Nursing Care for Mothers in Preterm Labor Who Use Substances: A Comparative Case Study Two Cases.

Abstract

This study employed an individual case study design. Its objective was to examine nursing care for mothers in preterm labor who used substances through a comparative study of two cases admitted to the labor room at Ban Phai Hospital, Khon Kaen Province. The two women with preterm labor were compared using Gordon’s 11 Functional Health Patterns and the nursing process as frameworks for nursing care planning.

The findings showed that Case 1 was a 23-year-old woman, G2P1001, who had received no antenatal care. Her last childbirth had been 7 years earlier. Two to three days before hospital admission, she had used methamphetamine by inhalation and had continued drinking beer throughout pregnancy until delivery. The Ban Phai Hospital emergency medical services team transported her from her home. She had experienced blood-stained mucus vaginal discharge for 2 hours and 5 minutes before presentation, and her cervix was dilated to 1 cm. Ultrasonography in the labor room indicated a gestational age of 35^2/7 weeks and breech presentation. A cesarean section was performed. The male neonate had a birth weight of 2,380 g and a length of 48 cm, with Apgar scores of 5, 6, and 9. During the first 2 hours after birth, the neonate’s DTX was 68 mg/dL and hematocrit was 50%. The neonate experienced birth asphyxia. At 9 hours after birth, respiratory distress developed, with rapid, shallow breathing at 60–78 breaths/min. High-flow oxygen was administered at 4 L/min with an FiO₂ of 0.4, followed by an attempt to wean the neonate from respiratory support. The neonate remained hospitalized for an additional 9 days. After clinical improvement, the pediatrician approved discharge. Case 2 was G4P3003, with an unknown gestational age. Her last childbirth had been 1 year earlier, and she had received no antenatal care. She began using methamphetamine at 16 years of age and continued using it by inhalation throughout pregnancy until delivery. She also smoked cigarettes during pregnancy. One day before presentation, clear fluid began leaking from the vagina. On admission, the cervix was fully dilated to 10 cm, and the amniotic fluid had a foul odor. She delivered vaginally. The female neonate had a birth weight of 2,510 g and a length of 50 cm, with Apgar scores of 9, 10, and 10. The Ballard score indicated a gestational age of 35 weeks. During the first hour after birth, the neonate’s DTX was 77 mg/dL and hematocrit was 47%. The neonate developed congenital pneumonia and respiratory failure; therefore, the pediatrician referred the neonate to a tertiary care hospital in the province.