Preterm Labor Flashcards by Annie Huynh

What are the 4 Tocolytics

Magnesium Sulfate
Terbutaline
Nifedipine
Indomethacin

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What is the therapeutic range of magnesium?

4-7.5 mEq/L

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Magnesium Sulfate

CNS depressant
Relaxes smooth muscle, including uterus
IV loading dose 4-6 gms/30 min
Maintenance dose 1-4 gms/hr

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Low Birth Weight

less than 2500 (5.5 lbs)

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What are the causes of preterm labor

Infection and Multifactorial

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Infection Causes of Preterm Labor

Cervical
Bacterial
Urinary Tract (can move to the baby)

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Multifactorial Causes of Preterm Labor

Chronic HTN
GDM
Preeclampsia
OB disorders in previous pregnancies
Placental Disorders
Medical Disorders
HX of previous preterm birth
Nonwhite race
Genital tract infection
Multifetal gestation (twins; uterus can hold this much and there is not
2nd trimester bleeding
Low pregnancy weight
Maternal HIV
Obesity
Advanced for Maternal age
Fetal disorders
Congenital fetal anomalies

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These factors can lead to the baby:

contractions/cervical change/ ROM
Placental Implantation bleeding (1st or 2nd trimester)
Maternal/ Fetal Stress
Uterine over-distention
Allergic reaction
Decrease progesterone

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Risk factors of Preterm Birth

Low- Pre-pregnant weight
Poverty
Nonwhite Race
Genetic Disposition
Multifetal gestation
No access to prenatal care
2nd trimester bleeding
UTI
Lack of education
Disadvantage living

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Risk factors are classified into 3 groups

Biophysical, Demographics, and Behavioral

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Signs and Symptoms Premature Birth

Uterine contractions
Suprapubic or pelvic pain or pressure
Low,dull backache
Abdominal pain or cramping with or without diarrhea
Painful menstrual-life cramps
Change or increase in vaginal discharge
ROM
Urinary Frequency

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fFn (Fetal Fibronectin)

Obtain a swab of vaginal secretion
Looking for a protein that can be found in the secretion
A negative result indicates there is a 95% the baby will not be premature

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Endocervical length

Vaginal ultrasound measures the cervical length
Shortened = preterm albor

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Lifestyle Modifications

No lifting and carrying heavy loads
No sex
Riding or standing for long periods of time
Strenuous physical work
Infrequent rest periods

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Bed rest Why

used to decrease pressure on the cervix to promote blood flow to the uterus

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Bed Rest Adverse Effects

Decreased muscle tone (atrophy)
Weight loss
Calcium Loss
Glucose Intolerance
Constipation
Thrombophlebitis
Fatigue
Depression
Anxiety

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How long bedrest should be

8 wks

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Interventions for Active PTL

Bedrest in a side-lying position
Hydration: dehydration is a cause of PTL
Tocolytics: suppress uterine activity
Antenatal glucocorticoids: promote fetal lung maturity and reduce complications

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What is the SE of magnesium

Hot flashes
NV
Headache
Lethargy
Dyspnea
Hypocalcemia
Blurred vision

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What are fetal side effects of Magnesium Sulfate

Decreased breathing movement, reduced variability, nonreactive NST

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Nursing Considerations for Magnesium Sulfate

Assess for women and fetus for baseline
Always given IV
Monitor magnesium lvl
Strict I & O
Total IV intake is 125/hr

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What is the reverse mag toxicity?

Calcium gluconate/ Calcium chloride

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What class is Terbutaline (Brethine)?

Beta2-adrengergic agonist

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What is the action of Terbutaline (Brethine)?

