Prematurity Flashcards
Definition of pre-term labor
Uterine contractions and cervical between 20-37 wks gestation
Second leading cause of infant mortality
number one for birth defects because of immaturity of body systems
Risk Factors of Pre-term
African american age <16 and >40 low socioeconomic status multi-gestation late or no prenatal care STIs hydramnios domestic violence
Causes of pre-term labor
Infections including UTI, chorioaminionitis, vaginal bacteria
PPROM (don’t necessarily have to deliver)
Pregnancy complications i.e.: DM, HTN
Key assessments in PTL
date, time, duration at ROM, LMP, fundal height, US dating, recent history of UTI or vag infection, back pain, pelvic pressure
Teaching for BV
Easily treated, pt report vaginal discharge that burns, itches, has odor.
How to get fluid after PROM
Have mom cough
PTL s/s
> 6 contractions in an hour q 10 minute contractions lasting more than an hour lower ab cramping, may be menstrual like dull, intermittent back low pain urinary frequency pelvic and /or suprapubic pressure or pain change in vaginal discharge ROM
Similar to almost all pregnancies so evaluation is critical
predicting PTL
Fetal bironectic> appear in cervico-vaginal fluids in any gestation prior to delivery
Cervical length > 3cm indicates that delivery in 2wks is unlikely
Tocolytic side effects
tachycardia maternal > 120, fetal > 180 hypotension hypokalemia hyperglycemia n/v palpitations pulmonary edema
Tocolytic meds
Mag sulfate
indomethacin
nifedipine
bethamethason (2 doses 24 hours apart) - helps surfactant
PTL assessments / interventions
explain meds know unit protocols vitals q 15-30/m Electronic Fetal Monitoring baseline labs Hourly I&O bethametasone (surfactant)
Preterm issues (cardio, gi, renal, immune, CNS)
increased apnea r/t lack of surfactant
smaller passages lead to easier obstruction
Cardio: low O2 levels present
GI: can’t coordinate suck/wallow. if don’t breathe well bowel can die
Renal: F&E imbalances r/t inability for kidneys to concentrate well
Immune: Greater risk for infection
CNS: Can’t control body temperature, immature glucose control
Common PTL characteristics
Hypothermia
hypoglycemia
hyperbole
problems r/t immature systems
Weight < 5.5lb scrawny poor muscle tone minimal subcut fat undescended testicles plentiful lanugo poor formed ear pinna fused eyelids soft spongy skull bones matted scalp hair absent creases in soles / palms minimal scrotal rug and prominent labia / clitoris thin transparent skin abundant vernix (don't wipe off right away)
5 “As of drug nursing
ask, advise, assess, assist, arrange
