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Nursing Protocol

PROTOCOL ANALYSIS
Preterm labor is a significant health problem for many pregnant women in the United States. It is estimated that eight to ten percent of all births in the United States are the result of premature labor, which account for approximately 440,000 births annually. Preterm labor is also the leading cause of perinatal morbity and mortality and results in health care expenditures of over three billion dollars per year. (ACOG, 2001). It was thought that the incidence of preterm labor would decrease in time, but this has not been the case. Although infant morbity has decreased due to technological advances in neonatal medicine, the incidence of preterm labor has actually increased (Goldenberg, 2002). Preterm labor is defined as: "contractions occurring between 20 to 36 weeks which occur regularly, leading to progressive cervical change." (ACOG, 2003). Diagnosing preterm labor is complicated and has a high false-positive rate. The effect of false diagnoses is that many women are treated unnecessarily and possibly suffer dangerous consequences due to treatment (Freda, 2003). Therefore, as a healthcare provider, it is important to have an effective, evidenced based protocol, which can be followed to aid in the diagnosing and treatment of preterm labor.
Labor is a multifactorial physiological process, which is controlled by hormones. Why these hormones are triggered in preterm labor is not entirely known but there are many hypotheses. Some hypothesis include: preterm labor is caused by a smooth muscle reaction due to estrogen and progesterone; oxytocin sensitivity; cytokine release and prostaglandin effect on myometrial contractions and corticotropin-releasing activation due to stress (Freda, 2003). Perhaps the most easily understood hypothesis is that the fetus is able to recognize a hostile intrauterine environment and then precipitates labor. Risk factors for preterm labor have been identified and can be divided into two classifications,...