Marion Villaraza rlencm109 2BSN-C

PRETERM (PREMATURE) LABOR o Bacterial vaginosis: This common

vaginal infection can also
➢ occurs after the 20th week but before contribute to preterm labor15 .
the 37th week of gestation
o Chorioamnionitis: This infection
➢ causes effacement and dilation of cervix
of the amniotic sac and
Etiology and Risk Factors membranes is a serious
✓ History of medical conditions complication that can lead to
preterm labor and other health
➢ Chronic hypertension: High blood problems for the mother and
pressure during pregnancy can baby
lead to complications like
preeclampsia, which can trigger ✓ Social and environmental factors:
preterm labor. substance abuse
➢ Diabetes: Uncontrolled diabetes o Smoking: Smoking during
during pregnancy can increase pregnancy increases the risk of
the risk of preterm birth, low preterm labor, low birth weight,
birth weight, and other and other complications19 .
complications. o Alcohol consumption: Excessive
➢ Autoimmune diseases: Conditions alcohol use during pregnancy can
like lupus or rheumatoid arthritis lead to fetal alcohol spectrum
can increase the risk of preterm disorders and increase the risk of
labor due to inflammation and preterm labor26 .
other complications. o Drug use: Illicit drug use,
➢ Previous preterm birth: Women particularly cocaine, is strongly
who have previously experienced associated with preterm labor
preterm labor are at a higher risk and other pregnancy
of experiencing it again in complications
subsequent pregnancies ✓ Multifetal pregnancy
✓ Present and past obstetric problems o carrying twins or more
o Cervical insufficiency: A weakened significantly increases the risk of
cervix that cannot hold the preterm labor
pregnancy to term can lead to o due to the increased strain on the
preterm labor. uterus, placenta, and other
o Premature rupture of membranes maternal systems
(PROM): When the amniotic sac ✓ Multigravida
breaks before labor begins, it can o refers to a woman who has had
increase the risk of infection and two or more pregnancies
preterm labor. o While not a direct cause of
o Placental abruption: When the preterm labor, it can be
placenta detaches from the uterine considered a risk factor
wall before delivery, it can lead to o women who have had previous
preterm labor and other pregnancies may be more
complications. susceptible to complications like
o Multiple gestations: Carrying twins or cervical insufficiency or infection
more increases the risk of preterm ✓ Anemia
labor due to the increased strain on o particularly iron deficiency
the uterus and placenta anemia, is associated with an
✓ Infection increased risk of preterm labor
o Urinary tract infections o can lead to reduced oxygen
(UTIs): UTIs can ascend to the delivery to the fetus and placenta
uterus and cause infection, ✓ Age
increasing the risk of preterm
labor16 .

MV
Marion Villaraza rlencm109 2BSN-C

o Both very young and older o evaluates the baby's well-being in

mothers are at increased risk of the womb
preterm labor o includes monitoring the fetal
o Young mothers may have less heart rate for any irregularities or
developed reproductive systems, signs of distress
increasing the risk of ➢ Abdominal cramping (may be
complications accompanied by diarrhea)
o Older mothers, particularly those o especially when accompanied by
over 35, may have a higher risk diarrhea, is a common symptom
of pre-existing health conditions of preterm labor
Diagnostic Studies: o can be caused by uterine
contractions or intestinal
➢ Transvaginal cervical sonography
irritation, which can be triggered
o uses a probe inserted into the
by hormonal changes or infection
vagina to visualize the cervix
➢ Low back pain
o measures the cervical length,
o can be caused by pressure on the
which is a key indicator of
nerves in the lower back due to
preterm labor risk
the expanding uterus or
o shorter cervical length is
by contractions of the uterus
associated with an increased risk
➢ Pelvic pressure or heaviness
of preterm birth
o can be caused by the weight of
➢ Immunoassay for fetal fibronectin
the baby pressing down on the
o analyzes a protein called fetal
pelvic organs or by cervical
fibronectin (FFN) found in
changes associated with preterm
cervicovaginal fluid
labor
o FFN is normally present in the
➢ Signs of labor:
amniotic sac, but its presence in
o Uterine contractions (painful or
the vaginal fluid can indicate a
painless); two contractions
weakening of the membranes and
lasting 30 seconds within 15
an increased risk of preterm labor
minutes;
➢ Vaginal examinations (Internal
o cervical dilation less than 4 cm;
Examination)
effacement 50% or less -Change
o involves a manual examination of
in character and amount of usual
the cervix to assess
discharge—may be thicker or
its dilatation (opening)
thinner, bloody, brown or
and effacement (thinning)
colorless, odorous
o it is less reliable than ultrasound
o Rupture of amniotic membranes;
and FFN testing due to its
length of time since rupture
subjective nature
➢ Signs of hemorrhage or infection
o can also be uncomfortable for the
patient o Vaginal bleeding: This could
indicate placental abruption,
Assessment: cervical laceration, or other
➢ AOG issues.
o refers to the number of weeks of o Heavy menstrual-like
pregnancy bleeding: This could be a sign of
o fundamental factor in a more serious problem.
determining the severity of o Fever: This could indicate a
preterm labor, as the earlier the urinary tract infection,
gestation, the higher the risk for chorioamnionitis, or other
the baby infections.
➢ Fetal status

