ABSTRACT
Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. A review of the current literature regarding antepartum surveillance provides the basis for a discussion of the techniques essential to quality nursing care during multifetal pregnancy. Guidelines are provided for nursing standards in documentation, terminology, and care during surveillance of multiple fetuses.
Subject(s)
Fetal Monitoring/methods , Pregnancy, Multiple/physiology , Prenatal Care/methods , Cardiotocography , Female , Fetal Monitoring/instrumentation , Humans , Obstetric Nursing , Pregnancy , Ultrasonography, PrenatalABSTRACT
Newer interventions for the treatment of preterm labor led to the development of a nursing program for preterm birth prevention. The Roy adaptation model was used as a framework for patient and community education. Quality improvement activities provided the impetus for nursing practice changes. Tools were developed to produce a comprehensive, consistent approach for patient care from assessment to discharge.
Subject(s)
Delivery Rooms/organization & administration , Obstetric Labor, Premature/prevention & control , Program Development , Adaptation, Psychological , Female , Hospitals, Community , Humans , Models, Nursing , Nursing Assessment , Nursing Records , Obstetric Labor, Premature/nursing , Obstetric Labor, Premature/psychology , Patient Discharge , Patient Education as Topic , Pregnancy , Total Quality ManagementABSTRACT
Evaluating women for pregnancy-related problems that may result in preterm birth frequently requires electronic fetal monitoring at early gestational ages. Caution is needed to interpret information correctly from the preterm fetal heart rate and uterine activity tracings. Interpreting fetal heart rate tracings from preterm fetuses requires knowledge of fetal physiologic development. Obtaining clear tracings of preterm uterine activity remains a challenge and heightens the importance of thorough nursing assessment, including inquiry about risk factors for pregnancy complications.
Subject(s)
Fetal Monitoring , Nursing Assessment , Obstetric Labor, Premature/nursing , Electronics, Medical , Embryonic and Fetal Development , Female , Fetal Monitoring/methods , Heart Rate, Fetal , Humans , Pregnancy , Risk Factors , Uterine ContractionABSTRACT
Perinatal mortality for twins is five to seven times that for singletons. This disparity is related to a variety of risk factors that may alter the health of the woman and her fetuses. With twin pregnancies, antepartum surveillance frequently begins earlier in gestation. Although extensive antepartum and intrapartum nursing care is required for women with twins, little has been published in the nursing literature to provide direction for caregivers. Factors such as zygosity and gestational age influence monitoring in twin pregnancies. Current clinical and technical nursing issues are reviewed and related to the antepartum and intrapartum electronic fetal monitoring of twins.
Subject(s)
Fetal Monitoring/nursing , Obstetric Nursing/methods , Twins , Female , Fetal Monitoring/methods , Fetal Monitoring/standards , Gestational Age , Humans , Labor Stage, Second , Obstetric Labor Complications/nursing , Obstetric Labor Complications/prevention & control , Patient Care Planning , Pregnancy , Prenatal CareABSTRACT
False labor is a common and frustrating problem for women and health-care providers. The purpose of this study was to compare characteristics of true and false labor. A convenience sample of 65 women compared data for three groups who were observed for labor including: false labor, women who were dismissed and returned in true labor more than 48 hours later, impending labor, women who were dismissed but returned in true labor 48 hours or less later, and early labor, women who were admitted for true labor directly following an observation period. Psychosocial differences among the groups were measured by the Maternal Adjustment and Maternal Attitudes (MAMA) scale and a semistructured interview schedule. Chart reviews were conducted to measure physiologic differences and perinatal outcomes. Descriptive and inferential statistics were computed using the SPSSX program. The following variables were statistically significant at P less than .05 for false labor: somatic scores on the MAMA scale, contraction frequency, cervical Bishop scores, gestational age, and Apgar scores. Increased frequency of abnormal labor patterns, intervention with amniotomy, and oxytocin augmentation were observed in false labor subjects. The negative emotional responses of women who were interviewed suggest a need for further investigation of interventions to promote both physical comfort and psychological support.
Subject(s)
Labor Onset/physiology , Labor, Obstetric/physiology , Adolescent , Adult , Attitude , Body Image , Cervix Uteri/physiology , Depression/psychology , Female , Humans , Labor Onset/psychology , Labor, Obstetric/psychology , Marriage , Maternal Behavior , Pregnancy/psychology , Pregnancy Outcome , Reproducibility of Results , Sex , Time Factors , Uterine Contraction/physiologyABSTRACT
Although electronic fetal monitoring (EFM) has been widely used in clinical practice for more than two decades, educational standards and competency validation for EFM use in hospitals have been developed only recently. This article highlights a community hospital's program for EFM. Basic education, staff development, and quality assurance activities involving staff nurses and managers are discussed.
