Assessment

PSYCHOSOCIAL. The reality of a premature delivery and a sick newborn in a neonatal intensive care unit (NICU) creates a tremendous amount of stress and emotion for the parents and significant others. Assess the patient's and the significant others' abilities to cope. The patient may experience guilt, suspecting that she did something wrong during the pregnancy to precipitate the labor.

Diagnostic Highlights

General Comments: PTL is generally diagnosed by the presence of contractions accompanied by cervical change. Testing is done to examine the possibility of delivery and cervical ripeness.

Test

Normal Result

Abnormality with Condition

Explanation

Fetal fibronectin (fFN)

Cervical length (via transvaginal ultrasound)

Absent in cervico-vaginal secretions between 20 and 37 wk

>30 mm at 24 wk; no evidence of a bulging bag of water or leakage of fluid

Positive

<25 mm (10th percentile) or evidence of funneling at 24 wk or leaking of the amniotic fluid at the internal os

If positive, 60%, will deliver within 1 wk; if negative, 99.3% do not deliver within 1 wk

Cervical effacement indicates that the cervix is ripening for labor

Other Tests: An abdominal ultrasound to assess the size and well-being of the infant, amniocentesis to obtain amniotic fluid to perform tests to determine fetal lung maturity (lecithin-sphingomyelin ratio, phosphatidylglycerol, surfactant-albumin ratio); complete blood count (CBC); vaginal/cervical/urine cultures (infections often precede PTL)

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