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Care of the Preterm Labor Patient

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					                                   POLICY/ PROCEDURE/PROTOCOL
Title: Care of the Preterm Labor Patient                                      Policy # MAT.105
Audience: All Maternity Units


Key Word: Preterm Labor; Tocolysis                                            Date             Page:
                                                                              Issued:
                                                                              1/19/05           1 of 4
Distribution: All holders of the policy and procedure manual


Prepared by: Women’s and Infant’s Services Standards Committee                Effective
                                                                              Date: 8/26/08

Approved by:                                            Date:
Women’s and Infant’s Services Standards Committee       5/24/05, 6/9/08
Women’s and Infant’s Services Quality Council            6/24/08
Infection Control                                       5/9/05
Department of OB/GYN                                    5/24/05
Kaleida Nurse Policy Council                            7/12/04, 7/8/08
Kaleida Nurse Executive Council                         9/9/05, 8/08

Regulation/ Standards- N/A
NYS:
Federal:
Joint Commission:
Review Date       6/08
Revision Date       6/08



I.     Introduction
       Prematurity is the leading cause of perinatal morbidity and mortality. A preterm labor patient is a
       patient under 37 weeks gestation, experiencing regular contractions that are associated with
       changes in the cervix.


II.    Communication and Responsibility
       Department of OB/GYN, Department of Nursing


III.   Scope of Practice
       Physicians, Residents, Certified Nurse Midwives, Certified Nurse Practitioners, Registered
       Nurses


IV.    Policy
       It is the primary care provider, who evaluates the presenting patient with complaints of preterm
       labor, and makes the decision if tocolytic therapy is to be used.
       A.        Signs and Symptoms of Preterm Labor include, but are not limited to:
                1.      Persistent Contractions (painful or painless).
                2.      Intermittent abdominal cramping, pelvic pressure, or backache.
                3.      Increase or change in vaginal discharge.
                4.      Vaginal spotting or bleeding.
Title: Care of the Preterm Labor Patient                             Date         Page         Policy #
                                                                     Issued:          2 of 4   MAT.105
                                                                     1/19/05

       B.      Absolute or Relative Contraindications to tocolysis:
               1.    Prolonged premature rupture of membranes
               2.    Continued cervical change despite adequate tocolytic drug
               3.    Intrauterine fetal death
               4.    Lethal fetal anomaly
               5.    Advanced cervical dilatation
               6.    Severe Intrauterine growth restriction
               7.    Chorioamnionitis
               8.    Significant abruption
               9.    Evidence suggestive of fetal hypoxia or fetal acidosis
               10.   Eclampsia


V.     Procedure – N/A



VI.    Protocol
       A.     Supportive Data:
               Tocolytic agents are somewhat effective in prolonging pregnancy for a short duration of
               time. The primary goal of tocolytic therapy presently is to prolong pregnancy long
               enough to administer maternal steroids for fetal lung maturation.
        B.     Content
               1.     Assessment/Data Collection:
                      a.    Place patient on fetal monitor. Adjust external components for best
                            tracing of contractions and fetal heart rate. Palpate contractions.
                      b.     Obtain maternal vital signs including temperature.
                      c.     The following procedures may be ordered:
                             1)      CBC
                             2)      Urinalysis for culture and sensitivity
                             3)      Fetal surveillance studies such as
                                     a)      Biophysical profile (See MAT.102-Biophysical Profile
                                             (BPP)
                                      b)     Transvaginal or abdominal ultrasound
                      d.    Sterile speculum exam by primary care provider:
                            1)       Nitrazine
                            2)       Fern
                            3)       Pooled fluid
                            4)       Cervical cultures
                            5)       Fibronectin swab (See MAT.108-Fetal Fibronectin (fFN) Testing
                                     on Cervicovaginal Secretions).

                                     KEYPOINT:       1. Positive fibronectin swab- increased probability
                                                        of Preterm labor. Treatment with tocolysis
                                                        indicated.
                                                     2. Negative fibronectin swab- with minimal
                                                        symptoms or risk factors 95 percent of patients
                                                        will remain undelivered for 2-3 weeks.
               2.     Care and Management:
                      a.    Maintain bed rest in lateral tilt, or upright position.
                      b.    Fetal monitoring as ordered.
                      c.    Initiate IV as ordered.
Title: Care of the Preterm Labor Patient                            Date         Page           Policy #
                                                                    Issued:       3 of 4        MAT.105
                                                                    1/19/05

                      d.      Offer comfort measures.
                      e.      Vital signs as ordered.
                      f.      Assist primary care provider with cervical exam.
                      g.      Administer tocolytic agent as ordered.
                      h.      Administer maternal steroids for fetal lung maturity as ordered.
                      i.      Administer pain control measures as ordered.
                      j.      Administer antibiotics as ordered.
                      k.      Encourage patient to void to avoid uterine irritability.

               3.      Safety:
                       a.      Call light within reach.
                       b.      Follow protocol outlines for specific tocolytic agent ordered by primary
                               care provider.

               4.      Infection Control:
                       Maintain Standard Precautions

               5.     Complications and Reportable Incidents:
                      a.    Persistent contractions
                      b.    Increased vaginal bleeding
                      c.    Spontaneous rupture of membranes
                      d.    Increased cervical dilatation
                      e.    Abnormal maternal vital signs (See MAT.20- Admission and Care of the
                            Laboring Patient Policy).
                      f.    Abnormal or changing fetal heart rate pattern (See MAT.77-Fetal
                            Monitoring Policy).

                6.    Emergency Management:
                      Prepare patient for surgical intervention or possible preterm delivery.

                7.     Patient/Family Education:
                      a.     Provide reassurance with assessment and data collection. Include social
                             support system in process.
                      b.      Provide appropriate time for patient to express fears and concerns.
                      c.     Provide appropriate information regarding issues relevant to preterm
                             labor and the premature neonate.
                      d.      Teach patient to monitor for and report changes in the status of her
                             contractions, level and location of pain or pressure, vaginal discharge or
                             bleeding, fetal movement or her own cardiac, respiratory, neurologic
                             status.


VII.   Documentation
       A.      Obstetric Total Care Progress chart (KH00246)
       B.      Medication Administration Record as needed
Title: Care of the Preterm Labor Patient                                                 Date              Page            Policy #
                                                                                         Issued:            4 of 4         MAT.105
                                                                                         1/19/05


VIII.     References:
          ACOG Practice Bulletin number 43. 2003. Management of Preterm Labor

          Green, Carol; Wilkinson, Judith. 2004 Maternal Newborn Nursing Care Plans. Mosby, St. Louis.

          Leveno. Kenneth; Cunningham, Gary; 2003 Williams Manual of Obstetrics, McGraw, New York.

         Lowdermilk, D.L, Perry, S.E., 2007, Maternity and Women’s Health Care, Ninth Edition, Pages
         925-937 Mosby, St. Louis, Missouri.

          Simpson, Kathleen Rice, Creehan, Patricia A. 2008. Perinatal Nursing. AWHONN. 3rd Edition.
          Pages 179-180.




Kaleida Health developed these policies and procedures in conjunction with administrative and clinical departments. These documents were
designed to aid the qualified health care team in making clinical decisions about patient care. These policies and procedures should not be
construed as dictating exclusive courses of treatment and/or procedures. No health care team member should view these documents and their
bibliographic references as a final authority on patient care. Variations of these policies and procedures in practice may be warranted based
on individual patient characteristics and unique clinical circumstances. Please contact the print shop regarding any associated forms.

				
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