Preterm Labor Nursing Diagnosis & Care Plan

Premature or preterm labor is described as early labor occurring before the pregnancy reaches 37 weeks. While preterm labor does not necessarily result in a preterm birth, immediate medical attention is needed to prevent complications.

If preterm labor results in preterm delivery, the baby will be born premature and may have serious health problems like underdeveloped lungs, breathing problems, cerebral palsy, and learning disabilities. 

Several factors can cause preterm labor:

Early intervention can help stop and prevent premature birth. Warning signs of preterm labor include:

  • Constant lower backache
  • Persistent and severe contractions occurring every 10 minutes or more
  • Vaginal spotting
  • Pelvic pressure 
  • Premature rupture of membranes
  • Change in vaginal discharge

Preterm labor can be diagnosed through a cervical examination. If the cervix has become effaced and dilated, the pregnant patient is in preterm labor. Other diagnostic tests conducted to confirm preterm labor include ultrasound and fetal fibronectin test. 

Nursing Process

Preterm labor does not necessarily lead to preterm birth. To prevent this, immediate interventions must be initiated. Nurses play a vital part in administering medications, monitoring the status of the mother and fetus, and providing emotional support. 

Medications like tocolytics and magnesium sulfate are prescribed to stop the contractions and delay delivery. If the labor has progressed and is imminent, corticosteroids are given to help improve fetal lung maturity. 

Anxiety

Anxiety in pregnancy is common and expected when experiencing preterm labor.

Nursing Diagnosis: Anxiety

  • Disease process
  • Situational crisis
  • A perceived threat to the fetus and self 
  • Conflict about life goals
  • Unfamiliar situation

As evidenced by:

  • Altered attention
  • Preoccupation
  • Confusion
  • Expresses tension 
  • Increased blood pressure
  • Increased heart rate
  • Crying 
  • Inability to concentrate
  • Expresses insecurity
  • Expresses distress
  • Fidgeting
  • Helplessness 

Expected outcomes:

  • The patient will demonstrate interventions that can reduce anxiety
  • The patient will verbalize understanding of the current situation and adhere to the plan of care

Assessment:

1. Assess the patient’s level of anxiety and outward expression.
Stress and anxiety cause changes in the body’s vascular system and hormone levels, potentially influencing early labor and delivery. Ask the patient how they are feeling regarding their current status. Monitor for signs of increasing distress, such as vital sign changes, restlessness, or shaking.

2. Assess for a history of mental health problems.
Stressful events can cause preterm labor. Assess for a history of anxiety, depression, or other possible psychiatric illnesses that could exacerbate the patient’s current status.

Interventions:

1. Educate the patient about the management of preterm labor.
A better understanding of what is happening and interventions performed can reduce the patient’s anxiety and promote adherence to the treatment regimen.

2. Build a therapeutic relationship.
The nurse is often a source of emotional support for the mother and can create a healthy and safe environment. Remain calm and professional to keep the patient’s anxiety low.

3. Encourage the patient to use relaxation techniques.
Relaxation can significantly reduce anxiety levels, especially for those experiencing preterm labor. Instruct on breathing techniques, and create a calming environment through soothing music, back rubs, and dim lighting.

4. Provide honest and accurate answers about the situation.
This will help the patient and family understand what is happening and significantly reduce stress and anxiety.

5. Assist the patient in planning for delivery.
Preterm labor may or may not result in delivery. Allowing the patient to be a part of the planning and providing choices (if applicable) can help prepare the patient in case delivery is imminent.


Situational Low Self-esteem

Low self-esteem may occur in response to preterm labor. The process can be a traumatic experience for the patient, with notable feelings of helplessness, fear, and guilt.

