SY 2020-2021

COLLEGE OF NURSING
Silliman University
Dumaguete City

Resource Unit on the Nursing Care for the Family Experiencing

Preterm Labor

Prepared by:
Reyes, Shania
Rodriguez, Mary Charity
Teves, Joi Owen

Submitted to:
Dr. Barbara Lyn Galvez
April 20, 2021
 Time Allotment: 30 minutes
Topic: Nursing Care for the Family Experiencing Preterm Labor
Topic Description: This topic deals with the nursing care for a family experiencing preterm labor. It includes the discussion of the
different signs and symptoms signifying the occurrence of preterm labor, as well as the predisposing factors and complications it can
result for both the mother and the fetus. It emphasizes the medical and nursing interventions that would be utilized to provide optimum
care for the family.
Central Objective: By the end of the 30 minutes virtual discussion on how to care for the family experiencing preterm labor, the
learners shall gain sufficient knowledge with a positive attitude on preterm labor and communicate effectively with the patient and her
family and the appropriate nursing actions with careful observations with the 80% level of competency.

Specific Objectives Content Teaching- Time Evaluation Method

Learning Allotment
Activities

At the end of the Virtual Answer the questions

presentation, the C1 presentation asked by the facilitator
students will be able to: through Google at 76% competency
Meet level.
1. Define preterm I. Overview of Preterm Labor 7 minutes
labor, identify its
signs and A. Definition
symptoms and the - Preterm labor is the onset of rhythmic
categories. contractions that produce cervical changes after
fetal viability but before fetal maturity.
(Lippincott Williams & Wilkins, 2011)
- Labor that occurs after 20 weeks but before 37
 weeks of gestation or fewer than 259 days
since the first day of the woman’s last
menstrual period (LMP). (WHO, 2018)
- Always potentially serious because if it results
in the infant’s birth, the infant will be
immature. (Sillbert-Flagg, J. & Pilliteri, A.
2018)

B. Signs and Symptoms

- According to Sillbert-Flagg, J. & Pilliteri, A.
(2018)., listen carefully to any woman who has
the following common symptoms of early
preterm labor or believes she is in preterm
labor because beginning symptoms of labor are
subtle and best recognized by the woman
herself. Need to identify includes:
● Persistent, dull, and low backache;
● Vaginal spotting;
● A feeling of pelvic pressure or
abdominal tightening;
● Menstrual-like cramping;
● Increased vaginal discharge;
● Uterine contractions’
● Intestinal cramping
- It is possible to predict which pregnancies will end
early by analyzing changes in the length of the cervix
by ultrasound exam and analysis of vaginal mucus for
the presence of fetal fibronectin, a protein produced by
 trophoblast cells (Jung, Park, Ryu, et al., 2016). If this
is present in vaginal mucus, it predicts that preterm
contractions are ready to occur; absence of the protein
predicts that labor will not occur for at least 14 days. .

C. Subcategories of Preterm Labor (WHO, 2018)

● Extremely preterm (less than 28 weeks)
● Very preterm (28 to 32 weeks)
● Moderate to late preterm (32 to 37 weeks)

2. Identify the II. Predisposing Factors Related to Preterm Labor 8 minutes

predisposing A. Physiological Factors
factors of preterm 1. Age of the mother
labor. - Women younger than age 18 are more
likely to have a preterm delivery.
- Women older than age 35 are also at
risk of having preterm infants because
they are more likely to have other
conditions (such as high blood pressure
and diabetes) that can cause
complications requiring preterm
delivery.
2. Multiple Gestations or pregnancies
- Pregnant people who are carrying
multiples (twins, triplets, or more) are
at an increased risk for early delivery,
 as well as other complications. One
study showed that more than 50% of
twin births occurred preterm, compared
with only 10% of births of single
infants.
3. Preterm Rupture of Membranes
- PROM is spontaneous rupture of fetal
membranes with loss of amniotic fluid
anytime beyond 28 weeks of pregnancy
but before the 3rd onset of labor
(ACOG, 2016b).
4. Cervical Insufficiency (Premature Cervical
Dilation)
- Formerly known as incompetent cervix.
Refers to a cervix that dilates
prematurely therefore cannot retain a
fetus until term (Roman, 2013). Occurs
when weak cervical tissue causes or
contributes to premature birth or loss of
an otherwise healthy pregnancy.

B. Medical Conditions
● Chorioamnionitis
- infection of the fetal membranes and
amniotic fluid.
● UTI
 - This type of infection can involve your
urethra (a condition called urethritis),
kidneys (a condition called
pyelonephritis) or bladder, (a condition
called cystitis).
● PIH
- Is a condition in which vasospasm
occurs during pregnancy in both small
and large arteries.

