Write a Research proposal with topic “Risk Factors for preterm labor”. As per professor , APA format to be used and include a PICOT ( Patient, problem, intervention, comparison, outcome and time) question. Please see attached 15 articles to be use and the template for the proposal. Select one nurse theorist and theory that is related to your work , describe the theory and how is applied ( page 3 in template) APA format.In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs, thus her Nursing Need Theory was developed.In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems” that shifted the focus of nursing from a disease-centered approach to a patient-centered approach.In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and viewed the professional function of nursing as finding out and meeting the patient’s immediate need for help.In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the fostering of efficient and effective behavioral functioning in the patient to prevent illness.In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to view the unitary human being, who is integral with the universe.In 1971, Dorothea Orem states in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental, or social needs.In 1971, Imogene King’s Theory of Goal attainment states that the nurse is considered part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health.In 1972, Betty Neuman in her theory states that many needs exist, and each may disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice.In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems who strives to maintain the balance between these various stimuli.In 1979, Jean Watson developed the philosophy of caring highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.Running head: RISK FACTORS FOR PRETERM LABOR
Risk Factors for Preterm Labor
Maybel Valdes
Ana G. Mendez University
Risk Factors for Preterm Labor
Article 1
1. Authors: Adam Sachs, Jean Guglielminotti, Russell Miller, Ruth Landau, Richard
Smiley, Guohau Li
2. Title (Year): Risk factors and risk stratification for adverse obstetrical outcomes after
appendectomy or cholecystectomy during pregnancy (2017)
3. Methodology
1. Sample: 19,926 women were included
All women who gave birth between January 1, 2003, and December 31, 2012, and
who underwent appendectomy, cholecystectomy, or both during their pregnancy were
included. Women with maternal and fetal diagnoses, those with ectopic pregnancy,
the possible surgical procedure of the newborn, and elective admission were
2. Study type: Cohort study
3. Results

Preterm labor (without preterm delivery) is the second most prevalent adverse
obstetrical event (35.4%) in pregnant women who have undergone appendectomy or
cholecystectomy during pregnancy

The common risk factors associated with preterm labor include:
o History of preterm labor
o Vaginitis or vulvovaginitis
o Sepsis
4. Conclusions
▪ The incidence of adverse obstetrical outcome following appendectomy or
cholecystectomy during pregnancy is approximately 5%
5. Recommendations
Future studies should explore the causation of the identified risk factors
Article 2
1. Authors: Ali Asghar Halimi asl, Saeed Safari, Mohsen Parvareshi Hamrah
2. Title (Year): Epidemiology and Related Risk Factors of Preterm Labor as an Obstetrics
Emergency (2016)
3. Methodology:
1. Sample: 810 cases were selected; participants were selected using the census method
from preterm labors at Shohadaye Tajrish Hospital between March 2008 and March
2. Study type: retrospective cross-sectional study
3. Results:
The following factors were found to be correlated to preterm labor:
▪ Multipartite
▪ Fetal anomaly
▪ Prenatal care
▪ Smoking
▪ In vitro fertilization
▪ Failure to take folic and iron supplements
▪ History of infertility
▪ C-section
▪ Trauma
▪ Systemic disease
▪ Hypertension
▪ Cephalic presentation
▪ Vaginal bleeding
▪ Placenta decolman
▪ Oligohydramnios
▪ Chorioamnionitis
▪ Cervical insufficiency
4. Conclusions:
The study identified the following risk factors of preterm labor:
▪ Intercourse during the preceding week
▪ Multipartite
▪ The short interval from the last delivery
▪ Preeclampsia
▪ Fetal anomaly
▪ Ruptured membranes
▪ Hypertension
▪ Amniotic fluid leakage
5. Recommendations
The study recommends pregnant women observe the following protective factors:
▪ Consume iron and folic supplements
▪ Monitor their weight
▪ Disclose a history of C-section and systemic disease
Article 3
1. Authors: Anna E. Toijonen, Seppo T. Heinonen, Mika V. M. Gissler, Georg Macharey
2. Title (Year): A comparison of risk factors for breech presentation in preterm and term
labor: A national, population-based case-control study (2020)
3. Methodology
1. Sample: 737,788 singleton births were included
2. Study type: Case-control study
3. Results

Preterm rupture of the membrane is associated with preterm labor

Risk factors of a breech presentation, following preterm labor in the 28th to 31st
gestation week, include:
o Low fetal birth weight
o Premature rupture of membrane
o Hypertension

