Nursing Care Plan for Preterm Labor / Premature Labor

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Pathophysiology

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 prior to 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.

Etiology

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.

Desired Outcome

Labor will be suppressed and pregnancy maintained until fetal maturity

Preterm Labor / Premature Labor Nursing Care Plan

Subjective Data:

  • Regular or frequent contractions
  • Dull backache
  • Pelvic pressure
  • Change in type of vaginal discharge

Objective Data:

  • Vaginal spotting or light bleeding
  • Premature rupture of membranes
  • Cervical dilation greater than 4 cm

Nursing Interventions and Rationales

  1. Obtain gynecological and obstetrical history from patient

  2. Previous preterm labor or pregnancies too close together can increase risk of preterm labor. Determine what symptoms began and when.

  3. Assess patient’s vital signs

  4. Get a baseline set of vitals prior to any interventions

  5. Place external fetal monitoring device to monitor fetal activity/ heart rate and contractions

  6. This allows you to observe and monitor frequency and quality of contractions as well as notice any signs of fetal distress

  7. Place patient in position of comfort on left side

  8. Positioning patient in left side-lying position may help with comfort, reduce contractions  and maintain maternal-fetal blood flow

  9. Initiate IV access and administer medications

    • Magnesium sulfate
    • Antiemetics
    • Tocolytics
    • Corticosteroids
    • Antibiotics
    • Analgesics
  10. 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 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

  11. Perform vaginal exam to assess for dilation and effacement

  12. Avoid multiple digital exams if membranes have ruptured.

    Determine progression, if any, of labor. If cervix is dilated >4 cm, it may not be possible to stop labor from progressing.

  13. Provide patient education

    • Symptoms of early labor
    • When to notify the doctor
    • How to time contractions
    • Avoid smoking
    • Avoid alcohol and substance abuse
    • Nutrition
    • Chronic condition management
    • Educate patient and caregivers regarding warning signs and symptoms, healthy diet and lifestyle choices to help prevent repeat preterm labor.
    • Encourage patient to properly manage chronic medical conditions to prevent further labor symptoms.

  14. If labor cannot be stopped, prepare patient for delivery

  15. In cases where labor cannot be stopped, prepare patient for delivery by providing education and information, resources for family members and emotional support.


References

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