ch 32 PTL, PPROM, post term Flashcards by McKenna Michael

diagnosis of preterm labor

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

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EGA for preterm

20.0 - 36.6

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EGA for term

37.0 - 41.6

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EGA for postterm

42.0 +

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PROM

prelabor rupture of membranes

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PPROM

preterm prelabor rupture of membranes
EGA <37.0

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*box 32.1 and 32.2

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causes spontaneous preterm labor and birth

-multifactoral
-infection
-congenital structural abnormalities of uterus

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medical risks PTL

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

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sociodemographic risks PTL

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

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1 risk PTL

previous preterm birth

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pregnancy associated risks PTL

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

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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

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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

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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

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

fetal fibronectin
(fFN)

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what does negative fFN indicate

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

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4 things that can affect fFN test

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

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2 signs cervical change (and PTL)

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

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criteria to evaluate if woman with PTL with have preterm birth

-risk factors
-fFN
-cervical length

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conservative medical management PTL

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

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how many weeks EGA is betamethasone/dexamethasone recommended for

24-34 wks

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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)