Revision Date: March 2013
Scope and Target Population
All patients who present in labor.
- Increase the percentage of female patients with PTL who receive antenatal corticosteroids.
- Increase the use of procedures that assist in progress to vaginal birth.
- Increase the percentage of women who are assessed for risk status on entry to labor and delivery.
- Increase the use of intrauterine resuscitation for tachysystole or Category III heart rate tracings.
- Patients should be assessed for active labor or rupture of membranes before being admitted.
- Active labor is defined as regular uterine contractions that are causing cervical effacement and dilation and the cervix is dilated at least 3 cm.
- Rupture of membranes can be confirmed by checking for pooling and ferning, a nitrazine test or with a commercially available indicator (AmniSure).
- Assess fetal well-being with either intermittent auscultation or continuous electronic fetal heart rate monitoring.
- Assess patient's level of risk on presentation.
- Initiate treatment for preterm labor as soon as possible after the diagnosis is established.
- Women with preterm labor at appropriate gestational age should receive a course of antepartum steroids to promote fetal lung maturity.
- Conduct frequent cervical checks (cervical checks afford best opportunity to detect labor progress and prevent failure to progress).
- Augment with oxytocin to achieve adequate labor for two to four hours.
- If patient is in Stage II labor and is not making progress, initiate management of protraction disorders (positioning, oxytocin augmentation, OB/surgical consult).
- When necessary, initiate intrauterine resuscitation such as maternal position, cervical exam for cord prolapse, monitoring maternal blood pressure, assessment for uterine hyperstimulation, discontinuing oxytocics and amnioinfusion.
- Recognize and manage fetal heart rate abnormal patterns.