Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS783 Exam 3 > Preterm Labor > Flashcards

Preterm Labor Flashcards

1
Q

preterm birth

A

birth after 20wks; before 37 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

late preterm

A

34-36wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

moderate preterm

A

32-33wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

very preterm

A

28-31wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

extremely preterm

A

<28wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 clinical processes of PTB?

A

1) premature activation of maternal or fetal hypothalamus pituitary adrenal (HPA) axis
2) pathological uterine distention
3) inflammation
4) decidual hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are risk factors for PTB?

A
  • prior PTB = strongest risk factor!
  • POVERTY!
  • being black
  • chronic stress
  • low prepregnancy BMI (<19)/weight <50kg (2x risk)
  • anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

weathering hypothesis

A

process of deteriorating health w/ cumulative disadvantage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are PTB prevention methods?

A
  • improved weight and nutrition
  • reduce infection
  • avoiding cocaine
  • smoking cessation
  • avoiding short (<18mo) interpregnancy interval
  • dx and tx of asymptomatic bacteriuria
  • improve sleep quality and reducing fatigue

ALSO:

  • psychological counseling during pregnancy
  • group prenatal care
  • relaxation techniques (e.g. yoga)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are non-successful prevention methods of PTB?

A
  • home uterine monitoring
  • bed rest
  • prenatal tx of vaginal infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are nutritional interventions to reduce PTB risk?

A
  • achieve appropriate prepregnancy weight
  • gain adequate amt of weight for BMI
  • take 200-300mg omega-3 fatty acids daily OR eat two fish meals/wk
  • healthy, balanced diet
  • achieve adequate iron stores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is PTB prevention in high-risk pts?

A
  • progesterone

- cerclage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are guidelines for using progesterone?

A
  • 250mg IM from 16-20wks through term in singleton pregnancy
  • short cervix: suppositories before 33wks
  • vaginal progesterone w/ no hx PTB and cervical length ≤20mm at 24wks or earlier
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

For which pts is cerclage indicated?

A

documented cervical insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is cerclage typically performed?

A

before 24wks - controversial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which pts should receive evaluation for cerclage?

A

1) hx cervical trauma (e.g. conization, LEEP)
2) progressively earlier births
3) two or more consecutive prior second trimester pregnancy losses
4) 3 or more early (<34wks) PTBs

17
Q

How can PTL and PPROM be assessed/dx’ed?

A

1) fetal fibronectin testing (fFN)
2) cervical length measurement
* both together, increases predictive power of both*
3) clinical dx

18
Q

Describe the presence of fetal fibronectin

A
  • high concentrations in amniotic fluid and interface b/w decidua and trophoblasts
  • normally found in cervical and vaginal secretions BEFORE 16-20wks GA

presence in cervicovaginal secretions AFTER 20 wks = abnormal EXCEPT as marker of imminent onset of labor at term

19
Q

How is fFN testing performed?

A
  • swab in posterior fornix of vagina

- rotate for 10sec

20
Q

What can affect reliability of fFN testing?

A 
w/in 24h
- vaginal exam
- sexual intercourse
- endovaginal U/S
- cervical exam
OR
- presents w/ vaginal bleeding
21
Q

How is cervical length associated w/ PTB?

A

decreasing length, especially <25mm in 2nd tri = increased risk PTB

22
Q

What sx of someone in PTL?

A
  • menstrual-like cramps
  • regular contractions
  • low backache
  • diarrhea
  • sensation of pelvic pressure
23
Q

What are clinical signs for dx of PTL?

A

Persistent uterine contractions: 4 q20mins OR 8 q60mins (or ≥6/hr*) WITH:

  • documented cervical change OR
  • cervical effacement of at least 80% OR
  • cervical dilation ≥2cm
  • rupture of membranes*

If do not meet these criteria = false labor
*from lecture

24
Q

What is the time frame for management of PTL?

A

admit, discharge, or transport w/in 4h of evaluation

25
Q

Subjective evaluation of PTL

A

hx and evaluation of sx

  • LOF
  • contractions: onset, duration, pattern
  • precipitating events, if any
26
Q

Objective evaluation of PTL

A
  • vitals
  • evaluate contractions
  • examine uterus for signs of abruption, tone, fetal size, fetal position
  • evaluate FHR
  • speculum exam
27
Q

What does a speculum exam tell us in PTL?

A
  • cervical dilation and effacement
  • presence of bleeding
  • status of fetal membranes
  • fFN swab in pts ≤35wks GA
  • rectovaginal GBS swab
  • GC/CT cultures in pts w/ risk factors
28
Q

When should a cervical exam be performed?

A

AFTER

  • membrane status and placental location determined
  • swabs and cultures done
29
Q

What is the stance on terbutaline?

A

Do NOT use for >48-72h –> maternal heart problems and death (FDA)

30
Q

What is the best clinical sign for birth in 7-14 days?

A
  • > 3cm dilated
  • 80% effaced
  • vertex
  • 0 station
  • spontaneous rupture of membranes
  • bright red blood
31
Q

What is more important, negative or positive predictive value in fFN testing?

A

NPV delivery w/in 7 days = 99.5% –> less intervention, avoid hospitalizations, physical and patient reassurance

NURS783 Exam 3 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions