Pregnancy Preterm Labor

Question 1

Effect of circulating steroid hormones on the liver’s metabolism of drugs.
 Reduce gastrointestinal (GI) motility and increased gastric pH.
 Increased glomerular filtration rate and increased renal perfusion, resulting in more rapid renal excretion of drugs.
 Expanded maternal circulating blood volume, resulting in dilution of drugs.
 Alteration in the clearance of drugs in later pregnancy, resulting in a decrease in serum and tissue concentration of drugs.

Answer 1

Physiology of pregnancy

Question 2

27 mg/day during pregnancy.
 Best absorbed with water or juice in an empty
stomach. Vitamin C increases the absorption of Iron.

Answer 2

Iron

Question 3

Common side effecfs of iron

Answer 3

Nausea
 Constipation
 Black tarry stool
 GI irritation
 Epigastric pain
 Vomiting
 Discoloration o

Question 4

Vitamin B9, Folate is needed in increased amount.
 400 mcg of folic acid daily.

Answer 4

Folic acid

Question 5

What does folic acid prevent in early pregnancy

Answer 5

Spontaneous abortion or birth defects.
 Neural tube defects which lead to spina bifida or skull
and brain malformations.

Question 6

 Vitamins A, B – Complex, B12, C, Calcium, D, E, Iron, and other Minerals.

Answer 6

Multiple vitamins

Question 7

Drugs for morning sickness (nausea and vomiting)

Answer 7

Doxylamine Succinate
 Pyridoxine Hydrochloride

Question 8

Nonpharmacologic measures of morning sickness (give 3)

Answer 8

 Eating crackers, dry toast, or other carbohydrates before rising.
 Avoiding high-fat or highly seasoned foods.  Eating small, frequent meals.
 Drinking fluids between meals.
 Drinking apple juice between meals.
 Eating a high-protein bedtime snack.
 Stopping smoking.
 Taking an iron supplement at bedtime.

Question 9

Drugs for pyrosis/heartburn

Answer 9

Sucralfate (Carafate)

Question 10

Give 3 pharmacologic measures of pyrosis

Answer 10

Nonpharmacologic Measures:
 Limiting the size of meals.
 Avoiding highly seasoned or greasy foods.
 Avoiding gas-forming foods (ex. cabbage, onions).
 Eating slowly and chewing thoroughly.
 Avoiding citrus juices.
 Drinking adequate fluids but not with meals.
 Avoiding reclining immediately after eating.

Question 11

Drugs for constipation

Answer 11

Metamucil
 Docusate Sodium (stool softener)

Question 12

3 pharmacologic measures for constipation

Answer 12

Nonpharmacological Measures:
 Increased fluid intake.
 Increased dietary fiber intake.
 Moderate Physical Exercise.

Question 13

Drugs 4 headache

Answer 13

Acetaminophen – most commonly ingested.
 Ibuprofen – classified as a pregnancy category C drug. If taken in late pregnancy, it may cause
premature closure of the ductus arteriosus.

Question 14

Give 3 Nonpharmacological Pain-relief Measures:

Answer 14

 Rest
 A calming environment.  Relaxation exercises.
 Alteration in routine.
 Mental imagery.
 Ice packs.
 Warm, moist heat.
 Postural changes.
 Correct body mechanics.  Changes in footwear.
Antidepress

Question 15

Antidepressant drugs

Answer 15

Selective Serotonin Reuptake Inhibitors (SSRIs)  Tricyclics

Question 16

What are the adverse affects of antidepressant drugs

Answer 16

HARMACOLOGY
o Low birthweight
o Infants born small for gestational age.
o Preterm delivery.
o Increased neonatal irritability and
decreased attentiveness.

Question 17

Is birth that occurs before the completion of 37weeks of pregnancy, regardless of birthweight.
 Cervical changes and uterine contractions that occur between 20 and 37 weeks of pregnancy.

