Exam 2 Flashcards
What are things that may be happening in the body for premature labor to occur?
-Premature Preterm Rupture of Membranes
-Incompetent Cervix
- Bleeding in Pregnancy
-Early
-Therapeutic Abortion/Miscarriage
-Molar Pregnancy
-Ectopic Pregnancy
-Late
-Placental Previa
-Placental Abruption
-Adherent Retained Placenta
What is the definition of preterm labor?
Cervical changes and uterine contractions occurring between 20 and 36 6/7 weeks gestation
What is the definition of preterm birth?
Any birth that occurs between 20 0/7 and 36 6/7 weeks gestation
What is the low birth weight value?
2500 grams or less (5.5 lbs)
What is it called when an infant is born underweight at term?
Intrauterine growth restriction (IUGR)
What is very low birth weight?
less than 1500 grams (3.3 pounds)
What are factors in labor that have some evidence to back up that they cause preterm labor?
Peridontal Dx
Placental implantation bleeding (1st or 2nd Tri)
Inflammation
Maternal & neonatal stress
Uterine overdistention
Allergic reaction
Low progesterone levels
What are factors that may take part in the development of preterm labor?
Chronic HTN
GDM
Preeclampsia
OB disorders in previous pregnancies
Placental disorders
Medical disorders
HX of previous preterm birth
Nonwhite race
Genital tract infection
Multifetal gestation
2nd trimester bleeding
Low pregnancy weight
Maternal HIV
Obesity
Advanced for Maternal age
Fetal disorders
Congenital fetal anomalies
What percent of preterm births are iatrogenic?
25%
Definition of iatrogenic?
-fetus was intentionally delivered prematurely due to maternal or fetal health reasons.
What percent of preterm births are caused by preterm premature rupture of membranes?
25%
What percent of preterm births occur spontaneously and may be preventable (idiopathic)?
50%
What are the most common risk factors for preterm birth?
-Previous history of preterm labor and birth
-Race with Black and Hispanics having a higher incidence of preterm birth than non-Hispanic whites (socioeconomic factors/health).
-Multiple gestation (the incidence of multiple gestation has increased in recent years due to in vitro fertilization (IVF)
What are signs and symptoms of preterm labor?
-Change in type of vaginal discharge – (watery, mucus, bloody)
-Increase in amount of D/C
-Pelvic or lower abdominal pressure
-Constant low backache
-Mild abdominal cramps (with or without diarrhea)
-Regular or frequent contractions (painful or painless)
-ROM
-Urinary frequency
What are self management tips for side effects of preterm labor?
Empty bladder
Drink 2/3 glasses of H20
Lie down on side for 1 hour
Palpate for contractions
What are reasons to go to the birthing facility/call provider?
-Contractions
-Cramping/Abdominal/Suprapubic/Pelvic Pain/Pressure
-Low, dull backache
-< q 10 mins w/wo pain ≥ 1 hour
-Vaginal bleeding
-malodorous vaginal discharge
-Fluid leaking from the vagina
What are predictive tests for determing the possibility of preterm labor?
Fetal fibrocentin (fFn), endocervical length
What are activities associated with preterm labor that may be contraindicated?
-Sexual activity (not contraindicated in pregnancy unless symptoms of preterm labor)
-Riding or standing for long periods of time
-Lifting and carrying heavy loads such as small children or laundry
-Strenuous physical work
-Infrequent rest periods
What is the home uterine activity monitoring used for?
ordered by the physician to aid in the detection of contractions.
What is a tocolytic?
medication used to arrest labor
What is the magnesium therapeutic range?
4-7.5
What are maternal contraindications of tocolytic use?
-Severe Preeclampsia
-Eclampsia
-Bleeding with hemodynamic instability
-Contraindications to specific medications
What are fetal contraindications of tocolytic use?
-Intrauterine fetal demise
-Lethal fetal anomaly
-Non-reassuring fetal status
-Chorioamnionitis
-Preterm premature ROM (PPROM)
What is the purpose of administering antenatal glucocorticoids?
Stimulates fetal lung maturation by promoting release of enzymes that induce production of lung surfactant. Aids in fetal lung maturity
When should adrenal glucocorticoids be given?
-Women between 24 – 34 weeks who are at risk for preterm birth within 7 days.
-Optimal benefit begins 24 hours after first application
What are contraindications of adrenal glucocorticoids?
Pulmonary edema, maternal diabetes or hypertension
What are nursing responsibilities of adrenal glucocorticoids?
-Give deep IM, (this is a painful injection) teach signs of pulmonary edema, assess lung sounds & blood glucose (will increase BS levels)
-Will increase WBCs for about 72 hours
-May see FHT as minimal variability or decrease to no accelerations for 24-72 hours
What happens in the 1st trimester with insulin?
production increases, glucose goes down (hypoglycemic)
What is a insulin antagonist during pregnancy?
human placental lactogen (HPL)
What are insulin requirements by the end of pregnancy?
increase as much as 4x the usual amount of insulin
When does the fetal pancreas begin to secrete adequate insulin?
10th week
What is a macrosomic baby?
big baby from mother having diabetes, uncontrolled blood sugars (IUGR)
What is eugluycemia?
normal range of glucose in the blood
