UNION CHRISTIAN COLLEGE

City of San Fernando La Union

School of Health Sciences

COMPETENCY
APPRAISAL 2:
ACTIVITY 3

Submitted by:
De La Cruz, Helen Grace B.
BSN IV
I. SUMMARY OF PRETERM LABOR JOURNAL ARTICLE

Preterm labor is labor that starts before 37 completed weeks of pregnancy. Labor is when
the uterus regularly tightens and the cervix starts to thin and open. This lets the baby enter
the birth canal. Not all women who have preterm labor will deliver their baby early. If
preterm labor leads to an early delivery, the premature newborn is at risk for problems
related to incomplete development of its organ systems. Preterm birth is a major cause of
newborn complications and death. Regular prenatal care can help to identify some, but not
all, women at risk for preterm labor. If preterm labor occurs, various measures can be
taken to both delay delivery and decrease the risk of newborn complications. It is difficult
to predict who will develop preterm labor. Certain obstetrical conditions and other factors
are known to increase a woman's risk. However, most preterm births occur in women who
have no known risk factors. The strongest risk factor for preterm birth is a previous
preterm birth, although most women who have had a preterm birth will have a term
pregnancy in the future. The longer your baby is in the womb, the better the chance he or
she will be healthy. Babies who are born prematurely are at higher risk of brain and other
neurological complications, as well as breathing and digestive problems. Some premature
babies grow up with a developmental delay and/or have learning difficulties in school. The
earlier in pregnancy a baby is born, the more health problems are likely to develop.
Premature labor does not always result in premature delivery. Some women with
premature labor and early dilation of the cervix are put on bed rest until the pregnancy
progresses. Treatment can be given in an attempt to slow or stop preterm labor. The
primary goal of treatment is to delay delivery long enough that steroids, which promote
development of the baby's lungs, can be given and produce the desired effects. Delaying
preterm delivery also allows the woman to be transferred, if necessary, to a facility that can
provide specialized care to a premature infant.

Reference: Funai, E. F. (2020, February). Preterm Labor Beyond the Basic . Retrieved from
https://www.uptodate.com/contents/preterm-labor-beyond-the-basics
II. REACTION
Preterm (or premature) labor happens when a woman’s body prepares for birth before the
baby is fully developed in the womb. The most important things you can do to help have a
healthy baby is to be in the best of health before you get pregnant and get prenatal care. It
may not be possible to avoid preterm labor and preterm birth, but you can take a few steps
that may help. It’s important that all women receive regular prenatal care throughout a
pregnancy. Your doctor follows an appointment schedule designed to meet both your and
your baby’s needs during each stage of pregnancy. The longer your baby gets to grow
inside you - right up to your due date - the less likely he or she is to have problems after
birth. Even the doctors can do a lot to delay an early delivery, as a mother you should do
your part also. As a future health care provider encouraging pregnant women to go for
quality care during the pregnancy period to prevent premature birth is important role of
us. The pregnant moms should take care of themselves and avoid getting sick to be able to
carry their babies through full term especially those who are higher risk like young
mothers with heart disease, hypertension, diabetes and other kind of disease that can
trigger. Preterm labor poses serious risks for your baby. Work with your health care
provider to understand your diagnosis and improve your chance of a healthy outcome.

III. NURSING RESPONSIBILITIES

Nursing care is a critical component of therapy for women experiencing preterm labor. Nurses
may play a pivotal role in diagnosing preterm labor through risk assessment and physical exam.
While treatment and management of preterm labor are usually beyond the nurse practitioner's
scope of practice, they can play an important role in preventing preterm birth through
assessment, action, or advocacy.
 Bed rest is enforced to relieve pressure of fetal head on cervix
 IVF is administered to reduce uterine contractions
 Administer tocolytic agents
 Instruct the patient to avoid strenuous activities
 Instruct the woman on how to count fetal movements
 Assess mother’s condition and evaluate signs of labor
 Monitor signs of labor and FHR
 Provide patient education
I. SUMMARY OF AMNIOTOMY JOURNAL ARTICLE

Amniotomy, also known as artificial rupture of membranes (AROM) and by the lay description
"breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider.
This procedure is common during labor management and has been performed by obstetrical
providers. The reasons for intentional rupture of the amniotic sac during labor are multifold and
include, but are not limited to, influencing the speed of labor, allowing for more direct
monitoring of fetal status, and qualitative assessment of the amniotic fluid.
Practitioners have believed that artificial rupture of membranes either can assist in inducing
labor or augmenting spontaneous labor. It is commonly felt that relieving the amniotic sac of
amniotic fluid induces uterine contraction activity, increases the strength of contractions, and
may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which
may assist in dilating the cervix. While these are commonly held beliefs of many practitioners,
the data to support amniotomy for these reasons is uncertain. Some studies have produced
data supporting the practice, while others suggest that this practice does not, in fact,
accomplish any of these outcomes. Amniotomy to shorten spontaneous labor does not produce
a noticeable difference when compared to no amniotomy. Nevertheless, when there is a delay
in labor, there is a modest reduction in the rate of cesarean section when rupture of
membranes in combination with the use of oxytocin is used as an early intervention.

