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NURS 4500: Midterm Material > Class 6: Preterm Labour > Flashcards

Class 6: Preterm Labour Flashcards

1
Q

complications in L&D are usually r/t (6)

A
  • 5 P’s
  • timing (gestation ie. preterm, postterm)
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2
Q

what is included in uncomplicated labor and birth

A
  • term pregnancy – routine, no health concerns
  • singleton fetus
  • spontaneous labor and birth with no maternal or fetal complications, that progresses at normal pace
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3
Q

complications in L&D generally require..

A
  • continuous EFM
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4
Q

what is preterm labor

A
  • cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy
  • labor occurring at equal to or less than 36+6 weeks gestation
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5
Q

what is preterm birth

A
  • any birth that occurs before completion of 37 weeks of pregnancy
  • birth occurring at equal to or <36+6 weeks gestation
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6
Q

what is one of the most significant contributors to neonatal morbidity and mortality

A
  • prematurity
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7
Q

what is considered a neonate? infant?

A
  • neonate: 28 days or younger
  • infant: >= 1 year
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8
Q

what is the main admin criteria for admin to NICU

A
  • pre-term birth
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9
Q

preterm birth and prematurity describe….

A
  • length of gestation, regardless of birth weight
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10
Q

frequently, infants born preterm also have…

A
  • low birth weight (but not always)
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11
Q

low birth weight describes only…. what is considered low birth weight

A
  • describes only birth weight
  • 2500g or less, regardless of gestation
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12
Q

____ can often lead to low birth weight

A
  • IUGR
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13
Q

which is more dangerous, low birth weight or preterm birth and why

A
  • preterm birth –> the organs havent had the full term gestation to develop
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14
Q

what birth weight is considered macrosomia

A

4000 g

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15
Q

describe preterm baby appearance (3)

A
  • very fragile skin
  • very skinny
  • no fat deposits
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16
Q

the lack of fat deposits with preterm babies causes issues w? (2)

A

issues controlling:
- temp
- BG

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17
Q

what are the categories of preterm labor and birth (2)

A
  • spontaneous
  • indicated
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18
Q

what is the occurrence of spontaneous preterm labor and birth

A
  • most preterm births are spontaneous
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19
Q

when is indicated preterm labor and birth advisable?

A
  • if there are fetal and/or maternal risk factors where birth is deemed necessary
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20
Q

what are examples of indications for induction (2)

A
  • placental abruption with bleeding or distress
  • HTN –> severe pre-eclampsia
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21
Q

what is required w indicated preterm labor and birth

A
  • weighing gains in fetal maturity vs the risks (fetal and/or maternal) of continuing w the pregnancy
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22
Q

what are common cause of indicated preterm birth (8)

A
  • diabetes
  • HTN disorders of pregnancy
  • placental disorders
  • fetal disorders
  • chronic IUGR or acute fetal compromise (abnormal NST, BPP, umbilical artery doptone analysis)
  • oligo or polyhydramnios
  • birth defects
  • still birth (will give mother few days to go into labor spontaneously)
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23
Q

what are common causes of spontaneous preterm birth (4)

A
  • preterm labor
  • PPROM
  • cervical insufficiency (incompetent cervix)
  • amnionitis
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24
Q

what is amnionitis? what can it cause?

A
  • infection in amnion
  • can cause excessive distension of uterus
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25
Q

what is included in prevention of spontaneous preterm labor (5)

A
  • preventive strategies to address risk factors –> each day gained in terms of fetal maturity is important
  • education aimed at health promotion & disease prevention
  • education about early symptoms of preterm labor (esp if risk factors)
  • teach what to do if symptoms occur
  • ongoing assessment of risk factors throughout pregnancy
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26
Q

pregnant people may sometimes ignore symptoms of preterm labour because of.. (2)

A
  • lack of awareness regarding significance
  • belief that symptoms are expected during pregnancy
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27
Q

what are risk factors for spontaneous preterm labor (9)

A
  • history of previous spontaneous preterm birth
  • family history of preterm labor
  • african race
  • genital tract infections
  • multifetal gestation
  • 2nd trimester bleeding (ie. abruption)
  • low prepregnancy weight
  • low socioeconomic status
  • lack of access to prenatal care
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28
Q

how can placental abruption cause spontaneous preterm labpr?

A
  • uterus contracts to control bleeding = can trigger contractions & labor
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29
Q

how can multifetal gestation cause spontaneous preterm labor?

A
  • uterus distends earlier
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30
Q

what are early S&S of preterm labor (4)

A
  • uterine activity
  • discomfort
  • vaginal discharge
  • urinary freq
31
Q

describe uterine activity in preterm labor and what can it be mistaken for?

A
  • feels like strong menstrual cramps if fetus smaller
  • can be mistaken for: pressure, sense of heaviness, gassy feeling
32
Q

what type of vaginal discharge is an early sign of preterm labor (2)

A
  • bleeding
  • amniotic fluid
33
Q

what S&S of discomfort are early signs of preterm labor (5)

A
  • lower abdominal cramping –> feel like gas pains
  • low back pain
  • menstrual like cramps
  • suprapubic pain or pressure
  • pelvic pressure or heaviness
34
Q

what should the pregnant person do if they are experiencing early signs of preterm labor (5)

A
  • empty bladder
  • hydrate
  • lie down on side for 1 hr
  • palpate for contractions
  • notify care provider or go to triage if symptoms continue
35
Q

why is early recognition & diagnosis of preterm labor so important? (3)

A
  • allows for longer time to educate birther for what to expect
  • more interventions available to prep fetus with underdeveloped lungs
  • need time to get mother to NICU
36
Q

what is the 3 criteria for diagnosis of preterm labor

A
  • gestational age between 20 and 37 weeks
  • uterine activity (contractions)
  • progressive cervical change
37
Q

progressive cervical change for the diagnosis of preterm labor includes.. (2)

A
  • effacement of 80%
  • cervical dilation of 2cm or greater
38
Q

what is 1 intervention used for preterm labor?

