Preterm labor refers to labor that occurs after the fetus has reached the period of viability (at least 20 weeks’ gestation but before the completion of the 37th wk). Carrying the pregnancy to term may be contraindicated if associated client or fetal risks outweigh the risks of delivering a preterm infant.
(To be used in conjunction with CP: The High-Risk Pregnancy.)
CLIENT ASSESSMENT DATA BASE
Note: Etiology is unknown in 70%–80% of cases; PROM occurs in the remaining 20%–30%.
Activity
Works outside home, job heavy/stressful
Unusual fatigue
Circulation
Hypertension, pathological edema (signs of PIH)
Preexisting cardiovascular disease
Ego Integrity
Moderate anxiety apparent
Elimination
Dark amber urine, decreased frequency/amount
Food/Fluid
Inadequate or excessive weight gain
Inadequate fluid intake
Dry mucous membranes
Pain/Discomfort
Intermittent to regular contractions (may not be painful) less than 10 min apart and lasting at least 30 sec for 30–60 min
Respiratory
May be heavy smoker (7–10 cigarettes/day), although any smoking during pregnancy is a risk factor
Safety
Infection may be present (i.e., UTI and/or vaginal infection).
Sexuality
Cervical os softening/dilated/effacing.
Bloody show may be noted.
Membranes may be ruptured (PROM).
Third-trimester bleeding.
Previous abortions, preterm labor/delivery, history of cone biopsy, less than 1 yr since last birth.
Uterus may be overdistended, owing to polyhydramnios, macrosomia, or multiple gestation.
Social Interaction
May be low socioeconomic status
Teaching/Learning
Inadequate or no prenatal care
May be under age 18 or over age 40
Alcohol/other drug use, diethylstilbesterol (DES) exposure
DIAGNOSTIC STUDIES
Ultrasonography: Assesses gestation (with fetal weight of 500–2499 g).
Nitrazine Test or “Ferning” Slide: Determines PROM.
White Blood Cell (WBC) Count: Elevation indicates presence of infection.
Plasma/cervicovaginal Oncofetal Fibronectin (onfFN): Elevated risk level associated with risk of preterm delivery, as well as pre-eclampsia and other abnormalities. (Currently under investigation as a clinical indicator or predictor of true/preterm labor.)
Urinalysis and Culture: Rule out UTI.
Vaginal Culture, RPR: Identify infection.
Amniocentesis: L/S ratio detects phosphatidyl glycerol (PG) for fetal lung maturity; or amniotic infection.
Electronic Monitoring: Validates uterine activity/fetal status.
NURSING PRIORITIES
1. Ascertain maternal condition/presence of labor and fetal well-being.
2. Assist with efforts to maintain pregnancy, if possible.
3. Prevent complications.
4. Provide emotional support.
5. Provide necessary information.
DISCHARGE GOALS
1. Cessation of uterine contractions
2. Free of complications and/or untoward effects
3. Dealing with situation in a positive manner
4. Signs of preterm labor/complications and therapy needs understood
(To be used in conjunction with CP: The High-Risk Pregnancy.)
CLIENT ASSESSMENT DATA BASE
Note: Etiology is unknown in 70%–80% of cases; PROM occurs in the remaining 20%–30%.
Activity
Works outside home, job heavy/stressful
Unusual fatigue
Circulation
Hypertension, pathological edema (signs of PIH)
Preexisting cardiovascular disease
Ego Integrity
Moderate anxiety apparent
Elimination
Dark amber urine, decreased frequency/amount
Food/Fluid
Inadequate or excessive weight gain
Inadequate fluid intake
Dry mucous membranes
Pain/Discomfort
Intermittent to regular contractions (may not be painful) less than 10 min apart and lasting at least 30 sec for 30–60 min
Respiratory
May be heavy smoker (7–10 cigarettes/day), although any smoking during pregnancy is a risk factor
Safety
Infection may be present (i.e., UTI and/or vaginal infection).
Sexuality
Cervical os softening/dilated/effacing.
Bloody show may be noted.
Membranes may be ruptured (PROM).
Third-trimester bleeding.
Previous abortions, preterm labor/delivery, history of cone biopsy, less than 1 yr since last birth.
Uterus may be overdistended, owing to polyhydramnios, macrosomia, or multiple gestation.
Social Interaction
May be low socioeconomic status
Teaching/Learning
Inadequate or no prenatal care
May be under age 18 or over age 40
Alcohol/other drug use, diethylstilbesterol (DES) exposure
DIAGNOSTIC STUDIES
Ultrasonography: Assesses gestation (with fetal weight of 500–2499 g).
Nitrazine Test or “Ferning” Slide: Determines PROM.
White Blood Cell (WBC) Count: Elevation indicates presence of infection.
Plasma/cervicovaginal Oncofetal Fibronectin (onfFN): Elevated risk level associated with risk of preterm delivery, as well as pre-eclampsia and other abnormalities. (Currently under investigation as a clinical indicator or predictor of true/preterm labor.)
Urinalysis and Culture: Rule out UTI.
Vaginal Culture, RPR: Identify infection.
Amniocentesis: L/S ratio detects phosphatidyl glycerol (PG) for fetal lung maturity; or amniotic infection.
Electronic Monitoring: Validates uterine activity/fetal status.
NURSING PRIORITIES
1. Ascertain maternal condition/presence of labor and fetal well-being.
2. Assist with efforts to maintain pregnancy, if possible.
3. Prevent complications.
4. Provide emotional support.
5. Provide necessary information.
DISCHARGE GOALS
1. Cessation of uterine contractions
2. Free of complications and/or untoward effects
3. Dealing with situation in a positive manner
4. Signs of preterm labor/complications and therapy needs understood
Chinese
French
German
Italian
Japanese
Korean
Russian
Spanish
