Online Class Day 3

yes meg.

Signs and Symptoms of Preterm Labor:
• Contractions (your abdomen tightens like a fist) every 10 minutes or more often
• Change in vaginal discharge (leaking fluid or bleeding from your vagina)
• Pelvic pressure—the feeling that your baby is pushing down
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

What to do?

Call your health care provider (nurse, doctor or midwife) or go to the hospital right away if you think you're having preterm labor, or if you have any of the warning signs. Call even if you have only one sign.
Your health care provider may tell you to:
• Come into the office or go to the hospital for a checkup.
• Stop what you're doing. Rest on your left side for one hour.
• Drink 2-3 glasses of water or juice (not coffee or soda).
If the symptoms get worse or do not go away after one hour, call your provider again or go to the hospital. If the symptoms get better, relax for the rest of the day.


Fetal Fibronectin (fFN): A Test for Preterm Delivery

Fetal fibronectin (fFN) is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining. During the first trimester and for about half of the second trimester (up to 22 weeks of gestation), fFN is normally present in the cervico-vaginal secretions of pregnant women. In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor). The greatest value of the fFN test is the high level of reliability of a negative test result.

According to American College of Obstetrics and Gynecology, “Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention”

In women with symptoms of preterm labor, a positive fFN result, while less reliable, allows doctors and patients to take preventive measures to delay labor for as long as possible and to consider labor-suppressing (tocolytic) medications.

Text References
(1) American College of Obstetricians and Gynecologists. Assessment of Risk Factors for Preterm Birth. ACOG Practice Bulletin, number 31, October 2001.

(2) Iams, J.D. Prediction and Early Detection of Preterm Labor. Obstetrics and Gynecology, volume101, number 2, pages 402-412, February 2003.

for the cause of the fights, everyone has almost the same answer and that is because of the way Martha acts during the course of pregnancy/manage her pregnancy (smoking..)

i agree with jenny and ara's preterm s/sx...

considering that the scenario is tainted with signs of domestic violence, further assessment of the situation would be necessary.

while saying that violence may be the outlet of the boyfriend in releasing his stress, it is still downright WRONG. his partner is preganant for crying out loud did he not think of that?

Persistent uterine contractions for every 20 minutes
Rupture of membranes
Persistent dull low backache
vaginal spotting
a feeling of pelvic pressure or abdominal tightening
menstrual like cramping
increase vaginal discharge

source: Pilliteri, A. 2007. Maternal and Child health Nursing: care of the childbearing and childrearing family. 5th edition.

risk factors:

Age of pregnancy (first)
Lifestyle: Smoker
Nonmodifiable factor of hypertension
Hx of bladder infection

Her husband is picking up fights with her probably because of her smoking habits which eventually affects her and the unborn baby and the children at home. Also, the husband is probably burdened of taking care of the kids and working? and then Martha is adding up to his stressor.
However, her husband might want to attend anger management sessions so that he would not hurt martha physically, emotionally, and sexually especially during pregnancy.

for jenny, what is the "clear picture" you are trying to say? can you at least give us examples of topic/discussion/education that you will give the patient?

Pilliteri cited the signs and symptoms of impending preterm labor that the mother should know. These are:

>persistent, dull, low backache
>vaginal spotting
>feeling of pelvic pressure or abdominal tightening
>menstrual like cramping
>increased vaginal discharge
>uterine contractions
>intestinal cramping

to address the issue of being physically abused, we can start with asking her how was her relationship with her boyfriend and from there further questions. In the course of discussing with her about her rough experiences, a lot of factors might be brought into light as to why she is being hit by her partner. Well it could be because it is not only her who experiences stress because of her pregnancy but also her partner. He is stressed about how costly her pregnancy is, where will he get the money to pay for hospital bills, or because there's another mouth to feed and so on and so forth.

I guess, the boyfriend is concern with the way Martha is misbehaving during the course of pregnancy. She’s smoking and he must be concern with the baby’s health. Or it’s the other way around, the boyfriend (maybe…) is not anymore concern with the Martha and the baby and is just looking for reason that Martha would consider leaving him alone.

I would give her a clear picture of what could possibly happen not only with her baby but with her as well if the hitting continue.

good point meg, thea and angel..for meg, yes, i agree with the hormones and also for thea and angel, as we have discussed in our women's health, there are several factors involved in abused women.