● Gestational Diabetes
- Occurs only during pregnancy.

● Iron deficiency Anemia

- A disorder of oxygen transport in which
hemoglobin synthesis is deficient.

C. Lifestyle and Environment

● Low socioeconomic profile
- Deficient knowledge of the appropriate
care or do not seek medical care of fear
of hospital bills.

● Minimal or no prenatal care

- The risk factors will not be identified or
prevented, and complications will not
be given immediate medical
 intervention.
● Multiple sexual partners
- This predisposes the pregnant women
to UTI and STD’s that may pose harm
to the fetus inside the womb.
● Poor nutrition or low pregnancy weight
- Mothers who do not comply to the
required calorie intake and vitamins
required for pregnant women have
higher risk of preterm delivery.
● Substance Abuse
- Mothers that are using excessive
alcohol and drugs have increased
incidence of preterm labor as well as
birth defects.

3. Identify at least 3 III. Complications of Preterm Labor 5 minutes

maternal
complications and A. Maternal
3 fetal ● Haemorrhage
complications - Maternal hemorrhage may occur at
during Preterm birth because of poor clotting ability.
Labor ● Hypovolemic Shock
- occur when 10% of blood volume, or
approximately 2 units of blood, have
been lost
● Infection
 - Infection tends to develop in women
who have lost appreciable amounts of
blood. This also may occur as a result
of microorganism that infests the
insicion from ceasarian delivery.
● Thromboembolism
- Prevalent among women with
prescribed with extended bed rest.
Women who is in preterm labor, in
some cases are prescribed with bed rest
to halt the delivery.

B. Fetal

● Respiratory distress syndrome

- Preterm infants are particularly susceptible
to several illnesses in the early postnatal
period, including respiratory distress
syndrome, apnea.
● Meconium Aspiration Syndrome
- Occurs when an infant aspirates
meconium-stained amniotic fluid before or
during birth. Meconium is irritating to the
airway and leads to both airway spasm and
pneumonia.
● Hypoglycemia
- decreased blood glucose
● Polycythemia
- The polycythemia that results causes
 increased blood viscosity, a condition that
puts extra work on the infant’s heart
because it is more difficult to effectively
circulate thick blood
● Hyperbilirubinemia
- an elevated level of bilirubin in the
blood). This can result from destruction
of red blood cells by a normal
physiologic process
- When abnormal destruction of red
blood cells occurs, it is termed
hemolytic disease.
● Sepsis
- The most prevalent perinatal infections
are those contracted from the vagina
during birth.
- Early-onset sepsis is most commonly
caused by group B streptococcus, E.
coli, Kelbsiella, and Listeria
monocytogenes.
- Late-onset, infections are more
commonly caused by Staphylococcus
aureus, Enterobacter, and Candida.
● Necrotizing Enterocolitis
- necrotizing enterocolitis (NEC) has
been ruled out, as this could result from
the temporary reduction in oxygen to
the bowel
4. Determine the IV. Management for Preterm Labor 10 minutes
different medical
and nursing A. Medical Interventions
interventions to
manage preterm ● Goals of management: inhibit uterine contractions to
labor delay labor and optimize fetal status before preterm
delivery
● Medical attempts can be made to stop labor if the
following conditions are met:
1. Fetal membranes have not ruptured
2. Fetal distress is absent
3. No occurrence of bleeding
4. No cervical dilatation and effacement
● If labor cannot be halted: C-section
● IV therapy
● Cervical and vaginal cultures, urine sample
● Antibiotics if an infection is ruled out
● Tocolytics such as Terbutaline (do not use for over 48-
72hrs)
● Corticosteroids like Betamethasone/Dexamethasone
● Analgesics
B. Nursing Interventions

