Preterm labour refers to the onset of regular uterine contractions that result in progressive cervical changes before the completion of 37 weeks of gestation, specifically between 20 and 36 completed weeks. In Nigerian clinical practice, establishing an accurate gestational age is vital because interventions change drastically after 34 weeks. Diagnostic confirmation requires documented uterine contractions occurring at a frequency of at least four every 20 minutes, or eight every 60 minutes, alongside documented cervical effacement of 80% or greater, or cervical dilation of 2 cm or more.
Evaluating a pregnant woman presenting with abdominal tightening requires a systematic approach. The nurse monitors uterine activity with a cardiotocograph while palpating the abdomen for tone and contraction duration. A sterile speculum examination is performed to inspect the cervix, collect high vaginal swabs for infection screening, and test for amniotic fluid leakage. The fetal fibronectin test, when available, helps predict the absence of delivery within the next week if the result is negative.
Tocolytics are medications administered to temporarily suppress uterine contractions. Their primary goal is not to halt labour permanently, but to buy 48 hours for maternal transport to a well-equipped facility and the administration of corticosteroids.
Common agents used include:
Antenatal corticosteroids accelerate the production of surfactant in the fetal lungs, significantly reducing the incidence of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. Standard protocol involves administering dexamethasone or betamethasone intramuscularly to women at risk of preterm delivery between 24 and 34 weeks of gestation. Nurses must monitor maternal blood glucose levels closely after administration, as steroids frequently induce transient hyperglycemia, especially in women with gestational diabetes.
Managing the delivery of a preterm infant requires specialized intrapartum attention. The lower birth weight and fragile tissues increase vulnerability to birth trauma. Continuous electronic fetal monitoring is essential to detect signs of fetal distress early. Obstetricians often recommend an episiotomy during the second stage of delivery to minimize intracranial pressure on the delicate preterm fetal skull. Pediatric and neonatal nursing teams must be present at the bedside immediately upon birth to initiate resuscitation and thermal care.
Holistic nursing care addresses both the physical stability of the mother and her profound psychological distress. The nurse maintains the client on strict bed rest in a left lateral position to optimize uteroplacental blood flow and reduce pressure on the cervix. Establishing clear communication channels helps alleviate anxiety regarding the baby's survival. Nurses facilitate early kangaroo mother care or skin-to-skin contact once the newborn is stable, promoting bonding, temperature regulation, and successful breastfeeding initiation.