# Situation: The nurse works in the obstetric admitting and labor unit of a provincial hospital that receives referrals from birthing facilities of rural health units (RHUs). A 24-year-old gravida 2, para 1, at 32 3/7 weeks' gestation, dated by an early ultrasound, is admitted in preterm labor with regular contractions and a cervical dilation of 3 cm. Membranes are intact, there is no bleeding or sign of infection, and the fetal heart rate tracing is normal. Which pair of medications should the nurse expect to be ordered?

> source: MyMerci (mymerci.kr)  
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> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse works in the obstetric admitting and labor unit of a provincial hospital that receives referrals from birthing facilities of rural health units (RHUs).

A 24-year-old gravida 2, para 1, at 32 3/7 weeks' gestation, dated by an early ultrasound, is admitted in preterm labor with regular contractions and a cervical dilation of 3 cm. Membranes are intact, there is no bleeding or sign of infection, and the fetal heart rate tracing is normal. Which pair of medications should the nurse expect to be ordered?

## 보기

1. Betamethasone and indomethacin
2. Magnesium sulfate and nifedipine
3. Betamethasone and nifedipine **✔ 정답**
4. Betamethasone and oral terbutaline until 37 weeks

**정답: 3**

## 해설

Antenatal corticosteroids are indicated from 24 0/7 to 33 6/7 weeks when birth within 7 days is likely, and a tocolytic such as nifedipine may be used for up to 48 hours so the steroid can act. Indomethacin is used only before 32 weeks because of its fetal effects, and magnesium sulfate for fetal neuroprotection is mainly given when birth is expected before 32 weeks. Long-term or oral tocolysis is not used.

## 심화 해설

Clinical context Preterm labor at 32 3/7 weeks with cervical dilation 3 cm, intact membranes, no bleeding or infection, and a normal fetal heart rate tracing places this patient in the window where two interventions work together: accelerate fetal lung maturity and temporarily reduce contractions so the steroid has time to act.

Why the correct pair is betamethasone and nifedipine Antenatal corticosteroids are recommended when delivery is anticipated within 7 days between 24 0/7 and 33 6/7 weeks. At 32 3/7 weeks, this patient is still within that range, and with regular contractions plus cervical change, birth within a week is a realistic concern. Betamethasone is the corticosteroid given to reduce neonatal respiratory distress, intraventricular hemorrhage, and necrotizing enterocolitis. A short course of a tocolytic can be used for up to 48 hours to allow the corticosteroid to achieve its effect. Nifedipine, a calcium channel blocker, is a first-line tocolytic for this purpose because it relaxes uterine smooth muscle with a favorable maternal side-effect profile. The goal of tocolysis here is not to stop labor until term, but to buy time for the steroid to work.

Why the other options are incorrect

| Option | Medication pair | Why it is not the best answer |
| --- | --- | --- |
| 1 | Betamethasone and indomethacin | Indomethacin, an NSAID, is generally limited to gestations before 32 weeks because of fetal risks such as premature ductus arteriosus closure and oligohydramnios. At 32 3/7 weeks, it is not the preferred tocolytic. |
| 2 | Magnesium sulfate and nifedipine | Magnesium sulfate for fetal neuroprotection is mainly indicated when birth is expected before 32 weeks. This patient is already past that threshold, so magnesium is not the priority medication. Nifedipine alone does not address fetal lung maturity. |
| 4 | Betamethasone and oral terbutaline until 37 weeks | Long-term or maintenance oral tocolysis is not recommended. Terbutaline also carries significant maternal cardiovascular risks. Tocolysis should be limited to 48 hours for steroid benefit, not continued for weeks. |

Pathophysiology and nursing application Preterm labor reflects premature activation of the same inflammatory and hormonal pathways that normally initiate term labor. Contractions plus cervical change define active preterm labor, and once the cervix is 3 cm dilated, the process is already established. The nurse should anticipate orders that address two separate problems: fetal immaturity and ongoing uterine activity. Corticosteroids and tocolytics are complementary, not interchangeable—one matures the fetus, the other temporarily quiets the uterus.

Watch out! Do not interpret nifedipine as a long-term solution. Its role is limited to a short window, typically 48 hours, while betamethasone is administered. After that, if labor progresses, delivery is allowed to proceed.

Key point! The gestational age cutoff matters. At 32 3/7 weeks, the patient is past the neuroprotection window for magnesium sulfate and past the safe use window for indomethacin, but still within the corticosteroid benefit window. This is why option 3 is the only pair that fits all the criteria.

Monitoring priorities for the nurse After betamethasone is given, monitor maternal blood glucose because transient hyperglycemia is common. With nifedipine, assess maternal blood pressure and heart rate, and watch for headache, flushing, or dizziness. Continue fetal heart rate monitoring and observe for signs of labor progression, rupture of membranes, vaginal bleeding, or infection, since any of these would change the plan. The intact membranes and absence of infection in this scenario support the decision to attempt short-term tocolysis rather than proceeding directly to delivery.

## 임상 시나리오

Preterm Labor at 32 Weeks: Steroid and TocolysisBetamethasone plus short-term nifedipine when birth is likely within 7 days
Antenatal corticosteroids are indicated from 24 0/7 to 33 6/7 weeks when birth within 7 days is likely. At 32 3/7 weeks with regular contractions and cervical dilation 3 cm, betamethasone should be given to reduce neonatal respiratory distress, intraventricular hemorrhage, and necrotizing enterocolitis.

A short course of nifedipine, a calcium channel blocker and first-line tocolytic, may be used for up to 48 hours to allow the corticosteroid to achieve its effect. The goal is not to stop labor until term but to buy time for steroid benefit.

CautionDo not use indomethacin at or after 32 weeks due to fetal ductus arteriosus closure and oligohydramnios risk. Magnesium sulfate for fetal neuroprotection is mainly for birth expected before 32 weeks. Avoid long-term or oral tocolysis.

## 핵심 개념

- **Antenatal corticosteroids** — Given between 24 0/7 and 33 6/7 weeks when birth within 7 days is likely to accelerate fetal lung maturity and reduce neonatal morbidity.
- **Tocolysis** — Short-term use of medications to suppress uterine contractions, typically for up to 48 hours to allow corticosteroids to take effect.
- **Nifedipine** — Calcium channel blocker and first-line tocolytic that relaxes uterine smooth muscle with a favorable maternal side-effect profile.
- **Indomethacin** — NSAID tocolytic limited to gestations before 32 weeks because of fetal risks such as premature ductus arteriosus closure and oligohydramnios.
- **Preterm labor** — Regular contractions with cervical change between 20 and 36 6/7 weeks gestation, requiring assessment for steroid and tocolytic therapy.

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