Nursing Care :Nursing Care :

for for

Pregnant’s Woman Pregnant’s Woman

with Preterm Labor Pain .with Preterm Labor Pain .

ByBy

Thanima SungsuwanThanima Sungsuwan

Hatyai Hospital Hatyai Hospital

SongkhlaSongkhla

19981998

DefinitionDefinition

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

Preterm Labor PainPreterm Labor Pain

Mortality or Morbidity Mortality or Morbidity 75 - 85 %75 - 85 %Low Birth WeightLow Birth WeightRespiratory Distress Syndrome !Respiratory Distress Syndrome !

EtiologyEtiology

Decrease of Progesterone during ChDecrease of Progesterone during Chorion & Decidua to activated arachidoorion & Decidua to activated arachidonic acid goes to Prostaglandins platelenic acid goes to Prostaglandins platelet - activating factors & monokines stimt - activating factors & monokines stimulated to Labor !ulated to Labor !

Risk Factors !Risk Factors !

Obstetrics HisroryObstetrics HisroryMedical HistoryMedical HistorySociodemographicSociodemographicNon cause : Non cause : 50 %50 %

Obstetric HistoryObstetric History

Multifetal gestationMultifetal gestationAbnormal or incompetent cervixAbnormal or incompetent cervixUterine anormaliesUterine anormaliesExcessive uterine activityExcessive uterine activityIncompetent cervixIncompetent cervix

Medical HistoryMedical History

AnemiaAnemiaHypertensionHypertensionPyelonephritis and UTIPyelonephritis and UTISexually transmitted diseaseSexually transmitted diseaseSmoking & other substance abuSmoking & other substance abu

se se

SociodemographicSociodemographic

Age : less than 20 or more 35 yrs.Age : less than 20 or more 35 yrs.Non - WhiteNon - WhiteLow socioeconomic statusLow socioeconomic statusPoor weight gainPoor weight gainPoor Prenatal CarePoor Prenatal Care

Psychological StressPsychological Stress

Initial EvaluationInitial Evaluation

Is Preterm labor Present ?Is Preterm labor Present ?Symptoms Symptoms SignsSigns

SymptomsSymptoms

Persistant contractions,Persistant contractions,

both painful & painless both painful & painless SpottingSpotting Menstrual - like cramps or pressMenstrual - like cramps or press

ureureAn increase in vaginal dischargeAn increase in vaginal discharge

SignsSigns

Contractions at a frequency Contractions at a frequency

of 6 to 8 / hr of 6 to 8 / hr Cevical dilatation of 2 cm or greater Cevical dilatation of 2 cm or greater

or effacement of greater than 80 %or effacement of greater than 80 %Change in dilatation or effacement Change in dilatation or effacement

on serial examinationon serial examination

ManagementManagement

Bed Rest 80 %Confirm the Diagnosis of Preterm LaborEvaluate CervixStart IV Fluid & hydrate with 1 lt. of NS

SDocument Fetal Well - BeingUltrasoundTocolysis consider Corticosteroids

IndicationIndication

Fetal well - beingFetal well - beingGestational age 20 - 37 wks.Gestational age 20 - 37 wks.Regular Uterine Contraction 1 time Regular Uterine Contraction 1 time

within 10 min. more than 30 sec.within 10 min. more than 30 sec.Cervical change of 2 cm or greater Cervical change of 2 cm or greater

& effacement greater than 80 %& effacement greater than 80 %Membrane IntactMembrane Intact

ContraindicationContraindication

Active phase : Cx > 4 cm.Active phase : Cx > 4 cm.Premature Rupture of MembranePremature Rupture of MembraneSevere ComplicationSevere ComplicationMaternal Heart DiseaseMaternal Heart DiseaseContraindacation of SympathomiContraindacation of Sympathomi

metic drugsmetic drugs

Tocolytic AgentsTocolytic Agents

Beta - adrenergic receptor agonists Beta - adrenergic receptor agonists *Terbutaline ( Bricanyl *Terbutaline ( Bricanyl RR ) )

Calcium channel blocking drugs Calcium channel blocking drugs * Verapamil * Verapamil

Magnesium SulfateMagnesium SulfateAntiprostaglandins or prostaglandin sAntiprostaglandins or prostaglandin s

ynthetase inhibitor * Salicylateynthetase inhibitor * Salicylateother other :*Ritrodrine:*Ritrodrine ,* Progesterone ,* ,* Progesterone ,*

Ethanol , * DiazoxideEthanol , * Diazoxide

Complication:Complication:

Fetal Heart Rate : < 120 / min oFetal Heart Rate : < 120 / min or > 140 / min r > 140 / min Fetal distress !Fetal distress !

Ps > 20 mmHg , Pd > 10 mmHgPs > 20 mmHg , Pd > 10 mmHgProlonged ( > 24 hr ) infusion of Prolonged ( > 24 hr ) infusion of

parenteral tocolytics.parenteral tocolytics.

Nursing Guide !Nursing Guide !

Before Nursing Care Before Nursing Care During Nursing Care During Nursing Care After Nursing CareAfter Nursing Care

* * Before Nursing CareBefore Nursing Care

Initial assessment to determine whether genuine Preterm Labor consider specific management strategies .

Search for a cause / precipitating factors .

* During Nursing Care* During Nursing Care

Honesty about value of preventitative

factors .General Health CareLeft Lateral Recumbent PositionInitiate Tocolysis consider Corticor

steroids if gestation is at 26 - 32 wks .Psycho - support & Closed Observati

on !

* After Nursing Care* After Nursing Care

Closed Observation Side Effects Discharge PlanningHome Care Management Involvement of Husband or

significant other

Discharge PlanningDischarge Planning

Fetal Growth & statusPersonal HygienePhysical & Emotional ChangeSexual needs / change ; intercourseAlleviation of Backache, Braxton hic

ks contaction, Dyspnea, Round ligament pain, Leg ache or edema

Preparation for babyDanger signs

Questions or Suggestion : Questions or Suggestion : feel free !feel free !

* * http://start.at/noina http://start.at/noina

* E- mail : thanima@usa.net* E- mail : thanima@usa.net

* ICQ # 5403640* ICQ # 5403640

Thank you !Thank you !