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OB > Preterm Labor > Flashcards

Preterm Labor Flashcards

1
Q

What are the 4 Tocolytics

A

Magnesium Sulfate
Terbutaline
Nifedipine
Indomethacin

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2
Q

What is the therapeutic range of magnesium?

A

4-7.5 mEq/L

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3
Q

Magnesium Sulfate

A

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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4
Q

Low Birth Weight

A

less than 2500 (5.5 lbs)

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5
Q

What are the causes of preterm labor

A

Infection and Multifactorial

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6
Q

Infection Causes of Preterm Labor

A

Cervical
Bacterial
Urinary Tract (can move to the baby)

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7
Q

Multifactorial Causes of Preterm Labor

A

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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8
Q

These factors can lead to the baby:

A

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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9
Q

Risk factors of Preterm Birth

A

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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10
Q

Risk factors are classified into 3 groups

A

Biophysical, Demographics, and Behavioral

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11
Q

Signs and Symptoms Premature Birth

A

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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12
Q

fFn (Fetal Fibronectin)

A

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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13
Q

Endocervical length

A

Vaginal ultrasound measures the cervical length
Shortened = preterm albor

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14
Q

Lifestyle Modifications

A

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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15
Q

Bed rest Why

A

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

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16
Q

Bed Rest Adverse Effects

A

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

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17
Q

How long bedrest should be

A

8 wks

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18
Q

Interventions for Active PTL

A

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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19
Q

What is the SE of magnesium

A

Hot flashes
NV
Headache
Lethargy
Dyspnea
Hypocalcemia
Blurred vision

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20
Q

What are fetal side effects of Magnesium Sulfate

A

Decreased breathing movement, reduced variability, nonreactive NST

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21
Q

Nursing Considerations for Magnesium Sulfate

A

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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22
Q

What is the reverse mag toxicity?

A

Calcium gluconate/ Calcium chloride

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23
Q

What class is Terbutaline (Brethine)?

A

Beta2-adrengergic agonist

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24
Q

What is the action of Terbutaline (Brethine)?

A

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

25
Q

What is the dosage and route of terbutaline

A

subcutaneous injection of 0.25 mg q 4 x3 dosage

26
Q

What is the SEs of Terbutaline

A

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

27
Q

Contraindications of Terbutaline

A

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

28
Q

What class is Nifedipine (Procardia)

A

Ca2+ Channel blocker

29
Q

What is the action of Nifedipine (Procardia)

A

Relaxes smooth muscles including the uterus by blocking calcium entry

30
Q

What is the dosage and route of Nifedipine (Procardia)

A

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

31
Q

SEs of Nifedipine (Procardia)

A

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

32
Q

Contraindications of Nifedipine (Procardia)

A

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

33
Q

What class is Indomethacin (Indocin)

A

Prostaglandin synthetase inhibitors

34
Q

Action of Indomethacin (indocin)

A

Relaxes uterine smooth muscle by inhibiting prostaglandins

35
Q

Dosage & Route of Indomethacin

A

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

36
Q

SEs of Indomethacin (Indocin)

A

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

37
Q

Considerations of Indomethacin

A

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

38
Q

Contraindications to Tocolytics (Maternal)

A

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

39
Q

Contraindications to Tocolytics (Fetal)

A

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

40
Q

What is the purpose of administering antenatal glucocorticoids

A

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

41
Q

When should they be given glucocorticoids?

A

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

42
Q

How is the glucocorticoids given

A

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

43
Q

Contraindications of Glucocorticoids

A

Pulmonary Edema (assessing lung sounds)
Maternal Diabetes
Maternal HTN

44
Q

SEs of Glucocorticoids

A

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

45
Q

What if you can’t stop the preterm birth….

A

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

46
Q

PPROM

A

Premature Preterm Rupture of membranes

47
Q

Definition of PPROM

A

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

48
Q

What is the cause(s) of PPROM

A

Unknown

49
Q

What is a contributor(s) of PPROM

A

Infection: Chorioamnionitis

50
Q

Risk Factors of PPROM

A

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)

51
Q

Treatments of PPROM

A

Antenatal glucocorticoids (noninfection)
Prophylactic antibiotics (infection occur)

52
Q

Management of PPROM

A

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

53
Q

Serum Creatine

A

1.1 mg/dL

54
Q

AST (Aspartate transaminase)

A

> 40 UL

55
Q

ALT (Alanine transaminase)

A

> 56 UL

56
Q

Very Low Birth Weight

A

1500 g

57
Q

Extremely Low Birth Weight

A

1000 g

58
Q

What range for Glycosylated hemoglobin A1c indicates good blood sugar control

A

4-6.5%

59
Q

Calories Based on BMI

A

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

OB (12 decks)

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