The risk factors in the 32nd to 36th gestation weels include:
o Pre-gestational diabetes
o Oligohydramnios, congenital anomaly
o Premature rupture of membrane
4. Conclusions
Obstetric risk factors induce breech presentation in preterm labor
5. Recommendations
Future studies, using other study designs, are necessary to determine causation
Article 4
1. Authors: Chang Chen, Jin Wen Zhang, Hong Wei Xia, Hui Xin Zhang, Ana Pilar Betran,
Lin Zhang, Xiao Lin Hua, Ping Feng, Dan Chen, Kang Sun, Chun Ming Guo, Hong Bo
Qi, Tao Duan, and Jun Zhang
2. Title (Year): Preterm Birth in China between 2015 and 2016 (2019)
3. Methodology
1. Sample: 89 hospitals participated; random sampling was used for selection
2. Study type: Cross-sectional survey
3. Results
The weighted national incidence of preterm birth, and labor, is 7.3% for all deliveries,
and 6.7% for all live births
Risk factors for preterm labor, and birth, include maternal, fetal, and placental conditions
4. Conclusions
The study determines the incidence figures for preterm birth in China and the associated
risk factors
5. Recommendations
Formulation of a more elaborate working definition of preterm birth and preterm
Differentiate the findings between all births and in live births
Article 5
1. Authors: Fereshteh Fakor, Seyedeh Hajar Sharami, Forozan Milani, Fariba Mirblouk,
Sodabeh Kazemi, Davoud Pourmarzi, Hannan Ebrahimi, Seyedeh Fatemeh Dalil Heirati
2. Title (Year): The association between level of maternal serum leptin in the third trimester
and the occurrence of moderate preterm labor (2016)
3. Methodology
1. Sample: 30 moderate preterm delivering women and 30 pregnant control group
2. Study type: Case-control study
3. Results

The Control group had higher average serum leptin (56.66±34.18) than the preterm
group (33.65±16.70)

There were no significant differences between the body mass index and age of

High serum leptin is associated with diminished risk of preterm labor
4. Conclusions
Low serum leptin level is a risk factor for preterm labor
5. Recommendations
Further studies with a larger sample size are required.
Article 6
1. Authors: Hamid Kermani Moakhar, Behnaz Sovizi, Mitra Eftekhari Yazdi
2. Title (Year): The relationship between maternal haemoglobin and haematocrit with low
birth weight and preterm labor (2019)
3. Methodology:
1. Sample (how many articles reviews, patients, questioners, tool, how did they select
the sample): 383 participants
2. Study type: Cross-sectional
3. Results:
There is a significant relationship between:
▪ Maternal HCT and preterm labor
▪ Maternal HB in first, second, and third trimesters with preterm labor
4. Conclusions:
Prompt diagnosis and treatment of maternal anemia would significantly lower the risk of
preterm labor
5. Recommendations:
Further studies should be conducted on pregnant women with high HCT and pregnancy
Article 7
1. Authors: Hassan Boskabadi and Maryam Zakerihamidi
2. Title (Year): Evaluation of maternal risk factors, delivery, and neonatal outcomes of
rupture of the membrane: A systematic review study (2019)
3. Methodology
1. Sample:
a. 15 articles were included in the study
b. 90 studies met the inclusion criteria; 40 duplicates were eliminated; 30 were
eliminated on relevance; and five eliminated for incomplete data, absence of
full text, and uncertainty regarding the type of study or target
2. Study type: A literature review
3. Results

Most studies explored a combination of risk factors, maternal and delivery
outcomes of premature rupture of membrane

Four studies explored maternal risk factor, one investigated delivery outcomes,
and one the neonatal outcomes of premature rupture of membrane
4. Conclusions

