Preterm birth is traumatic for both the parent and the child.

The parents are faced with an unexpected emotional crisis as a result of the natural process of pregnancy and birth being altered, whereas, the infant is faced with adjustment to extrauterine existence before final readiness for the event. Parents and the infant who are experiencing the crisis of premature birth need the concerted support of all members of the health care team.

a. Definition.

Preterm labor is labor that occurs prior to 38 weeks gestation. It may be spontaneous or medically induced.

b. Conditions That Predispose to Preterm Labor.

There are certain factors or reasons that may increase a woman’s chances of having premature labor, but the specific cause or causes of premature labor are not known. Sometimes a woman may have premature labor for no apparent reason. Nevertheless, it is important that you be familiar with the following conditions of a patient who may predispose to preterm labor:

(1) Spontaneous rupture of membranes.

(2) Cervical incompetency – weakness of the cervix.

(3) Uterine anomalies.

(4) Overdistended uterus caused by hydramnios or two or more fetuses.

(5) Anomalies of the products of conception.

(6) Faulty placentation – abruptio placentae, placenta previa.

(7) Retained intrauterine device.

(8) Fetal death.

(9) Serious maternal disease. This refers to a systemic disease in the mother, that when severe, may be due to serious hypoxia accompanying some diseases such as pneumonia and diseases with high fever.

(10) Unknown causes.

c. Responses to Preterm Labor.

(1) Once preterm labor is diagnosed, the patient and her obstetrician must decide if early delivery of the fetus is more advantageous for survival or is the fetus remaining in utero more advantageous for survival.

(2) Preterm labor is not interrupted if any of the following conditions are present:

(a) Labor is active and cervical dilation has progressed beyond 4 cm.

(b) There is severe bleeding.

(c) Gross fetal anomaly or anomalies is/are present.

(d) The fetus is already dead.

(e) There is fetal distress present.

(f) There are complications that contraindicate prolonging the pregnancy (e.g., severe maternal hypertension, ruptured membranes, intrauterine infection, and severe fetal intrauterine growth retardation).

d. Nursing Interventions When Preterm Delivery is Imminent.

(1) Prepare for delivery if interventions to arrest preterm labor fail.

(2) Inform the expectants parents of changes in the status of care. Many times the nature of emergencies in a labor and delivery area often allows time for brief explanations. Whenever possible, expectant parents should be given thorough explanations and emotional support.

NOTE: Parents should not be left alone if possible.

(3) Notify the nursery personnel and pediatrician when delivery is imminent.

(4) Assemble the resuscitation equipment and make sure it functions properly.

(5) Discourage the patient from bearing down if the presenting part is a head. Bearing down could cause damage to soft tissues. Preterm labor usually means a small fetus. Less cervical dilations and effacement are required due to the small size of the premature fetus.

Administration of medications during labor is kept to a minimum because the infant has an immature system that has difficulty metabolizing medication. Medications have an increased effect on the fetus.

Local anesthesia is used for delivery rather than general anesthesia. This again is due to the increased effect that general anesthesia has on the infant and the infant’s decreased ability to metabolize the anesthesia and to get it out of its system after delivery. Parents should be informed about these decisions.

e. Delivery of the Preterm Infant.

(1) Perform only those procedures that are absolutely necessary. Injury can occur easily and infection is of primary concern.

(2) Establish respirations then move the infant to a warm and humid environment that contains adequate oxygen. Position the head slightly down to allow for tracheal drainage and then position the head flat. Place the infant on its back with the shoulders elevated slightly so the abdomen is lower than the thorax. Ensure that the airway is kept clear. Place a folded towel or diaper under the infant’s shoulders and back. This allows for expansion of the thoracic cavity.

(3) Introduce the newborn briefly to the parents.

(4) Transfer the newborn to the special care nursery as soon as possible.