Nursing Care :

1. 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 26 - 32 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 ! * http://start.at/noina * E- mail : thanima@usa.net * ICQ # 5403640 Thank you !