MV
Marion Villaraza rlencm109 2BSN-C

o Foul-smelling vaginal ➢ Activity restrictions; Rest periods; Avoid

discharge: This could indicate an vigorous activity
infection of the cervix or uterus ➢ Increase fluid intake
o Tenderness or pain in the ➢ Avoid sexual intercourse
abdomen: This could indicate an ➢ Avoid nipple stimulation
infection in the uterus or ➢ Avoid stressful events
surrounding tissues ➢ Empty bladder regularly
➢ Signs of severe preeclampsia
o High blood pressure: A blood Magnesium Sulfate (MgSO4)
pressure reading of 160/110
mmHg or higher. ➢ central nervous system depressant
➢ relaxes smooth muscle (including the
o Protein in the urine: This
uterus)
indicates kidney damage.
➢ used to halt preterm labor contractions
o Headaches: Severe headaches ➢ used for preeclamptic clients to prevent
that are not relieved by
seizures
medication.
Adverse Effects
o Vision changes: Blurred vision,
seeing spots, or temporary loss of Maternal
vision. ➢ depressed respirations
o Abdominal pain: Pain in the upper ➢ depressed DTRs
abdomen, usually under the ribs ➢ hypotension
on the right side. ➢ extreme muscle weakness
o Nausea and vomiting: Severe ➢ flushing
nausea and vomiting that is not ➢ decreased urine output
relieved by medication. ➢ pulmonary edema
o Shortness of breath: This could ➢ serum magnesium levels > 7.5 mEq/ L
indicate fluid in the lungs. (3.75 mmol/ L)
o Swelling: Sudden weight gain or Newborn
swelling, especially in the face
➢ hypotonia and sleepiness
and hands.
Nursing Interventions
➢ Emotional status of mother
➢ intravenous controller device for
o Anxiety: This is a common
reaction to preterm labor. administration / protocol for
administration
o Fear: The mother may be fearful
➢ Discontinue infusion and notify HCP if
about the health of her baby.
adverse effects occur
o Depression: This can be a more ➢ Respirations < 12/ min
serious reaction to preterm labor. ➢ Urine Output < 100 mL/ 4 hr (25-30 mL/
➢ Presence of fetal fibronectin in cervical hr)
canal ➢ Monitor DTRs (deep tendon reflexes)
o tests for the presence of fetal ➢ Monitor magnesium levels: 4 to 7.5
fibronectin (FFN) in the cervical canal mEq/L(2 to 3.75 mmol/ L)
o FFN is a protein normally found in ➢ Keep Calcium Gluconate readily
the amniotic sac accessible as antidote
o presence in the cervical canal can
Nifedipine
indicate a weakening of the
membranes and an increased risk of ➢ Calcium Channel Blocker
preterm labor ➢ relaxes smooth muscles by blocking
calcium entry
Interventions:
➢ first-line agent to halt preterm labor
Halting Preterm Labor contractions in some health care
agencies

