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.
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.
- 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.
- 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.
- 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 Diagnosis for Preterm Labor
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.
| Nursing Interventions for Preterm Labor | Rationales |
| 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. |
Preterm Labor 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.
| Nursing Interventions for Preterm Labor | Rationales |
| 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. |
Preterm Labor Nursing Care Plan 3
Risk for Injury (Maternal)
Nursing Diagnosis: Risk for Injury (Maternal) related to the toxic side effects of tocolysis secondary to preterm labor.
Desired Outcomes:
- The patient will be able to avoid untoward effects of tocolytic therapy.
- The patient will be able to minimize or prevent maternal injury.
- The patient will be able to show a cessation of uterine contractions, dependent on the health of the fetus.
| Nursing Interventions for Preterm Labor | Rationale |
| Monitor the patient’s vital signs and note cardiac irregularities. | Beta-adrenergic medication has cardiac adverse effects including elevated blood pressure and heart rate. Calcium channel blockers produce maternal flushing and hypotension, so the nurse should carefully monitor the pulse rate and blood pressure if they were administered as tocolytics. |
| Measure the patient’s intake and output. | Magnesium levels need to be checked often, either clinically by looking at the output of the urine or by measuring serum levels every 6 to 8 hours. This avoids fluid excess. |
| Obtain the patient’s weight and record daily. | The patent’s weight upon admission and ongoing surveillance help identify any potential changes in fluid retention or urine function. Sympathetic activation during a stressful situation may result in fluid redistribution, which could alter the weight in pulmonary edema. |
| Place an external fetal monitoring device to the patient to track fetal activity, heart rate, and contractions. | The frequency and quality of contractions as well as any indicators of fetal distress can be observed and monitored. |
| Observe the patient for hot flashes, drowsiness, visual abnormalities, respiratory depression, and depressed tendon reflexes. | This could be a sign of neuromuscular depression and rising serum magnesium sulfate levels. When receiving treatment, patients most frequently experience mild facial flushing and warmth; however, these symptoms usually go away on their own. To track magnesium levels, patellar reflexes should be examined often. |
| Monitor uterine contractions and FHR electronically, or at least twice a day while receiving tocolytics orally. | The pace of drug administration can be changed or maintained by using tactile electronic monitoring of uterine contractions and FHS to continuously examine the fetal/uterine condition. With an external fetal monitor throughout labor, the patient may feel more at ease knowing that even if the baby will be small, the heartbeats appear to be of good quality, and the baby is responding well to the labor. |
| Encourage the patient to increase daily fluid intake to 2,000–3,000 ml, unless contraindicated. | The patient with arrested preterm labor can be safely cared for at home after first therapy if contractions have stopped and there is evidence of fetal well-being, provided they can consistently drink enough fluid to stay hydrated. |
| Position the patient in a lateral recumbent position. During an IV medication infusion, elevate the patient’s head | The lateral recumbent position minimizes supine hypotension, elevates placental perfusion, and lessens uterine irritability. The blood is encouraged to return to the uterus when lying on the left side. |
| Make sure that an antidote is readily available. | Antidote administration may be required to undo or negate the effects of tocolytic drugs. |
| Administer a fluid bolus or IV solution to the patient, as needed | Hydration might make the uterus less active. Hydration increases renal clearance and reduces hypotension prior to starting medication administration. Although it hasn’t been thoroughly studied, hydration may assist stop contractions, thus intravenous therapy to keep the patient hydrated should be started. It is believed that this works because dehydration causes the pituitary gland to secrete the antidiuretic hormone, which may also trigger the release of oxytocin, intensifying uterine contractions. |
| Monitor the patient’s serum potassium and glucose levels. | Increased blood glucose and plasma insulin levels, as well as the release of glycogen from muscle and the liver, may result in hyperglycemia when certain medications are taken. In order to prevent adverse effects in the infant, the medication should be stopped two hours prior to delivery. |
| Instruct the patient to use anti-embolic hose as instructed, and help the patient to perform a passive range-of-motion exercises every one to two hours. | Pregnancy increases the risk of deep vein thrombosis and other emboli by five times, particularly if the patient is advised a complete bed rest. This avoids blood pooling in the lower extremities, which can happen when the smooth muscles relax. |
| Insert an indwelling catheter to the patient as instructed. | Due to the fact that magnesium sulfate is eliminated through the kidneys, careful monitoring of urine output is necessary. |
Preterm Labor Nursing Care Plan 4
Nursing Diagnosis: Activity Intolerance related to stress and prolonged physical activity secondary to preterm labor, as evidenced by prolonged uterine contractions, difficulty to engage in activities and dyspnea.
