Early Onset of Labor - ATI CH 10

Early Onset of Labor - ATI CH 10 Early Onset of Labor - Preterm labor, premature rupture of membranes, and preterm premature rupture of membranes Preterm labor - uterine contractions and cervical changes that occur between 20 and 37 weeks of gestation. Name 5 risk factors that are associated with preterm labor: - ● Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac) ● Previous preterm birth ● Multifetal pregnancy ● Hydramnios (excessive amniotic fluid) ● Age below 17 or above 35 Name another 5 risk factors associated with preterm labor: - ● Low socioeconomic status ● Smoking ● Substance use ● Domestic violence ● History of multiple miscarriages or abortions Name an additional 7 risk factors associated with preterm labor: - ● Diabetes mellitus or hypertension ● Lack of prenatal care ● Recurrent premature dilation of the cervix ● Placenta previa or abruptio placentae ● Preterm premature rupture of membranes ● Short interval between pregnancies ● Uterine abnormalities What kind of subjective assessment data can be observed with preterm labor? - ◯ Persistent low backache ◯ Pressure in the pelvis and cramping ◯ Gastrointestinal cramping, sometimes with diarrhea ◯ Urinary frequency ◯ Vaginal discharge What kind of objective assessment data would be observed with preterm labor? - ■ Increase, change, or blood in vaginal discharge ■ Change in cervical dilation ■ Regular uterine contractions with a frequency of every 10 min or greater, lasting 1 hr or longer ■ Premature rupture of membranes What laboratory tests are associated with preterm labor? - ■ Fetal fibronectin ■ Cervical cultures ■ CBC ■ Urinalysis What are the common diagnostic procedures for a woman at risk for preterm labor? - Fetal fibronectin swab Ultrasound HUAM Cervical Cultures Biophysical profile Explain the significance of the following diagnostic procedures to preterm labor: Fetal fibronectin swab Ultrasound - ■ Obtain swab of vaginal secretions for fetal fibronectin between 24 and 34 weeks of gestation. This protein can be found in the vaginal secretions when the fetal membrane integrity is lost. This test is used to determine preterm labor. ■ Measure endocervical length with an ultrasound to assess for a shortened cervix, which is suggested in certain studies to precede preterm labor. Explain the significance of the following diagnostic procedures to preterm labor: HUAM Cervical Cultures Biophysical profile - ■ Use home uterine activity monitoring (HUAM), which is a uterine contraction monitor that can be used by the client at home. HUAM is not considered to be effective in preventing preterm labor. ■ Obtain cervical cultures to detect if there is a presence of infectious organisms. Culture and sensitivity results guide prescription of an appropriate antibiotic, if indicated. ■ Perform a biophysical profile and/or a nonstress test to provide information about the fetal well-being. What is the main nursing care objective in the management of preterm labor? - stopping uterine contractions What nursing care actions would the nurse implement when managing preterm labor? - ■ Activity restriction ■ Ensuring hydration ■ Identifying and treating an infection ■ Chorioamnionitis should be suspected with the occurrence of elevated temperature and tachycardia. ■ Monitor FHR and contraction pattern. Explain the significance of advising a woman to restrict activity for the management of preterm labor: - ■ Activity restriction Instruct the client on ways to modify her environment to allow for modified bed rest, yet have the ability to fulfill role responsibilities. Strict bed rest has been found to have adverse effects. Encourage the client to rest in the left lateral position to increase blood flow to the uterus and decrease uterine activity. Tell the client to avoid sexual intercourse. Why is it important to ensure that a woman facing preterm is adequately hydrated? - Dehydration stimulates the pituitary gland to secrete an antidiuretic hormone and oxytocin. Preventing dehydration prevents the release of oxytocin, which stimulates uterine contractions. When managing preterm labor, why is it important to monitor FHR and contraction pattern? - Fetal tachycardia, a prolonged increase in the FHR greater than 160/min may indicate infection, which is frequently associated with preterm labor. What is important for the nurse to consider regarding infection and the management of preterm labor? - ■ Identifying and treating an infection Have the client report any vaginal discharge, noting color, consistency, and odor. Monitor vital signs and temperature. ....................