The study determined that the critical risk factors for premature rupture of membrane,
which culminates in preterm labor, are:
o Diabetes
o Maternal hypertension
5. Recommendations
Extensive studies should be conducted to determine the correlation between premature
rupture of membrane and other neonatal morbidities
Article 8
1. Authors: Katie P. Daniels, Zulam Valdez, David H. Chae, and Amani M. Allen
2. Title (Year): Direct and vicarious racial discrimination at three life stages and preterm
labor: results from the African American women’s heart & health study (2020)
3. Methodology
1. Sample:
a. 208 African American women between 30 and 35 years living in San Francisco
Bay area were included
b. A purposeful sampling technique was used to gather data
2. Study type: Cross-sectional study
3. Results
A unit increase in direct adolescent racial discrimination is associated with a 48% rise in
the probability of preterm labor
A unit rise in childhood vicarious racial discrimination translates to a 45% increase in the
chances of preterm labor
4. Conclusions:
Racial discrimination is a risk factor for preterm labor in African American women living
in San Francisco, Bay Area.
5. Recommendations:
Promotion of public health and policy efforts to eradicate racial discrimination
Article 9
1. Authors: Kim Jeung-Im, Cho Mi-Ock, and Choi Gyu-Yeon
2. Title (Year): Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor
Symptoms and Preterm Birth (2017)
3. Methodology:
1. Sample: 193 women in the second trimester; sample selection was through random
2. Study type: Prospective cohort study
3. Results:
Logistic regression results
The following factors were found to be significantly related to preterm labor:
▪ Shorter cervix
▪ Twins
▪ BMI above 25kg/m2
▪ History of preterm labor
4. Conclusions:
▪ Numerous factors induce preterm labor in the second trimester
▪ Preterm labor may predict preterm birth
5. Recommendation
Future research to formulate an accurate screening tool to predict the incidence of
preterm labor
Article 10
1. Authors: N. Fourie, SM du Rand, D.G. Morton
2. Title (Year): Risks of preterm labor among women who attend public antenatal care
clinics (2018)
3. Methodology
1. Sample: 205 pregnant women, simple random sampling
2. Study type: Explorative, descriptive, and retrospective design
3. Results:
▪ Most women do not receive adequate quality antenatal care
▪ Some crucial tests and procedures were underreported by nurses
4. Conclusions
▪ Most cases of preterm labor, and birth, can be prevented in women who attend antenatal
5. Recommendations
o Nurses should compile comprehensive case history of all pregnant women
attending the clinic
o Clinics should consider home visits
o Nurses should gather complete obstetric history from either the patient or the
healthcare facility involved
o Compliance with the recommended health reporting guidelines
Article 11
1. Authors: Qin Li, Yuan-Yuan Wnag, Yuming Guo, Hong Zhou, Xiaobin Wang, Qiao-Mei
Wang, Hai Ping Shen, Yi-Ping Zhang, Dong-Hai Yan, Shanshan Li, Gongbo Chen, Lizi
Lin, Yuan He, Ying Yang, Zuo-Qi Peng, Hai-Jun Wang, and Xu Ma
2. Title (Year): Folic acid supplementation and the association between maternal airborne
particulate matter exposure and preterm delivery: A national Birth Cohort Study in China
3. Methodology:
1. Sample: 1,229,556 primiparas were included in the study
Participants were selected from 1,535,545 women who delivered between December
1, 2013, and November 30, 2014
Patients whose exposure to particulate matter records were unavailable were from
ethnic minority communities or had chronic illnesses were excluded
2. Study type: Cohort study
3. Results:

Women who begun taking folic acid supplements over three months before
pregnancy have a lower risk of preterm labor and preterm delivery

Respondents with particulate matter concentrations, especially PM1, PM2.5, and PM10
in the upper quartile had an elevated risk of preterm labor and preterm delivery
4. Conclusions:
Initiating folic acid supplementation three months before pregnancy lowers the risk of
preterm labor and preterm delivery
5. Recommendations
Promote folic acid supplementation in women planning for pregnancy
Article 12
1. Authors: Rafal Rzepka, Barbara Dolegowska, Aleksandra Rajewska, Daria Salata, Marta
Budkowska, Sebastian Kwiatkowski, and Andrzej Torbe
2. Title (Year): Diagnostic potential of evaluation of SDF-1α and sRAGE levels in
threatened premature labor (2016)
3. Methodology:
1. Sample: 211 pregnant women participated divided into two test groups A (72), B
(66), and two control groups C (40) and D (33); there is no information on the
sampling technique used
2. Study type: there is no information on the study design
3. Results:
▪ There was no statistically significant difference in plasma resistin (RE), sRAGE,
and WBC
▪ Plasma SDF-1α and sRAGE levels were lower in group A compared to B
▪ There is a negative correlation between latency duration and plasma CRP levels
▪ Women in group A delivered within 48 hours after the onset of preterm labor
4. Conclusions:
▪ Low plasma SDF-1α and sRAGE levels are predisposing factors for preterm labor
▪ Assessment of SDF-1α and sRAGE levels is essential to prevent preterm labor
5. Recommendations:
Further research on the observed correlation is required
Article 13
1. Authors: Shun Yasuda, Masayo Tanaka, Hyo Kyozuka, Satoshi Suzuki, Akiko
Yamaguchi, Yasuhisa Nomura, and Keiya Fujimori
2. Title (Year): Association of amniotic fluid sludge with preterm labor and histologic
chorioamnionitis in pregnant Japanese women with intact membranes: A retrospective
study (2019)
3. Methodology
1. Sample:

