Chapter 32 Flashcards
Preterm Birth
Any birth that occurs between 20-37 weeks gestation
Risk factors for spontaneous preterm labor
hx of spontaneous preterm labor, not white, genital tract infection, multifetal gestation, second trimester bleeding, low prepregnancy weight.
what is the only factor show to be definitely associated with preterm labor?
infection
common causes of indicated preterm labor
gestational diabetes, chronic HTN, preeclampsia, previous cesarean birth, seizures, thromboembolism, advanced maternal age, HIV or herpes, obesity
women whose cervical length is greater than ______ are unlikely to have preterm birth.
30 mm
Fetal fibronectin (fFN)
Diagnostic test for preterm labor; collect fluid from the woman’s vagina using a swab; the presence of fFN during the late second and early third trimesters may be indicative of preterm labor coming
Signs and Symptoms of Preterm Labor
contractions occurring more than q 10 min for 1 hour or more, lower abdominal cramping, dull lower back pain, suprapubic pain or pressure, urinary frequency, change in character or amount of usual discharge, rupture of amniotic membranes
Teaching for Preterm Labor
Empty your bladder. Drink 2-3 glasses of water or juice. Lie down on your side for 1 hour. Palpate for contractions. If sx continue, call pcp or go to hospital. If sx go away then resume light activity.
Tocolytics
meds given to stop labor after uterine contractions and cervical change has already occurred.
Maternal contraindications to tocolysis
preeclampsia w/ severe features, bleeding, contraindications to specific tocolytic meds
Fetal contraindications to tocolysis
intrauterine fetal demise, lethal fetal anomaly, nonreassuring fetal status, chorioamnionitis, PROM
Magnesium Sulfate Safety Alert
frequently assess respiratory status, DTR’s, and LOC to monitor for toxic levels; depresses the CNS
Don’t give Nifedipine with
Magnesium sulfate or Terbutaline
Nifedipine (Calcium Channel Blocker) Safety Alert
Change positions slowly!!
Magnesium Sulfate Antidote
Calcium gluconate
When should Indomethacin be given
at less than 32 weeks gestation
Indomethacin
monitor for hemorrhage or signs of bleeding
Terbutaline
monitor blood glucose and potassium levels
Magnesium sulfate therapeutic range
4-7.5 mEq/L
Antenatal glucocorticoids
given IM to accelerate fetal lung maturity by stimulating fetal surfactant production
Antenatal glucocorticoids should be given when
between 24-34 weeks gestation
Where to give antenatal glucocorticoids
deep IM: vastus lateralis or ventral gluteal
The most important function of tocolytics
to give time to administer antenatal glucocorticoids and get them working to accelerate fetal lung maturity
Risk factors for preterm PROM
hx of cervical cerclage, UTI, short cervical length, uterine overdistention, preterm labor, second and third trimester bleeding, low BMI, pulmonary disease, low socioeconomic status, cigarette smoking, nutritional deficiencies
The most common maternal complication of preterm PROM
Chorioamnionitis
Chorioamnionitis
bacterial infection of the amniotic cavity
postterm pregnancy
42 or more weeks gestation
teaching for postterm pregnancy
perform daily fetal movement counts (4 an hour). assess for sx of labor. call pcp if membranes rupture or there is a decrease in or no fetal movement. keep appointments
Dysfunctional Labor (dystocia)
a long, difficult or abnormal labor
Hypertonic uterine dysfunction
frequent and painful contractions that are ineffective in causing cervical dilation or effacement to progress
Hypotonic uterine dysfunction
most common type; woman initially makes progress into active phase of labor but then contractions become weak and inefficient or stop altogether.
prolonged latent phase in the nulliparas woman
more than 20 hours
prolonged latent phase in the multiparas woman
more than 14 hours
protracted active phase dilation in the nulliparas woman
less than 1.2 cm in an hour
protracted active phase dilation in the multiparas woman
less than 1.5 cm in an hour
protracted descent in the nulliparas woman
less than 1 cm in an hour
protracted descent in the multiparas woman
less than 2 cm in an hour
arrest of descent in the nulliparas woman
greater than or equal to 1 hour
arrest of descent in the multiparas woman
greater than or equal to 1/2 hour
failure of descent for both nulliparas and multiparas women
no change during deceleration phase and second stage
precipitous labor in the nulliparas woman
greater than 5 cm an hour
precipitous labor in the multiparas woman
10 cm in an hour
cephalopelvic disproportion (CPD)
disproportion between the size of the fetus and the size of the mother’s pelvis
external cephalic version (ECV)
used in an attempt to turn the fetus from a breech or should presentation to a vertex presentation for birth
internal version
when the hcp puts a hand into the uterus and changes the fetus position for birth
What is the bishop score used for
to evaluate inducibility
