ch 32: preterm labor & birth complications

Question 1

What are risk factors for preterm labor?

Answer 1

-infection
-congen structual abnormalities of uterus
-maternal and fetal STRESS
-uterine overdistension
-allergic reaction
- ↓ progesterone
-hx of preterm labor
-hx of bleeding at 20 weeks

Question 2

What is considered a preterm birth?

Answer 2

any birth that occurs btwn 20 & 36 6/7 weeks

Question 3

How many weeks is VERY PRETERM?

Answer 3

< 32 weeks

Question 4

How many weeks is MODERATELY PRETERM?

Answer 4

32-34 weeks

Question 5

How many weeks is LATE PRETERM?

Answer 5

34 to 36 6/7 weeks

Question 6

What is considered as low birthweight?

Answer 6

≤ 2500 g

Question 7

What should you instruct a pt to do if she thinks she is feeling Braxton Hicks ctxs?

Answer 7

-STOP what youre doing
-empty bladder
-lie on ur side
-drink 2-3 cups of water or juice
-rest/wait for 1 hr
-if s/s same or worse, CALL HCP
-if s/s stop, report at next appt

Question 8

The injection of what medication can decrease the risk for preterm birth?

Answer 8

progesterone

Question 9

What lifestyle modifications should women at risk for preterm labor make?

Answer 9

-activity restriction
-quiet environment
-stay hydrated and keep bladder empty
-restric sex to avoid stimulation of ctxs

Question 10

What are Tocolytics?

Answer 10

medications that suppress uterine ctxs

Question 11

What are 4 Tocolytic drugs commonly used?

Answer 11

1) Indomethacin
2) Nifedipine
3) Mag sulfate
4) Terbutaune

Question 12

What are nursing considerations for mag sulfate?

Answer 12

-limit IV fluid intake at 125 mL/hr
-STOP if rr <12 bpm
-have calcium gluconate available (antidote)
-pt shou;d remain in sidelying position

Question 13

What is PPROM?

Answer 13

membrane rupture < 37 weeks

Question 14

What is the nursing care for PPROM?

Answer 14

-MONITOR FOR S/S OF INFECTION
-fetal assessment
-antenatal glucocorticoids for ALL WOMEN w/ PPROM btwn 24-37 weeks
-7 day course of broad spectrum axb
-admin mag sulfate for fetal neuroprotection

Question 15

What is REQUIRED before performing AROM?

Answer 15

fetal head MUST BE ENGAGED

Question 16

What is the nursing care after an AROM?

Answer 16

1: CHECK FHT IMMEDIATELY AFTER

-assess color, odor, amount
-monitor ctxs
-temp check q 2 hr
-MONITOR for s/s of chorioamnionitis

Question 17

What are s/s of chorioamnionitis?

Answer 17

-↑ temp (may also see fetal tachy)

Question 18

How is chorioamnionitis treated?

Answer 18

axbs: usually ampicillin and gentamycin

Question 19

What does the BISHOP score assess?

Answer 19

-inducibility
-assesses
1) cervical dilation
2) effacement
3) consistency
4) position
5) fetal station

Question 20

What BISHOP score is favorable for induction?

Answer 20

8 or 9

Question 21

What do you do if there is a cord prolapse?

Answer 21

1 TAKE PRESSURE OFF CORD (in trendelenberg or knee chest pos): place sterile gloved hand into vagina and hold presenting part OFF cord while calling for assistance

2) palapte FHTs, NEVER ATTEMPT TO REPLACE CORD
3) give O2 mask 10L
4) cover exposed cord with sterile wet gauze
5) stay w/ pts while other staff members prepare for C-SECTION: support presenting fetal part and provide reassurance

Question 22

What is an amniotic fluid embolism?

Answer 22

escape of amniotic fluid into maternal circulation

Question 23

What are s/s of amniotic fluid embolism?

Answer 23

dyspnea, cyanosis, pulm edema, chest pain, hypotension, tachycardia, hemorrhage, shock, cardiac arrest

Question 24

What is the treatment for amniotic fluid embolism?

Answer 24

-O2, intubate, ventilate
-maintain CO, CPR
-fluid replacement
-correct coagulation failure
-deliver baby

Question 25

What needs to be checked before labor augmentation w/ pitocin?

Answer 25

-assess FHT
-cervix dilation and effacement

Question 26

How do you administer pitocin?

Answer 26

1 mu/min then increase by 1-2 mu/min
-no more frequent than every 30 to 60 min

Question 27

What is considered uterine tachysystole?

Answer 27

over 5 ctx in 10 min

Question 28

What are methods of labor augmentation?

Answer 28

1) ambulation
2) nipple stimulation
3) hydrotherapy
4)amniotomy
5) oxytocin infusion

Question 29

What is external cephalic version ECV?

Answer 29

attempt to turn fetus from breech/shoulder presentation to vertex presentation

Question 30

What needs to be checked before performing an ECV?

Answer 30

-US to determine fetal position, locate UC, rule out PLACENTA PREVIA , evaluate maternal pelvis adequacy
-assess amniotic fluid, gest age, and presence of anomalies
-give tocolytic
-continuous monitoring
-rhogam

Question 31

What is considered a postterm pregnancy?

Answer 31

≥ 42 weeks

Question 32

What are the MATERNAL risks of POSTTERM labor?

Answer 32

-labor and birth interventions more likely
-may experience fatigue and psychologic reactions as EDB passes
-dysfunctional labor and birth canal trauma

Question 33

What are the FETAL risks of POSTTERM labor?

Answer 33

-macrosomia
-prolonged labor
-oligohydramnios, meconium/fluid aspiration
-birth trauma, shoulder dystocia
-comprimising effects of “aging” placenta
-postmaturity syndrome

Question 34

What are indications for a C-SECTION?

Answer 34

-mom: specific cardiac disease -fetal: nonreassuring fetal status, malpresentation, active maternal herpes lesions
-maternal-fetal: CPD, placenta abruption, placenta previa, hx of previous c section, mom request

Question 35

What meds are used for c-sections?

Answer 35

-spinal epidural and general anesthetic

Question 36

What are the indications for prostaglandins?

Answer 36

preinduction cervical ripening:
-before oxytocin induction
-when bishop score is 4 or <

Question 37

How long does a woman have to remain supine/sidelying after prepidil gel?

Answer 37

30 min

Question 38

How long does a woman have to remain supine/sidelying after cervidil insert?

Answer 38

2hrs