Preterm labor is regular uterine contractions after 20 weeks and before 37 weeks of pregnancy that cause cervical change or regular contractions with an initial presentation with cervical dilation of 2 cm or more. Preterm birth is birth after 20 weeks gestation and before 37 completed weeks gestation. Preterm birth affects over 15 million babies and their mothers and families worldwide. In 2019, in the United States, the preterm birth rate rose for the fifth year in a row to 10.23% from 10.02% in 2018, and the highest level was reported in more than a decade. Preterm babies are at risk for a multitude of complications that account for 36.3% of reported infant deaths (Griggs et al., 2020).
Nursing Care Plans
One goal of Healthy People 2030 is that 90% of all women will receive prenatal care starting in the first trimester. Early prenatal care allows clients to be educated concerning signs of preterm labor so that interventions can occur early. Management involves suppression of preterm labor when tests show immature fetal pulmonary development, cervical dilation is less than 2 cm and the absence of factors that contraindicate continuation of pregnancy.
The nurse should monitor closely for signs of fetal or maternal distress, and provide comprehensive supportive care for clients in preterm labor.
Here are 7 nursing care plans and nursing diagnoses for preterm labor:
- Activity Intolerance
- Risk for Injury (Maternal)
- Risk for Injury (Fetal)
- Acute Pain
- Deficient Knowledge
- Situational Low Self-Esteem
Anxiety has both short-term and long-term effects on maternal, pregnancy and fetal outcomes. With increased anxiety, the cortisol hormone appears to cross the placenta and affect the fetus, disrupting ongoing processes, affecting the limbic and prefrontal cortex, and releasing chemicals such as acetylcholine and adrenaline in the mother’s body. These chemicals pass through the placenta into the fetus and have detrimental effects on proper fetal growth. Anxiety can also lead to inappropriate maternal responses to the fetus during pregnancy and decrease the ability to play a motherly role. Accordingly, it is essential to find some efficient therapeutic plans to reduce maternal anxiety during pregnancy (Bazrafshan et al., 2020).
May be related to
- Situational crisis
- Perceived or actual threats to self and fetus
Possibly evidenced by
- Increasing tension
- Sympathetic stimulation
- The client will verbalize understanding of the individual situation and possible outcomes.
- The client will report anxiety is reduced and/or manageable.
- The client will appear relaxed; with maternal vital signs within normal limits.
Nursing Assessment and Rationales
1. Assess support systems available to the client or couple, whether the client remains hospitalized or is to return home to await delivery.
The assistance and caring of significant others, including caregivers, are extremely important during this time of uncertainty and stress. If the client is to return home, additional support will be required to meet self-care needs and homemaker activities as well as child care, as appropriate. Fostering an environment of intentional support and empathetic dialogue can build mutual trust, and assist the nurse in understanding the client’s perceptions of their experiences of preterm labor (Griggs et al., 2020).
2. Monitor maternal signs of preterm labor.
The nurse should be aware of the symptoms of preterm labor because they may occur in any pregnant woman, with or without risk factors. Common symptoms of early preterm labor are persistent, dull, and low backache; vaginal spotting; a feeling of pelvic pressure or abdominal tightening; menstrual-like cramping; increased vaginal discharge; uterine contractions; and intestinal cramping.
3. Continuously monitor maternal and fetal vitals.
Monitor the client’s vital signs and neurologic status closely. Respirations should be at least 12 breaths/min. FHR should be at 120-160 beats/min. Decreasing FHR can indicate fetal distress.
Nursing Interventions and Rationales
1. Explain the procedures, nursing interventions, and treatment regimen.
Information and knowledge of the reasons for these activities can decrease fear of the unknown. Clients desire honest and complete information, an opportunity to answer questions, and an explanation of medical terms, procedures, and expectations of care conferred in the language they understand and at the appropriate literacy level (Griggs et al., 2020).
2. Answer questions honestly, especially information regarding contraction patterns and fetal status.
The provision of clear information can help the client or couple understand what is happening and may reduce anxiety. The healthcare team should avoid using terms with negative connotations such as fetus, nonviable, incompatible with life, spontaneous abortion, and miscarriage as these terms might trivialize or dehumanize the client’s experiences (Griggs et al., 2020).
