Education does not improve patient perception of preterm uterine contractility

Article Abstract:

When preterm labor is diagnosed early, the effectiveness of management strategies and the outcome of pregnancies complicated by preterm labor are improved. Current management strategies include teaching high-risk patients the signs and symptoms of labor and utilizing home monitoring devices. The reliability of patient-perceived signs and symptoms of labor and the value of educational programs to enhance perception has been questioned. The home monitoring program is designed to measure, record and transmit uterine contraction patterns over the telephone, which are then interpreted by a 24-hour perinatal nursing service. The patient's perceptions of uterine contractions were compared to actual patterns recorded by a home monitoring device to evaluate the impact of an intensive patient education program on preterm delivery prevention. Thirty-eight women were evaluated for three weeks. The uterine activity was monitored at home for two 60-minute periods a day. For the first three days no preterm labor education was given. This was followed by an intensive nurse-instructed program demonstrating the signs and symptoms of preterm labor, a program which included a 'hands on' session. Uterine contractions were underreported in 35 percent of the patients and overreported in five percent of the women. The under- and overreporting of contractions did not vary in seven consecutive three-day study intervals. Under 10 percent of the contractions documented by the home monitoring device were perceived by the patient. The perception of contractions was not improved by the intensive education sessions with the nurses. Since early diagnosis is essential if preterm birth is to be reduced, relying on patient-perceived symptoms may not be optimal. However, since contractions are not the only indicator of labor, teaching patients feelings associated with contractions should not be abandoned, but rather used in conjunction with other evaluation tools such as home monitoring devices. Although education did not improve the perception of labor contractions, patients should continue to participate in their care by reporting signs and symptoms of labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Study and teaching, Labor (Obstetrics), Uterus, Uterine contractions

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Uterine contractility patterns after an episode of preterm labor

Article Abstract:

Preterm delivery, occurring before the 36th week of pregnancy, is associated with a poor infant outcome. Although the survival of premature infants has improved, the incidence of preterm delivery has remained unchanged. Efforts to reduce the incidence of preterm births have focused on preventing preterm labor. Although the causes of preterm labor are unknown, certain environmental and social influences can help identify women at risk. Whether early identification of women at risk is useful in reducing preterm labor and delivery remains controversial. The onset of labor is signaled by regular, persistent uterine contractions accompanied by dilation and thinning of the cervix. To see if there are characteristic patterns of uterine contractions that can help predict those pregnancies that will deliver preterm, 116 women receiving treatment to prevent preterm labor were studied. A recording device used to monitor uterine activity, a tocodynamometer, was attached to the women while they remained at home. Measurements were made twice a day for one hour until delivery. A woman was sent to the hospital if four or more contractions per hour were recorded. Preterm delivery occurred in 52 women (45 percent), while 64 women (55 percent) delivered after 36 weeks, at term. There was no difference between preterm and term delivery of women with respect to uterine contraction patterns occurring between 24 and 29 weeks of pregnancy. The uterine activity between 30 and 36 weeks of pregnancy was greater in the women who subsequently delivered early. Of the women having more than three contractions per hour per week during the 30th week of pregnancy, 28 percent delivered preterm. Women who had fewer than three contractions per hour per week were likely carry to term. It is concluded that increased uterine activity in women receiving treatment for an episode of preterm labor are at a greater risk for preterm delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Uterus, Pregnant, Pregnant uterus

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A "PROPP" for the Bronx: preterm birth prevention education in the inner city

Article Abstract:

When preterm labor is diagnosed early, the effectiveness of management strategies and the outcome of pregnancies complicated by preterm labor improves. Current management strategies include teaching high-risk patients the signs and symptoms of labor and utilizing home monitoring devices. The home monitoring program is designed to measure, record and transmit uterine contraction patterns via the telephone to be interpreted by a 24-hour perinatal nursing service. However, the luxury of this type of preterm labor surveillance may not be available or practical for the inner-city indigent woman, who is unfortunately at a particularly high risk for preterm birth. For this reason, a community-wide prevention program was developed specifically for inner-city pregnant women. The program, known as ''A PROPP for the Bronx'' (program to reduce obstetric problems and prematurity), has as its main feature strong educational tools. One aspect of the program includes a 12-minute prenatal educational videotape in English and Spanish, which includes information regarding the consequences of preterm birth, the recognition of symptoms of labor, the treatment of symptoms and ways to change adverse behaviors. The impact of the tape, which was viewed in the waiting areas and in small groups, was evaluated among 615 high-risk women. Since an educational program is only useful if the information is actually retained, it is important to know the amount of information retained for the program to succeed. An evaluation tool ascertained the amount of knowledge already possessed by the patient, the transfer of that information from the videotape and booklets to the patient and whether that information was retained by the patient after delivery. The evaluation tool found that a significant amount of information in the videotape was transferred and retained by both English- and Spanish-speaking patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Pregnant women, Premature birth, Poor women, Health education

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