● Instruct woman to be on bed rest, preferably in left-

side lying position and activity restriction
● Assess maternal VS
● Continue external fetal monitoring
● Monitor uterine contractions for intensity, strength,
and frequency
● Obtain vaginal and cervical cultures as well as a
sample of urine
● Obtain CBC, hemoglobin and hematocrit, serum
electrolytes, and fetal fibronectin as ordered for
laboratory studies
● Assess for contraindications to drug therapy e.g.
tocolytics (magnesium sulfate) such as: hypertension,
hemorrhage, cardiac disease, hypersensitivity to
tocolytics, advanced cervical dilation, fetal demise,
chorioamnionitis, non-reassuring FHR
● Assess for signs and symptoms of drug toxicity such
as: Decreased DTR, Muscles flaccidity, CNS
depression, Decreased respiratory rate, Decreased
renal function.
● Have antidote ready at the bedside (calcium gluconate)
● Assess patient’s anxiety level and any possible
feelings of guilt related to the cause of preterm labor
● Prepare for C-section
C. Client education
● Educate patient about preterm labor and birth (esp.
how to identify warning signs)
● Instruct women to eat nutritious foods, remain well-
hydrated (8-10 glasses a day), and limit strenuous
activities.
● Avoid activities that could stimulate labor such as
nipple stimulation
● Instruct patient to contact the physician immediately if
signs of ruptured membranes or infection occurs
● Educate patient on the importance of prenatal care.
● Instruct patient that if uterine contractions occur:
empty the bladder, lie on the left side, increase fluid
intake, and contact healthcare provider
● Instruct patient to maintain good perineal care and
avoid douching
 Nursing Care Plan with Two Nursing Diagnoses

NURSING CARE PLAN FOR THE FAMILY EXPERIENCING PRETERM LABOR

NURSING GOAL/OBJECTIVES INTERVENTIONS RATIONALE OUTCOME/EVALUATION

DIAGNOSIS

Risk for maternal and Within our 5 hours of Independent: Independent: After 5 hours of nursing care, the risk for
fetal injury r/t preterm nursing care, the risk for maternal and fetal injury has been
labor and tocolytic maternal and fetal injury eliminated while preterm labor is halted as
therapy will be eliminated while 1. Assess patient’s 1. A patient that is evidenced by:
preterm will be halted as knowledge well-informed
evidenced by:  regarding will be more
preterm labor willing to  Uterine contractions stopped after
and birth participate in the tocolytic therapy
 Uterine process
contractions will
stop after tocolytic  Maternal and fetal vital signs
therapy 2. Obtain baseline 2. Assessment is remained within normal parameters
data and history important as it
of events provides a
 Maternal and fetal leading up to baseline for  Patient did not manifest any signs
vital signs will the beginning future and symptoms of the adverse effects
remain within of labor comparisons of tocolytics
normal parameters

3. Monitor uterine 3. To provide  FHR remained within acceptable

 Patient will not contractions for baseline data for parameters
manifest any signs duration, future
and symptoms of strength and comparisons
the adverse effects frequency
of tocolytics
 4. Continue 4. Continuous
 FHR will remain external fetal monitoring
within acceptable monitoring provides updates
parameters on fetal well-
being

5. Provide
reassurance to 5. Reassurance
the client while helps in calming
also educating the patient.
her on the Education on
potential potential
complications complications
helps in
preparing the
client for the
6. Monitor I&O worst case
hourly scenario
  
6. I&O ensures
interventions for
adequate
hydration. A risk
of tocolytics
include
pulmonary
edema. A urine
output of 30cc/hr
is important to
7. Stress the make sure that
importance of kidneys are
left-side lying functioning well
 position and since magnesium
bed rest; limit sulfate is
physical excreted in the
activities kidneys

7. Bed rest relieved

8. Have antidote pressure of the
ready at fetus on the
bedside (if cervix while left-
MgSO4 is side lying
administered) enhances uterine
perfusion

9. Educate client
on the side 8. Calcium
effects and gluconate is the
benefits of each antidote for
drug as well as magnesium
stressing the sulfate toxicity
importance of
taking the
medications on
time 9. Allows the
patient to report
to the healthcare
provider if any
10. Teach patient to unwanted effects
recognize are felt. Stressing
warning signs the importance of
of preterm taking the
labor and when medications
 to call the allows patient to
healthcare adhere to the
provider regimen

10. So patient will

11. Assess for not delay in
magnesium seeking medical
sulfate toxicity treatment
especially
DTRs and signs
of pulmonary
edema (such as
angina and 11. To ensure safety
SOB) of the patient
when
Dependent: administering
tocolytics.
Pulmonary
1. Obtain urine edema is a
sample, complication of
cervical and the therapy
vaginal
cultures, and
fetal fibronectin
as ordered Dependent: 

1. Urine, vaginal
and cervical
cultures rule out
the presence of
infection, if it is
2. Initiate IV the cause for
therapy preterm labor.
 Fetal fibronectin
helps predict
whether labor
will continue or
not
3. Administer
tocolytics
(terbutaline, 2. To ensure that
magnesium the client is well-
sulfate) hydrated.
Dehydration
increases the
likelihood of
4. Administer preterm labor
betamethasone

