Gender Ethnicracial And Life Span Considerations

Women who are younger than 17 or older than 35 years of age are more likely to have PTL. PTL is more prevalent in African Americans than in European Americans; it is also associated with low socioeconomic status, low educational level, domestic violence, and single parenthood.

HISTORY. Ask the date of the patient's last menstrual period to estimate delivery date. If the patient reports using cigarettes, alcohol, or other harmful substances, determine the amount and frequency. Ask about the onset of contractions and their frequency, duration, and intensity (Box 4).

• BOX 4 Signs and Symptoms of Preterm Labor

Uterine contractions (painful or painless),

Bloody show

cramping, lower back pain

Gastrointestinal upset: Nausea, vomiting,

Feeling of pelvic pressure or fullness

diarrhea

Change in the amount or character of

General sense of discomfort or "just feeling bad"

amniotic fluid

Sensation that baby is frequently "balling up"

Have the patient describe the contractions; sometimes false labor is felt in the lower abdomen and is irregular. Ask if the patient feels the baby move. Ask about any medical problems because some pharmacologic treatment may be contraindicated in certain instances (cardiac disease, hypertension, renal disease, uncontrolled diabetes, and asthma).

PHYSICAL EXAMINATION. A thorough initial examination is needed to help determine if the patient is in PTL or in false labor. Apply a fetal monitor to determine the frequency and duration of contractions. Palpate the fundus of the uterus; if the patient is having PTL, note uterine firmness. Obtain the fetal heart rate with an electronic fetal monitor, noting baseline, presence or absence of accelerations or decelerations, and variability. After checking with the physician, perform a sterile vaginal examination to determine dilation, station, and effacement. Note any vaginal bleeding, bloody show, or leakage of amniotic fluid. Nitrazine (pH) paper can be used during the examination to detect if the membranes have ruptured (paper turns blue because pH is alkaline). Note that an elevated temperature indicates infection or dehydration.

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