07.05 Preterm Labor

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Overview

  1. Term = 37-40 weeks gestation
  2. Preterm = before 37 weeks, but after viability
    1. 20-36.6 weeks gestation
  3. Viability = the time when the baby could survive outside the womb
    1. Usually between 20-24 weeks, depending on who you ask
    2. 20 weeks is considered viability by most texts
    3. 23 weeks is the earliest a hospital will revive a fetus (and only some hospitals) → ethics

Nursing Points

General

  1. Labor that occurs between 20-36.6 weeks
  2. Baby at risk for respiratory difficulty due to underdeveloped lungs and other organs

Assessment

  1. Regular contractions
  2. Cramping
  3. Change in vaginal discharge (maybe it was white and thick, now it is thin and brown or bloody)
  4. Pelvic pain
  5. Low back pain
  6. PROM or PPROM (risk for infection)

Therapeutic Management

  1. Attempt to stop labor
  2. Administer tocolytics
    1. i.e. Terbutaline
  3. Monitor mom and baby
    1. Fetal heart tones
    2. Contraction pattern
  4. Bedrest
  5. Fluids
  6. Monitor for infection

Nursing Concepts

  1. Safety
  2. Infection Control

Patient Education

  1.  Importance of bedrest
  2.  Signs and symptoms to report
    1. ROM
    2. Pressure
    3. Increase in cramping/contractions
    4. Back pain

Reference Links

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Video Transcript

In this lesson I will explain preterm labor and what we need to do for this patient and how you will be a part of this

Let’s first look at some important terms. Term, so this means 37-40 weeks gestation. Preterm is before 37 weeks, but after viability so this would be 20 to 36.6 weeks gestation. Viability is the time when the baby could survive outside the womb. Viability is considered 20 weeks however you will probably here conflict on this because hospitals do not consider a fetus viability until later. The earliest a hospital will revive a fetus is 23 weeks and not all hospitals do that. This becomes an ethical decision the hospitals doctors agree upon. So for instance around my area the earliest a hospital will revive is 25 week. So most text refer to viability at 20 weeks so for this just confirm with your textbook.

So now what is preterm labor? So remember our preterm definition was 20 to 36.6 weeks So preterm labor is labor that occurs between 20 to 36.6 weeks. Babies are supposed to be born at or around 40 weeks so although 36.6 weeks is not that far away just one week can make a difference for development. So these babies are at a big risk for respiratory difficulty. Their lungs are not as developed. Their brains aren’t as developed so they will sleep more because their brain develops through sleep. So preterm babies are just more at risk because they have not had adequate time to fully grow. Think of the womb as an oven and whatever you are cooking comes out too early. It just isn’t done cooking!

So now what is our assessment going to look like for this patient. The patient could have regular contractions or even slight constant cramping. Low back pain can also be present because these contractions can radiate around the back. The patient might have a change in vaginal discharge. So maybe it is white and thick and now it changes and is thin and brown or bloody. PPROM is our preterm premature rupture of membranes. So this patient could have leaking of fluids or a big gush. We’ll use nitrazine or amnisure to confirm the rupture. She will be a huge risk for infection because the barrier is gone. The patient could also feel pressure and have pelvic pain. This usually comes because the fetus is lower in the pelvis. So all these things we will assess for. So lets say your patient is assessed and confirmed to be in preterm labor now lets look at their management.

So what are we going to do for this patient? Well first we want to attempt to stop labor the labor. This can be done by administering tocolytic such as terbutaline. Also if they are severely dehydrated it can cause contractions so we want to hydrate. We always have a little joke that on labor day and memorial day weekend those women are going to be at their family picnic in the heat and all come in after contracting and dehydrated. And they do so they are monitoring and rehydrated and hopefully sent home. Oral hydration will be done if we can and if not IV hydrate. We will monitor mom and baby. So monitor contractions and cervical exams if labor is not stopped for progression. If we are able to slow labor we don’t want to do too many checks because this can progress the labor. We are sticking a hand in to the cervix which can cause irritation so we don’t want that. Fetal heart tones will be monitoring to ensure the fetus is happy and tolerating whatever is happening. The patient will likely go on bedrest so she is at risk for blood clots. So for this patient we want her with compression hose and to move her legs to help prevent blood clots. Our last managment piece is to monitor for infection. If this patient has ruptured prematurely then she is at risk for infection. So we would limit cervical exams to prevent infection.

This patient needs to be educated on the signs to watch for with preterm labor. So contractions, leaking fluids, pressure or pelvic pain or any bleeding and spotting. Also if the patient is put on bedrest she needs to understand the importance of this. The why behind it and the risk if she doesn’t follow it.

Safety and Infection Control are our nursing concepts. We need to do the best we can for this patient to keep her and the fetus safe and we need to prevent infection because these patients can be at risk.
So onto the key points. If you remember these then you will remember preterm labor. It is labor that starts between 20 and 36.6 weeks gestation. Patients require bed rest management and tocolytics to stop labor. The symptoms might look like something like this. She is contracting and its radiating to her back and causing back pain, she is having pelvic pressure with some increase in vaginal discharge and spotting or your patient comes in with premature rupture of membranes. All bad signs of preterm labor.

Make sure you check out the resources attached to this lesson and review the symptoms and how you will manage the patient. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

A nurse is teaching pregnant clients about the risks of preterm labor. At what gestation are fetal lungs are thought to be mature enough to function outside the womb without support?

  • Question 2 of 7

A 27-week pregnant client arrives to the hospital in labor. On cervical exam, she is 10 cm dilated. What is the priority nursing action?

  • Question 3 of 7

Which of the following conditions would most likely cause vaginal bleeding during the third trimester of pregnancy?

  • Question 4 of 7

A nurse is educating a pregnant client on signs of preterm labor. What should be included in this education? Select all that apply.

  • Question 5 of 7

A nurse is caring for a 29-week pregnant client who reports lower back pain, lower abdominal pain, and contractions every 5-10 minutes. Vital signs are HR 92, BP 138/86, temp 100.4, RR 18, SpO2 98%. What is the priority nursing action?

  • Question 6 of 7

A pregnant patient who is 32 weeks’ gestation is experiencing preterm labor and has been brought in to the hospital. Which of the following interventions are appropriate for the management of preterm labor? Select all that apply.

  • Question 7 of 7

A nurse is caring for a client that is 26 weeks pregnant who has been put on bedrest for preterm labor. Which of the following should be included in her care? Select all that apply.

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