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OB > Exam 2: PTL > Flashcards

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.

25
Q

Toradol

A

-60 mg IM or IV single dose
-30 mg multiple doses
-Non-steroidal and anti-inflammatory

26
Q

Nifedipine

A

-Calcium channel blocker
-Relaxes smooth muscle
-20 mg po
-Watch for hypotension

27
Q

Terbutaline

A

-Relaxes uterus
-No longer given PO for home management
-Side effects: nervousness, tremor,
tachycardia, palpitations

28
Q

Magnesium Sulfate

A

-Calcium channel blocker, smooth muscle relaxer
-Slows contractions down

29
Q

Magnesium Sulfate: Administration

A

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

30
Q

Mag Sulfate: Nursing Interventions

A

-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)

31
Q

Antidote for Magnesium Sulfate

A

Calcium gluconate

32
Q

Management PTL: Antenatal Glucocorticoids

A

-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.

33
Q

Glucocorticoids

A

-contraindicated in women w/ systemic infections.
-High Risk for hyperglycemia if on medication for GDM or pre-gestational diabetes.
-HTN may worsen

34
Q

Prophylactic Progesterone

A

-hx of SABs- given up to 12 weeks gestation.
-recommended for women who have previously given birth prematurely

35
Q

Cervical Cerclage

A

-Incompetent cervix
-stitches to hold cervix closed
-removed prior to delivery
-12-14 weeks or emergency

36
Q

Triage with PTL summary

A

-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.

37
Q
A

OB (7 decks)

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