Relaxes smoot muscles, inhibiting uterine activity by stimulating beta2-receptors

What is the dosage and route of terbutaline

subcutaneous injection of 0.25 mg q 4 x3 dosage

What is the SEs of Terbutaline

Tachycardia; 101 HR, 120 or greater don't give the patient another dosage and call the provider Hyperglycemia

Contraindications of Terbutaline

HR > 120 beats/min Heart Dx could cause stroke Severe Preeclampsia and Eclampsia Gestational Diabetes will ^ their BG Hyperthyroidism: Synthroid will make it work hard; heart is pushing more blood though Giving it at the top of the contraction so the baby will get more

What class is Nifedipine (Procardia)

Ca2+ Channel blocker

What is the action of Nifedipine (Procardia)

Relaxes smooth muscles including the uterus by blocking calcium entry

What is the dosage and route of Nifedipine (Procardia)

initial 10-20 mg PO, then q 3-6h until contractions are rare

SEs of Nifedipine (Procardia)

Usually mild, hypotension, headache, flushing (constriction), dizziness, nausea

Contraindications of Nifedipine (Procardia)

Check the mother's BP Should not be given concurrently with Mag and Terbutaline

What class is Indomethacin (Indocin)

Prostaglandin synthetase inhibitors

Action of Indomethacin (indocin)

Relaxes uterine smooth muscle by inhibiting prostaglandins

Dosage & Route of Indomethacin

50 mg PO then 25-59 mg q 6h x 48 hrs; vaginal Rectal: <32 wks PO

SEs of Indomethacin (Indocin)

NV Heartburn Less common: GI bleeding (NSAIDs), prolonged bleeding time (NSAIDs, thrombocytopenia)

Considerations of Indomethacin

Used only if gestational age is >32 wks Administer only for 48hrs Hepatic/Renal disease = DO NOT USE Active PUD = DO NOT USE Poorly controlled HTN = DO NOT USE Asthma or coagulation disorder = DO OUT USE

Contraindications to Tocolytics (Maternal)

Severe Preeclampsia Eclampsia Bleeding w/ hemodynamic instability (check the source of the bleeding before checking the dilation) Specific Medications

Contraindications to Tocolytics (Fetal)

Intrauterine fetal demise Lethal fetal anomaly Non-reassuring fetal status Chorioamnionitis PPROM

What is the purpose of administering antenatal glucocorticoids

Stimulates fetal lung maturation = ^ the release of enzymes induce production of lung surfactant

When should they be given glucocorticoids?

Women between 24-34 wks @ risk of preterm birth within 7 days

How is the glucocorticoids given

Betamethasone 12 mg Deep IM 2 doses 24 hrs apart Dexamethasone 6 mg Deep IM 2 doses 12 hrs apart

Contraindications of Glucocorticoids

Pulmonary Edema (assessing lung sounds) Maternal Diabetes Maternal HTN

SEs of Glucocorticoids

Raise blood glucose Burn ^ WBC 72 hrs FHT: minimal/ decrease no accler. 24-72 hr 0-5 beats

What if you can't stop the preterm birth....

Transfer to a tertiary center: NICU and Peri-Neonatologist Start STERIOD therapy immediately for lung maturity

PPROM

Premature Preterm Rupture of membranes

Definition of PPROM

When a pt amniotic sac ruptures prior to 37 wks gestation, PROM rupture of sac and leakage

What is the cause(s) of PPROM

Unknown

What is a contributor(s) of PPROM

Infection: Chorioamnionitis

Risk Factors of PPROM

Cord prolapse (so small; and cord come out; emergency bc the head hit the cord which will cut off circulation) Cord Compression Placental abruption (Placenta pull away from the wall; not get it nutrients and O2)

Treatments of PPROM

Antenatal glucocorticoids (noninfection) Prophylactic antibiotics (infection occur)

Management of PPROM

Observe for infection (fever, abdominal tenderness, vaginal discharge, ^ WBC) Frequent biophysical profiles (BATMAN) NonStress Test

Serum Creatine

1.1 mg/dL

AST (Aspartate transaminase)

>40 UL

ALT (Alanine transaminase)

>56 UL

Very Low Birth Weight

1500 g

Extremely Low Birth Weight

1000 g

What range for Glycosylated hemoglobin A1c indicates good blood sugar control

4-6.5%

Calories Based on BMI

35 cal/kg/IBW/day 25 kg/IBW/day