MV
Marion Villaraza rlencm109 2BSN-C

Adverse Effects be associated with complications

Maternal like preeclampsia
➢ Urine evaluation
➢ tachycardia
o Analyzing urine for protein,
➢ hypotension
glucose, and ketones helps detect
➢ dizziness
preeclampsia, gestational
➢ headache
diabetes, and other metabolic
➢ nervousness
imbalances
➢ facial flushing
➢ Presence of edema
➢ fatigue
o particularly in the hands and
➢ nausea
face, can indicate fluid retention
Newborn and potential preeclampsia
➢ hypotension ➢ Contractions
o Monitoring the frequency,
Nursing Interventions
duration, and intensity of
➢ Follow agency protocol for contractions is essential for
administration assessing the progress of labor
➢ Avoid using with MgSO4 – severe and identifying any signs of
hypotension can occur abnormal labor patterns
➢ Monitor for adverse effect ➢ progression of labor
o involves tracking the dilation and
effacement of the cervix,
Monitor MATERNAL status
the descent of the baby, and
➢ Vital signs the position of the baby to assess
o includes monitoring temperature, the progress of labor and identify
pulse, respiration, and blood any potential complications
pressure
Monitor FETAL status
o Changes in these vital signs can
indicate complications like ➢ FHT
infection, dehydration, or o typically monitored using
preeclampsia a doppler ultrasound device or,
➢ Breath sounds during labor, with electronic fetal
o Auscultating the lungs monitoring
for wheezing, crackles, or o normal range for a fetal heart
diminished breath sounds can rate is between 120 and 160
help identify respiratory distress beats per minute
or fluid buildup in the lungs o accelerations, decelerations, or a
➢ Hematologic and cervical status decrease in variability, can
o involves monitoring blood count indicate potential issues with the
(hemoglobin and hematocrit) to baby's oxygen supply or other
assess for anemia or blood loss, complications
and cervical dilation and ➢ Fetal activity
effacement o a simple but effective way to
➢ Blood and urine glucose levels assess the baby's well-being
o helps identify gestational diabetes o Mothers are encouraged to count
or other metabolic issues that can fetal movements throughout the
affect maternal and fetal health pregnancy
➢ Fundal height o decrease in fetal activity can be a
o helps assess fetal growth and the sign of distress and should be
position of the baby reported to a healthcare provider
➢ Maternal weight
o can help identify excessive weight
gain or fluid retention, which can

MV
Marion Villaraza rlencm109 2BSN-C

Medications ➢ Increasing size

1. Tocolytic Therapy Maternal risk
a. Betasympathomimetics: ➢ if infant is excessively large
terbutaline (Brethine)
Diagnostic Test
b. Magnesium sulfate
i. Prostaglandin inhibitors: ➢ Fetal assessment
indomethacin (Indocin) o contraction stress test (CST)
ii. Calcium channel blockers: ▪ measures the baby's heart
nifedipine (Procardia) rate response to uterine
2. Corticosteroid Therapy contractions
a. Betamethasone (Celestone) ▪ goal is to simulate labor
i. 24 to 48 hours before contractions to see how
birth the baby's heart rate
ii. Reduces incidence and reacts to the temporary
severity of RDS in preterm decrease in oxygen and
infants blood supply
iii. Enhances formation of o ability to tolerate labor induction
surfactant of labor
iv. Contraindicated if woman ▪ Cervical status: The cervix
has an infection needs to be favorable for
Provide Care r/t Administering induction, meaning it's
Medications ripe and ready for labor.
Factors like cervical
➢ Teach about medication dilation, effacement, and
➢ Use an infusion pump position are assessed.
➢ Obtain baseline hematologic data &
▪ Fetal well-being: The
electrocardiographic (ECG) readings if baby's health and ability
appropriate to tolerate contractions
➢ Monitor VS are evaluated using tests
➢ Maintain hydration; Monitor for like the CST and
pulmonary edema biophysical profile.
➢ Monitor for signs of hypokalemia and ▪ Maternal health: The
hyperglycemia mother's overall health,
➢ Monitor I & O including any existing
➢ Provide care related to magnesium medical conditions or
sulfate therapy complications, is taken
➢ Prepare for preterm birth into account.
➢ Provide emotional support ▪ Previous pregnancies: A
➢ Reduce anxiety history of previous
➢ prepare for perinatal death pregnancies and deliveries
can provide insights into
the likelihood of successful
POST-TERM PREGNANCY induction.
➢ Extends beyond 42nd week of gestation Assessment/Analysis
➢ 2 weeks beyond estimated date of birth
➢ AOG; LMP; EDB
(EDB)
➢ Biophysical profile - amount of amniotic
➢ 37 to 42 weeks AOG is considered full-
fluid Presence of meconium in amniotic
term
fluid
Risk Factors ➢ Level of anxiety r/t delayed date of birth
Fetal risk ➢ Newborn appearance

