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Threatened preterm labour and ruptured membranes: assessment, the treatments to monitor and transfer

  • Safe practice

Before 37 weeks, the nurse counts contractions, avoids vaginal exams if the waters broke, watches the treatments and prepares transfer.

Updated

What it is

A birth from week 22 to before week 37 is preterm. Preterm birth is one of the main causes of newborn death and illness worldwide. Threatened preterm labour is diagnosed from three things: gestational age, uterine contractions and the state of the cervix. Premature rupture of membranes is a leak of amniotic fluid before labour starts; before 37 weeks it is preterm rupture. The team may give medicines to delay birth and to mature the fetal lungs. Nursing care is assessment, safe monitoring of those treatments, infection watch and timely transfer to a level with newborn intensive care.

What it requires

  • Signs to teach: more than 5 contractions per hour or regular painful ones, low back pain or pelvic pressure, spotting, bleeding, mucus with blood, a leak of fluid.
  • Cervical signs of threatened preterm labour: shortening of 50 % or more, dilatation of 1 cm or more, a central cervix.
  • Other risk factors: multiple pregnancy, cervical incompetence, uterine malformations, extreme ages, tobacco, alcohol and drugs, genitourinary infection, diabetes, hypertension, no or late prenatal care.
  • Amniotic fluid is usually colourless and smells sweeter than urine.
  • Ovular infection after rupture is about 6 % when it lasts under 24 hours and 30 % when it lasts longer.

Components

  • A watch, and an external tocodynamometer if available.
  • A Pinard stethoscope, Doppler or monitor for the fetal heart.
  • Pads to check the fluid, a thermometer and the vital signs chart.

How it is applied (and why)

  1. Confirm gestational age from the last period or early ultrasound — the definition and the treatment depend on it.
  2. With the woman on her left side, palpate and count contractions for one hour — compare with the normal pattern for her weeks.
  3. If the count is a little above normal, wait one hour and count again — if it persists, refer.
  4. Ask about fluid loss and check the pad for colour and smell — rupture changes the plan of care.
  5. If the membranes may have ruptured, do not do a digital vaginal exam — it raises the risk of infection.
  6. Monitor maternal temperature, pulse and fetal heart rate as the protocol sets — infection and fetal distress show there.
  7. With a beta-mimetic tocolytic, watch pulse, blood pressure, glucose and tremor; avoid maternal pulse over 120 — doses per protocol.
  8. Confirm the WHO conditions for corticosteroids are recorded before giving the ordered dose — wrong use causes harm.
  9. Arrange transfer to a hospital with a newborn unit and send the record — a preterm baby needs specialised care.
  10. Teach the warning signs and support the woman and her family — fear is common.

In nursing practice

  • Symptomatic treatment is used only if the cervix is not dilated beyond 3 cm and there is no amnionitis, severe preeclampsia, active bleeding or fetal distress, and the fetus is alive.
  • There is not enough evidence to order or forbid bed rest systematically; adapt it to the woman's real situation.
  • Ruptured membranes after 37 weeks: birth within 24 hours lowers infection; 34 to 37 weeks: induction is likely; before 34 weeks without infection: corticosteroids, antibiotics and close monitoring.
  • WHO 2022: tocolysis is used only when it brings more benefit than risk and its preconditions are met; nifedipine, oxytocin receptor antagonists and nitric oxide donors had the best benefit–risk profiles.

Common mistakes

  • Doing a digital vaginal exam after rupture of membranes.
  • Counting contractions with the woman on her back, or for less than an hour.
  • Giving a corticosteroid without recorded gestational age or without excluding infection.
  • Waiting for birth in a hospital without a newborn unit instead of transferring early.

Test yourself

Think of the answer, then tap the question to see it.

On what three findings is the diagnosis of threatened preterm labour based?

Gestational age, uterine contractions and the state of the cervix.

Why does the nurse avoid digital vaginal exams when the membranes have ruptured?

Because they raise the risk of ovular and fetal infection.

Which conditions does WHO set for antenatal corticosteroids?

Reliable gestational age, imminent preterm birth, no maternal infection, adequate childbirth care, and adequate care for the preterm newborn; before 34 weeks.

Which maternal pulse should be avoided during a beta-mimetic tocolytic infusion?

A pulse over 120 beats per minute.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011); Preterm labor (MedlinePlus, U.S. National Library of Medicine, 2026); Premature rupture of membranes (MedlinePlus, U.S. National Library of Medicine, 2026); Updated WHO recommendations on antenatal corticosteroids and tocolytic therapy for improving preterm birth outcomes (Lancet Glob Health) (Europe PMC (open access), 2022).

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