Nursing Diagnosis: Situational Low Self-esteem

  • Decrease in environmental control 
  • Difficulty accepting alteration in the perceived role
  • Powerlessness
  • Unrealistic self-expectations
  • Feeling responsible for preterm labor

As evidenced by:

  • Depressive symptoms 
  • Helplessness 
  • Expresses loneliness
  • Indecisive behavior
  • Self-negating verbalizations

Expected outcomes:

  • The patient will openly discuss any feelings of guilt or poor self-worth
  • The patient will express a positive outlook and self-appraisal by discharge

Assessment:

1. Assess for a history of preterm labor.
A history of preterm labor, especially with the most recent pregnancy, increases the risk of future preterm labor. If the patient is unaware of this, they may feel immense responsibility for causing their preterm labor.

2. Assess the patient’s self-esteem and coping skills.
Proper assessment of the patient’s self-esteem and past coping skills can help the nurse develop interventions to support the mother’s mental and emotional well-being.

Interventions:

1. Encourage the patient to verbalize feelings about the current situation.
In preterm labor, patients may blame themselves for what is happening, causing severe distress and anxiety. Encouraging the patient to verbalize feelings allows the nurse to intercept misunderstandings and discuss fact vs. emotion.

2. Provide accurate information about the condition and its management.
There are causes of preterm labor related to lifestyle factors (smoking, poor prenatal care), but many are out of one’s control, and there is no way to know the exact cause. The nurse can provide accurate information and focus on the management and delaying delivery in an attempt to guide the mother away from guilt or blame.

3. Provide reassurance during preterm labor.
Providing reassurance can help decrease stress and anxiety, promote self-esteem, and encourage coping with the current status.

4. Encourage family members to participate in the plan of care.
Having a reliable support system can strengthen and promote confidence in the patient.


Risk for Injury

Preterm labor can increase the risk of injury to the patient and baby. If delivery cannot be stopped, the preterm infant can have health complications and birth injuries. Premature babies will require special care in the neonatal intensive care unit.

Nursing Diagnosis: Risk for Injury

  • Disease process
  • Early labor and delivery 
  • Delivery of premature infant

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.

Expected outcomes:

  • The patient will adhere to the treatment regimen and reach at least 37 weeks gestation
  • The patient will deliver a preterm infant without any complications

Assessment:

1. Assess the progression of preterm labor.
Assessing cervical opening and uterine contractions can determine if interventions to prevent early delivery are possible.

2. Assess fetal heart rate and any notable changes in fetal movement.
This will help determine the fetus’s condition inside the uterus. An increase or decrease in fetal heart rate can indicate fetal distress and may require an emergency cesarean delivery.

Interventions:

1. Educate the patient about interventions that can help prevent the progression of preterm labor and early delivery.
When the patient knows and understands what is happening, she will be more likely to adhere to the interventions and treatment regimen.

2. Administer tocolytics as indicated.
Medications like magnesium sulfate and other tocolytics can help reduce uterine contractions.

3. Encourage bed rest.
If hospitalized, bed rest may be prescribed to reduce pressure on the cervix and slow preterm delivery. The mother should only get up to go to the bathroom. Blood clots are a concern with bed rest so ensure sequential compression devices are on the lower legs while in bed.

4. Administer steroid therapy as needed.
Steroids may be provided to help reduce respiratory distress syndrome, necrotizing enterocolitis, and neonatal death in premature infants, as this drug can enhance the formation of surfactant in the fetal lungs.


References

  1. Preterm Labor. Mayo Clinic. Reviewed: February 08, 2022. From: https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842
  2. Preterm Labor. Standford Medicine Children’s Health. 2021. From: https://www.stanfordchildrens.org/en/topic/default?id=preterm-labor-90-P02497
  3. Preterm Labor. Suman V, Luther EE. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536939/
  4. Premature Labor. Traci C. Johnson, MD. WebMD. Reviewed: August 8, 2022. From: https://www.webmd.com/guide/premature-labor
  5. Preterm Labor and Birth. ACOG The American College of Obstetricians and Gynecologists. Updated January 2022. From: https://www.acog.org/womens-health/faqs/preterm-labor-and-birth
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Maegan Wagner, BSN, RN, CCM

Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.