Reference: Mahdy, H., & Glowacki, C. (2019, July 30). Amniotomy. Retrieved from
https://www.statpearls.com/kb/viewarticle/17472
II. REACTION

The primary aim of amniotomy is to speed up contractions and, thus, shorten the length of
labor. Nevertheless, there are concerns regarding unintended adverse effects on the woman
and baby. On my own opinion, we can use amniotomy if it is necessary but I cannot
recommend that amniotomy should be introduced routinely as part of standard labor
management and care or even use of amniotomy alone for treatment of delay in labor.
Combined use of amniotomy and intravenous oxytocin is more effective than amniotomy alone.
In some people it may be beneficial in preventing prolonged labor, but some instances there
might be inappropriate uses that may cause harm include infection, umbilical cord
compression, vasa previa with subsequent maternal hemorrhage.

III. NURSING RESPONSIBILITIES

 Baseline assessment prior to procedure
 Assisting the physician during the procedure
 Assess for complications
 Note for the color, quantity, odor and chart amniotic fluid
 Assess temperature after AROM
 Monitor fetal tachycardia
 Change under pads frequently
I. SUMMARY OF MECHANISM OF LABOR JOURNAL ARTICLE

Labor is a physiologic process during which the fetus, membranes, umbilical cord, and placenta
are expelled from the uterus. The mechanisms of labor, also known as the cardinal movements,
involve changes in the position of the fetus’s head during its passage in labor. These are
described in relation to a vertex presentation. Although labor and delivery occurs in a
continuous fashion, the cardinal movements are described as the following 7 discrete
sequences; engagement, descent, flexion, internal rotation, extension, external rotation and
expulsion. To accommodate itself to the maternal pelvic dimensions, the fetus must undergo a
series of changes in the attitude of its presenting part. This is required for fetal descent through
the birth canal. The cardinal movements of labor in a vertex presentation are as follows:
Engagement: fetal presenting part
Descent: occurs because of pressure in the fetus by the uterine fundus
Flexion: shortest head diameter passes through the pelvis
Internal rotation: allows the longest fetal head diameters to match the longest maternal pelvic
meter
Extension: internal rotation is complete
External rotation: allow the shoulders to rotate internally to fit the pelvis
Expulsion: after the shoulders delivery, rest of the body will follow.
It is important for the reader to understand that these are not separate events. They are all
closely related, and some will happen simultaneously.

Reference: Chambers, J., & Faye Alabdulghafoor·Obstetrics & Gynaecology. (2019, December
16). Mechanism of Labour - OSCE Guide. Retrieved from https://geekymedics.com/mechanism-
of-labour/
II. REACTION
Understanding the mechanisms of labor means that the health care provider knows what is
taking place during delivery and anticipates the next step in the birth process. This
understanding promotes better management. Mechanism of normal labor is the most
important aspect to be studied in nursing. It not only guides the actions of be performed while
conducting a normal delivery but its study also ensures a safe and uneventful normal vaginal
delivery. Most of us in our clinical experience must have observed how a normal delivery is
conducted. But very few actually realize that in the hurry of conducting the delivery we fail to
wait and observe the movements that take place during the delivery. A good nurse will always
support in conduction of a vaginal delivery and not quickly conduct it without knowing about
the mechanism that is occurring inside the pelvis. Hence it is very essential to learn about
mechanism of normal labor, its principles and steps to distinguish it from an abnormal one.

III. NURSING RESPONSIBILITIES

Series of events that take place on genital organ in an effort to expel the viable production of
conception out of the womb through vagina into the outer world, and nurses will always be
there to do their responsibilities in order to make sure the safety of the mother and the baby.
 Monitor vital signs
 Bladder care
 Administer analgesic
 Preparation for delivery
 Instruct patient on quality pushing. The abdominal muscles must aid the involuntary
uterine contractions to deliver the baby out.
 Provide a quiet environment for the patient to concentrate on bearing down.
 Repeat doctor’s instructions. At this phase, the patient barely hears the conversation
around the room because all her energy and thoughts are being directed toward giving
birth.
 Take note of the time of delivery and proceed to initiate essential newborn care.
 Assist in restrictive episiotomy for patients who had vaginal births.