PRETERM LABOR

1. What is late deceleration? What is the nursing management would you

recommend?
 Late deceleration in fetal heart rate monitoring, a transient decrease in
heart rate occurring at or after the peak of a uterine contraction and
resulting from fetal hypoxia.
Nursing Interventions
If a patient develops a nonreassuring deceleration pattern such as late or
variable decelerations:
• Notify the healthcare provider about the pattern and obtain further orders,
making sure to document all interventions and their effects on the FHR
pattern.
• Reduce or discontinue oxytocin as dictated by the facility’s protocol, if it is
being administered.
• Provide reassurance that interventions are being done to effect a pattern
change.
Additional interventions specific for a late deceleration FHR pattern would
include:
• Turning the client on her left side to increase placental perfusion
• Administering oxygen by mask to increase fetal oxygenation
• Increasing the IV fluid rate to improve intravascular volume
• Assessing client for any underlying contributing causes
• Providing reassurance that interventions are to effect pattern change
Specific interventions for a variable deceleration FHR pattern would include:
• Changing the client’s position to relieve compression on the cord
• Providing reassurance that interventions are to effect pattern change
• Giving oxygen and IV fluids as ordered
2. What orders can you anticipate for patients?
 Give oxygen if indicated.
 Report findings to physician/CNM and document in chart.
 Provide explanation to woman and partner.
 Monitor for further FHR changes.
 Maintain maternal position on left side.
 Maintain good hydration with IV fluids (normal saline or lactated Ringer’s).
 Discontinue oxytocin if it is being administered and late decelerations
persist despite other interventions.
 Administer oxygen by face mask at 7–10 L/min.
 Monitor maternal blood pressure and pulse for signs of hypotension;
possibly increase flow rate of IV fluids to treat hypotension.
 Follow physician’s orders for treatment for hypotension if present.
 Increase IV fluids to maintain volume and hydration (normal saline or
lactated Ringer’s).
 Assess labor progress (dilatation and station).
 Assist physician with fetal blood sampling: If pH stays above 7.25, physician
will continue monitoring and resample; if pH shows downward trend
(between 7.25 and 7.20) or is below 7.20, prepare for birth by most
expeditious means.
3. List the dangers of elective induction of labor
 Failed induction. About 75 percent of first-time mothers who are induced
will have a successful vaginal delivery. This means that about 25 percent of
these women, who often start with an unripened cervix, might need a C-
section. Your health care provider will discuss with you the possibility of a
need for a C-section.
 Low heart rate. The medications used to induce labor — oxytocin or a
prostaglandin — might cause abnormal or excessive contractions, which
can diminish your baby's oxygen supply and lower your baby's heart rate.
 Infection. Some methods of labor induction, such as rupturing your
membranes, might increase the risk of infection for both mother and baby.
Prolonged membrane rupture increases the risk of an infection.
  Uterine rupture. This is a rare but serious complication in which your uterus
tears open along the scar line from a prior C-section or major uterine
surgery. Very rarely, uterine rupture can also occur in women who had
never had previous uterine surgery. An emergency C-section is needed to
prevent life-threatening complications. Your uterus might need to be
removed.
 Bleeding after delivery. Labor induction increases the risk that your uterine
muscles won't properly contract after you give birth (uterine atony), which
can lead to serious bleeding after delivery.
4. How does APGAR score differ from the preterm baby to the full term baby?
 An Apgar score of 7 to 10 is considered good. A baby who receives a score
of 4 to 6 requires assistance, and a baby with a score of 0 to 3 needs full
resuscitation. Premature babies may receive lower Apgar scores simply
because they are somewhat immature and unable to respond with loud
crying and because their muscle tone is often poor.
 The Apgar score is well-characterized in full-term infants but not in
premature infants.
5. Can this situation be avoided?
Prevention of Preterm Labor:
Though there are high end treatments to treat premature babies, there are
medical interventions to prevent preterm labor. There are ways to hold the labor
until your baby is completely ready.
1. 18 months gap between pregnancies:
The risk of preterm labor reduces if you wait for 18 months from the previous
pregnancy. The period is between the last birth and the next conception.
2. Check with your doctor:
Getting regular and early prenatal care can help your healthcare provider treat
any risk factors and makes sure you will have a healthy pregnancy.
3. Control certain lifestyle factors:
Avoid smoking, boozing and taking drugs as they can cause preterm labor.
4. Check your weight:
Gaining excess weight will increase the chances of preeclampsia and gestational
diabetes, both of which can cause preterm labor. Too little weight is also risky.
The correct weight will improve the likelihood of a full-term.
5. Prenatal vitamins:
Taking a prenatal supplement will enhance your overall health. Research states
that folic acid supplements will reduce the risk of placental abruption that is
responsible for early labor.
6. Eat well:
Having a healthy balanced diet will not only give you a healthy baby but also helps
you deliver at the right time. Intake of foods rich in omega 3 fatty acids (walnuts,
flax seeds, salmon, DHA eggs) is known to reduce the risk of preterm labor.
Vitamin C foods (berries, citrus, bell peppers) and calcium-rich foods also help.
7. Eat at frequent intervals:
Pregnant women who eat at least five meals a day (five smaller, or three meals
and two snacks) are at a lower risk of premature labor.
8. Hydrate:
Drink as much water as you can to keep yourself hydrated.
9. Dental care:
Preventing gum diseases is one of the ways to avoid preterm labor. You need to
check with your dentist, and brush and floss regularly.
10. Do not hold urine:
Holding your urine, can cause bladder inflammation, and irritates the uterus
leading to contractions. It can also lead to urinary infections, which are also the
causes of preterm contractions.
