This is the case study
Case Study: A 25-year-old presented to the labor and delivery unit with complaints of uterine cramping and lower back pain. The client denied any vaginal bleeding and had a history of preterm birth at 32 weeks (about 7 and a half months) gestation with her last pregnancy. The baby from that pregnancy is three years old has no developmental issues. The client’s gestational age is 30 weeks (about 7 months). She is O+, and all other lab values are normal. No evidence of sexually transmitted infections (STI’s).
(Group Beta Strep is missing from the labs and most often is obtained at 35 – 37 weeks (about 8 and a half months) gestation. Without this information, it is often determined to treat the patient anyway, to protect a premature baby from the risk.)
What additional information should the nurse obtain from the client?
What nursing intervention is most appropriate in this situation?
What screening tests should be obtained to determine the risk for preterm labor?
If the client is in preterm labor, what medications would the nurse expect to be ordered, and what are the priorities for the nurse to assess post-administration? (Include dose, side effects and expected outcomes of the medication).
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Additional Information
Upon entering the hospital, information is obtained from an expecting patient in this condition. We first want to assess how long the client has been experiencing this pain and whether the pain is constant or activity induced. Information regarding the last pregnancy and delivery is vital as well. We want to ask the client about the delivery and if there were any complications associated.
Interventions
Several interventions are suitable for this patient. Safety is most important. We’d want to start by assessing the mothers’ vitals along with an assessment of the baby using a fetal. Heart monitor. The patient should also be on bed rest to prevent further inducing labor. Once safety is established, we want to assess the patient for indications of preterm labor. A pelvic exam can be performed to assess the cervix and determine if there has been any dilation. During the pelvic exam, testing can also assess for rupture of the amniotic sac. This is done by testing vaginal fluids using litmus paper.
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Screening
The primary screening test to be administered is the Fetal Fibronectin Test. “The fetal fibronectin test assesses the risk of preterm birth by measuring the amount of fetal fibronectin in cervicovaginal secretions. In fact, fetal fibronectin is one of the best predictors of preterm birth in all populations studied so far, including low‐ and high‐risk women without preterm labor, twins, and women in preterm labor.” (Berghella & Saccone., 2019). Fetal fibronectin assists in keeping the amniotic sac and uterus attached. Rupture is an indication of preterm labor. During this test, the physician swabs the vagina and samples fluid from the cervix and vagina. The test assesses the likelihood of delivering in the immediate future.
Medication and Follow Up
If the patient is in preterm labor, the doctor will likely order Tocolytics to delay delivery. These medications include Ritodrine, Nifedipine, Indomethacin, and Magnesium Sulfate. These are used to only delay labor short term, up to 72 hours. For long-term delay, Terbutaline 0.25mg intravenously to delay contractions. Another dose should be administered if contractions are still persistent after 15 minutes. The max dosage is 75mg. This medication can harm pregnant women as it increases the risk of cardiac issues. Assessment of vital signs and heart monitoring is essential after administration. It is also important to monitor the baby for signs of distress.