Desired Outcomes:
- The patient will be able to participate in activities that are appropriate to the situation.
- The patient will be able to show a reduction of uterine contractions.
- The patient will be able to avoid complications that arise from complete bed rest.
| Nursing Interventions for Preterm Labor | Rationale |
| Assess the patient’s uterine contractions and fetal response. | Fetal heart monitoring is used to assess the uterine activity and determine whether or not there are contractions, their frequency, length, and strength in order to inform the preterm labor care plan. In addition to these methods, the nurse may also observe the patient’s behavior, inquire about the frequency and discomfort of the patient’s contractions, and palpate the uterus to count the number of contractions. |
| Assess the patient’s vital signs and previous experiences that led up to preterm labor. | Examine the patient’s vital signs and find out the sequence of events that led to the start of labor. The evaluation serves as a starting point for subsequent comparisons. |
| Determine any psychosocial support available for the patient. | In the usual course of family life, a high-risk pregnancy and the consequent requirement for total bed rest are stressful circumstances. The expectant patient and her partner therefore require the psychosocial support of their friends and family. and the mother’s bed rest. |
| Provide comfort measures that will help the patient such as back rubs, changes of position, and decreased stimuli in the room. | Relaxation methods and comfort measures relieve stress and exhaustion in the muscles while fostering a positive sense of wellbeing. The condition of a person’s psycho-physiological well-being can be improved with instruction in the use of relaxation techniques. |
| Educate the patient about the reason for bed rest and activity limits. | The recommendation of bed rest is predicated on the idea that it is safe for both the mother and the fetus and beneficial at preventing preterm birth. Recreational exercise may really enhance the outcomes of high-risk pregnancies and lower the chance of preterm birth. |
| Reduce activities and place the patient in a side-lying, lateral recumbent position. | These precautions are designed to keep the fetus away from the cervix, and bed rest may lessen uterine irritation while improving uterine perfusion. In order to improve placental blood flow, the patient should be placed on her side. Vital signs should also be regularly checked, and tachycardia should be reported to the healthcare professional. |
| Group nurse care activities, including monitoring vital signs, administering medications, and assessing patients together. | Longer periods of downtime between interruptions are encouraged by clustering nurse care. The nurse’s holistic approach to patient care places a special emphasis on promoting the patient’s psychological health and assisting them in adjusting to the physiological stress that comes with complete bed rest. |
| Provide the patient with uninterrupted time to rest or sleep. | This will help the patient to regain energy and strength. |
| Introduce diversional activities for the patient such as reading, watching TV, listening to music and other recreational activities. | This may make it easier to relax and helps to encourage rest. The provision of privacy within a family unit and more organized activities to relieve boredom by recreational activities like scrapbooking, blanket making, and knitting supplies while hospitalized are additional measures to minimize the negative effects of long-term bed rest and prolonged hospitalization. |
| Give the patient enough time to complete activities. | It is most beneficial if the patient will be able to complete exercises and ADLs on their own. |
| Allow the patient to express both their good and negative emotions. | Patients go through a challenging time as a result of labor and go through a lot of change. The patient should express their feelings and talk about them. |
Preterm Labor Nursing Care Plan 5
Nursing Diagnosis: Acute Pain related to frequent uterine contractions secondary to preterm labor, as evidenced by expressions of pain or discomfort, muscle tension, increased respiratory rate and guarding behavior.