A
  • tocolytics
39
Q

what are tocolytics

A
  • medicals given to suppress labor after uterine activity and cervical changes have occurred
40
Q

tocolytics have not been shown to reduce the rate of preterm birth, rather their purpose it to

A

gain time

41
Q

tocolytics aim to gain time to: (2)

A
  • for maternal transport to facility w NICU capabilities
  • for admin of glucocorticoids for fetal lung maturity (to decrease neonatal morbidity and mortality)
42
Q

what is an example of a tocolytic? what does it do?

A
  • indomethicin
  • NSAID which blocks production of prostaglandins
43
Q

what is considered one of the most effective and cost-efficient interventions for preventing neonatal morbidity and mortality associated w preterm labor? how?

A
  • admin of antenatal glucocorticoids IM to birth

= reduces the severity of neonatal resp distress syndrome

44
Q

what are 2 types of glucocorticoids used for promotion of fetal lung maturity

A
  • betamethasone
  • dexamethasone
45
Q

what dose of betamethasone is used for promotion of fetal lung maturity

A

12 mg IM x 2 doses, 24h apart

46
Q

what dose of dexamethasone is used for promotion of fetal lung maturity

A

6 mg IM x 4 doses, 12 hrs apart

47
Q

what is the NIH recommendation for glucocorticoids for promotion of fetal lung maturity

A
  • women 24-34 weeks gestations
48
Q

what is the SOGC recommendation for glucocorticoids for promotion of fetal lung maturity

A
  • admin for bithers between 24 and 34+6 weeks gestation
49
Q

if there is a need to transfer to a tertiary facility, when should the first dose of glucocorticoids be given

A
  • first dose prior to transfer
50
Q

what role does magnesium sulphate play in preterm labor

A
  • used to reduce or prevent neonatal neurological morbidity (ex. cerebral palsy)
51
Q

antenatal magnesium sulphate for fetal neuroprotection should be considered from…

A
  • viability to <= to 33+6 weeks gestation
52
Q

describe the duration of magnesium sulphate therapy (3)

A
  • max of 24 hrs of therapy
  • or discontinue if delivery is no longer imminent
  • or dc at birth
53
Q

what is the dose of magnesium sulphate for fetal neuroprotection

A
  • 4g load
  • then 1g/hr maintenance infusion until birth
54
Q

labor that progresses to cervical dilation of ___ cm is likely to lead to preterm birth? this is termed?

A
  • 4cm
    = inevitable preterm birth
55
Q

due to the small fetal size in preterm birth, birth may occur without?

A
  • a fully dilated cervix = labor may progress quickly to birth
56
Q

what is there a risk of with preterm birth?

A
  • head getting caught on cervix
57
Q

preterm births in _____ lead to better neonatal and maternal outcomes. therefore, women at risk should be…

A
  • preterm births in tertiary care centers lead to better neonatal and maternal outcomes
  • women at risk should be transferred quickly to ensure the best possible outcome
58
Q

what needs to attend birth w preterm birth? why?

A
  • neonatal time –> skilled in neonatal resus
59
Q

preterm labor and birth can lead to..

A
  • fetal demise or neonatal death –> one of the leading causes of neonatal mortality
60
Q

if the fetus is not at gestational age of viability , what provision should be provided

A
  • palliative care provision
61
Q

what is neonatal loss

A
  • newborn passes away after birth
62
Q

define still birth

A
  • newborn passes away before or during birth
63
Q

what is preterm rupture of membranes

A
  • rupture before 37 weeks gestation
64
Q

what is premature rupture of membranes

A
  • spontaneous rupture of membranes before the onset of labor at any gestational age
65
Q

what is preterm premature ROM

A
  • includes both aspects (before labor and preterm)
66
Q

what are risk factors for PPROM (7)

A
  • history of preterm birth, especially w PPROM
  • history of cervical cerclage
  • UTI or genital tract infection
  • short cervical length
  • preterm labor
  • uterine overdistension
  • 2nd and 3rd trimester bleeding
67
Q

the mngmt of PPROM depends on (2)

A
  • overall context –> fetal and maternal risks
  • gestational age
68
Q

if birth is delayed after PPROM for gains in fetal maturity, what should be closely monitored?

A
  • closely monitored for infection
  • monitor fetal status –> BPP
69
Q

what is chorioamnionitis

A
  • bacterial infection of the amniotic cavity
70
Q

when does chorioamnionitis usually occur? what is its prevalance?

A
  • usually occurs after ROM
  • occurs in 25% of preterm births
71
Q

what is the benchmark for being concerned about temperature? what is the intervention for this?

A
  • > 38*
  • admin of antibiotics
72
Q

chorioamnionitis is the most common cause of..

A
  • fetal tachycardia
73
Q

chorioamnionitis can cause: (2)

A
  • pneumonia
  • sepsis for fetus

NURS 4500: Midterm Material (19 decks)

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