Nursing Care :

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Nursing Care

• for
• Pregnants Woman
• with Preterm Labor Pain .

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By
Thanima Sungsuwan Hatyai Hospital
Songkhla 1998
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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 .

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Preterm Labor Pain

• Mortality or Morbidity 75 - 85
• Low Birth Weight
• Respiratory Distress Syndrome !

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Etiology

• Decrease of Progesterone during Chorion
  Decidua to activated arachidonic acid goes to
  Prostaglandins platelet - activating factors
  monokines stimulated to Labor !

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Risk Factors !

• Obstetrics Hisrory
• Medical History
• Sociodemographic
• Non cause 50

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Obstetric History

• Multifetal gestation
• Abnormal or incompetent cervix
• Uterine anormalies
• Excessive uterine activity
• Incompetent cervix

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Medical History

• Anemia
• Hypertension
• Pyelonephritis and UTI
• Sexually transmitted disease
• Smoking other substance abuse

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Sociodemographic

• Age less than 20 or more 35 yrs.
• Non - White
• Low socioeconomic status
• Poor weight gain
• Poor Prenatal Care
• Psychological Stress

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Initial Evaluation

• Is Preterm labor Present ?
• Symptoms
• Signs

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Symptoms

• Persistant contractions,
• both painful painless
• Spotting
• Menstrual - like cramps or pressure
• An increase in vaginal discharge

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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

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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

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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

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Contraindication

• Active phase Cx gt 4 cm.
• Premature Rupture of Membrane
• Severe Complication
• Maternal Heart Disease
• Contraindacation of Sympathomimetic drugs

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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

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Complication

• Fetal Heart Rate lt 120 / min or gt 140 / min
  Fetal distress !
• Ps gt 20 mmHg , Pd gt 10 mmHg
• Prolonged ( gt 24 hr ) infusion of parenteral
  tocolytics.

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Nursing Guide !

• Before Nursing Care
• During Nursing Care
• After Nursing Care

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Before Nursing Care

• Initial assessment to determine whether genuine
  Preterm Labor consider specific management
  strategies .
• Search for a cause / precipitating factors .

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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 !

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After Nursing Care

• Closed Observation
• Side Effects
• Discharge Planning
• Home Care Management
• Involvement of Husband or significant other

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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

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Questions or Suggestion
feel free !

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• E- mail thanima_at_usa.net
• ICQ 5403640
• Thank you !