6.5 Preterm Flashcards
Preterm (def)
Less than 37 weeks
Symptoms of Pre-term labor (6)
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
Risk factors for PTL (9)
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
Why is being on your feet a lot a risk factor for PTL?
Due to poor circulation, decreased venous return
Why is smoking a risk factor for PTL?
Vasoconstriction → decreased perfusion
What factors diagnose PTL?
• Documented _________
• Documented ________: (2)
1) Documented uterine contractions
2) Documented cervical change
• Effacement of 80%
• Dilation >1cm
What tool is used to detect PTL uterine contractions?
A tocometer
Biochemical markers to predict PTL
Best identify who will not experience PTL:
• Salivary estriol
• Fetal fibronectin (FFN)
Salivary Estriol: What does a negative test mean? How accurate is it?
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
Salivary Estriol: What does a positive test mean? How accurate is it?
A positive test predicts the likelihood of delivering in the next 2 weeks.
o Only right 7-25% of the time
Fetal Fibronectin: Its presence inthe birth canal between _____ weeks could indicate ____.
24-37 weeks
PTL
Fetal Fibronectin: What does a negative test mean? How accurate is it?
A negative test predicts the likelihood of not delivering in the net 2 weeks
o Correct 95% of the time
Fetal Fibronectin: What does a positive test mean? How accurate is it?
A positive test predicts the likelihood of delivering in the next 2 weeks.
o Only correct 25-40% of the time
Two tools that can help diagnose PTL
o Transvaginal ultrasound
o Home uterine activity monitoring (HUAM)
What is the purpose of tocolytic therapy?
Suppression of uterine activity
Five tocolytics
- Ritodrine
- Terbutaline
- Magnesium sulfate
- Indomethacin
- Nifedipine
Ritodrine: Class / Action
Betamimetic: Relaxes smooth mucscle
Terbutaline: Class / Action
Betamimetic: Relaxes smooth muscle
Terabutaline: Possible ADEs
- Cardiac (4)
- Muscles and CNS (3)
- GI and electrolyte (3)
- Respiratory
- Tachycardia
- Dysrhythmias
- Myocardial ischemia
- Hypotension
- Jitteriness, Apprehension
- Tremors / muscle weakness
- Headache
- N/V
- Hyperglycemia
- Hypokalemia
• Pulmonary edema
Magnesium Sulfate: Class/Action
CNS Depressant
Magnesium Sulfate: Antidote
Calcium Gluconate
What are normal blood levels for magnesium sulfate? How often are labs drawn?
Normal: 4-7 or 8
Labs drawn every 6 hours
Magnesium sulfate: ADEs (4)
- Decreased RR
- Absent or decreased deep tendon reflexes (DTRs)
- Muscle weakness
- Oliguria (decreased urine output).
Normal urine output:
- Per hour
- Per 24 hours
30 cc / hr
500 cc / 24 hour
Nifedipine: Class / Action
Calcium Channel Blocker
Toxolytics: How to position mom
Left Lateral Position to increase perfusion
Toxolytics: What to assess (5)
- Assess vital signs regularly
- Maternal HR
- Assess sxs of pulmonary edema
- Assess urinary output Q1hr
- Monitor for ketonuria
Toxolytics: When to notify a provider
Notify HCP if HR >120 (disorganized)
Sxs of pulmonary edema
Decreased breath or lung sounds
Bethamethazone (BM): Indications
To promote (accelerate) fetal lung maturity
Bethamethazone: Class
Glucocorticoid
Dexamethasone: Indication
To promote (accelerate) fetal lung maturity
Dexamethasone:Class
Glucocorticoid
How often are glucocorticoids administered?
May be repeated in 7 days (if birth has not occurred)
Contraindications of PTL drugs (8)
- Severe preeclampsia or eclampsia
- Active vaginal bleeding
- Intrauterine infection
- Cardiac disease
- Acute fetal distress
- Chronic IUGR
- Birth inevitable
- Continuation of pregnancy impractical
________ = intrauterine infection
Choriamniotis
When is birth inevitable?
4cm
When is continuation of pregnancy impractical? (4)
- Fetal demise
- Lethal fetal anomaly
- EGA >37 weeks
- EFW >2500g
PROM: Def
Premature Rupture of Membranes
• Def: > 1hour before the onset of labor – at ANY gestational age.
PPROM: Def
Preterm Premature Rupture
• Def: Rupture of membranes before 37 weeks
PPROM: Incidence
Occurs in 25% of all women who deliver preterm
Criteria for a PPROM mom to be able to stay at home (4)
o Temp Q4h when awake
o Monitor sxs of infection
o Assess for uterine ctx
o Daily fetal movement counting
FMC
“Fetal Movement Counting”
Counts or Kicks
PPROM Activity for mom (4)
- Modified bed rest
- NPV
- Proper hygiene
- No tub baths
Biweekly tests done with PPROM (3)
- Fetal testing (NST, BPP)
* Amniotic fluid measurements
What is a normal amniotic fluid measurement at full term?
800-1200 ccs
Signs & Symptoms of Choriamniotis (4)
o Fetal tachycardia
o Elevated maternal temp
o Uterine tenderness
o Decreased CTXs
Newborn Respiratory Risk
Respiratory Distress Syndrome (RDS)
What test checks for lung maturity?
• How is it done?
• What number puts infant at risk?
L/S Ratio
• Via blood or via amniocentesis
• < 3 if diabetic = risk for RDS
