Preterm Labor on the NCLEX
Preterm labor risk factors, tocolytic drugs and their cautions, and why betamethasone matters.
Preterm labor questions test two drug lists: the ones that slow labor and the one that matures the lungs.
Definition and risk factors
Regular contractions with cervical change between 20 and 36 6/7 weeks. Risk factors: prior preterm birth (the strongest), multiple gestation, infection (including UTI), short cervix, smoking, substance use, short interval between pregnancies. Early warning symptoms to teach: low backache, pelvic pressure, menstrual-like cramps, increased discharge, more than 4-6 contractions an hour.
Tocolytics: buying time
Goal is to delay delivery long enough for steroids and transfer, typically up to 48 hours. Nifedipine: watch for hypotension, headache, flushing. Indomethacin: used before 32 weeks; risk of premature closure of the ductus arteriosus and reduced amniotic fluid with prolonged use. Magnesium sulfate: also given for fetal neuroprotection before 32 weeks; monitor DTRs, respirations, urine output, and keep calcium gluconate available. Terbutaline: short-term only; hold for maternal HR over 120 and avoid in cardiac disease. Report chest pain or palpitations.
Betamethasone
12 mg IM, two doses 24 hours apart, for pregnancies at risk of delivery between roughly 24 and 34 weeks. Stimulates fetal surfactant production and cuts the risk of respiratory distress syndrome, IVH, and NEC. Maximum benefit begins after the course completes, which is exactly why tocolysis buys 48 hours. Watch maternal glucose afterward; steroids raise it, which matters most in diabetic patients.
Nursing care
Continuous fetal and contraction monitoring. Left lateral positioning and hydration per orders. Screen for infection (chorioamnionitis makes tocolysis inappropriate). Tocolysis is also withheld with significant bleeding, fetal compromise, or intrauterine fetal demise: in those cases delivery is safer than delay.
Frequently asked
Why give magnesium sulfate before 32 weeks?
Fetal neuroprotection. It reduces the risk of cerebral palsy in very preterm infants, separate from any tocolytic effect.
Betamethasone timing on the exam?
Two IM doses 24 hours apart, ideally completed 24 hours before delivery. That timeline is why the tocolytic and the steroid are ordered together.
When would the team let preterm labor proceed?
Chorioamnionitis, severe pre-eclampsia, significant abruption, or fetal compromise. Stopping labor is only right when staying pregnant is safer than delivering.
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