3. Encourage the use of relaxation techniques.
Application of relaxation exercises among 60 hospitalized primiparous pregnant clients at risk of preterm labor could significantly lessen the pregnancy anxiety level. The relaxation exercises were trained through the educational booklet and CD, and face-to-face and question-and-answer communications (Bazrafshan et al., 2020).
4. Encourage verbalization of fears or concerns.
The nurse should assess the client’s views of their pregnancy at the time of preterm labor. Incorporating this type of assessment will help provide individualized empathetic care (Griggs et al., 2020). Saisto et al., (2006) found that support interventions for pregnant women, which included discussions of concerns and feelings about birth, taught positive birth imagery (Kao et al., 2017).
5. Encourage the client to engage in complementary and alternative medicine (CAM).
Mind-body interventions, which constitute a major portion of the overall use of CAM, can provide support to alleviate or reduce feelings of stress. These include autogenic training, hypnotherapy, imagery, prayer, auto-suggestion, tai-chi, and yoga. These complementary therapies can have physiological as well as psychological benefits, which may consequently reduce the physio-pathological impact of stress (Kao et al., 2017).
6. Provide relaxation-focused nursing care to the client.
Relaxation-focused nursing care (RFNC) was created using Hypnobirthing and the Transactional Model. Hypnobirthing philosophy aims to reduce stress, fear, and tension in the pregnant woman by creating positive thoughts and emotions using the laws of mind. The Transactional Model defines stress as a special relationship between a person and the environment. It identifies the stressors of the person and indicates how they should be handled. RFNC is formed by using these two models and comprises positive language, a positive environment, and reducing stressors. RFNC may reduce the client’s state of anxiety, lower cortisol levels, and thus prevent preterm labor by lowering the severity of uterine contractions (Özberk et al., 2020).
7. Arrange psychotherapy sessions for the client as indicated.
The results of a study indicated that adding six sessions of individual face-to-face psychotherapy, one hour per day for six consecutive days, to inpatient medical care of clients successfully treated for preterm labor, reduced anxiety, and pregnancy stress, while enhancing their perceived control. Psychotherapy involves supportive elements focusing on responsiveness to needs for helping others through the insight obtained via empathic immersion in the therapy. This approach focuses on the client’s emotions (Mirtabar et al., 2020).
Recommended books and resources for your NCLEX success:
Saunders Comprehensive Review for the NCLEX-RN
Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.
Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items
Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.
Saunders Q & A Review for the NCLEX-RN® Examination
This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.
NCLEX-RN Prep Plus by Kaplan
The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.
Illustrated Study Guide for the NCLEX-RN® Exam
The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.
NCLEX RN Examination Prep Flashcards (2023 Edition)
NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.
Other care plans related to the care of the pregnant mother and her baby:
- Abortion (Termination of Pregnancy) | 8 Care Plans
- Cervical Insufficiency (Premature Dilation of the Cervix) | 4 Care Plans
- Cesarean Birth | 11 Care Plans
- Cleft Palate and Cleft Lip | 7 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans
- Hyperbilirubinemia (Jaundice) | 4 Care Plans
- Labor Stages, Induced, Augmented, Dysfunctional, Precipitous Labor | 45 Care Plans
- Neonatal Sepsis | 8 Care Plans
- Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
- Placental Abruption | 4 Care Plans
- Placenta Previa | 4 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 5 Care Plans
- Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
- Preeclampsia and Gestational Hypertension | 6 Care Plans
- Prenatal Infection | 5 Care Plans
- Preterm Labor | 7 Care Plans
- Puerperal & Postpartum Infections | 5 Care Plans
- Substance Abuse in Pregnancy | 9 Care Plans
Recommended journals, books, and other interesting materials to help you learn more about preterm labor nursing care plans and nursing diagnosis:
- Ajib, F. A., & Childress, J. M. (2021, November 14). Magnesium Toxicity – StatPearls. NCBI. Retrieved April 9, 2022.
- Bazrafshan, S., Kheirkhah, M., Inanlou, M., & Rasouli, M. (2020, August). Controlling the anxiety in Iranian pregnant women at risk of preterm labor by undergoing the counseling group intervention. Journal of Family Medicine and Primary Care, 9(8), 4016-4025.