Answer 17

Preterm labor

Question 18

Give 3 Nonpharmacologic Treatment Measures for preterm labor

Answer 18

 Bed rest.
 Hydration (6 to 8 glasses of fluids daily or more, IV
fluid bolus).
 Pelvic rest (no sexual intercourse or douching).
 Screening for intrauterine and UTI.

Question 19

Stopping Preterm Labor

Answer 19

:
 Focus is on stopping contractions before cervix dilated beyond 3 cm.
 Fetal surveillance includes monitoring heart rate, assesing lung maturity.

Question 20

Tocolytic drugs should not be used if

Answer 20

Woman is hemorrhaging because bleeding will increase.
 Fetal distress is noted.
 Cervix is dilated 5 cm or more because it will no
longer be effective.

Question 21

Tocolytic theraphy

Answer 21

Tocolytic Therapy decreases uterine contraction.
 Beta2 – Adrenergic Receptor Agonists
 Calcium Antagonists
 Magnesium Sulfate
 Calcium Channel Blockers
 Nifedine (Procardia)
 Indomethacin (Indocin) Prostaglandin Inhibitors

Question 22

Goals of tocolytic theraphy

Answer 22

Interrupt or inhibit uterine contractions to create additional time for fetal maturation in utero.
 Delay delivery so antenatal corticosteroids can be delivered to facilitate fetal lung maturation.
 Allow safe transport of the patient to the appropriate facility if required.

Question 23

 Stimulating beta2 – receptors on uterine smooth muscle.
 Decreases the intensity and frequency of uterine contraction as it relaxes the muscle.

Answer 23

Terbutaline

Question 24

Adverse Reaction in Preterm Labor

Answer 24

:
 Maternal Side effects include tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia.

Question 25

Calcium antagonist.
 Central nervous depressant.
 Relaxes the smooth muscle of the uterus through
calcium displacement.
 Used more as a tocolytic.
 Adminstered as a 4 – 6 g IV loading dose over 20 –
30 minutes followed by a 2 – 4 g/hour continuous
infusion for 12 – 24 hours after contraction ceased.
 Continuous infusion should not eceed 5 to 7 days or
a maximum of 40 g/ 24 hours.

Answer 25

Magnesium sulfate

Question 26

Antidote 4 magnesium sulfate

Answer 26

calcium gluconate and emergency equipment
nearby for respiratory depression.

Question 27

it speed up maturity of lungs.

Answer 27

Corticosteroid

Question 28

Corticosteroid drugs

Answer 28

Betamethasone
Dexamethasone

Question 29

Purposes of corticosteroids

Answer 29

 Accelerates lung maturation and lung surfactant development in the fetus in the utero.
 Decreases the incidence and severity of respiratory distress syndrome (RDS).
 Increase survival or preterm infants. Promotion of Fetal Lung Maturity

Question 30

Promotion of fetal lung maturity

Answer 30

goal of tocolytic therapy until steroids can hasten lung maturity.
RDS can be reduced if steroids are given to mother 24 to 28 hours before birth in fetus less than 34 weeks of gestation.
 After delivery, infant is treated with prophylactic surfactant therapy to reduce risk of developing RDS.

Question 31

Gestational hypertension with proteinuria.
 Delivery of infant and placenta is the only cure.

Answer 31

Preeclampsia

Question 32

Signs and Symptoms of Preeclampsia:

Answer 32

 Hypertension
 Protein in the urine.
 Headaches
 Visual Problems.
 Pitting Edema.

Question 33

– a severe sequela of preeclampsia.

Answer 33

HELLP Syndrome
Hemolysis
Elevated liver enzymes
Low platelet count

Question 34

Treatment of Preeclampsia:

Answer 34

 Methyldopa (Aldomet)
 Hydralazine (Apresoline)
 Labetalol (Trandate)
 Prazosin (Minipress)
 Nifedipine (Procardia)
 Clonidine (Catapres)

Question 35

Maternal seizure.
 New on-set grand mal seizures in patient with
preeclampsia.
 Delivery is generally postponed for 1 to 3 hours if
fetal status allows.

Answer 35

Eclampsia