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OB > 12.2a Preterm Labor and Birth > Flashcards

12.2a Preterm Labor and Birth Flashcards

1
Q

Preterm Labor

A
  • Regular contractions and change in cervical effacement/dilation
    OR
  • Presentation with regular uterine contractions and at least 2cm dilation
  • Occurs between 20 weeks to 36 weeks 6 days
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2
Q

Preterm Birth

A
  • Birth between 20 weeks and 36 6/7 weeks

Very Preterm - Less than 32 weeks
Moderately Preterm - 32-34 weeks
Late Preterm - 34-36 6/7 weeks

  • Risk is directly related to degree or prematurity
  • Usually increased risk of early death and long term health problems
  • Before 32 weeks is greatest risk
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3
Q

Preterm Birth vs LBW

A
  • Preterm birth is more dangerous due to less time in uterus leading to immature body systems
  • Low birth weight can be caused by IUGR (inadequate fetal growth), issues with uteroplacental perfusion (gestational hypertension, poor nutrition)
  • Birth Weight is NOT a substitute for gestational age
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4
Q

Spontaneous/Indicated Preterm Birth

A

Spontaneous - Birth without maternal/fetal illness

Indicated - Iatrogenic (done to resolve an illness)

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5
Q

Risks of Spontaneous Preterm Birth

A
  • History of genital tract colonization/infection/instrumentation
  • African Americans
  • Bleeding of Uncertain Origin
  • Uterine Anomalies
  • Use of Assisted Reproductive Technology
  • Multiple Gestation
  • Cigarettes/Drugs
  • <19.6 BMI or >30
  • Periodontal Disease
  • Limited Education/Socioeconomic Class
  • Late Entry into Prenatal Care
  • High Levels of Stress
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6
Q

Causes of Spontaneous Preterm Labor/Birth

A
  • Infection
  • Anomalies of Uterus
  • Implantation of Placenta on Uterine Septum
  • Unexplained Vaginal Bleeding After 1st Trimester
  • Genetic Predisposition
  • Stress
  • Fetal Allergies
  • Decrease in Progesterone
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7
Q

Causes of Preterm Birth

A
  • Gestational Diabetes
  • Chronic Hypertension
  • Preeclampsia
  • Previous C-sections
  • Cholestasis
  • Placental Abruption/Previa
  • Seizures, Thromboembolisms, Asthma, Bronchitis, HIV, Herpes, Obesity, Smoking
  • Fetal Compromise (poor growth, abnormal NST/BPP, poly/oligohydramnios, blood group alloimmunization, birth defects, multiple gestation, twin to twin transfusion syndrome)
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8
Q

Risk Factors Spontaneous Preterm Birth

A
  • Social Determinants of Health
  • Lack of Access to Prenatal Care
  • Genetics
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9
Q

Endocervical Length

A
  • Cervical measurement predicts when labor has begun

- Cervix size greater than 30mm are unlikely to give preterm birth even with symptoms

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10
Q

Fetal Fibronectin Test

A
  • Glycoprotein “Glue” found in plasma and produced during fetal life
  • Normally appears in cervical/vaginal secretions early in pregnancy than again in late pregnancy
  • Fluid is collected with a vaginal swab
  • fTN present in late second and early third trimesters indicates placental inflammation which may cause spontaneous preterm labor
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11
Q

CARE MANAGEMENT

A
  • Onset of preterm labor can easily be mistaken for normal discomforts of pregnancy (insidious)

PREVENTION

  • Disease prevention, preconception counseling, smoking cessations
  • Prophylactic progesterone supplementation from 16-36 weeks can help prevent. Does not work in multiple gestation pregnancies
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12
Q

Interventions of Preterm Labor

A
  • Transfer mother to hospital before birth
  • Administer antibiotics to prevent Group B Strep
  • Glucocorticoids (betamethasone, dexamethasone) to help reduce respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis. (Helps maturate fetal lungs)
  • Magnesium Sulfate for women giving birth before 32 weeks to reduce cerebral palsy in infants.

