Page 452 - Encyclopedia of Nursing Research

PReveNTION OF PReTeRM BIRTH, PReTeRM lABOR, AND lOW BIRTH WeIGHT n 419

is 17.8% for African American women com- 2007). Some tocolytic drugs temporarily delay
pared with 10% to 11.5% for White, Hispanic, preterm birth, allowing for corticosteroid
Asian, and Pacific Islander women (Ashton treatment, but there is no evidence that toco- P
et al., 2009; Institute of Medicine, 2007; lysis prevents preterm birth (Anotayanonth,
Osterman et al., 2009; Muglia & Katz, 2010; Subhedar, Neilson, & Harigopal, 2010;
Whitehead et al., 2009). The causes of dispar- Crowther, Hiller, et al., 2009; Goldenberg,
ity are unclear (Institute of Medicine, 2007; 2002; Institute of Medicine, 2007). Antibiotics
Fry-Johnson & Rowley, 2010; Muglia & Katz, are used for treating suspected maternal
2010; Paul, Boutain, Manhart, & Hitti, 2008; infections, especially Group B streptococcus,
Whitehead et al., 2009). The use of risk assess- which is a cause of significant neonatal mor-
ment tools, however, has not been successful bidity and mortality, but are not effective for
in predicting preterm birth. Between 10% and the single purpose of preventing preterm
30% of women designated as high risk have birth. Cervical cerclage is also ineffective,
normal outcomes, and 20% and 50% of those but further research is needed to differenti-
designated as low risk have a preterm birth or ate the various causes of a shortened cervix.
low-birth-weight infant (Andolsek & Kelton, lastly, there is also no evidence for the effi-
2000). Others report, however, that concep- cacy of maternal hydration, sedation, home
tualization of pregnancy as at risk leads to uterine monitoring, and bed rest (Institute
unnecessary interventions (Jordan & Murphy, of Medicine, 2007; Maloni, 2010; Meher,
2009; lyerly et al., 2009). Abalos, & Caroli, 2010; Say, Gulmezoglu, &
The goals of treatment to prevent pre- Hofmeyer, 2010; Sosa, Althabe, Belizán, &
term birth are to reduce uterine contractions Bergel, 2010).
in order to delay time to delivery and to opti- Some interventions are associated
mize fetal status (Goldenberg, 2002). Delay with adverse effects and are of concern.
of birth allows time for fetal development to Tocolytic drugs are associated with mater-
offset the effects of extreme low birth weight nal pulmonary edema and cardiac arrhyth-
and prematurity and for administration of mia, and magnesium sulfate is associated
a single course of antenatal corticosteroids with increased fetal and neonatal death
that stimulate fetal lung development and (Anotayanonth et al., 2010; Crowther
reduce neonatal respiratory distress syn- et al., 2009; Goldenberg, 2002; Institute of
drome (Crowther & Harding, 2009; National Medicine, 2007). Antepartum bed rest is
Institutes of Health, 1994). Delay also allows associated with an array of physiological and
transfer to a tertiary medical center, as birth psychological side effects, including mus-
near a neonatal intensive care unit is a major cle atrophy, cardiovascular deconditioning,
predictor of neonatal survival (DiRenzo maternal weight loss, and decreased infant
et al., 2006; Goldenberg, 2002; Institute of birth weight, depression, and major family
Medicine, 2007). problems (Maloni, 2010). In contrast, leisure
There is considerable variation in the physical activity is associated with a reduc-
management of preterm labor and preterm tion in preterm birth (Domingues et al.,
birth prevention (Goldenberg, 2002; Institute 2009; evenson, Siega-Riz, Savitz, leiferman,
of Medicine, 2007). Therapeutic treatments & Thorp, 2002; Institute of Medicine, 2007).
include tocolytic drugs, antibiotics, cervi- The repeated use of ineffective interventions,
cal cerclage, bed rest/activity restriction, especially those with major side effects, sug-
hydration, sedation, home uterine monitor- gests lack of attention to research evidence
ing, nurse home visitation, and psychoso- and also suggests that evidence-based prac-
cial support, but the majority are ineffective tice has not been well integrated into obstet-
(Goldenberg, 2002; Institute of Medicine, ric clinical practice (Fox, Gelber, Kalish, &