3. To halt uterine
contractions and
5. Administer delay labor
antibiotics 

4. To prevent RDS
and aid in fetal
lung maturity

5. Only done if an
infection is ruled
out
 NURSING GOAL/OBJECTIVES INTERVENTIONS RATIONALE OUTCOME/EVALUATION
DIAGNOSIS

Deficient diversional Within our 5 hours of
activity r/t bed rest as nursing care, the patient
manifested by physical will engage in
limitations appropriate diversional
activities with the help of
the nurse as evidenced
by:
 Identify activities
that are
appropriate to
her condition or
status.
Independent: Independent: After 5 hours of nursing care, the patient
has engaged in appropriate
diversional activities with the help
1. Assess the 1. It will determine of the nurse as evidenced by:
patient by taking the patient’s
his/her vital signs ability to
( BP, perform a certain
temperature, activity. It will
Respiratory rate, help the nurse to
pulse rate) proceed or not  Identified activities that are
with such appropriate to her condition or
activity. status

 Verbalization of 2. It provides  Verbalized understanding of

2. Assess the baseline data
importance of importance of bed rest
patient’s mental, which will
bed rest physical, determine the
emotional, and patient’s
 Verbalization of environmental readiness to  Verbalized that she enjoyed the
enjoyment of status engage in a leisure activities such as watching
leisure activities
particular tv, listening to music etc.
such as watching
activity
tv, listening to
music etc. 3. Assess for
evidence of the 3. These are
patient having an indicators of
 Maternal and boredom.
Fetal VS are interest in  Maternal and Fetal VS remained at
something to normal parameters
within normal
parameters read or do,
 daytime napping,
and expressed
inability to do
leisure activities
due to
hospitalization.

4. Activity
4. Assess the tolerance will
activity tolerance determine the
of the patient. duration of
activity patients
can participate in
within limits of
their illness/
status.

5. These activities
5. Provide low-level promote mental
activities to the stimulation.
patient’s Examples
tolerance. include access to
WiFi, iPods,
iPads, iPhones,
laptop
computers,
Kindles, and Get
Well Network.
Offering books
or magazines
related to the
patient’s
recreational or
 other interests,
watch television,
and providing
writing
implements for
brief intervals of
activity are other
alternative
actions.

6. It will signal the

6. Let the patient nurse when an
verbalize what activity should
she feels during be stopped or
activity continued so as
to prevent
exhaustion for
the patient.
7. Allow woman to 7. Provision of
express her clear information
concerns, guilt, can help the
and fears and client understand
provide updates what is currently
regarding happening.
maternal and Allowing her to
fetal status express her
feelings helps to
relieve her
bottled-up
feelings
8. Educate the 8. Educate the
 woman on the woman on the
importance of importance of
bed rest and why bed rest and why
she is advised to she is advised to
limit physical limit physical
activities activities

9. Provide 9. Physical activity

uninterrupted may trigger
periods for rest uterine
and sleep contractions

10. Recheck vital 10. To have a

signs after an comparison on
activity the baseline data
gathered before
an activity.

Other Possible Nursing DX:

1. Situational low self-esteem r/t feelings of responsibility for preterm labor

2. Activity intolerance r/t prolonged physical activity and stress
3. Risk for poisoning dose-related and toxic side effects of tocolytics
4. Acute pain r/t muscle contraction
6. Deficient knowledge r/t misinterpretation or lack of information
References:

Lippincott Williams & Wilkins (2011). Health Assessment: Made Incredibly Visual. 2nd Edition. Wolters Kluwer

Sillbert-Flagg, J. & Pilliteri, A. (2018). Maternal and child health nursing: Care of the childbearing & childrearing family. 8th
edition. Philippines: Wolters Kluwer
VeryWell Family. (n.d.). 11 Premature Birth Risk Factors (2020). Retrieved June 30, 2020, from
https://www.verywellfamily.com/risks-factors-for-premature-birth-2748463

Ward, S. & Hisley, S. (2016). Maternal-child nursing care: Optimizing outcomes for mothers, children, & families. Philadelphia:
FA Davis Company

World Health Organization. (n.d.). Preterm Birth. Retrieved February 19, 2018, from https://www.who.int/news-room/fact-
sheets/detail/preterm-birth#:~:text=There%20are%20sub-categories%20of,(32%20to%2037%20weeks).

ER, A. (2017, December 28). Deficient Diversional Activity - Nursing Diagnosis & Care Plan. Health Conditions. https://health-
conditions.com/deficient-diversional-activity-ncp-nd/.

Martin, P. B. (2019, April 3). 8 Prolonged Bed Rest Nursing Care Plans. Nurseslabs. https://nurseslabs.com/prolonged-bed-rest-

nursing-care-plans/#deficient-diversional-activity