ch 32: preterm labor & birth complications Flashcards
What are risk factors for preterm labor?
-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
What is considered a preterm birth?
any birth that occurs btwn 20 & 36 6/7 weeks
How many weeks is VERY PRETERM?
< 32 weeks
How many weeks is MODERATELY PRETERM?
32-34 weeks
How many weeks is LATE PRETERM?
34 to 36 6/7 weeks
What is considered as low birthweight?
≤ 2500 g
What should you instruct a pt to do if she thinks she is feeling Braxton Hicks ctxs?
-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
The injection of what medication can decrease the risk for preterm birth?
progesterone
What lifestyle modifications should women at risk for preterm labor make?
-activity restriction
-quiet environment
-stay hydrated and keep bladder empty
-restric sex to avoid stimulation of ctxs
What are Tocolytics?
medications that suppress uterine ctxs
What are 4 Tocolytic drugs commonly used?
1) Indomethacin
2) Nifedipine
3) Mag sulfate
4) Terbutaune
What are nursing considerations for mag sulfate?
-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
What is PPROM?
membrane rupture < 37 weeks
What is the nursing care for PPROM?
-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
What is REQUIRED before performing AROM?
fetal head MUST BE ENGAGED
What is the nursing care after an AROM?
1: CHECK FHT IMMEDIATELY AFTER
-assess color, odor, amount
-monitor ctxs
-temp check q 2 hr
-MONITOR for s/s of chorioamnionitis
What are s/s of chorioamnionitis?
-↑ temp (may also see fetal tachy)
How is chorioamnionitis treated?
axbs: usually ampicillin and gentamycin
What does the BISHOP score assess?
-inducibility
-assesses
1) cervical dilation
2) effacement
3) consistency
4) position
5) fetal station
What BISHOP score is favorable for induction?
8 or 9
What do you do if there is a cord prolapse?
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
What is an amniotic fluid embolism?
escape of amniotic fluid into maternal circulation
What are s/s of amniotic fluid embolism?
dyspnea, cyanosis, pulm edema, chest pain, hypotension, tachycardia, hemorrhage, shock, cardiac arrest
What is the treatment for amniotic fluid embolism?
-O2, intubate, ventilate
-maintain CO, CPR
-fluid replacement
-correct coagulation failure
-deliver baby
What needs to be checked before labor augmentation w/ pitocin?
-assess FHT
-cervix dilation and effacement
How do you administer pitocin?
1 mu/min then increase by 1-2 mu/min
-no more frequent than every 30 to 60 min
What is considered uterine tachysystole?
over 5 ctx in 10 min
What are methods of labor augmentation?
1) ambulation
2) nipple stimulation
3) hydrotherapy
4)amniotomy
5) oxytocin infusion
What is external cephalic version ECV?
attempt to turn fetus from breech/shoulder presentation to vertex presentation
What needs to be checked before performing an ECV?
-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
What is considered a postterm pregnancy?
≥ 42 weeks
What are the MATERNAL risks of POSTTERM labor?
-labor and birth interventions more likely
-may experience fatigue and psychologic reactions as EDB passes
-dysfunctional labor and birth canal trauma
What are the FETAL risks of POSTTERM labor?
-macrosomia
-prolonged labor
-oligohydramnios, meconium/fluid aspiration
-birth trauma, shoulder dystocia
-comprimising effects of “aging” placenta
-postmaturity syndrome
What are indications for a C-SECTION?
-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
What meds are used for c-sections?
-spinal epidural and general anesthetic
What are the indications for prostaglandins?
preinduction cervical ripening:
-before oxytocin induction
-when bishop score is 4 or <
How long does a woman have to remain supine/sidelying after prepidil gel?
30 min
How long does a woman have to remain supine/sidelying after cervidil insert?
2hrs