11. Get the flu shot:
It can reduce the risk of preterm labor. Flu is a serious problem that can affect
your baby growth. It can cause preterm labor and birth defects in babies.
12. Rest and Relax:
Get rid of stress, depression and anxiety since psychological factors can affect
your baby’s growth. If you remain anxious for a long period, your health gets
affected and as a result, your baby may be born with low weight. Balance your life
with exercise, diet, work and rest for physical and mental health.
13. Practice polar bear position:
Experts say that practicing polar bear pose for 15 minutes, four times a day will
take off the pressure from the cervix. By doing so, the baby moves away from the
cervix and goes closer to mom’s lungs. This way, the baby will be comfortable,
and it prevents preterm labor. It also eases labor.
6. What is the rationale of taking the baby to NICU? Which other babies need
special care?
 Premature babies are not fully equipped to deal with life in our world.
Their little bodies still have underdeveloped parts that include the lungs,
digestive system, immune system and skin. Thankfully, medical technology
has made it possible for preemies to survive the first few days, weeks or
months of life until they are strong enough to make it on their own.
Babies may be sent to the NICU if:
 they're born prematurely
 difficulties occur during their deliveries
 they show signs of a problem in the first few days of life
7. What are the nursing management after a C section?
 The postpartal care period of a woman who has undergone emergent
cesarean birth is divided into two: immediate recovery period and
extended postpartal period.
 After surgery, the woman would be transferred by stretcher to the
postanesthesia care unit.
 If spinal anesthesia was used, the woman’s legs are fully anesthetized so
she cannot move them.
  Pain control is a major problem after birth because it was so intense that it
interfered with the woman’s ability to move and deep breathe.
 This may lead to complications such as pneumonia or thrombophlebitis.
 Use a pain rating scale to allow a woman to rate her pain.
 Some women may need patient controlled analgesia or continued epidural
injections to relieve the pain.
 Supplement the analgesics with comfort measures such as change in
position or straightening of bed linen.
 Instruct the woman to ambulate because this is the most effective method
to relieve gas pain.
 Inform the woman that she should not take acetylsalicylic acid or aspirin
because this can interfere with blood clotting and healing.
 Instruct the woman to place a pillow on her lap as she feeds the infant to
deflect the weight of the infant from the suture line and lessen the pain.
 Football hold for breast feeding is a way to keep the infant’s weight off the
mother’s incision.
 During the extended postpartal period, the woman most commonly
experiences gastrointestinal function interference.
 Note carefully the woman’s first bowel movement after surgery because if
no bowel movement has been observed, the physician may order a stool
softener, a suppository, or an enema to facilitate stool evacuation.
 Teach the woman to eat a diet high in roughage and fluid and to attempt to
move her bowels at least every other day to avoid constipation.
 Incisional pain may interfere with the woman’s ability to use her abdominal
muscles effectively, so the physician may prescribe a stool softener.
 Caution the woman not to strain to pass stools because this puts pressure
on their incision.
 Advice the woman to keep their water pitcher full as a reminder for her to
drink fluids.
 Reassure the woman that it is normal not to have bowel movements for 3
to 4 days postoperatively, especially if there is enema administered before
surgery.
PLACENTA PREVIA
1. What is the nursing diagnosis of this case?
 Active blood loss or hemorrhage due to disrupted placental implantation
during pregnancy
2. Enumerate the different diagnostic procedures to be done to the patient.
 Diagnosis might require a combination of abdominal ultrasound and
transvaginal ultrasound, which is done with a wandlike device placed inside
your vagina. Your health care provider will take care with the position of
the transducer in your vagina so as not to disrupt the placenta or cause
bleeding.
3. Why does bleeding happen? Describe the bleeding of PP?
 Bleeding often happens as the lower part of the uterus thins during the
third trimester of pregnancy. This causes the area of the placenta over the
cervix to bleed.
 The most common symptom of placenta previa is bright red, painless
bleeding from the vagina. This is most common in the third trimester of
pregnancy.
4. What are the complications of PP?
The greatest risk of placenta previa is too much bleeding (hemorrhage). The risk
of bleeding is higher if a lot of the placenta covers the cervix. Other complications
include:
 Placenta doesn't attach to the uterus as it should
 Slowed growth of your baby in the womb
 Preterm birth. This means before 37 weeks of pregnancy.
 Birth defects
5. Differentiate placenta previa vs abruption placenta
Category Placenta Previa Abruptio Placenta
Problem Low implantation of the Premature separation of
placenta the placenta
Incidence It occurs in It occurs in about 10% of
approximately 5 in every pregnancies and is the
1000 pregnancies most common cause of
perinatal death.
Bleeding Always present May or may not be
present
Color of blood in Bright red Dark red
bleeding episodes
Pain during bleeding Painless Sharp, stabbing pain
6. What would be your medical management (3) and nursing intervention (5)
before delivery?
BEFORE DELIVERY
 Bed rest (side lying position)
 NO vaginal or pelvic examinations
 Assessment of FHR and bleeding
 Lateral position
 No vaginal or pelvic examinations
 Termination of pregnancy
MEDICAL MANAGEMENT
 Women with placenta previa who experience heavy bleeding may require
blood transfusions in order to replace lost blood. Intravenous fluids are
usually given. In cases where the patient is contracting, tocolytic drugs
(medications that slow down or inhibit labor) are given. Magnesium sulfate
and terbutaline (Brethine) are examples of such medications.
 A woman with placenta previa may be given corticosteroid medications to
accelerate fetal lung maturity (when the infant is premature) prior to
Cesarean delivery (C-section).