➢ Decreased amniotic fluid

➢ Decreased placental function

MV
Marion Villaraza rlencm109 2BSN-C

PRECIPITOUS LABOR AND DELIVERY Assessment

(PRECIPITATE LABOR) ➢ Rapid cervical dilation
➢ Labor lasting less than 3 hours duration o If cervix is opening quickly,
Complications indicating a fast progression of
labor
Maternal complications
➢ Accelerated fetal descent
➢ perineal laceration o baby is moving down the birth
➢ postpartum hemorrhage canal at a faster rate than
Newborn complications expected
➢ History of rapid labor
➢ anoxia
o woman has previously
o a complete lack of oxygen supply
experienced a labor that was
to the body or a specific organ,
significantly shorter than average
such as the brain
➢ Rapid uterine contractions with
o Respiratory failure: The lungs are
decreased periods of relaxation between
unable to take in enough oxygen
contractions
o Circulatory problems: The heart
o contractions are coming
cannot pump blood effectively,
frequently and intensely, with
preventing oxygenated blood
little rest in between
from reaching tissues
o Carbon monoxide Interventions
poisoning: Carbon monoxide ➢ Have a precipitous delivery tray
binds to hemoglobin, preventing available.
oxygen from being carried by the ➢ Stay with the client at all times.
blood ➢ Provide emotional support and keep the
o Drowning: The lungs are filled client calm.
with water, blocking oxygen ➢ Encourage the client to pant between
intake contractions.
➢ intracranial hemorrhage ➢ Prepare for rupturing membranes when
o also known as a brain bleed, the head crowns.
occurs when a blood vessel in the ➢ Do not try to prevent the fetus from
brain ruptures and bleeds being delivered.
o can happen within the brain ➢ delivery before the arrival of the health
tissue itself care provider
o or in the spaces surrounding the o Apply gentle pressure to the fetal
brain head upward toward the vagina
o MAIN CAUSES to prevent damage to the fetal
▪ High blood head and vaginal lacerations
pressure: Weakened blood o support the perineal area, Ritgen
vessels can burst due to maneuver
high pressure o Support the infant’s body during
▪ Head injury: Trauma to delivery.
the head can damage o Deliver the infant between
blood vessels, leading to contractions, checking for the
bleeding cord around the neck.
▪ Aneurysm: A weakened o Use restitution to deliver the
area in a blood vessel can posterior shoulder
bulge and rupture o Use gentle downward pressure to
▪ Arteriovenous move the anterior shoulder under
malformation (AVM): A the pubic symphysis
tangle of abnormal blood
vessels can rupture

MV
Marion Villaraza rlencm109 2BSN-C

➢ Newborn ▪ large fetus or a baby in a

o Place the infant on the mother’s malposition can cause
abdomen or breast to induce complications like
uterine contractions. obstructed labor, shoulder
o Dry and cover the infant to keep dystocia, or the need for a
the body warm. cesarean delivery
o Establish airway (e.g., position o bones and tissues of the maternal
head slightly lower than chest to pelvis
drain mucus by gravity; rub back ▪ contracted pelvis or pelvic
and sole to initiate crying) girdle pain can make labor
➢ Allow the placenta to separate naturally difficult or even impossible
➢ Faulty uterine contractions
o Hypertonic
DYSTOCIA
▪ Increased frequency of
➢ dysfunctional or difficult labor that is contractions
prolonged or more painful ▪ Older primigravidas
Etiology and Risk Factors ▪ Increased fetal molding
o Hypotonic
Mechanical factors:
▪ slowing of rate and
➢ cephalopelvic disproportion intensity of contractions
o baby's head is too large or the
Maternal complications
mother's pelvis is too small,
preventing the baby from passing ➢ cervical trauma
through the birth canal ➢ postpartum hemorrhage
➢ contracted pelvis ➢ infection
o mother's pelvis is abnormally ➢ and exhaustion
shaped or smaller than average ➢ fetus may be excessively large,
➢ malpresentation or position malpositioned, or in an abnormal
o baby is not positioned head-down presentation
(vertex) in the uterus, making it Shoulder Dystocia
harder for the baby to descend
➢ head is born, but anterior shoulder
through the birth canal
cannot pass under pubic arch
➢ multiple gestation
➢ feto-pelvic disproportion r/t excessive
o Having twins or more increases
fetal size (>4000 g)
the risk of preterm labor due to
➢ maternal pelvic abnormalities
the increased pressure on the
uterus and cervix Newborn
➢ occiput posterior position of fetus ➢ may experience asphyxia, birth injuries
o baby's head is facing the Mother
mother's back instead of her
➢ may experience blood loss from uterine
front, which can lead to a longer
atony or rupture, trauma, infection
and more difficult labor
➢ problems caused by
o uterine contractions Diagnostic Studies
▪ Excessive or prolonged
➢ Ultrasonography - fetal and pelvic size
contractions can restrict
blood flow to the placenta,
leading to fetal distress Assessment
and potential
➢ Progress of labor
complications like brain
o abnormal contraction pattern
injury or death
➢ Status of mother
o fetus
o Excessive abdominal pain