- Bushra, R., Aslam, N., & Yar Khan, A. (2011, March). Food-Drug Interactions. Oman Medical Journal, 26(2), 77-83.
- Eggermont, K., Beeckman, D., Van Hecke, A., Delbaere, I., & Verhaeghe, S. (2016). Needs of fathers during labor and childbirth: A cross-sectional study. Women and Birth.
- Griggs, K. M., Hrelic, D. A., Williams, N., McEwen-Campbell, M., & Cypher, R. (2020, November/December). Preterm Labor and Birth A Clinical Review. The American Journal of Maternal/Child Nursing, 45(6), 328-337.
- Hicks, M. A., & Tyagi, A. (2022, January 31). Magnesium Sulfate – StatPearls. NCBI. Retrieved April 9, 2022.
- Janighorban, M., Heidari, Z., Dadkhah, A., & Mohammadi, F. (2018, January). Women’s Needs on Bed Rest during High-risk pregnancy and Postpartum Period: A Qualitative Study. Journal of Midwifery and Reproductive Health, 6(3), 1327-1335. https://doi.org/10.22038/jmrh.2018.28162.1304
- Junge, C., von Soest, T., Weidner, K., Seidler, A., Eberhard-Gran, M., & Garthus-Niegel, S. (2018, February 19). Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal stud. Birth, 45, 469-477.
- Kao, M.-H., Hsu, P.-F., Tien, S.-F., & Chen, C.-P. (2017, November 27). Effects of Support Interventions in Women Hospitalized With Preterm Labor. Clinical Nursing Research, 1-18.
- Klawetter, S., Greenfield, J. C., Speer, S. R., Brown, K., & Hwang, S. S. (2019, May 5). An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents. AIMS Public Health, 6(2), 160-183.
- Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing. Elsevier.
- Maloni, J. A. (2010, August 26). Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth. Biological Research for Nursing, 12(2), 106-124.
- Mirtabar, S. M., Faramarzi, M., Khazaei, R., & Dini, M. (2020, August 10). Efficacy of psychotherapy for anxiety reduction in hospital management of women successfully treated for preterm labor: a randomized controlled trial. Women & Health, 60(10), 1151-1163.
- Oktriani, T., Ermawati, & Bahctiar, H. (2018). The Difference Of Pain Labour Level With Counter Pressure And Abdominal Lifting On Primigravida In Active Phase Of First Stage Labor. Journal of Midwifery, 3(2).
- Özberk, H., Mete, S., & Bektas, M. (2020, July 17). Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor. Biological Research for Nursing.
- Reddy, R. (2022, February 2). Calcium Channel Blocker Toxicity – StatPearls. NCBI. Retrieved April 9, 2022.
- Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Wolters Kluwer.
- Sivaramakrishnan, G., & Sridharan, K. (2016, May 13). Adverse drug reactions in the oral cavity. Drug and Therapy Perspectives, 32, 297-303.
- Soneji, S., & Beltran-Sanchez, H. (2019, April 19). Association of Maternal Cigarette Smoking and Smoking Cessation With Preterm Birth. JAMA Network Open, 2(4).
- Surbek, D., Drack, G., Irion, O., Nelle, M., Huang, D., & Hoesli, I. (2012, April 29). Antenatal corticosteroids for fetal lung maturation in threatened preterm delivery: indications and administration. Archives of Gynecology and Obstetrics, 286, 277-281.
- Walsh, C. A. (2020). Maternal activity restriction to reduce preterm birth: Time to put this fallacy to bed. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 1-3.
- Xiao, C., Gangal, M., & Abenhaim, H. A. (2014, February 25). Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births. Journal of Perinatal Medicine, 42(5), 585-589.
- Zeraati, M. R., & Naghibi, T. (2019, July 10). Acute Pulmonary Edema Following Administration of Magnesium Sulfate in a Pregnant Patient. Journal of Advances in Medical and Biomedical Research, 27(124), 43-46.
- Zizzo, A. R., Hvidman, L., Salvig, J. D., Holst, L., Kyng, M., & Petersen, O. B. (2021, December 7). Home management by remote self-monitoring in intermediate- and high-risk pregnancies: A retrospective study of 400 consecutive women. Acta Obstetricia et Gynecologica Scandinavica, 101(1), 135-144.
Reviewed and updated by M. Belleza, R.N.