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OB > 6.5 Preterm > Flashcards

6.5 Preterm Flashcards

1
Q

Preterm (def)

A

Less than 37 weeks

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2
Q

Symptoms of Pre-term labor (6)

A

o Pelvic pressure
o Low, dull backache
o Menstrual-like cramps
o Change or increase in vaginal discharge
o Intestinal cramping with or without diarrhea.
o Ctxs occurring < or = q10 minutes

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3
Q

Risk factors for PTL (9)

A 
o	Infection
o	Long Distance Traveling
o	“On feet” > 50%
o	Stress: Acute or chronic
o	Poor nutrition, being underweight
o	Late or no prenatal care
o	Lower SES or education
o	ETOH, tobacco, illicit drug use
o	Pre-existing or pregnancy complications
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4
Q

Why is being on your feet a lot a risk factor for PTL?

A

Due to poor circulation, decreased venous return

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5
Q

Why is smoking a risk factor for PTL?

A

Vasoconstriction → decreased perfusion

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6
Q

What factors diagnose PTL?
• Documented _________
• Documented ________: (2)

A

1) Documented uterine contractions

2) Documented cervical change
• Effacement of 80%
• Dilation >1cm

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7
Q

What tool is used to detect PTL uterine contractions?

A

A tocometer

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8
Q

Biochemical markers to predict PTL

A

Best identify who will not experience PTL:
• Salivary estriol
• Fetal fibronectin (FFN)

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9
Q

Salivary Estriol: What does a negative test mean? How accurate is it?

A

A Negative test predicts the likelihood of not delivering in the next 2 weeks.

o 98% accurate that you will not go into preterm labor

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10
Q

Salivary Estriol: What does a positive test mean? How accurate is it?

A

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only right 7-25% of the time

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11
Q

Fetal Fibronectin: Its presence inthe birth canal between _____ weeks could indicate ____.

A

24-37 weeks

PTL

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12
Q

Fetal Fibronectin: What does a negative test mean? How accurate is it?

A

A negative test predicts the likelihood of not delivering in the net 2 weeks

o Correct 95% of the time

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13
Q

Fetal Fibronectin: What does a positive test mean? How accurate is it?

A

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only correct 25-40% of the time

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14
Q

Two tools that can help diagnose PTL

A

o Transvaginal ultrasound

o Home uterine activity monitoring (HUAM)

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15
Q

What is the purpose of tocolytic therapy?

A

Suppression of uterine activity

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16
Q

Five tocolytics

A
  • Ritodrine
  • Terbutaline
  • Magnesium sulfate
  • Indomethacin
  • Nifedipine
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17
Q

Ritodrine: Class / Action

A

Betamimetic: Relaxes smooth mucscle

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18
Q

Terbutaline: Class / Action

A

Betamimetic: Relaxes smooth muscle

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19
Q

Terabutaline: Possible ADEs

  • Cardiac (4)
  • Muscles and CNS (3)
  • GI and electrolyte (3)
  • Respiratory
A
  • Tachycardia
  • Dysrhythmias
  • Myocardial ischemia
  • Hypotension
  • Jitteriness, Apprehension
  • Tremors / muscle weakness
  • Headache
  • N/V
  • Hyperglycemia
  • Hypokalemia

• Pulmonary edema

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20
Q

Magnesium Sulfate: Class/Action

A

CNS Depressant

21
Q

Magnesium Sulfate: Antidote

A

Calcium Gluconate

22
Q

What are normal blood levels for magnesium sulfate? How often are labs drawn?

A

Normal: 4-7 or 8

Labs drawn every 6 hours

23
Q

Magnesium sulfate: ADEs (4)

A
  • Decreased RR
  • Absent or decreased deep tendon reflexes (DTRs)
  • Muscle weakness
  • Oliguria (decreased urine output).
24
Q

Normal urine output:

  • Per hour
  • Per 24 hours
A

30 cc / hr

500 cc / 24 hour

25
Q

Nifedipine: Class / Action

A

Calcium Channel Blocker

26
Q

Toxolytics: How to position mom

A

Left Lateral Position to increase perfusion

27
Q

Toxolytics: What to assess (5)

A
  • Assess vital signs regularly
  • Maternal HR
  • Assess sxs of pulmonary edema
  • Assess urinary output Q1hr
  • Monitor for ketonuria
28
Q

Toxolytics: When to notify a provider

A

Notify HCP if HR >120 (disorganized)

29
Q

Sxs of pulmonary edema

A

Decreased breath or lung sounds

30
Q

Bethamethazone (BM): Indications

A

To promote (accelerate) fetal lung maturity

31
Q

Bethamethazone: Class

A

Glucocorticoid

32
Q

Dexamethasone: Indication

A

To promote (accelerate) fetal lung maturity

33
Q

Dexamethasone:Class

A

Glucocorticoid

34
Q

How often are glucocorticoids administered?

A

May be repeated in 7 days (if birth has not occurred)

35
Q

Contraindications of PTL drugs (8)

A
  • Severe preeclampsia or eclampsia
  • Active vaginal bleeding
  • Intrauterine infection
  • Cardiac disease
  • Acute fetal distress
  • Chronic IUGR
  • Birth inevitable
  • Continuation of pregnancy impractical
36
Q

________ = intrauterine infection

A

Choriamniotis

37
Q

When is birth inevitable?

A

4cm

38
Q

When is continuation of pregnancy impractical? (4)

A
  • Fetal demise
  • Lethal fetal anomaly
  • EGA >37 weeks
  • EFW >2500g
39
Q

PROM: Def

A

Premature Rupture of Membranes

• Def: > 1hour before the onset of labor – at ANY gestational age.

40
Q

PPROM: Def

A

Preterm Premature Rupture

• Def: Rupture of membranes before 37 weeks

41
Q

PPROM: Incidence

A

Occurs in 25% of all women who deliver preterm

42
Q

Criteria for a PPROM mom to be able to stay at home (4)

A

o Temp Q4h when awake
o Monitor sxs of infection
o Assess for uterine ctx
o Daily fetal movement counting

43
Q

FMC

A

“Fetal Movement Counting”

Counts or Kicks

44
Q

PPROM Activity for mom (4)

A
  • Modified bed rest
  • NPV
  • Proper hygiene
  • No tub baths
45
Q

Biweekly tests done with PPROM (3)

A
  • Fetal testing (NST, BPP)

* Amniotic fluid measurements

46
Q

What is a normal amniotic fluid measurement at full term?

A

800-1200 ccs

47
Q

Signs & Symptoms of Choriamniotis (4)

A

o Fetal tachycardia
o Elevated maternal temp
o Uterine tenderness
o Decreased CTXs

48
Q

Newborn Respiratory Risk

A

Respiratory Distress Syndrome (RDS)

49
Q

What test checks for lung maturity?
• How is it done?
• What number puts infant at risk?

A

L/S Ratio
• Via blood or via amniocentesis
• < 3 if diabetic = risk for RDS

OB (15 decks)

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