Preterm Labor for Certified Emergency Nursing (CEN)
Included In This Lesson
Outline
Preterm Labor
Definition/Etiology:
False labor is contractions that do not result in cervical change.
True labor:
- Contractions >8/hour PLUS
- Cervical dilation >3 cm OR
- Cervical length <2 cm on transvaginal ultrasound OR
- Cervical length 2-3 cm and positive fetal fibronectin (swab collection from cervix)
Gestational age >34 weeks: just let them deliver
Gestational age 20-34 weeks:
- Steroids IV given to mom to protect neonate against mortality
- Tocolytics for up to 48 hours to delay birth (Indomethacin, Nifedipine)
- Antibiotics for prophylaxis against early-onset neonatal group B streptococcal (GBS) infection
- Magnesium sulfate IV for fetal neuroprotection if <32 wks
Gestational age 20-22 weeks is considered the earliest possible time for tocolysis, and is generally only attempted if there is an acute issue like appendicitis or pyelonephritis causing preterm labor which is curable and unlikely to cause recurrent preterm labor.
Pathophysiology:
Preterm labor is usually precipitated by:
- Pathological uterine distention
- Placental abruption
- Exaggerated inflammatory response to altered genital tract microbiome / infection
- Stress-induced premature activation of the maternal or fetal hypothalamic-pituitary-adrenal axis, leading to hormonal changes
Can also be precipitated by:
- Acute abdomen (appendicitis, bowel obstruction, cholecystitis)
- Pyelonephritis
- Placental abruption
- Pneumonia
- Thyroid storm
- Premature rupture of membranes
Clinical Presentation:
- Menstrual-like cramping
- Mild, irregular contractions
- Low back ache
- Pressure in vagina and pelvis
- Vaginal discharge of mucus, clear, or slightly bloody
- Spotting, light bleeding
True labor is accompanied by cervical changes over hours:
- Dilation (>3cm supports actual preterm labor)
- Effacement (thinning and shortening)
- Softening
- Anterior position
Collaborative Management:
Transvaginal ultrasound:
- Can determine if cervix is insufficient and membranes are prolapsing
- Cervix length <3cm increases suspicion of preterm labor
Obstetric ultrasound:
- Cervical length
- Fetal position
- Placental abnormalities
- Fetal abnormalities
- Fetal weight
Labs:
- Urine culture
- Rectovaginal group B streptococcal (GBS) culture
- Gonorrhea, chlamydia, syphilis testing PRN
Evaluation | Patient Monitoring | Education:
- Fetal heart rate monitoring
- Frequent maternal vitals
- May need to transfer to a facility with a NICU
- Monitor timing of contractions
Linchpins: (Key Points)
- Gestational age 22-34 weeks is considered the timeline in which interventions can promote maternal/fetal safety and provide benefit.
- Coordinate transfer to a facility with a NICU if indicated.
- Collaborate with labor & delivery colleagues.
- Monitor vitals for bleeding and placental abruption.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Lockwood, C. J. (2022, September 23). Preterm labor: Clinical findings, diagnostic evaluation, and initial treatment. UpToDate. https://www.uptodate.com/contents/preterm-labor-clinical-findings-diagnostic-evaluation-and-initial-treatment
- Lockwood, C. J. (2022, May 16). Spontaneous preterm birth pathogenesis. UpToDate. https://www.uptodate.com/contents/spontaneous-preterm-birth-pathogenesis
- Simhan, H. N. (2022, October 24). Inhibition of acute preterm labor. UpToDate. https://www.uptodate.com/contents/inhibition-of-acute-preterm-labor
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System