PROM and Pre-term Labour Flashcards
Give at least 5 causes of premature rupture of membranes. HINT: Its so early!
Infection: Vaginal or amniotic (chorioamnionitis)
Trauma
Sexual intercourse, recent
Stress (maternal)
Overdistention of the uterus i.e. from multiple gestation or polyhydramnios
Early opening of the cervix (incompetent cervix)
Abnormal fetal presentation
Repeaters: previous history of PROM
Low body mass index: nutritional deficiencies
Yeast infection
What are the two most serious complications of PROM?
Infection- ruptured amniotic sac creates an entry point for bacteria
Cord compression - prolonged loss of fluid causes loss of cushion for umbilical cord
True or False: A woman at 32 weeks AOG who has experienced PROM should be prepared for induction of labour or caesarean birth.
False. If fetus is between 34 to 36 weeks of gestation or more, labour induction or caesarean birth may be considered.
True or False: If infection is suspected, IV antibiotics may be given to the mother to manage this.
True. Current guidelines: administration of IV antibiotics for 48 hours followed be 5 days of oral antibiotics. Drugs include ampicillin, erythromycin, amoxicillin and azithromycin.
Pre-term labour is labour beginning after ___ AOG but before ____ AOG.
Preterm Labour (PTL) is labour beginning after the 20th week o gestation but before the end of the 37th week of pregnancy.
Give at least 5 factors associated with preterm labour. HINT: IM NOT READY.
Incompetent cervix: cervical length less than 25mm
Medical conditions: diabetes, hypertension, drug abuse
No or inadequate pre-natal are
Obesity
Twins (multifetal gestation)
Repeaters: previous history of PROM or PTL
Enabled reproductive techniques: conception using technology
Amniotic fluid not adequate
Developmental/chromosome defects
Years: older maternal age
Give at least three manifestations of pre-term labour:
Uterine contractions that may or may not be painful
Cramps similar to menstrual cramps
Constant low backache: intermittent or irregular mild low back pain
Sensation of pelvic pressure or feeling that baby is pushing down or is heavier
Pain, discomfort or pressure in the vulva or thighs
Change in character and amount of usual discharge: may be thicker or thinner, bloody, brown or colourless,
This is a protein present in fetal tissues that is normally found in cervical and vaginal secretions until 16 to 20 weeks AOG and again near term. Early appearance suggests that labour might begin early.
Fetal fibronectin
Delivery may be prevented if uterine contractions are stopped before the point of no return, which is usually at how many cm of cervical dilation?
3 cm
Identify the classification and give a sample drug:
This tocolytic blocks the entry of an essential mineral that is essential for smooth muscle (uterine) contraction.
Calcium Channel blocker
Sample drug: Nifedipine (Procardia)
Identify the classification and give a sample drug:
Inhibits the synthesis of an inflammatory mediator which normally stimulate uterine contractions.
Prostaglandin synthesis inhibitor
Most common drug: Indomethacin
Identify the classification and give a sample drug:
Relaxes the smooth muscles of the uterus by acting on beta-2 receptors
Beta-adrenergic
Common Drug: Terbutaline
Name at least 4 common side effects of calcium channel blockers.
Flushing of the skin
Headache
Transient increase in maternal and fetal HR
Orthostatic hypotension
Name 3 main fetal and neonatal side effects of indomethacin:
Constriction of the ductus arteriosus
Pulmonary hypertension
Oligohydramnios
Why is it important for patients taking indomethacin to be closely monitored for s/s of infection?
The anti-inflammatory effect of indomethacin can mask infection because fever may not be present.
What important assessment needs to be done to monitor for reduced amniotic fluid volume, a common side effect of taking indomethacin?
Check fundal height at the beginning of therapy and daily thereafter
What are the most common side effects of terbutaline?
Cardiac side effects such as:
Maternal and fetal tachycardia
Decreased BP
Dysrhythmias
Myocardial ischemia
This should always be available at bedside to reverse serious adverse effects of terbutaline/
Propranolol (Inderal)
These are a class of drugs administered to speed up fetal lung maturation if birth seems inevitable an AOG id les than 34 weeks.
Corticosteroids
Corticosteroids act to stimulate the fetal lungs toproduce _______a substance which helps keep air sacs open.
Surfactant
Give at least 2 corticosteroids that can be given to promote fetal lung maturation.
Betamethasone
Dexamethasone
True or False: A woman with gestational diabetes or pre-existing diabetes who requires corticosteroidsmay require an increase in insulin dose.
True. Steroids stimulate the liver to produce more glucose from non-carbohydrate sources.