54 patients were included in the study

All patients who attended Fukushima University Hospital between January 2010
AND December 2013 and had singleton pregnancies devoid of obstetric
complications were included. Persons who had twins, multiple pregnancies, fetal
anomalies, and obstetric complications were excluded.
2. Study type: Retrospective study
3. Results:
Patients with amniotic sludge have a lower duration of pregnancy compared to those
4. Conclusions
Amniotic sludge is a risk factor for preterm labor and chorioamnionitis in pregnant
Japanese women
5. Recommendations
Prospective studies exploring the management of patients with amniotic sludge, with
a cervical length greater than 25 millimeters, should be conducted
Article 14
1. Authors: Sue V. Kildea, Yu Gao, Margaret Rolfe, Jacqueline Boyle, Sally Tracy, and
Lesley M. Barclay
2. Title (Year): Risk factors for preterm, low birth weight, and small for gestational age
birth among Aboriginal women from remote communities in Northern Australia (2016)
3. Methodology
1. Sample: 713 singleton births
2. The study included all aboriginal women who gave birth:
a. At the regional hospital
b. En route to the hospital
c. In the resident community
d. In a hostel
Study type: Cohort study
3. Results
a. The incidence of preterm labor, and birth, is 19.4%
b. The study found that the following factors are correlated to preterm labor and
subsequent birth:
i. Teenage motherhood
ii. Maternal history of preterm birth
iii. Smoking
iv. Inadequate antenatal care
v. Placental complications
vi. Pregnancy-induced hypertension
4. Conclusions:
▪ The incidence of preterm labor, and birth, among Aboriginal women, is high
▪ Some risk factors for preterm labor can be modified
5. Recommendations
Promote culturally responsive, women-centered care to remote communities
Article 15
1. Authors: Wendy N. Nembhard, Britni L. Ayers, R. Thomas Collins, Xiaoyi Shan, Nader
Z. Rabie, Di Chang, James M. Robbins, Pearl A. McElfish
2. Title (Year): Adverse pregnancy and neonatal outcomes among Marshallese women
living in the United States (2019)
3. Methodology
1) Sample: 2,488 women out of the 91662 singleton births in two Arkansas counties
were Marshallese and were therefore included in the study
2) Study type: Cross-sectional study
3) Results:
Marshallese women have a significantly higher incidence of adverse pregnancy
outcomes compared to non-Hispanic white women
4. Conclusions:
Marshallese women have a higher incidence of adverse pregnancy outcomes such as
preterm labor, preterm birth, and small-for-gestational-age cases
5. Recommendations:
Further studies to determine whether the perinatal outcomes observed herein apply to
other Pacific Islander communities are required.
Running head: [Insert Running Header here ALL CAPS]
[Insert Title here]
“[Insert Name of Author here]”
Universidad del Turabo
NR502: Proposal
“[Insert start month of session]” Session, “[Insert year here]”
NOTE: This is a template and guide. Delete all highlighted materials.
[Insert Running Header here ALL CAPS]
[Insert Title here]
Note that there is no heading that says Introduction. The paragraph or two that follows
the title on the first page of your text is assumed to be your introduction. Your introduction
follows the title of your paper (note that the title is not bolded). You should start your
introduction with a powerful statement or two to stimulate interest. You should identify the
purpose of your paper and provide a preview of what the paper will include. Remember that
formal papers are in third person, so no I, me, we except in specified areas.
Significance of the Practice Problem
Start this section with identification of the practice problem. This section should also
answer the question “why is this important?” You should address the significance to the
patient/client (e.g., pain, suffering, quality of life, impact on income potential, etc.), the family,
healthcare system (e.g., impact on cost or delivery systems), and society (e.g., cost of care, need
for healthcare policy). Discuss the incidence and/or prevalence and include the financial impact
if at all possible. You might discuss the impact on length of stay, readmission, home health care
requirements, disability and/or mortality. Also, you should address any quality, safety, legal, and
ethical implications. This discussion must be substantiated by citations from professional
Research Question
This section should include your PICOT (patient, intervention, comparison, outcome,
time) question but also should provide thorough descriptions of your population, intervention,
comparison intervention, outcome, and timing (if appropriate to your question). This section
[Insert Running Header here ALL CAPS]
contains, in essence, your operational definitions of the variables in the question. If you use
definitions from the literature, be sure to cite them. Include objectives (general and specifics).
Theoretical Framework
This section should include the theoretical framework that supports your proposal.
Describe the theory or model that served as the foundation for your project. This may be a
nursing theory or a theory from another discipline if pertinent and applicable.
Synthesis of the Literature
Synthesize at least 10 primary research studies and/or systematic reviews; do not include
summary articles. This section is all about the scientific evidence rather than someone else’s
opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and
make your own decision about quality and applicability to your question even if you did find out
about the study in a review of the literature. The studies that you cite in this section must relate
directly to your PICOT question. This is a synthesis rather than a study-by-study review. Address
the similarities, differences, and controversies in the body of evidence. The literature review
should include the following: 1.Objective of the literature review; 2.Overview of the subject
under consideration; 3.Particular position, those opposed, and those offering completely
different arguments; 4.Discussion of both the distinctiveness of each source and its similarities
with the others.
Practice Recommendations
So. . . using available evidence, what is the answer to your question? This section is for
you to summarize the strength of the body of evidence (quality, quantity, and consistency), make
a summary statement, and based on your conclusions drawn from the review, give a
[Insert Running Header here ALL CAPS]
recommendation for practice change based on scientific evidence. This would logically be the
intervention of your PICOT question. Perhaps you found substantiation for usual practice, and
you recommend reinforcement and education regarding this best practice.
Project Setting
This section should include a description of the setting of the Project. Include the type of
setting, description of a typical client, and the vision and mission, and organizational structure
and culture. Describe how organizational need was established. Identify the stakeholders.
Describe how organizational support was confirmed and plans for sustainability.
Project Description: methodology
This section should begin with a description of your change model and why it was selected as the
model for this specific change. You should learn about the model from a primary source (i.e., do
not cite a textbook). The model that you selected should be appropriate to the change that you
recommended (i.e., individual change or organizational change). Use the model to describe the
practice change that you recommended even if that is reinforcement and education regarding the
status quo. Your change process should be specific to your setting. You can make each step of
the model a level 2 heading (title case and flush left) and then describe how you implemented
that step of the change in your selected setting. Your change process must be specific to your
question and the answer that you found through your literature review and your setting. It should
be a well thought-out process using the model as a guide. Describe the setting for your project.
Include discussion of barriers and facilitators. Discuss your role in the project and the
leadership qualities and skills that were utilized for successful completion of the project.
Methodology includes:

