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Preterm Labor_Prevention of Delivery

Preterm Labor_Prevention of Delivery - PretermLabor/...

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Preterm Labor/Prevention of Delivery 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
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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.
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  • Spring '10
  • toole
  • uterine contractions, preterm labor, fetal lung maturity, OUTCOMES/EVALUATION  CRITERIA—CLIENT, uterine activity, terbutaline sulfate

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