SYMPTOMS OF PRETERM LABOR

  • Uterine Contractions
  • Pain
  • Vaginal Discharge between 20-36 weeks
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13
Q

Diagnosing Preterm Labor

A
  • Gestational Age 20-36 weeks
  • Uterine Activity with Cervical Effacement/Dilation
  • Initial Presentation with Regular Contractions and 2cm Dilation
  • Presence of fFN
  • MUST HAVE CERVICAL CHANGES
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14
Q

Lifestyle Modifications for Preterm Birth

A
  • Activity Restriction (Bed Rest, Hydration, Limited Work)

- Restrict Sexual Activity (Pelvic Rest)

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15
Q

S/S Preterm Labor

A
  • Change in Vaginal Discharge (watery, mucus, or blood)
  • Increase in Vaginal Discharge
  • Pelvic/Lower ABD pressure
  • Constant low, dull backache
  • Mild abdominal cramps without diarrhea
  • Regular and frequent contractions or uterine tightening (painless)
  • Ruptured membranes
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16
Q

WHAT TO DO IF YOU SUSPECT PRETERM LABOR

A
  • Stop what you are doing and lie on your side
  • Drink 2-3 glasses of water/juice
  • Wait 1 hour
  • If symptoms get worse, see HCP
  • If symptoms go away, tell HCP your experience during next visit
  • If symptoms come back, call HCP
17
Q

Tocolytics

A
  • Used to arrest labor after cervical changes have occurred
  • There is no FDA approved tocolytic but medications used to treat asthma, analgesics, and anti-inflammatory medications have “off-brand” tocolytic effects.
  • Tocolytics do not reduce the rate of pre-term birth
  • These are given to allow time for a mom to get to a healthcare facility before birth
  • Corticosteroids are given to maximize reduction of morbidity/mortality
  • Magnesium Sulfate is the most common tocolytic
18
Q

Contraindications to Tocolytics

A

MATERNAL

  • Preeclampsia with severe features or Eclampsia
  • Bleeding with hemodynamic instability

FETAL

  • Intrauterine fetal demise
  • Non-reassuring fetal status
  • Chorioamnionitis (bacteria in amniotic fluid)
  • PROM
19
Q

Tocolytic Nursing Interventions

A
  • Explain purpose of medication
  • Side-lying position to enhance placental perfusion and reduce pressure on cervix
  • Monitor VS, lung sounds, respiratory effort, FHR, labor status
  • Assess for adverse effects
  • Fluid balance (daily weight, I&O)
  • Limit fluids (2500-3000 mL/day) especially with b-adrenergic agonist or magnesium sulfate
  • Encourage diversional/relaxation techniques
  • Assess DTR and LOC
20
Q

Magnesium Sulfate

A

Tocolytic

  • CNS depressant (relaxes smooth muscle including uterus)
  • IV 40g in 1000mL piggyback using controller pump
  • Loading Dose 4-6g over 20-30 minutes
  • Maintenance dose 1-4 g/hour
  • ONLY USED FOR STABILIZATION
  • Monitor magnesium serum levels with higher doses
  • Therapeutic Range 4-7.5 mEq/L (5-8 mg/dL)
  • Calcium Gluconate FOR TOXICITY
  • DO NOT GIVE TO WOMEN WITH MYASTHENIA GRAVIS (muscle weakness)
21
Q

Terbutaline (Brethine)

A

Beta Adrenergic Agonist

  • SubQ 0.25mg every 4 hours (used no longer than 24 hours)
  • DO NOT USE IN WOMEN WITH HEART DISEASE, DIABETES, PREECLAMPSIA WITH SEVERE FEATURES, ECLAMPSIA, HYPERTHYROIDISM, HEMORRHAGE, CHORIOAMNONITIS
  • Propranolol is reversal for cardiovascular toxicity
22
Q

Indomethacin

A

NSAID

  • Relaxes uterine smooth muscle by inhibiting prostaglandins
  • Loading dose 50mg then 25-50 mg PO every 6 hours for 48 hours
  • Used only if gestational age is less than 32 weeks
  • DO NOT USE IN RENAL/HEPATIC DISEASE PATIENTS, PEPTIC ULCER DISEASE, POORLY CONTROLLED HYPERTENSION, ASTHMA, COAGULATION DISORDERS
  • DETERMINE AMNIOTIC FLUID VOLUME AND DUCTUS ARTERIOSUS FUNCTION BEFORE THERAPY AND WITHIN 48 HOURS OF THERAPY. DISCONTINUE IF RESULTS ARE CRITICAL
23
Q

Nifedipine

A

Calcium Channel Blocker

  • Relaxes smooth muscle including uterus by blocking calcium entry
  • Initial dose 10-20 mg PO every 3-6 hours until contractions are rare.
  • After use long acting formula 30 or 60mg every 8-12 hours for 48 hours
  • Corticosteroids are given at same time as long acting formula
24
Q

Antenatal Glucocorticoids

A
  • Given IM to accelerate fetal lung maturity
  • Reduces respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, death
  • Given to all women between 24-34 weeks gestation at risk for preterm birth
  • At least 48 hours before birth is most ideal

Betamethasone - 12mg IM 2 doses 24 hours apart
Dexamethasone - 6mg IM 4 doses 12 hours apart

25
Q

Neonatal Resuscitation

A
  • Depends on feasibility which is determined by baby size and physical appearance assessment

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