Exam 2: PTL Flashcards

1
Q

What is PreTerm Labor?

A

Regular contractions accompanied by cervical change between 20-37 weeks of pregnancy.

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2
Q

What is Preterm Birth?

A

Any birth prior to 37 weeks of pregnancy.

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3
Q

What is Late Term?

A

Birth that occurs between 34 & 36 weeks of gestation.

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4
Q

What is Very preterm?

A

Birth occurs before 32 weeks gestation.

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5
Q

Complications of Preterm for the newborn

A

-Respiratory Distress Syndrome
-Neurodevelopment Impairments
-Infections
-Thermoregulation Problems
-Jaundice
-Hypoglycemia
-Feeding Issues
-Life-long disability (cerebral palsy, hearing loss, vision loss)

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6
Q

3 most common risk Factors for PTL

A

-Prior Preterm
-Multiple gestation
-Uterine/cervical abnormalities

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7
Q

Medical risk factors for PTL

A

-Previous PTB
-Multifetal gestation
-uterine/cervical abnormalities
-Genital Tract Infections
-UTIs, STDs
-Second trimester bleeding
-IVF
-Underweight
-Obesity
-High Blood Pressure/preeclampsia

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8
Q

Lifestyle risk factors for PTL

A

-Late or no prenatal care
-Smoking
-Substance Abuse
-Domestic Violence
-Sexual Abuse
-Lack of social support
-Stress

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9
Q

Symptoms of Preterm Labor

A

-Contractions every 10 min or often
-Change in vaginal discharge/leaking fluid
-vaginal bleeding
-Low, dull backache
-cramps that feel like menstrual cramping
-abdominal cramps without diarrhea

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10
Q

Proposed causes of PTL

A

-uterine distention
-Infection: UTIs, pyelonephritis, bacterial vaginosis, periodontal
-bleeding
-Sociodemographic factors-poverty, lack of support, and stress.

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11
Q

3 most influential factors in prediction of PTB

A

-Fetal Fibronectin (FFN)
-Shortened cervical Length (CL)
-Prior spontaneous PTB

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12
Q

Fetal Fibronectin (FFN)

A

-Diagnostic Test
-Predicts who will not go into preterm labor
-A glycoprotein “glue” found in plasma and produced during fetal life.
-Normally appears in cervical and vaginal secretions early and late pregnancy.
-Procedure done 24-34 weeks gestation.
-PTL unlikely to occur with a negative result
-No cervical intercourse or CL within 24 hours of test.

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13
Q

Cervical Length (CL)

A

-less than 15 mm @ 22-24 weeks
-Trans-vaginal ultrasound to measure the length of the cervix.
-negative results can be reassuring and prevent unnecessary interventions.

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14
Q

History of PTB

A

-Obstetric history helps identify patients who need to be monitored closely as well as prophylactic therapy.

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15
Q

Additional Assessments of PTL

A

-Cervical Exam
-Sterile speculum for ROM
-Amnisure
-Sterile Speculum for ROM
-Screen for UTI and other infections
-Assess fetal well being
-Monitor uterine activity (TOCO)

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16
Q

Management of PTB

A

-Prevention
-Early Recognition
-Predicting the risk/diagnosis
-interventions

17
Q

Management: Prevention

A

-Heath promotion
-Disease prevention
-Treat infections
-Prenatal care
-Hydration

18
Q

Management: Early Recognition

A

-Awareness of Symptoms
-Education

19
Q

Management: Predicting risk/intervention

A

-ID for those who do require intervention.
-ID of those who do NOT require intervention.
-Degree of intervention is dependent on predicting risk, triaging PTL is vital to proper intervention.

20
Q

Managent Focus

A

Delay delivery for 48-72 hrs to administer antenatal steroids to facilitate lung maturity.

21
Q

Management: Lifestyle

A

-Activity Restriction
-Restriction of sexual activity
-Modified bed rest
-Monitoring uterine activity at home
-Managing stress
-Utilizing Social Support
-Maternal Effects:
*physical
*psychosocial
*support system

22
Q

Tocolytics

A

-Ibuprofen
-Indocin
-Toradol
-Nifedipine
-Terbutaline
-Magnesium Sulfate

23
Q

Ibuprofen

A

-NSAID
-Blocks the production of prostaglandin which
slows or stops the contractions
-600 mg every 6-8 hours
-Can decrease amniotic fluid if given after 32
weeks
-AFI is needed if given

24
Q

Indocin

A

-NSAIDs keep the body from making
prostaglandins, substances which cause uterine contractions.
-May cause indigestion in women, take with food or antacid.
-Two potential serious side effects for the fetus: a reduction in the amount of urine the fetus produces and changes in the way the
blood circulates through the fetus’s body.

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Toradol
-60 mg IM or IV single dose -30 mg multiple doses -Non-steroidal and anti-inflammatory
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Nifedipine
-Calcium channel blocker -Relaxes smooth muscle -20 mg po -Watch for hypotension
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Terbutaline
-Relaxes uterus -No longer given PO for home management -Side effects: nervousness, tremor, tachycardia, palpitations
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Magnesium Sulfate
-Calcium channel blocker, smooth muscle relaxer -Slows contractions down
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Magnesium Sulfate: Administration
IVPB -Infusion pump needed -Loading dose, 6 gm -maintenance dose 3 or more -Requires 2 RNs -Side effects: hot flashes, sweating, burning at IV site, N/V, muscle weakness
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Mag Sulfate: Nursing Interventions
-Education -Ice to iv site -Cool wash rags and cool room -Antiemetics available -Assess: resp. status, deep tendon reflexes, ( loss of DTRs), change in LOC, oliguria (less than 30 cc/hr)
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Antidote for Magnesium Sulfate
Calcium gluconate
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Management PTL: Antenatal Glucocorticoids
-24-34 weeks gestation -Betamethasone -Dexamethasone -Single rescue dose: if 2 doses have elapsed after ANS and pt is not. delivered & less than 33 weeks.
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Glucocorticoids
-contraindicated in women w/ systemic infections. -High Risk for hyperglycemia if on medication for GDM or pre-gestational diabetes. -HTN may worsen
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Prophylactic Progesterone
-hx of SABs- given up to 12 weeks gestation. -recommended for women who have previously given birth prematurely
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Cervical Cerclage
-Incompetent cervix -stitches to hold cervix closed -removed prior to delivery -12-14 weeks or emergency
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Triage with PTL summary
-History/risk factors -Clinical evaluation for signs of true labor -Patients with symptoms of PTL need: FFN, CL, UA, and evaluation of infection -Transfer to a level 3 NICU if needed -Completion of a course of ANS -Tocolytic agents if needed -Prophylactic antibiotics should be considered if GBS is a possible concern.
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