Exam 2: PTL Flashcards
What is PreTerm Labor?
Regular contractions accompanied by cervical change between 20-37 weeks of pregnancy.
What is Preterm Birth?
Any birth prior to 37 weeks of pregnancy.
What is Late Term?
Birth that occurs between 34 & 36 weeks of gestation.
What is Very preterm?
Birth occurs before 32 weeks gestation.
Complications of Preterm for the newborn
-Respiratory Distress Syndrome
-Neurodevelopment Impairments
-Infections
-Thermoregulation Problems
-Jaundice
-Hypoglycemia
-Feeding Issues
-Life-long disability (cerebral palsy, hearing loss, vision loss)
3 most common risk Factors for PTL
-Prior Preterm
-Multiple gestation
-Uterine/cervical abnormalities
Medical risk factors for PTL
-Previous PTB
-Multifetal gestation
-uterine/cervical abnormalities
-Genital Tract Infections
-UTIs, STDs
-Second trimester bleeding
-IVF
-Underweight
-Obesity
-High Blood Pressure/preeclampsia
Lifestyle risk factors for PTL
-Late or no prenatal care
-Smoking
-Substance Abuse
-Domestic Violence
-Sexual Abuse
-Lack of social support
-Stress
Symptoms of Preterm Labor
-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
Proposed causes of PTL
-uterine distention
-Infection: UTIs, pyelonephritis, bacterial vaginosis, periodontal
-bleeding
-Sociodemographic factors-poverty, lack of support, and stress.
3 most influential factors in prediction of PTB
-Fetal Fibronectin (FFN)
-Shortened cervical Length (CL)
-Prior spontaneous PTB
Fetal Fibronectin (FFN)
-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.
Cervical Length (CL)
-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.
History of PTB
-Obstetric history helps identify patients who need to be monitored closely as well as prophylactic therapy.
Additional Assessments of PTL
-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)
Management of PTB
-Prevention
-Early Recognition
-Predicting the risk/diagnosis
-interventions
Management: Prevention
-Heath promotion
-Disease prevention
-Treat infections
-Prenatal care
-Hydration
Management: Early Recognition
-Awareness of Symptoms
-Education
Management: Predicting risk/intervention
-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.
Managent Focus
Delay delivery for 48-72 hrs to administer antenatal steroids to facilitate lung maturity.
Management: Lifestyle
-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
Tocolytics
-Ibuprofen
-Indocin
-Toradol
-Nifedipine
-Terbutaline
-Magnesium Sulfate
Ibuprofen
-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
Indocin
-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.
Toradol
-60 mg IM or IV single dose
-30 mg multiple doses
-Non-steroidal and anti-inflammatory
Nifedipine
-Calcium channel blocker
-Relaxes smooth muscle
-20 mg po
-Watch for hypotension
Terbutaline
-Relaxes uterus
-No longer given PO for home management
-Side effects: nervousness, tremor,
tachycardia, palpitations
Magnesium Sulfate
-Calcium channel blocker, smooth muscle relaxer
-Slows contractions down
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
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)
Antidote for Magnesium Sulfate
Calcium gluconate
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.
Glucocorticoids
-contraindicated in women w/ systemic infections.
-High Risk for hyperglycemia if on medication for GDM or pre-gestational diabetes.
-HTN may worsen
Prophylactic Progesterone
-hx of SABs- given up to 12 weeks gestation.
-recommended for women who have previously given birth prematurely
Cervical Cerclage
-Incompetent cervix
-stitches to hold cervix closed
-removed prior to delivery
-12-14 weeks or emergency
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.