Desired Outcomes:
- The patient will be able to report minimized discomfort.
- The patient will be able to utilize relaxation techniques effectively.
- The patient will be able to appear relaxed and will rest appropriately.
| Nursing Interventions for Preterm Labor | Rationale |
| Determine the extent of the patient’s pain and discomfort. | Everybody experiences pain differently, and it varies depending on their physical, psychological, and cultural circumstances. The effects of hormonal and chemical changes before, during, and after birth may have an impact on a woman’s ability to tolerate pain. |
| Determine the patient expectation for pain alleviation. | While some patients may be content when their pain is less severe, others may demand that their suffering be completely gone. This affects how well the treatment modality is seen to work and how motivated they are to try new treatments. |
| Monitor the fetal and maternal vital signs. | A baseline for comparisons in the future is provided by an assessment. For continuous examination of contractions and fetal responsiveness, connect a contraction and FHR monitor. Monitoring of the uterus and the developing fetus provides proof of fetal health. |
| Analyze and record the characteristics of the patient’s uterine activity. | FHR monitoring is used to assess uterine activity and determine whether or not there are contractions as well as their frequency, length, and strength in order to create a preterm labor care plan. |
| Place the patient in a lateral recumbent position. | Changes in position could improve comfort and boost venous return. The fetal adaption to the size and contours of the patient’s pelvis is aided by a lateral recumbent position, which also improves placental circulation. |
| Teach the patient some relaxation techniques including deep breathing exercises, visualization, guided imagery, soft music. | By addressing the stressors, educating about the preterm labor process, and offering comfort through relaxation techniques, nursing care is thought to have a favorable impact on anxiety. After determining the level of stress and anxiety they are experiencing, nurses are advised to practice relaxation techniques. If the patient’s stress and anxiety levels may be reduced by adopting relaxation-focused nursing care, the severity of uterine contractions may lessen, lengthening the gestational period. Therefore, this is advantageous for both mother and fetal health. |
| Utilize nursing comfort techniques like changing the linens, giving back rubs, and therapeutic touch. | Massage is one of the most efficient non-pharmacological ways to lessen pain. The gelatinous substance within the spinal column receives the impulse of pain during labor from the uterus along the numerous nerve fibers leading to the uterus. The brain receives pain signals from the transmission cells. Along tiny nerve fibers, stimulation such as vibration, stroking, or massage causes the opposing messages to travel faster and stronger. |
| Assist and educate the patient on beathing exercises. | The diaphragm is kept from entirely depressing and pressing against the growing uterus by using conscious breathing techniques or by programming breathing patterns to occur at specified rates. The patient takes a cleansing breath before beginning the practice, inhaling comfortably but thoroughly, followed by an exhalation that is somewhat stronger than the inhalation to avoid hypoventilation. |
| Administer analgesics as ordered. | Mild analgesics alleviate discomfort and muscle strain. An epidural is recommended if the patient desires medication for labor pain relief. |
| Determine the analgesic’s ability to relieve pain as prescribed and monitor the patient for any indications and symptoms of adverse effects. | Since painkillers are absorbed and digested differently depending on the patient, their effectiveness must be assessed individually. |
| Assist the patient during the epidural block administration if indicated. | An epidural block is administered by injecting anesthetic medications into the spinal canal, covering the nerves as they leave the spinal cord. No direct injections are made into the spinal cord or nerves. It is more accurate to refer to an epidural block for labor as analgesia (pain relief) than anesthesia (obliterating all sensation). Additionally, an epidural block lessens postpartum depression. |
More Preterm Labor Nursing Diagnosis
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. (2022). 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. (2020). 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
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