1. for Pregnant’s Woman with Preterm Labor Pain .
Nursing Care :
for
Pregnant’s Woman
with Preterm Labor Pain .

2. By
Thanima Sungsuwan
Hatyai Hospital
Songkhla
1998

3. Definition
Preterm Labor refers to onset of Labor occurs after 20 week’ gestation and prior to 37 completed week’ gestation or 259 days of LMP event not Low Birth weight of New Born .

4. Preterm Labor Pain Mortality or Morbidity 75 - 85 % Low Birth Weight
Respiratory Distress Syndrome !

5. Etiology
Decrease of Progesterone during Chorion & Decidua to activated arachidonic acid goes to Prostaglandins platelet - activating factors & monokines stimulated to Labor !

6. Risk Factors ! Obstetrics Hisrory Medical History Sociodemographic
Non cause : 50 %

7. Obstetric History Multifetal gestation Abnormal or incompetent cervix
Uterine anormalies
Excessive uterine activity
Incompetent cervix

8. Medical History Anemia Hypertension Pyelonephritis and UTI
Sexually transmitted disease
Smoking & other substance abuse

9. Sociodemographic Age : less than 20 or more 35 yrs. Non - White
Low socioeconomic status
Poor weight gain
Poor Prenatal Care
Psychological Stress

10. Initial Evaluation
Is Preterm labor Present ?
Symptoms
Signs

11. Symptoms Persistant contractions, both painful & painless Spotting
Menstrual - like cramps or pressure
An increase in vaginal discharge

12. Signs Contractions at a frequency of 6 to 8 / hr
Cevical dilatation of 2 cm or greater
or effacement of greater than 80 %
Change in dilatation or effacement
on serial examination

13. Management Bed Rest 80 % Confirm the Diagnosis of Preterm Labor
Evaluate Cervix
Start IV Fluid & hydrate with 1 lt. of NSS
Document Fetal Well - Being
Ultrasound
Tocolysis consider Corticosteroids

14. Indication Fetal well - being Gestational age 20 - 37 wks.
Regular Uterine Contraction 1 time within 10 min. more than 30 sec.
Cervical change of 2 cm or greater & effacement greater than 80 %
Membrane Intact

15. Contraindication Active phase : Cx > 4 cm.
Premature Rupture of Membrane
Severe Complication
Maternal Heart Disease
Contraindacation of Sympathomimetic drugs

16. Tocolytic Agents
Beta - adrenergic receptor agonists *Terbutaline ( Bricanyl R )
Calcium channel blocking drugs * Verapamil
Magnesium Sulfate
Antiprostaglandins or prostaglandin synthetase inhibitor * Salicylate
other :*Ritrodrine ,* Progesterone ,* Ethanol , * Diazoxide

17. Complication:
Fetal Heart Rate : < 120 / min or > 140 / min Fetal distress !
Ps > 20 mmHg , Pd > 10 mmHg
Prolonged ( > 24 hr ) infusion of parenteral tocolytics.

18. Nursing Guide ! Before Nursing Care During Nursing Care
After Nursing Care

19. * Before Nursing Care
Initial assessment to determine whether genuine Preterm Labor consider specific management strategies .
Search for a cause / precipitating factors .

20. * During Nursing Care Honesty about value of preventitative factors .
General Health Care
Left Lateral Recumbent Position
Initiate Tocolysis consider Corticor
steroids if gestation is at wks .
Psycho - support & Closed Observation !

21. * After Nursing Care Closed Observation Side Effects
Discharge Planning
Home Care Management
Involvement of Husband or significant other

22. Discharge Planning Fetal Growth & status Personal Hygiene
Physical & Emotional Change
Sexual needs / change ; intercourse
Alleviation of Backache, Braxton hicks contaction, Dyspnea, Round ligament pain, Leg ache or edema
Preparation for baby
Danger signs

23. Questions or Suggestion : feel free !*
* E- mail :
* ICQ #
Thank you !