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OB > ch 32 PTL, PPROM, post term > Flashcards

ch 32 PTL, PPROM, post term Flashcards

1
Q

diagnosis of preterm labor

A

-EGA between 20 and 37 wks
-regular uterine contractions and cervical change (>2 cm)

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2
Q

EGA for preterm

A

20.0 - 36.6

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3
Q

EGA for term

A

37.0 - 41.6

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4
Q

EGA for postterm

A

42.0 +

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5
Q

PROM

A

prelabor rupture of membranes

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6
Q

PPROM

A

preterm prelabor rupture of membranes
EGA <37.0

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7
Q

*box 32.1 and 32.2

A
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8
Q

causes spontaneous preterm labor and birth

A

-multifactoral
-infection
-congenital structural abnormalities of uterus

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9
Q

medical risks PTL

A

-infection (genital tract, peridontal disease, other)
-inadequate nutritional status (prepregnancy BMI <19.6 or >30)

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10
Q

sociodemographic risks PTL

A

-low socioeconomic status
-limited education
-late/no prenatal care
-unmarried
-race: black
-tobacco
-substance abuse
-psych stress (abuse)

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11
Q

1 risk PTL

A

previous preterm birth

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12
Q

pregnancy associated risks PTL

A

-bleeding of uncertain origin
-*previous spontaneous preterm birth
-uterine anomoly
-assisted repro tech
-multifetal gestation

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13
Q

S+S preterm labor

A

“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

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14
Q

instructions nurse gives to pt calling with S+S of PTL

A

-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

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15
Q

when does woman with S+S of PTL need to go to hospital immediately

A

-regular contractions
-vaginal bleeding
-fluid leaking from vagina
-odorous vaginal discharge

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16
Q

substance that shouldn’t be released from uterus from 24-36 wks EGA, but tested if suspected PTL

A

fetal fibronectin
(fFN)

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17
Q

what does negative fFN indicate

A

negative: mom most likely won’t deliver within 2 wks

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18
Q

4 things that can affect fFN test

A

-vaginal exam (lube)
-semen (within 24 hrs)
-amniotic lube
-blood

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19
Q

2 signs cervical change (and PTL)

A

-cervical length (>30 mm in 2nd tri means preterm birth is unlikely)
-cervical funneling

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20
Q

criteria to evaluate if woman with PTL with have preterm birth

A

-risk factors
-fFN
-cervical length

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21
Q

conservative medical management PTL

A

-corticosteroids
-bed rest/ limited activity
-hydration
-sedation

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22
Q

how many weeks EGA is betamethasone/dexamethasone recommended for

A

24-34 wks

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23
Q

what does betamethasone help reduce incidence of

A

-resp distress syndrome (RDS)
-intraventricular hemorrhage (IVH)
-necrotizing enterocolitis (NEC)
-neonatal death

24
Q

IVH

A

intraventricular hemorrhage

25
Q

NEC

A

necrotizing enterocolitis

26
Q

RDS

A

respiratory distress syndrome

27
Q

dosing for betamethasone?
dexamethasone?

A

beta: 12 mg IM x 2 doses, 24 hrs apart (preferred)
dexa: 6 mg IM x 4 doses, 12 hrs apart

28
Q

maternal side effects corticosteroid therapy

A

-transient increase WBC and Plt
-transient hyperglycemia

29
Q

fetal side effects corticosteroid therapy

A

-transient decrease breathing movements and body movements

30
Q

term for breaking up uterine activity

A

tocolysis

31
Q

goals tocolysis (3)

A

-inhibit contractions (PTL, tachysystole)
-prevent cervical change
-prolong fetal time in utero

32
Q

maternal contraindications to tocolysis

A

(any condition that would warrant birth)
-preeclampsia with severe features or eclampsia
-cardiac disease
-bleeding with hemodynamic instability
-intrauterine infection

33
Q

fetal contraindications to tocolysis

A

-EGA>34 wks
-fetal death
-lethal fetal anomaly
-acute fetal distress/non reassuring fetal status
-pPROM (relative contraindication, may lead to infection)

34
Q

*med guides 687-688 (nifedipine and mag)

A
35
Q

action of mag sulfate

A

-CNS depressant
-smooth muscle relaxant

36
Q

tocolytic meds (4)

A

-magnesium sulfate
-beta-mimetic: terbutaline/brethine
-NSAID: indocin
-CCB: nifedipine (drug of choice)

37
Q

action of terbutaline

A

stops tachysystole

38
Q

side effect nifedipine for tocolysis

A

hypoTN

39
Q

uses of mag sulfate

A

-preeclampsia
-HTN
-PTL
-neonatal neuroprotection (decreased rates cerebral palsy)

40
Q

dosage mag sulfate

A

4 gm loading dose over 30-60 min
1 gm/hr until birth

41
Q

max infusion time for mag sulfate

A

24 hrs

42
Q

nursing interventions for PTL

A

-lateral position
-calm environment
-regulate fluid status
-comfort (pain meds, support)
-avoid/limit digital cervical exams
-admin meds as ordered
-continuous monitoring

43
Q

what do tocolytic meds increase risk for in mom

A

pulmonary edema
*watch fluid status carefully

44
Q

Spontaneous rupture of amniotic
sac and leakage of fluid prior to the onset of
labor at any gestational age

A

PROM

45
Q

first nursing action after ROM

A

check FHR

46
Q

management pPROM EGA>34 wks

A

delivery

47
Q

management pPROM EGA 32-34 wks

A

-assess fetal lung maturity
-if mature: delivery

48
Q

management pPROM <32 wks

A

expectant management:
-fetal assessment
-monitor complications
-Abx 7 days
-glucocorticoids

49
Q

risk factors chorio

A

-pPROM, PROM
-long labor
-prenatal infection
-poor prenatal care

50
Q

biggest S+S chorio (2)

A

-maternal fever
-fetal tachy

51
Q

Tx chorio

A

-delivery
-parenteral Abx

52
Q

maternal complications chorio

A

-dysfunctional labor and C/S
-wound infection
-endometritis, sepsis

53
Q

neonatal complications chorio

A

-pneumonia
-bacteremia
-sepsis

54
Q

S+S postterm pregnancy

A

-maternal weight loss (less AFI)
-decreased fundal height (placenta isn’t working well)
-meconium stained fluid
-advanced fetal bone maturation (esp skull)

55
Q

maternal risks with postterm pregnancy

A

-dysfunctional labor (perineal trauma)
-hemorrhage
-infection

56
Q

Tx postterm pregnancy

A

-induction
-C/S

57
Q

fetal risks postterm pregnancy

A

-abnormal growth: SGA or macrosomia
-decreased placental perfusion: hypoxia, oligohydramnios
-meconium stained amniotic fluid (meconium aspiration syndrome)

OB (21 decks)

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