Preterm Labor

Question 1

What is preterm labor?

Answer 1

defined as any other birth prior ro 37 weeks of pregnancy

Question 2

What is late term?

Answer 2

Occurs between 34 & 36 weeks gestation

Question 3

What is very preterm?

Answer 3

Occurs before 32 weeks gestation

Question 4

Complications of preterm for newborn

Answer 4

Respiratory distress syndrome and Neurodevelopment impairments

Question 5

3 common risk factors of preterm labor

Answer 5

Prior preterm, multiple gestation, and uterine or cervical abnormalities

Question 6

Cervix incompetency

Answer 6

cervix begins to close leading to losses

Question 7

Medical risk factors

Answer 7

• previous PTB
  -multifetal gestation
  -Uterine/cervical abnormalities
  -Genital tract infections
  -UTI/STD
  -2nd trimester bleeding
  -IVF
  -underweight before pregnancy
  -obesity
  -Hight BP/preeclampsia

Question 8

Lifestyle risk factors

Answer 8

late/no prenatal care
smoking
substance abuse
domestic violence
sexual abise
lack of social support
stress

Question 9

S/S of PTL

Answer 9

contractions every 10 minutes or more often
change in vaginal discharge/leaking fluid
vaginal bleeding
low, dull backache
cramps that feel like menstrual cramps
abdominal cramps w or without diarrhea

Question 10

3 most influential factors in prediction

Answer 10

1. Fetal Fibronectin (FFN)
2. Shortened cervical length
3. Prior spontaneous PTB

Question 11

What is Fetal Fibronectin?

Answer 11

FFN is a glycoprotein “glue” found in plasma and produced during fetal life.
Normally appears in cervical and vaginal secretions early and late pregnancy
24-34 weeks gestation
Predicts who will not go into preterm labor
*No cervical intercourse or CL within 24 hours of test
Positive= may deliver in 2 weeks
Negative= reassuring

Question 12

What is cervical length?

Answer 12

Transvaginal ultrasound to measure the length of the cervix.
Normal is >20mm w/ a strong positive predictive value
Cervical length <15mm at 22-24 weeks gestation is very abnormal and high risk of PTL

Question 13

Additional assessments

Answer 13

-Cervical exam
-sterile speculum exam of ROM
-Amnisure
-Screen for UTI and other infections
-Assess fetal well being
-Monitor uterine contractions

Question 14

Ibuprofen

Answer 14

-NSAID
-blocks the production of prostaglandin which slows or stops the contractions
- 600-800 every 6-8 hours
- can decrease amniotic fluid if given after 32 weeks
-AFI is needed if given past 32 weeks

Question 15

Indocin

Answer 15

-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 fetus: a reduction in the amount of urine the fetus produces and changes in the way the blood circulates through fetus’ body

Question 16

Toradol

Answer 16

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

Question 17

Nifedipine

Answer 17

• Calcium channel blocker
  -relaxes smooth muscle
  -20MG PO
  -Watch for hypotension

Question 18

Terbutaline

Answer 18

• .25 mg SQ every 30 minutes x3
  -relaxes uterus
  -No longer given PO for home management
  -Side effects: nervousness, tremor, tachycardia, palpitations
  -Nursing interventions: Pulse less than 120 bpm prior to administration of med

Question 19

Magnesium sulfate

Answer 19

-Calcium channel blocker, smooth muscle relaxer
-Slows contractions down
-Neuroprotection for baby brain

Question 20

Mag sulfate administration

Answer 20

-IVPB
-infusion pump needed
-Loading dose, 6gm
-maintenance dose 3 or more
-needs 2 RN’s
-Side effects: hot flashes, sweating, burning at IV site, N/V, muscle weakness

Question 21

Mag sulfate interventions

Answer 21

-Education
-Ice to IV site
-cool wash rags and cool room
-Antiemetics available: Zofran
-Assess: resp. status, deep tendon reflexes, change in LOC, oliguria (less than 30 ml/hr)

Question 22

Management of Antenatal Glucocorticoids

Answer 22

-used prophylactically
-reduces incidence of RDS
-24-34 weeks gestation
-Bethamethasone: most commonly used: 2 injections of 12 mg every 24 hours apart
-Dexamethasone: 4 doses of 6 mg IM, every 12 hours apart
-Single rescue dose: if 2 doses have elapsed after ANS and patient is not delivered and less than 33 weeks

Question 23

Glucocorticoids

Answer 23

-contraindicated in women with systemic infections
-Women who are on medication for GDM or pregestational DM are at high risk of significant hyperglycemia
-HTN may worsen

Question 24

Management of PTL prophylactic progesteron

Answer 24

-Effective with patients with a history of SAB’s given up to 12 weeks gestation
-Recommended for women who have previously given birth prematurely- weekly IM injections or daily vaginal suppositories from 16-34 weeks

Question 25

Progesterone

Answer 25

If cervical changes are shown prior to 20 weeks, it it now being used

Question 26

Cervical Cerclage

Answer 26

• stitches to hold cervix closed
  -incompetent cervix (weak cervix)
  -Used preventively at 12-24 weeks, or as an emergency when cervix length shows thinning
  -Rarely used after 24 weeks
  -General/regional anesthesia used
  -Removed prior to delivery