Exam 2

Question 1

What are things that may be happening in the body for premature labor to occur?

Answer 1

-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

Question 2

What is the definition of preterm labor?

Answer 2

Cervical changes and uterine contractions occurring between 20 and 36 6/7 weeks gestation

Question 3

What is the definition of preterm birth?

Answer 3

Any birth that occurs between 20 0/7 and 36 6/7 weeks gestation

Question 4

What is the low birth weight value?

Answer 4

2500 grams or less (5.5 lbs)

Question 5

What is it called when an infant is born underweight at term?

Answer 5

Intrauterine growth restriction (IUGR)

Question 6

What is very low birth weight?

Answer 6

less than 1500 grams (3.3 pounds)

Question 7

What are factors in labor that have some evidence to back up that they cause preterm labor?

Answer 7

Peridontal Dx
Placental implantation bleeding (1st or 2nd Tri)
Inflammation
Maternal & neonatal stress
Uterine overdistention
Allergic reaction
Low progesterone levels

Question 8

What are factors that may take part in the development of preterm labor?

Answer 8

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

Question 9

What percent of preterm births are iatrogenic?

Answer 9

25%

Question 10

Definition of iatrogenic?

Answer 10

-fetus was intentionally delivered prematurely due to maternal or fetal health reasons.

Question 11

What percent of preterm births are caused by preterm premature rupture of membranes?

Answer 11

25%

Question 12

What percent of preterm births occur spontaneously and may be preventable (idiopathic)?

Answer 12

50%

Question 13

What are the most common risk factors for preterm birth?

Answer 13

-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)

Question 14

What are signs and symptoms of preterm labor?

Answer 14

-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

Question 15

What are self management tips for side effects of preterm labor?

Answer 15

Empty bladder
Drink 2/3 glasses of H20
Lie down on side for 1 hour
Palpate for contractions

Question 16

What are reasons to go to the birthing facility/call provider?

Answer 16

-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

Question 17

What are predictive tests for determing the possibility of preterm labor?

Answer 17

Fetal fibrocentin (fFn), endocervical length

Question 18

What are activities associated with preterm labor that may be contraindicated?

Answer 18

-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

Question 19

What is the home uterine activity monitoring used for?

Answer 19

ordered by the physician to aid in the detection of contractions.

Question 20

What is a tocolytic?

Answer 20

medication used to arrest labor

Question 21

What is the magnesium therapeutic range?

Answer 21

4-7.5

Question 22

What are maternal contraindications of tocolytic use?

Answer 22

-Severe Preeclampsia
-Eclampsia
-Bleeding with hemodynamic instability
-Contraindications to specific medications

Question 23

What are fetal contraindications of tocolytic use?

Answer 23

-Intrauterine fetal demise
-Lethal fetal anomaly
-Non-reassuring fetal status
-Chorioamnionitis
-Preterm premature ROM (PPROM)

Question 24

What is the purpose of administering antenatal glucocorticoids?

Answer 24

Stimulates fetal lung maturation by promoting release of enzymes that induce production of lung surfactant. Aids in fetal lung maturity

Question 25

When should adrenal glucocorticoids be given?

Answer 25

-Women between 24 – 34 weeks who are at risk for preterm birth within 7 days.
-Optimal benefit begins 24 hours after first application

Question 26

What are contraindications of adrenal glucocorticoids?

Answer 26

Pulmonary edema, maternal diabetes or hypertension

Question 27

What are nursing responsibilities of adrenal glucocorticoids?

Answer 27

-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

Question 28

What happens in the 1st trimester with insulin?

Answer 28

production increases, glucose goes down (hypoglycemic)

Question 29

What is a insulin antagonist during pregnancy?

Answer 29

human placental lactogen (HPL)

Question 30

What are insulin requirements by the end of pregnancy?

Answer 30

increase as much as 4x the usual amount of insulin

Question 31

When does the fetal pancreas begin to secrete adequate insulin?

Answer 31

10th week

Question 32

What is a macrosomic baby?

Answer 32

big baby from mother having diabetes, uncontrolled blood sugars (IUGR)

Question 33

What is eugluycemia?

Answer 33

normal range of glucose in the blood