Antepartum bleeding & premature labor Flashcards
Early AP Bleeding could be indicative of?
Spontaneous Abortion
Incompetent Cervix
Ectopic Pregnancy
Hydatidiform Mole
Late AP Bleeding could be indicative of?
Placenta Previa
Placental Abruption
Placenta Accreta
Classifications of spontaneous abortions?
threatened, inevitable, complete
What is Rhogam?
medication given to Rh negative mothers for spontaneous abortion management
S/S of spontaneous abortion?
Cramping, Backache, Bleeding, Passing tissue
S/S of an Ectopic Pregnancy?
No menses or spotting (6-8wk) Rt. shoulder pain Breast tenderness Nausea Lower abdominal pain Slow chronic bleeding Fainting/Light headedness Signs of shock
What is Methotrexate?
- chemo drug used as medical management for ectopic pregnancy
- used only if tube is in tact
- folic acid antagonist = inhibits cell division
S/S of a Molar Pregnancy?
- Almost always before 18 wks gestation
- Bleeding: Brownish
- Passage of grapelike clusters - very bloody
- Uterus large for dates
- Absence fetal parts on u/s
- No FHTs
- hCG - elevated
- Hyperemesis common
- Pre-eclampsia earlier in gestation-1st trimester
What are the strongest indicators of preterm delivery? (4)
- Shortened cervix (use transvaginal US)
- Cervicovaginal fibronectin
- Previous PTD
- Infection (e.g. BV)
Management of Incompetent Cervix?
- Cerclage (about 14-15 weeks)
- Prior to procedure:
- GBS, Chlamydia, and GC cultures
- Trendelenberg position
- Suture cut at 36-37 weeks
- Instruct in symptoms of PTL
S/S of Preterm Labor?
- may be asymptomatic
- Fatigue
- Menstrual like cramps or contractions ≥ 6/ hr
- Dull low backache
- Heaviness in pelvis
- Increase in vaginal discharge
Assessment for PTL: Fetal Fibronectin Testing
- positive = > .05mcg/mL
- A negative test is highly predictive that preterm labor will not occur.
- can be done by a trained RN
When is Fibrinolactin present?
< 20 wks of preggo and as labor approaches
Progressive cervical change accompanied by contractions <37 weeks gestation is indicative of?
Preterm labor
What are tocolytic drugs?
anti-contraction meds or labor suppressants
Why would corticosteroids be given during for preterm labor?
- to accelerates fetal lung maturation, helps with the development of surfactant
- decreases intraventricular hemorrhage
Corticosteroid administration is recommended for all women who threaten preterm labor between?
24-34 wks
Corticosteroid tx for preterm labor?
- Betamethasone 12 mg IM x 2 doses 24 hours apart
- Dextramethasone 6mg IM x 4 doses 12 hour apart
When is the fetal surfactant completely developed?
35th wk
Tocolytic drugs?
- Magnesium Sulfate
- Nifedipine (CCB)
Placenta Previa
- when the placenta lies close to, or on top of the cervix
Signs and Symptoms of Placenta Previa?
- 2nd / 3rd trimester bleeding that is:
- Unrelated to labor
- Painless
- Bright red bleeding
- Uterus relaxed (not contracting)
- Often starts as spotting
- Subsequent bleeding often much heavier
Nursing Care for Placenta Previa?
- No vaginal examinations
- Bedrest
- Monitor blood loss / color
- Monitor VS
- Anticipate orders (IV, U/S )
- Electronic Fetal Monitoring
- Type and cross-match
Signs and Symptoms of Placental Abruption?
- Usually 3rd trimester
- Usually associated with labor onset
- Painful
- Rigid uterus
- Dark red bleeding
- Bleeding may not be visible (occult bleeding)
- Rapid change in VS ( P & BP due to shock)
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