MV
Marion Villaraza rlencm109 2BSN-C

o VS (BP, T, RR) o pain in her chest, which may be

➢ Status of fetus sharp or stabbing
o fetal distress (tachycardia or ➢ Cyanosis
bradycardia) o woman's skin and mucous
membranes turn bluish due to a
lack of oxygen in the blood
Interventions
➢ Fetal bradycardia and distress
Labor o baby's heart rate slows down
➢ Monitor uterine contractions. significantly
➢ Monitor color of amniotic fluid. o the baby shows signs of distress,
➢ Assess for prolapse of the cord after such as decreased movement or
membranes rupture. changes in heart rate patterns

Mother Interventions

➢ temperature and heart rate. ➢ Institute emergency measures to

➢ pelvic examination, measurements, maintain life.
ultrasound, and other procedures ➢ O2 - 8 to 10 L/min by face mask;
➢ prophylactic antibiotics as prescribed to resuscitation bag 100% O2.
prevent infection. ➢ intubation and mechanical ventilation.
➢ IV fluids as prescribed. ➢ Side lying position
➢ intake and output. ➢ IV fluids, blood products, and meds to
➢ hydration. correct coagulation failure
➢ breathing techniques and relaxation ➢ fetal status.
exercises. ➢ emergency delivery when the client is
➢ rest and comfort as with a normal stabilized.
delivery, such as back rubs and position ➢ emotional support to the client, partner,
changes. and family.
➢ fatigue and pain and administer
sedatives and pain medications as
FETAL DISTRESS
prescribed.
Assessment
Fetus
➢ FHR: < 110 beats/min ; > 160
➢ fetal heart rate; fetal distress.
beats/min
➢ fetal monitoring if oxytocin is prescribed
o is outside the normal range,
for hypotonic uterine contractions
indicating possible problems with
➢ oxygen, suction, and resuscitation
oxygenation or heart function
equipment
➢ Meconium-stained amniotic fluid
o baby has passed meconium (first
AMNIOTIC FLUID EMBOLISM stool) into the amniotic fluid,
which can be a sign of fetal
➢ escape of amniotic fluid into the
distress or hypoxia
maternal circulation.
➢ Fetal hypoactivity or hyperactivity
➢ Debris
o is either moving less than
o containing amniotic fluid deposits
expected or moving excessively,
in the pulmonary arterioles and is
both of which can signal a
usually fatal to the mother
problem with oxygen supply
Assessment ➢ Progressive decrease in baseline
➢ Abrupt onset of respiratory distress variability
o woman may suddenly experience o fetal heart rate is becoming less
difficulty breathing, often with variable, indicating a lack of
shortness of breath and rapid normal fluctuations and
breathing potentially reduced oxygenation
➢ Chest pain ➢ Severe variable decelerations

MV
Marion Villaraza rlencm109 2BSN-C

o fetal heart rate drops sharply and ➢ inlet contraction occurs when the
abruptly, often associated with narrowing of the anteroposterior
cord compression, which can diameter
restrict blood flow to the baby ➢ Assess the position of the fetus through
➢ Late decelerations Leopold’s maneuver of UTZ -Abnormal
o fetal heart rate drops after the positions of the fetus
peak of a contraction, indicating a ➢ Assess head moulding
potential problem with placental Diagnostic Studies
blood flow and oxygen delivery
➢ Transvaginal cervical sonography
Interventions (Trans-V)
➢ D/C oxytocin if infusing. ➢ Vaginal examinations to determine
➢ Place the client in a lateral position. cervical changes
➢ Administer O2 8 to 10 L/min, via face Interventions
mask.
Mother status
➢ Monitor maternal and fetal status.
o In the event of fetal distress, ➢ Monitor progress of labor (use
prepare the client for emergency partograph and apply cardiotocography
cesarean delivery machine)
➢ Monitor Membranes
Fetal status
CEPHALOPELVIC DISPROPORTION (CPD)
➢ Monitor FHT (use fetoscope/doppler or
➢ narrowing, or contraction of the birth
apply cardiotocography machine
canal, can occur at the inlet, midpelvis,
or outlet
➢ causes a disproportion between the size
of the fetal head and the pelvic
diameters
➢ failure of labor to progress
Risk Factors
Size of the pelvis
➢ Teenagers, Petit women, Obese,
GDM/DM, PIH, History of CPD
➢ The small size of the pelvis may be the
result of rickets in the early life of the
mother
➢ A genetic predisposition
➢ A pelvis that isn’t fully matured in a
young adolescent.
Fetal Status
➢ Macrosomia
➢ Malpositioning of the fetus difficult or
impossible for the fetal presenting part
to fit through the pelvis.
➢ Fetal anomalies (Hydrocephalus,
Hydrops fetalis, and tumors, Conjoined
twins)
Assessment
➢ Assess the pelvis (pelvimetry)

MV