterm labor

Complications of Preterm Labor

  • Preterm delivery
  • Low birth weight
  • Breathing difficulties for the newborn
  • Underdevelopment of the newborn’s organs and vision
  • Higher risk for the newborn to develop cerebral palsy, learning difficulties, and behavioral problems

Diagnosis of Preterm Labor

The diagnosis of preterm labor is made based on the presenting signs and symptoms which include regular uterine contractions and softening, thinning, and dilation of the cervix before week 37 of pregnancy.

The tests and procedures that may be performed to assess these signs and symptoms include the following:

  • Pelvic exam – pelvic examination includes the assessment of the firmness and tenderness of the uterus and evaluation of the baby’s size and its present position. If the ruptured bag of waters has been ruled out, an internal examination might be performed which will determine whether the cervix has begun to open or if there is uterine bleeding present.
  • Ultrasound – an ultrasound examination done intravaginally may be performed to measure the length of the cervix. This examination is also helpful in the determination of the baby’s position, the volume of the amniotic fluid, position of the placenta, and an estimate of the baby’s current weight.
  • Uterine monitoring – a uterine monitor is used to assess the duration and frequency of uterine contractions.
  • Lab tests – lab tests including a swabbing of the vaginal wall for the presence of infection may be performed. A urine sample may also be helpful to ascertain the presence of infection.

Treatment of Preterm Labor

Mediations and surgical procedures may be requested for the pregnant mother. However, these treatment options only provide temporary solutions.

  1.  Medications
    • Corticosteroids – these are prescribed to help the fetal lungs to develop and mature by increasing the lung surfactant when the baby is between 30 to 32 weeks of gestation.
    • Magnesium sulfate – this drug is commonly given to pregnant women at risk of giving birth between the 24th to 32nd weeks of pregnancy. Research shows that it helps reduce the risk of cerebral palsy in preterm babies.
    • Tocolytics – tocolytic drugs are known to slow contractions. These drugs are mostly used to delay delivery and give time for other treatments such as corticosteroids to work.
  2. Preventive Surgery. Cervical cerclage is a procedure performed in women with a short cervix. A strong suture is used to keep the cervix close until the 36th week of pregnancy to prevent preterm labor.
  3. Preventive medication. The use of an injectable hormone is one of the preventive options for women at high risk of premature labor. It is normally started from the beginning of the second trimester up to the 37th week of pregnancy. 

Nursing Care Plans for Preterm Labor

Nursing Care Plan 1

Nursing Diagnosis: Risk for Fetal Injury related to preterm labor

Desired Outcome: The fetus will remain safe by attempting to maintain pregnancy at least when the fetus reaches maturity.

InterventionsRationales
Assess the mother’s condition that might cause contraindication of steroid therapy for fetal lung maturity.Steroids may be contraindicated in maternal patients with gestational diabetes, pregnancy-induced hypertension (PIH), and chorioamnionitis.
Administer medications as prescribed.• Corticosteroids – prescribed to help the unborn baby’s lungs to develop and mature.

•Magnesium sulfate – this drug is commonly given to pregnant women at risk of giving birth between the weeks 24-32. Research shows that it helps reduce the risk of cerebral palsy in preterm babies.

•Tocolytics – known to slow contractions. These drugs are mostly used to delay delivery and give time for other treatments such as corticosteroids to work.
Assess and monitor the fetal heart rate. Check for cervical changes and presence of uterine activity.Tocolytics may increase fetal heart rate and therefore FHR needs to be closely monitored. Persistent cervical changes or uterine contractions may indicate failure to respond to tocolytic treatment.
Consider preventive measures to manage preterm labor.Cervical cerclage is a surgical procedure performed to keep the cervix close until week 36 of pregnancy to prevent preterm labor. Another preventive measure is the use of an injectable hormone, which is normally started in the beginning of the second trimester up to the 37th week of pregnancy.   
Inform the mother and partner the importance of follow-up care.The mother will be asked to come back for weekly repeated doses of corticosteroids until the fetus is delivered within 7 days of the last administration.
Educate the mother and partner/caregiver about the signs of sepsis and hypoglycemia and provide the appropriate contact information should these occur.These are the risks following preterm delivery.

Nursing Care Plan 2

Nursing Diagnosis: Anxiety related to situational crisis of preterm labor as evidenced by increasing tension, decreased attention span, restlessness, shortness of breath, disorganized thought process, crying, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to reduce his/her own anxiety level.

InterventionsRationales
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control.
Do not leave the patient when the anxiety levels are high. Re-assure that the healthcare team are here to help him/her.To ensure the patient’s safety.  
Provide factual and honest answer to questions regarding fetal status and contraction pattern.To ensure that clear information gets to the mother and partner. This might help reduce anxiety levels.
Monitor the vital signs of the mother and fetus.To check if the vital signs have stabilized.
Provide a supportive approach when the patient has anxiety by giving simple and short directions or information.The patient has a limited attention span and is irritable or restless during a panic attack, thus simple and short directions are important in helping the patient cope with the situation.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.
Administer “as needed” or PRN sedative medications only when approved by the labor & delivery team.Mild sedatives may provide tranquilizing and soothing effect to the patient. However, these should be used with extreme caution during preterm labor.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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