Describe the design
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Identify the variable

Describe the reliability and validity of the instrument

Describe the population and the sample.

Describe the steps to protect the rights of human according to IRB criteria.

Discuss the procedure to complete the study.
This section may be in first person.
Project Evaluation Results
This section must include how you are going to evaluate the planned change project.
Remember that your plan must evaluate the outcome(s) identified in your PICOT question.
Discuss recruitment and selection of participants or subjects including inclusion and exclusion
criteria. Discuss the evaluation design and whether you will use primary or secondary data for
the comparison group. Discuss formative and summative criteria for evaluation and time points
for the evaluation. Describe and include any tool(s) that are to be used in your project
evaluation as Appendices and discuss the reliability and validity of the tool(s). Identify the type
of data (i.e., nominal, ordinal, interval, or continuous) produced by the evaluation tool(s).
Discuss how you will control extraneous variables. Discuss planned analysis of your evaluation
data. Discuss how you will protect human rights and ensure privacy of health information.
This section may be in first person.
Discussion and Implications for Nursing and Healthcare
Discuss the conclusions you can make from the project evaluation results: review and
answer your PICOT question. Examine, interpret, and qualify the results. Discuss internal
validity and limitations of the project evaluation. Take into account sources of potential bias and
[Insert Running Header here ALL CAPS]
other threats to internal validity, the imprecision of measures, and other limitations and
weaknesses of the evaluation (adapted from APA, 2010, p. 35).
Describe the implications of your project and the project evaluation on nursing practice
and healthcare. Do not overstate the significance. Identify the impact on the appropriate
microsystem. Include any recommendations you have as a result of this project and project
evaluation. Also, include what you might recommend with replication of this project and project
evaluation and your potential next steps for this practice problem.
Summary and Conclusion
The conclusion should start with a statement regarding the intent of the paper and your
achievement toward that intention. Also, it should briefly say what was included in the paper.
Remember that the introduction is a preview, and this section should contain a summary.
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Remember that this is a reference list rather than a bibliography. A bibliography is everything
you read to prepare the paper but a reference list is only what you cited. If there is not a citation
for a reference, it should not be here. PLEASE make sure that your references here and your
citations throughout the paper are in APA format. Take the time to make sure that they are
correct. We have already formatted the paper for you with this template.

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