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1、Nursing Care for Women with Preterm Labor, Premature Rupture of Membranes, and Fetal Distress,徐丽华 上海交通大学护理学院,Learning Objectives,Define the key terms: preterm labor, premature rupture of membranes, fetal distress Understand the difference in perterm birth and low birth weight Identify risks factors
2、of perterm labor Understand the current intervention to treat preterm labor Discuss the nursing care for women experienced perterm labor, perterm rupture of membranes, and fetal distress,Pertem Labor,Defination: Cervical change and uterine contractions occurring between 20 weeks an 37 weeks of pregn
3、ancy Perterm birth lead 75% of the perinatal mortality Perterm birth also is the second leading death of infants in the USA, next to CHD. (Comerford Freda, 2000),Perterm Labor and Low Birth Weight,Perterm Labor: 37 weeks of gestational age Low birth weight: weight at time of birth is less than or eq
4、ual to 2500 grams. Intrauterine growth retadation: IUGR,Risk Factors of Preterm Labor,Demographic Risks: young mother, low socioeconomic status, unmarried, low level of education Medical risk: history of preterm birth, multiple abortions, uterine anomalies, low pregnancy weight, DM, Hypertention，mul
5、tiple gestation, infection, incompetent cervix, UTI, bleeding, placenta previa or abruptio plancenta, anemia, fetal anomalies,Behavioral and Environmental Risk for Preterm Labor,Diethylstilbestrol (DES) Exposure Smoking Poor Nutrition Alcohol or other substance use, expecially cocaine Late or no pre
6、natal care Stress, uterine irritability, long working hours, inabillity to rest,Risk Factors for Perterm Labor,Bacterial Vaginosis 40 % increased risk Syphilis and gonorrhea 50% increased risk Asymptomatic bacteriuria 50% increased risk,Symptoms of Preterm Labor 20-37 weeks of gestational age,Pelvic
7、 pressure feels like the baby is pushing down Low, dull backache Menstrual-like cramps Change or increase in vaginal discharge Uterine contractions (hardness), every 10 minutes or more often with or without pain Intestinal cramping with or without diarrhea,Supression of Uterine Activity,Tocolytics T
8、herapy： Ritodrine（Yutopar） Terbutaline Magnesium Sulfate Indomethacin,Contraindications to Tocolysis,Maternal factor： Severe PIH or eclampsia Active vaginal bleedings Intrauterine infection Cardiac distress Medical or obsteric condition that contraindicates continuation of pregnancy,Contraindication
9、s to Tocolysis,Fetal Factors: Estimated gestational age 37 weeks Dilation of 4 cm Estimated weight of birth 2500 grams Fetal Demise Lethal fetal anomaly Chorioamnionitis Acute Fetal Distress Chronic IUGR,Nursing Diagnossi for Perterm Labor,Knowledge deficit related to-recognition of preterm symptoms
10、 Risk for maternal or fetal injury related to preterm labor and birth Anxiety related to perterm birth and family consequences Impaired mobility related to prescribed bed rest Anitipatory grieving related to preterm labor and birth,Nursing care for women with tocolytic therapy,Position on Lf side fo
11、r better placenta perfusion Assess blood pressure, pulse (not 120/min), and respiratory rate Assess signs of pulmonary edema (chest pain, shortness of breath, crackles, rhonchi) Assess urinary output q1h, monitor for ketonuria Limit fluid intake to 2500-3000 ml/day Provide psychosocial support and r
12、elease anxiety Monitor electrolyte, blood glucose level,Promoting Fetal Lung Maturity,Antenatal glucocorticoid therapy: betamethasone, dexamethasone Action: stimulates fetal lung maturation by promoting release of enzymes that induce production and or release of lung surfactant Nursing consideration
13、: Assess signs of infection, pulmonary edema, blood glucse level, lung sound, takes 24 hours for drug to effective, not to give women 35 weeks of pregnancy.,Health Teaching for pertem labor prevention,When perterm labor occur: Lie down on your left side for 1 hour Drink 2-3 glassess of water or juic
14、e Palaate for contractions If no contraction, assume light activity, if sysmpotm come back, need to notify health care professionals. Life style modification,Sigsn of Perterm Lobor,Uterine contractions every 5 minutes or less Vaginal bleeding Odorous vaginal discharge Fluid leaking from the vagina,P
15、remature Rupture of Membrance (PROM ) 胎膜早破,Definition: Rupture of the amniotic sac andleakage of amniotic fluid beginning at least 1 hours before the onset of labor at any gestational age.,PROM-Incidence,Preterm premature rupture of the membranes (PPROM): it is membranes rupture before 37 weeks of g
16、estation 25% of all cases of preterm labor Infection precedes PPROM Complains of sudden gush of fluid from the vagina or slow leak of fluid from the vagina.,PPROM-Infection,Infection is the serious side effect of PPROM Chorioamnionitis: intraamniotic infection of the chorion and amnion that can harm the fetus and newborn,Incidence of PPROM and Preterm Birth,3-30% of women with PPROM will have poistive amniotic fluid culture May lead to sepesis, congenital pneumonia, meningitis of the newbo
