Report rupture of membranes, vaginal bleeding, or a sudden increase in contraction frequency or intensity.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client at 31 weeks gestation reports menstrual-like cramping, low backache, and pelvic pressure. Which additional finding would most strongly support a diagnosis of preterm labor?
Answer: A. Preterm labor is defined by regular contractions accompanied by documented cervical change (dilation and/or effacement) before 37 weeks. Symptoms alone are nonspecific; cervical change confirms that labor is progressing and distinguishes it from false labor.
Question 2 of 5
A client at 30 weeks gestation is being evaluated for preterm labor with a fetal fibronectin test. The nurse explains the clinical value of a negative result. Which statement is accurate?
Answer: A. Fetal fibronectin testing has strong negative predictive value: a negative result makes preterm birth within the next 1 to 2 weeks unlikely, which can prevent unnecessary interventions. A positive result is less specific and only modestly predicts preterm birth.
Question 3 of 5
A nurse is evaluating the progress of a client in active labor whose cervix has remained at 6 cm for 4 hours despite adequate contractions. How should the nurse document this finding?
Answer: B. Lack of cervical dilation over time despite adequate uterine activity is an arrest of dilation, a form of dystocia (dysfunctional labor). Precipitous labor is excessively rapid; a normal labor curve shows steady progress; transition phase refers to 8 to 10 cm dilation, not an arrest at 6 cm.
Question 4 of 5
A nurse is monitoring a client in the latent phase of the first stage of labor. Which cervical dilation range corresponds to this phase?
Answer: A. The latent phase of the first stage of labor spans from 0 to about 5 to 6 centimeters of dilation. The active phase follows from about 6 centimeters to full dilation at 10 centimeters.
Question 5 of 5
A client's labor has been progressing, but cervical dilation has not changed in 3 hours despite adequate contractions, and the fetal head remains high. The nurse recognizes this as which complication?
Answer: B. Failure of the cervix to dilate and the fetus to descend despite adequate contractions is consistent with labor dystocia and possible cephalopelvic disproportion, where the fetal head is too large for the maternal pelvis.
Keep the streak going with more questions like these, each with a full rationale.
What is preterm labor?
It matters because preterm birth is a leading cause of newborn illness and death due to immature organ systems, especially the lungs. Risk factors include infection, multiple gestation, previous preterm birth, dehydration, and cervical insufficiency. The goal of care is to stop or delay labor long enough to give corticosteroids for fetal lung maturity.
Key points to remember
- Regular contractions (often every 10 minutes or less) with cervical dilation or effacement before 37 weeks define preterm labor.
- Symptoms include low backache, pelvic pressure, menstrual-like cramps, and increased or watery/bloody vaginal discharge.
- Urinary tract and vaginal infections are common, treatable triggers.
- A positive fetal fibronectin test or a shortened cervix on ultrasound predicts higher risk.
- The greatest neonatal threat is respiratory distress syndrome from immature lungs and surfactant deficiency.
Signs & symptoms
- Regular contractions before 37 wks
- Low backache, pelvic pressure
- Cervical change, ↑ discharge
Nursing priorities
- Monitor uterine contractions and fetal heart rate continuously and assess cervical change.
- Promote bed rest, often in the left lateral position, and provide hydration as ordered.
- Administer tocolytics as prescribed (such as magnesium sulfate, nifedipine, or terbutaline) to suppress contractions.
- Give antenatal corticosteroids (betamethasone or dexamethasone) as ordered to accelerate fetal lung maturity.
- Identify and treat underlying causes such as infection or dehydration.
Labs & values
Patient teaching
- Recognize warning signs: regular cramping, low back pain, pelvic pressure, or fluid leaking, and seek care.
- Empty your bladder, drink fluids, and rest on your side if you feel contractions starting.
- Take the full course of any prescribed antibiotics and keep follow-up appointments.
Red flags: report now
- Report rupture of membranes, vaginal bleeding, or a sudden increase in contraction frequency or intensity.
- Report fetal heart rate decelerations or decreased fetal movement.
- Watch for terbutaline side effects (maternal tachycardia, chest pain) and hold and notify the provider if heart rate exceeds 120.
- Report cervical change despite tocolysis, as delivery may be imminent.
References
Clinical references for this topic