>as a nurse, you can explore how the client views her current situation. You can assess also the current coping mechanisms she is using and most importantly, is to know if she is aware of the possible outcomes of her pregnancy if she is being abused by her boyfriend.

> for the possible reasons why her boyfriend is abusing her is not reflected on the case. However, it is found out that most common reason given for the increased risk of violence during pregnancy is that the father/male partner feels a greater sense of stress over the impending birth. The stress manifests itself
as frustration, which is directed back at the perceived source: the mother and her unborn child. The
underlying causes of the stress experienced by the father are unclear and more research is needed to
deepen our understanding of them, so that we can find more effective ways to detect women at risk.

Reference: Domestic Violence During Pregnancy, http://www.paho.org/English/AD/GE/VAWPregnancy.pdf

The reason why her partner is hurting her is unknown. Maybe the partner could not “accept” that the baby Martha is bearing is not his child. Or maybe the father is hitting her, because he can see that Martha is an irresponsible mother to the baby because she is smoking and not protecting herself.

As what we have studied in Women’s Health, domestic violence is still an unresolved issue. Women tend not to admit that they are being violated by their husbands or partners for they’re afraid of the consequences of the partner leaving them or what the other people may think of them.

As I said, maternal hormones affect the emotional status of a pregnant woman. They are prone to mood swings. Martha is an emotional wreck at this time.

I can only assume that the boyfriend in this case may not be ready for fatherhood yet. Because if he is, then he would not be picking fifhts knowing that his partner is pregnant. He would be more understanding of her situation ven if she will nag him often

Maybe his boyfriend doesn’t want to face their problem and wants to turn back on his responsibility for his girlfriend.

i forgot to add..

she has history of miscarriages

this is her first prenatal visit... meaning in her past pregnancies she did not seek consultation at all..

as to he socio-economic backgroud, ther was not much information presented that poses risk for PTL

The risk factors involved in this case are the following:

Age
history of miscarriages on her previous pregnancies/ history of preterm labor
receiving inadequate prenatal care
HTN in pregnancy
Smoking (1 pack every 1-2 days)
Rising stress levels and being hit by her partner
Bladder infections

the risk factors that may contribute for premature birth/delivery on the case of martha are the following: hypertensive, bladder infection, hx of 2 miscarriage, gave birth to premature baby in the past, stress

Risk factors include:
-age (experienced pregnancy at a young age, 1st 2 pregnancy)
-smokes 1 pack of cigarette in 1 to 2 days
-hypertensive since age 20
-bladder infections
-high level of stress (inc. catecholamines)
-history of miscarriage (2x)
-history of preterm labor

Risk factors:
- History of miscarriages, previously she delivered a preterm baby (30 weeks gestation)

- She is a smoker, (1 pack of cigarette every 1 to 2 days)

- Utero placental insufficiency – the patient is hypertensive & smoker

- Frequent bladder infections

- Hormonal changes as a result of High level of stress (marital problems)

- Stressful life situations (domestic violence)

Risk Factors will include pregnancy at a young age, history of having 2 miscarriages, she smokes 1 pack of cigarettes every 1 to 2 days, hypertensive eversince she was 20, often experiences bladder infections, Increased stress, history of physical abuse.

martha has been living a life not fit for pregnancy

she smokes
she is hypertensive at an early age (essential hypertension)
she has history of UTI


also, her stress level is increased lately
BUT... because of the high level of maternal hormones, pregnant women are prone to have mood swings... it may seem that martha is "abused", but if you look at it from another POV maybe she has been an emotional wreck lately in which her boyfriend is unable to cope with and deals with the situation by hitting her.

Risk factors for preterm labor present on Martha's case:
(From Maternal and Child Nursing Book of Pilliteri,2008)

> history of miscarriages on her previous pregnancies
>started previous pregnancies at a young age.. possibly around 20 y/o
>receiving inadequate prenatal care
>hypertension in pregnancy
>Smoking
>Rising stress levels and being hit by her boyfriend
>Bladder infections

altered family processes r/t the stress of adlescent pregnancy
we have to consider that it is not only the mother here but the rest of her family that carries the burden of her situation. While the mother here carries more of the physiologic burgen of pregnancy, her family also suffer from the psychologic and social aspect of the situation.

health-seeking behaviors r/t special care necessary for healthy adolescent pregnancy
we all know that pregnant women needs more nuttrients and so on.. and adolescent should know this, howvere, being the an adolescent she may well still be used to her original lifestyle.

these are some prenatal diagnoses that are important at the arly stage of pregancy