ch 32 PTL, PPROM, post term Flashcards
diagnosis of preterm labor
-EGA between 20 and 37 wks
-regular uterine contractions and cervical change (>2 cm)
EGA for preterm
20.0 - 36.6
EGA for term
37.0 - 41.6
EGA for postterm
42.0 +
PROM
prelabor rupture of membranes
PPROM
preterm prelabor rupture of membranes
EGA <37.0
*box 32.1 and 32.2
causes spontaneous preterm labor and birth
-multifactoral
-infection
-congenital structural abnormalities of uterus
medical risks PTL
-infection (genital tract, peridontal disease, other)
-inadequate nutritional status (prepregnancy BMI <19.6 or >30)
sociodemographic risks PTL
-low socioeconomic status
-limited education
-late/no prenatal care
-unmarried
-race: black
-tobacco
-substance abuse
-psych stress (abuse)
1 risk PTL
previous preterm birth
pregnancy associated risks PTL
-bleeding of uncertain origin
-*previous spontaneous preterm birth
-uterine anomoly
-assisted repro tech
-multifetal gestation
S+S preterm labor
“flu like”
-malaise/discomfort
-change in vaginal discharge (increase or change in appearance)
-pelvic/lower abdominal pressure
-constant low dull backache
-mild abdominal cramps w/ or w/o diarrhea
-regular or frequent uterine Cxs
-ROM
instructions nurse gives to pt calling with S+S of PTL
-empty bladder
-drink 2-3 glasses water/juice
-rest laterally 1 hour
-palpate Cxs
-if Cxs continue (5+ in 1 hr): go to hospital
-if Cxs go away: resume light activity
when does woman with S+S of PTL need to go to hospital immediately
-regular contractions
-vaginal bleeding
-fluid leaking from vagina
-odorous vaginal discharge
substance that shouldn’t be released from uterus from 24-36 wks EGA, but tested if suspected PTL
fetal fibronectin
(fFN)
what does negative fFN indicate
negative: mom most likely won’t deliver within 2 wks
4 things that can affect fFN test
-vaginal exam (lube)
-semen (within 24 hrs)
-amniotic lube
-blood
2 signs cervical change (and PTL)
-cervical length (>30 mm in 2nd tri means preterm birth is unlikely)
-cervical funneling
criteria to evaluate if woman with PTL with have preterm birth
-risk factors
-fFN
-cervical length
conservative medical management PTL
-corticosteroids
-bed rest/ limited activity
-hydration
-sedation
how many weeks EGA is betamethasone/dexamethasone recommended for
24-34 wks
what does betamethasone help reduce incidence of
-resp distress syndrome (RDS)
-intraventricular hemorrhage (IVH)
-necrotizing enterocolitis (NEC)
-neonatal death
IVH
intraventricular hemorrhage
NEC
necrotizing enterocolitis
RDS
respiratory distress syndrome
dosing for betamethasone?
dexamethasone?
beta: 12 mg IM x 2 doses, 24 hrs apart (preferred)
dexa: 6 mg IM x 4 doses, 12 hrs apart
maternal side effects corticosteroid therapy
-transient increase WBC and Plt
-transient hyperglycemia
fetal side effects corticosteroid therapy
-transient decrease breathing movements and body movements
term for breaking up uterine activity
tocolysis
goals tocolysis (3)
-inhibit contractions (PTL, tachysystole)
-prevent cervical change
-prolong fetal time in utero
maternal contraindications to tocolysis
(any condition that would warrant birth)
-preeclampsia with severe features or eclampsia
-cardiac disease
-bleeding with hemodynamic instability
-intrauterine infection
fetal contraindications to tocolysis
-EGA>34 wks
-fetal death
-lethal fetal anomaly
-acute fetal distress/non reassuring fetal status
-pPROM (relative contraindication, may lead to infection)
*med guides 687-688 (nifedipine and mag)
action of mag sulfate
-CNS depressant
-smooth muscle relaxant
tocolytic meds (4)
-magnesium sulfate
-beta-mimetic: terbutaline/brethine
-NSAID: indocin
-CCB: nifedipine (drug of choice)
action of terbutaline
stops tachysystole
side effect nifedipine for tocolysis
hypoTN
uses of mag sulfate
-preeclampsia
-HTN
-PTL
-neonatal neuroprotection (decreased rates cerebral palsy)
dosage mag sulfate
4 gm loading dose over 30-60 min
1 gm/hr until birth
max infusion time for mag sulfate
24 hrs
nursing interventions for PTL
-lateral position
-calm environment
-regulate fluid status
-comfort (pain meds, support)
-avoid/limit digital cervical exams
-admin meds as ordered
-continuous monitoring
what do tocolytic meds increase risk for in mom
pulmonary edema
*watch fluid status carefully
Spontaneous rupture of amniotic
sac and leakage of fluid prior to the onset of
labor at any gestational age
PROM
first nursing action after ROM
check FHR
management pPROM EGA>34 wks
delivery
management pPROM EGA 32-34 wks
-assess fetal lung maturity
-if mature: delivery
management pPROM <32 wks
expectant management:
-fetal assessment
-monitor complications
-Abx 7 days
-glucocorticoids
risk factors chorio
-pPROM, PROM
-long labor
-prenatal infection
-poor prenatal care
biggest S+S chorio (2)
-maternal fever
-fetal tachy
Tx chorio
-delivery
-parenteral Abx
maternal complications chorio
-dysfunctional labor and C/S
-wound infection
-endometritis, sepsis
neonatal complications chorio
-pneumonia
-bacteremia
-sepsis
S+S postterm pregnancy
-maternal weight loss (less AFI)
-decreased fundal height (placenta isn’t working well)
-meconium stained fluid
-advanced fetal bone maturation (esp skull)
maternal risks with postterm pregnancy
-dysfunctional labor (perineal trauma)
-hemorrhage
-infection
Tx postterm pregnancy
-induction
-C/S
fetal risks postterm pregnancy
-abnormal growth: SGA or macrosomia
-decreased placental perfusion: hypoxia, oligohydramnios
-meconium stained amniotic fluid (meconium aspiration syndrome)
